NHS Norwich CCG Engagement, Consultation and Communications Strategy

NHS Norwich CCG Engagement, Consultation and Communications Strategy 2017-2020 1

Version Circulated to Date Draft 1 PCAG February 2017 Draft 2 PCAG March 2017 Draft 3 PCAG, JE, & IM Mar ch2017 Draft 4 PCAG April 2017 Draft 5 IM,JE, LMCG June 2017 Draft 6 LMCG, IM & JE July 2017 August 2017 IM, LMCG July 2017 IM, LMCG August 2017 Draft 9 LMCG contents page 30 August 2017 2

Contents page Introduction 3 Context 3 How this strategy was developed 4 Aims and Objectives 5 Our principles of engagement 6 Our plans 7 Understanding our target audience 7 Internal engagement and communications 7 External engagement and communications 9 Seldom heard groups 11 Appendix 1 13 Appendix 2 16 3

1. Introduction 1.1 Norwich CCG has six aims enshrined in the Constitution as reviewed in 2016 which are: Improvement in the quality and safety of care Transformation and integration of health and social care services in the communities of Norwich Improvement in the health and well -being of the population of Norwich accompanied by a reduction in health inequalities Management of resources responsibly and ethically to deliver best value for the taxpayer Increased participation of local people in health and care decisions, both public and personal. This strategy has been produced to contribute to bringing about the last of these aims. It is based on a conviction that increasing the participation of patients, carers, the wider public and stakeholders will help achieve the CCG s other key aims. 2. Context 2.1 From its creation in 2012/13, Norwich CCG has sought to fulfil the duties laid on CCGs by the Health and Social Care Act 2012 with respect to patient and public participation (a full list of national and local drivers can be found in Appendix 1). The two complementary duties are: A Public Participation duty CCGs have a statutory duty to ensure public involvement and consultation in commissioning processes and decisions. This includes involvement of the public, patients and carers in: - Planning of commissioning arrangements, which might include consideration of allocation of resources, needs assessment and service specification - Proposed changes to services which may impact on patients B Individual Participation duty CCGs must promote patient and carer involvement in decisions related to their care or treatment. This requires collaboration between patients, carers and professionals, recognising the expertise and contribution made by us all. This duty requires CCGs to ensure that they commission services which promote involvement of patients across the full spectrum of prevention or diagnosis, care planning, treatment and care management. This includes: - Personalised care planning, including patient choice and the option of a personal health budget when a person is eligible - Shared decision-making, regarding individual episodes of care and longer term care 4

- Self-care and self-management support to better manage health and prevent illness - Information with targeted support to enable patients to be more in control of their health 2.2 Norwich CCG has aimed to embed patient and public participation in line with NHSE s commitment to ensure that public, patient and carer voices are at the centre of our healthcare services, from planning to delivery. What this means in NHSE s terms was set out as: - Every level of our commissioning system will be informed by insightful methods of listening to those who use and care about our services. - Our approach will focus on the assets in communities working in coproduction with patients, families and carers and collaborating to improve outcomes. Additionally, Norwich CCG has engaged with the voluntary and community sector creating partnership working where possible. There has also been a commitment to communication both externally and to health and care stakeholders internally. 2.3 This Strategy and Plan builds on that which Norwich CCG agreed at inception in 2013. It is set within the context of NHS England s Five Year Forward View (2016) with its message that the health service needs to change over the next five years and arguing for a new and more engaged relationship with patients, carers, citizens and communities in order to promote wellbeing, prevent ill health, support people to be more in control of their own care and involve them directly in decisions about the future of health and care services. It also takes into account developments in primary care, including delegation of commissioning responsibility from NHSE to CCGs, the GP Forward View with its emphasis on improving access to general practice and the emergence of the Multispeciality Community Provider model. 2.4 The changing health and care landscape, including the introduction of Sustainable Transformation Plans, means that communication and engagement are now even more critical to ensure that those in the local population are aware of and can contribute to discussions and plans for local services. 3. How this strategy has been developed 3.1 This is an integrated stakeholder engagement and communications strategy for the CCG. The principles of communication and engagement both within and between ourselves and our partners, patients, carers and stakeholders are set out here. We have based some of this strategy on the invaluable work of our former internal Patient and Community Advisory Group (PCAG), which included some key pieces of work that have helped inform these plans and approaches. 5

