Patient and Public Engagement (PPE) Priorities Paper for the WLCCG Board (December 2012)

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1 Introduction This paper sets out how the Clinical Commissioning Group will deliver its core aims for PPE and updates members on progress made in the last year. In particular, the CCG Board is asked to agree four priorities outlined in the paper. The work in developing the paper has been agreed by the PPE Sub-committee, members of which reflect a diverse range of local interests. This echoes the close collaboration that the CCG has achieved with colleagues and partners in Kensington & Chelsea and Westminster LINk/Healthwatch, the Social Council, and the voluntary sector. The proposals in this paper will also be presented to the WLCCG s Patient Reference Group (PRG) at their next meeting on 13 th December. Many aspects of the work outlined in this paper will need to be developed and delivered with the support of the PRG s members. A number of important national policies and documents have provided the strategic framework for guiding the priorities outlined in this paper: The Health and Social Care Act 2012 In this legislation, the Government uses the mantra no decision about me, without me for patients and their own care. Through the Act it intends to apply this objective to health and social care systems at both the local and national level. CCGs will be expected to consult the public on their annual commissioning plans and involve them in any changes that affect local services The NHS Future Forum recommended that CCGs should be obliged to involve patients and the public at all levels of the health and wellbeing system enshrined in the principle of shared decision making. Appropriate training and support should be available for those organisations and individuals charged with engaging and representing patients and the public, and for patient representatives themselves. David Gilbert Model To ensure that West London CCG engages and consults with patients, carers and the wider local community throughout the commissioning process, it is recommended that this CCG adopt the David Gilbert commissioning cycle model, as the framework to guide commissioners in the development and design of new services. The overall aim of this framework is to achieve meaningful involvement and the development of partnerships between patients, carers and healthcare staff to shape current and future service delivery. The cycle identifies 5 stages through which this needs to take place. Stage 1: Analyse & plan - community engagement to identify needs and aspirations Stage 2: Analyse & plan public engagement to develop priorities, strategies and plans Stage 3: Design pathways - Patient and carer engagement to improve services Stage 4: Specify and procure - patient, care and public engagement to procure services Stage 5: Deliver & improve patient and care engagement to monitor services Page 1 of 6

2 These are set out in the diagram below: All the priorities set out in this paper will aim to adhere to the ethos and aims of the David Gilbert Cycle. Case studies of patient led redesign PPE is not a new concept to WLCCG. Ways in which patients and their representatives have been engaged in the planning, design and procurement of new services are outlined below: For the procurement of a new Musculoskeletal service, a patient procurement panel was set up to support the commissioning process. Members of the panel were recruited through the support of local LINk/Healthwatch and were provided with training to enable them to understand the procurement process and gain the necessary skills to interview the potential providers. Moreover the panel participated in the Pre Qualification Questionnaire Assessment day, working with the NHS Inner North West London Engagement Team to develop a series of PPE questions for the Invitation to Tender (ITT) documentation, took part in the tender application scoring process and provided a hand over to the members of the new Service User Review Group. The success of the procurement panel has provided a model for other service redesigns. The Out of Hospital Strategy Better care Closer to Home will entail significant changes to how services will be provided in the local area. Meaningful PPE will be key to its success, and to this end local voluntary organisations have already been invited to contribute their ideas on the OOH strategy at two public events. Those invited represent the diverse range of local communities in K&C and Queens Park and Paddington. More recently a workshop, with patient involvement, was held to consider option for the future of the respiratory service. Further consultation events are planned for the New Year. To ensure active patient feedback and their views are taken into account throughout the development and implementation of the strategy, the CCG is in the process of inviting patient representatives onto the working groups for the Provider Network, Respiratory, Cardiology and Diabetes services. The OOH Strategy will also provide the first opportunity test the CCG s new engagement framework for commissioning new services. Page 2 of 6