4. Aims and Objectives 4.1 Norwich CCG is an outward facing organisation, with patients as the focus of all we do. Our challenge is to work with patients, carers, the wider public, our member practices, our partners, the voluntary and community sectors to achieve consistent patient and stakeholder voice into our work and commissioning decisions. We want people in Norwich and the part of Broadland that we cover to have a good understanding of the challenges facing the NHS now and in the future. We want to know what our patients and public think about the quality of their local health services. We want them to know that their views can influence how services are commissioned and delivered. We are focused on securing views from relevant stakeholders and integrating them into our plans. Communications and engagement are central to achieving these aims. 4.2 This strategy sets out our principles and priorities for the next three years. In particular we will: value the patient voice, and develop a culture that listens, hears, and uses these insights to inform commissioning and service transformation harvest the experience and views of local clinicians integrating patient experience and feedback about services, and systematise these to provide a rich resource to improve the design and delivery of patient care gather the views of our population about our priorities and plans using a wider range of engagement exercises and methodologies than consultation alone, seeking greater involvement throughout the process 4.3 Key to success is the effectiveness of our relationships with our member practices. We will nurture that member relationship, and our ambition is to become an excellent Clinical Commissioning Group (CCG), working with excellent practices across our patch. It s important that our members own the CCG, through strong systems of peer review and working together. This will be achieved by supporting and co-designing where possible primary care services as defined through OneNorwich; the way our practices now work together to strengthen primary care and associated services in Norwich and the part of Broadland we are responsible for. All of this will be driven by the quality of our engagement and communication with our member practices. 4.4 The CCG has the following communications and engagement objectives which are central to delivering our ambition and our vision: Develop consistent key messages and a brand identity that can be communicated to all audiences Deliver the CCG s strategic objectives by working with other NHS and social care teams, stakeholders, partners and patients in strategic planning and service transformation 6

Support a cultural shift in primary care from providing clinical advice and support to delivering leadership and management, arranged around clusters of GP practices and in which patients and local communities are actively involved Integrate patient/public involvement into our commissioning planning and decision-making Deliver engagement that aligns with our approach to achieving improvements in quality, innovation, productivity and prevention (the QIPP agenda) Develop consistent, regular and high quality communications channels reaching clinicians, staff, stakeholders, the public and patients Influence and improve key stakeholders and public perceptions of the new healthcare system in Norwich and Broadland, developing innovative communications across an integrated care system Secure the CCG s reputation for effective public and patient engagement, and promote its success beyond the boundaries of Norfolk and Waveney 4.5 This strategy is a dynamic document and the plans its sets out will be regularly reviewed, thereby demonstrating our continuing commitment to delivering this challenging agenda in a changing environment. Organisations commissioning healthcare have a responsibility to communicate and consult with NHS staff including clinicians as well as with patients, stakeholders and the public. Our aim is to achieve sustained engagement in the CCG s work over the long term. 5. Our principles for engagement, consultation and communications 5.1 We will make the very best use of existing communication channels and products, both in NHS organisations in Norwich and Broadland areas, our patients and public, carers and in partner organisations, such as working with colleagues in the local county, district and borough councils. The principles that will underpin our day to day work are: Being open, honest and explaining the reasons for what we do Responding to questions promptly and fully Having a clear, easy to recognise corporate style or brand in all we do Working in partnership with other agencies to plan and coordinate communication Promoting our achievements and building credibility and trust in our work and the services we start to commission Making sure that NHS Norwich CCG staff have the appropriate engagement communications skills and expertise to deliver internally and externally, encouraging feedback at all levels and showing where services and systems have changed to reflect this Using clear language in plain English with no jargon so that everyone can understand what we are saying (translated when required) Being sensitive and respectful to the needs and aspirations of others 7