3 Collecting Information on patient experience The CCG will continue to monitor patient experience and local services to ensure that the high standards are maintained and any issues are handled promptly and effectively. Quarterly patient experience reports on all local Trusts are circulated to the Quality, Patient Safety and Risk and PPE Sub-committees of WLCCG. The data in these reports is collected in the following ways: - PREMs (Patient Reported Experience Measures) which is a simple questionnaire that is given to a patient, relative or carer to ask them about their experience of the care or treatment they received. - Patient Reported Outcome Measures (PROMs) measure quality from the patient perspective. Initially covering four clinical procedures, PROMs calculate the health gain after surgical treatment using pre and post operative patient surveys. - Annual Patient Surveys and Patient Experience Tracker (PET) - GP Patient Survey run by Ipsos-Mori on behalf of the Department of Health across all PCT/CCGs in England. Complaints about services are handled by the Quality, Patient Safety and Risk subcommittee. According to its Terms of Reference, two of the Sub-committee core objectives are to review complaints and incidents so that lessons are learned and there is an improvement in the patient experience and to review patient feedback and experience and ensure this informs commissioning decisions and care delivery. To achieve this it will be regularly reviewing complaints reports, patient experience and patient feedback, and Datix reports. Membership of the Sub-committee includes a Patient Representative, Alison Cameron. The CCG also gathers intelligence from its member practices on the performance of local services through the monthly meetings of the Commissioning Learning Sets. At each CLS meeting under the heading Clinical Governance practices are given the chance to highlight any concerns about particular services may of which have a direct impact on patient experience. In future, both the public facing internet site and internally facing extranet sites hosted by the CCG will allow members of the public and member practices respectively to interface with the CCG and draw to their attention any matters of concern. Expanding the reach of the CCG The general public are by and large not aware of the changes taking place to the commissioning structure of the NHS, including the demise of PCTs and the advent of CCGs. In its first year of operation as a fully authorised statutory body, the CCG will want (and be required by law) to promote its work to its local constituents and patients, not least to those parts that are hard to reach and who have in the past accessed health services the least. This can be carried out a number of different ways some examples are described below: - All CCG Board meetings will be held in public. Papers will be published on its website and feedback/questions will be encouraged. This will enable the Board to become more accountable to local people by allowing them to observe and scrutinise Board decisions. - The CCG will engage patients in the implementation of its Out of Hospital Strategy, Better Care Closer to Home, by inviting patients to join working groups in specific areas such as the Providers Network, Respiratory, Diabetes, Cardiology and St Charles Development. This work is currently being co-ordinated by Liam Knight, Programme Manager - OOH Strategy Implementation and each individual work stream will be led by individual commissioners/clinical leads. - The CCG will hold its first AGM in 2013/14, which will be open to all local residents. The AGM will present the CCG s Annual Report, which will set out the work that has been carried out in the last year and its intentions for the following year. The meeting will be well publicised in the local media and provide an opportunity for the CCG to widen its membership base beyond the normal channels. It will build a stronger link between the CCG and the community it serves by publicly making itself accountable for its work. Page 3 of 6

4 - The new public website, when it is established in the new year, will provide an important platform and forum for highlighting the CCG s work. The website s content will include introductory information about the CCG, its Board and constituent parts, public health facts and advice, links to relevant providers, a PPE page outlining the work of the PPE and PRG Sub-committees and how members of the public can get involved, a Calendar with key events and consultations, an e-newsletter as well as forums and feedback mechanisms. Tendering for potential website developers across the 8 CCGs will shortly be undertaken by the Communications Team, with the full site being established early in the New Year. Four Key priorities In addition, the CCG Board is asked to consider four priorities for future PPE work, that could significantly improve the way in which the CCG and its members engages with its key constituent local patients and residents. (1) Recruitment and retention of Patient Leads The CCG will identify and recruit patient leads in different specialist areas, mirroring the clinical leads. The expert patients will support and guide the commissioning process and help to design care pathways that reflect the patient perspective. They will be patients who have considerable experience and knowledge that can be used to design new and innovative services. Recruiting Patient Experts will entail: - Putting together JD/PS of Role - Advertising and recruiting roles locally - Providing support/training to the experts - Linking clinical and patient leads - Focusing on OOH priority areas Costs of recruitment and remuneration to experts is expected to cost 2000 p.a. Putting Advertisements in the local press Travel and other costs refunded approx. 20 patients attending bimonthly meetings p.a. The recruitment of the PPE Leads is currently being led by Jonathan McInerny, Locality Manager and Liam, Knight, Programme Manager - OOH Strategy Implementation. (2) PPE and Equality and Diversity (E&D) Training Package The CCG will ensure that there is a package of training and support for appropriate patients staff and members so that they are able to carry out their duties and roles effectively. The training will cover statutory requirements of E&D and PPE. The local Link/Healthwatch will provide some training and support for Expert Patients, Board members and CCG Member practices until March Dates for the training courses will be publicised in mid December. The courses will explore the different forms of PPE, explaining the legal context and social/business benefits of engaging patients, as well as the different PPE techniques that can be used. In addition, Equality and Diversity training for CCG members and staff can also be provided until March 2013 by Adelia Perrier, Equality and Diversity Lead. These can cover the following subjects: An introduction to equality and diversity - for those who have never had equality training Refresher E&D training for those with some previous training/knowledge Equality Analysis Training Page 4 of 6

5 However, the CCG should consider developing a separate package of training in 2013/14 that will be aimed at specific categories of people: - Patient leads, procurement panel 2-3 days on the NHS commissioning process, the importance of engagement and the role of Heathwatch - Clinical Leads, commissioners half-day introductory courses on equality and PPE, with regular refresh training - CCG Board members shorter 1 to 2 hour refresher courses that can be used at away days or included in other training events, - Member practices minutes of awareness raising at the practices, CLS meetings or plenaries If agreed by the Board, the CCG would put out to tender a contact for training and support, inviting local organisations to bid. Lead by a panel facilitated by the Chair of the PPE Sub-committee, a preferred bidder would be appointed early in the New Year, with the aim that the training begins from April The cost of putting out tender a training package would not be high, which means that the statutory tendering process would not need to be followed. Bidders would be encouraged to estimate their overall budget as part of the application process. (3) Patient Participation Groups Local Enhanced Service (LES) The CCG should consider spearheading an expansion in the number of Patient Participation Groups in the area. The Patient Participation Directed Enhanced Service (DES) has been in operation at the national level from April 2011 to March The practices that have signed up to this DES have been expected to set up a Patient Participation Group (PPG) that its fully representative of its patient population, carry out an annual survey of their patients to identify local priorities, agree and publish action plans with the agreement and support of the PPG on their website and review the plans on a regular basis. To date, only 20 out of 55 practices have a fully active PPG. K&C LINk/Healthwatch have provided limited support to the practices to enable them to carry out the work this could continue under Healthwatch. Under DES, practices receive an overall payment of 1.10 per registered patient divided into six different components (1 st /2 nd year): establishing a PRG (20%/0%), agreeing priorities (20%/10%), collating patient views(20%/20%), providing PPG with ability to comment on survey (20%/30%), agreeing with the PPG an action plan (20%/30%), and publicising the action plan on a website (0%/10%). Strict deadlines apply to when reports should be published on the website. Subject to a DH decision, the PPG DES may finish in April If this happens, a refined PPG LES could be developed, learning from the lessons of the PPG DES, which could begin in April Like the DES, the LES would require a PPG to be set up and maintained in each practice, local patients surveyed every year, the collating and publishing of patient views and demonstration that they have acted on them. However, unlike the DES, which has had mixed results, the LES would provide more incentives for practices to achieve positive outcomes and results by ensuring they: Carry out a review of the implementation of the Action Plan Held PPG meetings at least twice a year that are chaired and led by a local patient Include a PPG section on their website, with a named PPG patient lead Provide evidence that they have implemented actions identified in their Local Patient Participation Report Unlike, the DES, which seems to focus more on process rather than outcomes, the PPG LES would provide greater incentives for practices to achieve real changes on the ground that reflect local, patient opinion. There would need to be clear guidance on what practices would need to do, with dedicated support from Healthwatch, especially for smaller practices. To broaden the scope, the CCG Board would need to strongly encourage all practices to commit themselves to the LES. It could also be included as an agenda item for future plenary and CLS meetings. Subject to national guidance, work could begin soon on developing a PPF LES. The PPE Clinical Lead, Dr Rajakulendran would agree a new LES specification the drafting of which would be led by the PPE Officer and Locality Manager, with the support of the Primary Care Contracting Team. Page 5 of 6

6 (4) PPE Commissioning toolkit The CCG Board is also asked to agree a toolkit that all commissioners will be expected to use when designing new services or developing new strategies/policies. The framework, based on the David Gilbert Cycle is designed to guide and support the commissioning from beginning to end. The tool is designed to be flexible, easy to use, succinct and efficient. It has been developed with input from the PPE, OOH, Communications and Equality and Diversity teams as well as colleagues from LINK/Healthwatch. The PPE Sub-committee is currently seeking external expertise to develop the toolkit so that it comprehensively reflects the David Gilbert Cycle and meets the highest standards of current practice. It will also be piloted as part of the implementation of the Out of Hospital Strategy programme. Implementing the work The CCG will shortly recruit a full-time PPE officer who will undertake much of the work outlined in the paper. The PPE Officer will need to work closely with other key staff in the LINK/Healthwatch, the Commissioning Support Unit and the National Commissioning Board too. He/she will report to the PPE Sub-committee, chaired by Dr Rajakulendran and through the Sub-committee to this Board. Page 6 of 6