Avoiding jargon and acronyms where possible Making sure we reach the right audiences at the right time, and making sure what we do is accessible to those receiving it Using the resources available to us prudently to deliver the maximum benefit, cost-effectively Using good engagement and communications methods consistently with clear, strong messages, often over a period of time to achieve impact Our commitment goes beyond that of our statutory duties and we feel this reflects the commitment of the governing body and council of members have to involvement, engagement, communications and co-production (where possible) (see appendix 1 for our legal obligations). 5. Our Plans 5.1 Understanding our target audiences For engagement and communications purposes we have set out our main target audiences. A range of audiences have been identified and we will communicate with these at differing levels, making sure we use a wide range of channels for engagement, consultation and communications. Key audiences Patients, carers and the public Internal members, staff, clinicians and the CCG Governing Body, Council of Members External - clinicians, the staff of providers and decision making bodies Stakeholders e.g. NHSE, County, District and Borough Councils, MPs and opinions formers, the voluntary and independent sectors and suppliers, the media 5.2 Internal communications 5.2.1 Effective engagement and consultation in the wider sense will be key to communicating effectively with the patients, stakeholders and the general public. This will promote an understanding of the CCG s vision and priorities. All staff will receive timely and consistent messaging on all areas of our work and openness and feedback will be encouraged. Internal communication and staff engagement is crucial to the success of the organisation and will have a vital role to play in achieving the CCG s business objectives. Through well-managed internal communications, we will deliver a common understanding of our goals and values and bring the new CCG brand to life through our staff. In addition, internal communication and engagement will help to keep staff 8

motivated, inspired and committed. Good internal communication will help retain staff, as well as attract more staff to the organisation. 5.3 Our internal engagement objectives Use internal communications channels to make sure the CCG team have a good understanding of the organisations vision, goals, strategic vision, and the savings challenges we must deliver, plus our quality ambitions Use communications to develop an informal, non-hierarchical matrix feel to the organisation, creating an honest and open working environment where staff and our members can be heard, listened to and valued Ensure that as an organisation, we make decisions quickly and empower our managers to do so too Establish systems and processes to make information easily available Evaluate the effectiveness of our internal communications and engagement through an annual communications audit as part of the staff survey 5.4 Our Audiences and how we will communicate and engage with them 5.4.1 Stakeholders Internal The CCG Governing Body CCG Executive All CCG staff Clinical Leads Member practices PPGs We do this through: our monthly GP Bulletin to everyone in primary care and all commissioning staff weekly face-to-face staff briefings and updates on our CCG Website Members section 5.5 External engagement and consultation 5.5.1 Background (National) There has been a sea change in the way the NHS wants us to commission services going forward. We, as a Norfolk and Waveney system, were asked to produce a Sustainability and Transformation Plan in light of the financial constraints on NHS and Social care services. More information on the plans can be found on one of our partner organisation website Healthwatch Norfolk, who has agreed to host our Norfolk and Waveney STP plans. http://www.healthwatchnorfolk.co.uk/ingoodhealth/ 9

NHS England has produced a document which outlines their forward view of primary care over a five year period. https://www.england.nhs.uk/five-year-forward-view/ The CCG is in the process of developing plans for this and more detailed information can be found at appendix 2 5.5.2 Background (Local) A Patient and Community Advisory Group, formed after engagement with the voluntary sector, individual patients and members of patient participation groups (PPGs,) has recently been disbanded in favour of placing more emphasis on use of the Community Involvement Panel. The CCG has made a commitment to refresh and bolster the Community Involvement Panel (CIP). The panel is made up of local people who use NHS services and organisations and who have expressed an interest in being involved when the CCG is looking to change services, commission new services and decommission service where appropriate. The CIP will Consider proposals for change and identify issues which may be of particular interest or concern for patients Help to build a common understanding about the health care needs of patients through regular events Bring a patient and carer perspective to designing and shaping Norwich CCG s proposals for re-designing primary care, reflecting NHS England Five Year Forward View and GP Forward View. We aim to develop a minimum of two open meetings a year to continue to involve the wider public, patients, carers and stakeholders in our plans as well as consulting members of the CIP directly on specific subjects. 5.6 Who we will engage with and how We will engage with specific groups/stakeholders as set out in the table on the next page. If at any time we see a gap in our methods of engagement we will revise this to ensure no community is excluded. 10

Stakeholders Department of Health NHS England and the Area Team for Cambridge, Suffolk and Norfolk STP Board Commissioning Support Unit (CSU) Other CCGs, particularly in Norfolk and Suffolk Independent and salaried contractors: GPs, dentists and pharmacists Optometrists Contracted NHS provider Trusts IC24 our out of hours provider County councils, borough and district councils MPs Private and voluntary sector providers Health and Wellbeing Boards (Norfolk and Suffolk) and the System Leadership Partnership Health Overview and Scrutiny Committees Norfolk and Suffolk Local Professional Committees Media East of England Ambulance Service Patients, stakeholders and the public Community Involvement Panel People who use local health services and their carers Patient Participation Groups (PPGs) Seldom heard groups who traditionally experience difficulties accessing NHS services Our patient population in Norwich, South Norfolk and Broadland Interest groups Voluntary, community and third sector organisations Charitable organisations Norfolk and Suffolk HealthWatch Governors of local Foundation Trusts Methods for engaging NHS England Assurance Reports System Leadership Partnership and Health and Wellbeing Boards Board to Boards and Executive to Executive meetings CCG Governing Body meetings Attendance at key meetings, forums and events Websites Information updates as required Information updates as required Methods of engagement Bi-monthly governing body reports Regular stakeholder meetings, minimum of two per annum Email alerts Media campaigns and advertising Specific targeted engagement events Focus groups Online surveys Formal Consultations where required CCG officers attending partnership events and forums on a regular basis Market research and insight projects 11

We also see a need to positively engage with Local Government, this includes local MPs, HOSC, local district and parish councillors, Norfolk County Council (councillors and officers). We will do this through pro-active briefings where we are making changes to the Norwich health system. This will include MPs, council leaders and relevant chairs or portfolio holders at a county and district level as well as councillors sitting on the Health and Wellbeing Board. 5.7. Seldom-heard groups in Norwich, South Norfolk and Broadland There are a range of seldom heard groups in our community. The CCG will ensure all external engagement activities and communications are inclusive and take place through a range of channels that reach all groups, taking into consideration all barriers to communication, including language and access to computers. We are committed to engaging with patients, carers and the public in all stages of the commissioning cycle. This is essential and will make sure we always develop innovative, patient-centred services. As commissioners, we will make sure that the views of patients and the public are listened to, heard and acted upon. We are particularly focused on accessing seldom heard and vulnerable groups, this will include; Migrant Workers Gypsy, Traveller and Roma communities Looked After Children Individuals within the criminal justice system Asylum seekers and refugees Black, Asian and Minority Ethnic (BAME) Groups People with Learning Disabilities People with long-term mental health problems. Lesbian, Gay, Bisexual and Transgender people Homeless and insecurely housed people Young people and children The CCG already has an excellent reputation for working with a number of the above groups in respect of improving access to services and providing information in accessible formats https://www.youtube.com/channel/uci6l5hodtifew8bmbgpkvjg we will continue to work in inclusive and innovative ways. 6. Key next steps The CCG will ensure that patient and stakeholder engagement is built into the project plan for the development of the new model of care for Norwich, in line with GP Forward View as set out in appendix 2. We will do this by: 12

Establishing a communications and engagement workstream as a part of the project programme Aligning the CIP members to the neighbourhood groups Developing and agreeing a communications and engagement plan by February 2018. Monitoring and reviewing the communications and engagement plan through the period of the project, ensuring that it meets the requirements of the national assessment/isap process. Ultimately establishing a new model of care for Norwich, utilising the MCP model of delivery, which will have been actively developed in conjunction with local stakeholders, service users and patient groups. 13

APPENDIX 1 The national and local perspective what we know National drivers There are a series of key national drivers for the need to conduct patient and public engagement in the commissioning of services including: The Health and Social Care Act 2012 Health and Wellbeing Boards HealthWatch Norfolk (and Suffolk where looking at STP joint plans) The Local Government and Public Involvement in Health Act 2007 and the The Cabinet Office Code of Practice on Consultation (2004) The NHS Constitution (2009) gives a legal right to staff and patients to know what they are entitled to and how to access this The Equality Act 2010 Equality Delivery System2 (EDS2) Everyone Counts: Planning for Patients 2014/15 to 2018/19 Transforming Participation in Health and Care September 2013 Local Authority Health Scrutiny June 2014 Sign up to Safety Report Nov 2014 rehabilitation of offenders act 1974 as amended 2014 Local drivers Delivery of the Integrated Plan Delivery of the QIPP and Reform Plan Meeting the requirements of the System Leadership Partnership and Health and Wellbeing Boards Patient Related Outcome Measures (PROM) data Delivery of the Quality Premium Delivery of the CCGs Out of Hospital Strategy The CCGs Five Year Strategic Plan The Five Year Forward Plan for Primary Care Sustainability and Transformation Plan (STP) The CCG Two Year Operational Plan As part of producing the Sustainability Transformation Plan (STP), NHS England has published guidance in relation to engagement. This will be through six principles of engagement as outlined in the diagram below 14

Our legal requirements There are a range of legal requirements on commissioning bodies that directly impact on the duty of the NHS to consult with the patients and the wider public. Section 14Z2 of the Health and Social Care Act 2012: Public involvement and consultation by Clinical Commissioning Groups (1) This section applies in relation to any health services which are, or are to be, provided pursuant to arrangements made by a clinical commissioning group in the exercise of its functions ( commissioning arrangements ). (2) The clinical commissioning group must make arrangements to secure that individuals to whom the services are being or may be provided are involved (whether by being consulted or provided with information or in other ways): (a) in the planning of the commissioning arrangements by the group, (b) in the development and consideration of proposals by the group for changes in the commissioning arrangements where the implementation of the proposals would have an impact on the manner in which the services are delivered to the individuals or the range of health services available to them, and in decisions of the group affecting the operation of the commissioning arrangements where the implementation of the decisions would (if made) have such an impact. In plain English, the CCG is required to involve the public in decisions that we are going to make about the services that will be provided to them. Simply informing the public that we have decided to close services, e.g. community hospitals, even if there are very strong arguments in favour of closure, does not meet the language of the statute. Other legal requirements There are a range of legal requirements on commissioning bodies that directly impact on the duty of the NHS to consult with the patients and the wider public. 15

CCGs are required to comply with these legislation and policies too. In summary these are: Human Rights Act 1998 superseded by the Equality Act 2012 Equity and Excellence: Liberating the NHS no decision about me without me Health and Social Care Act 2012, sections 13Q and 14Z2, which mirror the Real Involvement guidance, in Section 242of the 2006 Act, and apply to CCGs Section 11 of the Health and Social Care Act 2001 Formal consultation, incorporating the four reconfiguration tests (August 2010) Requirement to carry out impact and equality assessments Everyone Counts: Planning for Patients 2014/15 to 2018/19 Transforming Participation in Health and Care September 2013 Local Authority Health Scrutiny June 2014 Rehabilitation of offenders act 1974 as amended 2014 Patient and public participation in commissioning health and care (2017) The NHS Equality Delivery System2 (EDS2) 16

APPENDIX 2 Five Year Forward View for Primary Care & our plans for Norwich As a patient or a clinician, you would not choose to recreate from scratch the historical partitions between primary, community, mental health and social care and acute services. The boundaries make it harder to provide joined-up, person-focused care that is preventative, high quality and efficient. The NHS Five Year Forward View introduced the concept of new models of care. The Department of Health s 2016/17 mandate to NHS England sets out the expectation that 50% of the country will be covered by new care models by 2020. Norwich is moving towards a Multispeciality Community Provider model (MCP) An MCP is a new type of integrated provider. It combines the delivery of primary care and community-based health and care services not just planning and budgets. It also incorporates a much wider range of services and specialists wherever that is the best thing to do. This is likely to include some services currently based in hospitals, such as some outpatient clinics or care for frail older people as well as some diagnostics and day surgery, mental health and even potentially social care provision. The building blocks of an MCP are the care hubs of integrated teams. Each typically serves a community of around 30,000-50,000 people. The underlying logic of an MCP is that by focusing on prevention and redesigning care, it is possible to improve health and wellbeing, achieve better quality, reduce avoidable hospital admissions and elective activity, and unlock more efficient ways of delivering care. A New Model of Care is the next step for our very successful YourNorwich and Healthy Norwich programmes, together with strengthening primary care. Our aim is to prevent poor health by helping people to look after themselves better and provide care out of hospital, closer to where people live. 17

The Norwich MCP Model This is how we think the new model of care will improve services 18