A conversation about commissioning intentions - NHS South Tees CCG working with our local community summary report 1
Acknowledgements We would like to thank all of the individuals and organisations who have taken part in this engagement event and shared their experiences of using local services. Your contributions have helped to inform our commissioning decisions and we will share the next stages in the development of our commissioning intentions at our public engagement event in November and on our website www.southteesccg.nhs.uk. 2
Background NHS South Tees Clinical Commissioning Group (CCG) is committed to making a difference to the population of Middlesbrough and Redcar and Cleveland by improving their health outcomes and their experience of using local healthcare services. We are in the process of planning commissioning priorities for 2016/16 and are keen to ensure that members of the public and key stakeholders are given the chance to help shape our commissioning intentions. Our CCG is responsible for planning, designing and paying for a range of local NHS services. These services include planned and emergency hospital care, rehabilitation, most community services and mental health and learning disability services. There are some big health challenges in the South Tees area, including: A growing elderly population with long-term health needs Levels of heart disease, stroke and cancer Illnesses caused by smoking Illnesses caused by alcohol Managing hospital admissions and demand for health services Financial pressures The CCG commissions a specific set of healthcare services that include: Planned inpatient and day-case hospital services Urgent care services from hospitals and walk in centres, NHS 111 and local out of hours services when GP practices are closed General non specialised maternity and children s services Community based services Mental health services Continuing health care and free nursing care services Medicines prescribed by the GP Practices within the CCG boundary Diagnostic and treatment services such as x ray or hearing aid services To find out more about the CCG please see Appendix 1. Our approach The views of patients, carers and the public matter to us. We want to involve them, as well as doctors, nurses, other healthcare professionals and managers in the decisions we make. By working with patients, carers, voluntary and community sector organisations and the public, we are able to develop services which meet the health needs of our community. 3
As part of our continuing commitment to engaging with our local population, we sought the views of local people, patients, carers and stakeholders about our commissioning intentions. This was done in a number of ways: We circulated information widely to stakeholders including members of MY NHS, voluntary and community groups, GP practices and GP patient groups We held an event on 8 th August 2014 for all stakeholders We used press releases and advertisements in the local media to raise awareness of the above activities and encourage as many people as possible to attend. An event was organised on the 8 th August 2014 to discuss with members of the public our commissioning priorities for 2014/15. The event was held at Community Hall, Middlesbrough and Stockton Mind, Lothian Road in Middlesbrough as it was considered to be a central location with good bus links. We used our existing contacts and networks to encourage people to attend the event. In order to obtain as much feedback as possible, copies of the presentations and key questions were uploaded onto our website so those delegates who were unable to attend would still be able to contribute to the process. All attendees were provided with a delegate pack which contained: Agenda Copy of the presentations MY NHS sign up forms Evaluation form Approximately fifty people attended the event on 8 th August. Topics of discussion included CCG commissioning plans, carers, health and wellbeing, mental health and learning disabilities, urgent care and planned care. 4
Format of the event Dr Henry Waters, CCG Chair, briefly described the current NHS landscape and provided an overview of the challenges that the CCG and the NHS are facing. Dr Waters then explained that each table would have a facilitator from the CCG who would give a brief explanation of our priority areas for commissioning services. Delegates were asked to give their views on the proposed commissioning intentions and to highlight any gaps. Each table of stakeholders had 15 minutes to discuss each of five topics with CCG staff and representatives. Scribes at each table recorded the conversations and key themes. Subjects discussed were: Carers Health and wellbeing Urgent care Planned care Mental health and learning disabilities. There was an opportunity at the end of the event for participants to give feedback and comments by using the forms provided. 5
Key points from roundtable discussions The key discussion points have been summarised and put into themes below followed by a brief update (in the green boxes) on our proposed commission intentions for 2015/16 : Carers Carers need to be assessed at the same time as the patient and appropriate training be given for carers to enable them to provide care. Better support is required to empower carers Patients and carers should be given the opportunity to assess their own needs A huge improvement is needed in communications between services and agencies Our CCG are passionate about ensuring access to services for carers. We work closely with our two local authorities (LA); Middlesbrough Council and Redcar and Cleveland Council to ensure that health and care services that are commissioned meet the needs of carers. The CCG and LA in Middlesbrough are currently in the process of developing their joint Carers Strategy. The strategy will help both organisations to better support the needs of carers. We have a draft commissioning intention to improve the physical and mental health of local carers, improve the provision provided to carers so that they are aware of the support for them and impact on the wider health economy. Health and Wellbeing Cancer Fear is a barrier to screening. Target those people who would not usually attend 6
Ensure a clear and understandable patient pathway is available once cancer is detected Utilise community venues to promote screening and health messages Alcohol Help people to take ownership of their problem by providing relevant support Maternal and child health Information on the effects of smoking and alcohol should be given at school including the effects of alcohol consumption during pregnancy Peer support should be used to encourage and support mums to breastfeed Parenting skills should be taught in schools Weight management services School meals should be healthy and tuck shops should sell healthy snacks only Teach people how to cook healthy meals Diabetes Patients need more help around healthy eating General Utilise social media Improve links with the voluntary and community sector to engage the population and provide services where appropriate Work effectively with partners such as the local authority Improving the health and wellbeing of our local population is a huge challenge for the CCG. We have dedicated clinically led workstream which has members from partner organisations including local authority and voluntary and community sector to try to tackle some of the challenges. Many of the projects that come out of the workstream are linked to education of patients and to addressing the challenges. We have a draft commissioning intention to improve local awareness of signs and symptoms of diabetes and improve the support and education for patient s diabetes. We are also now undertaking a review of our Life Store service to understand how we can better reach out to communities. Urgent Care Need for more information and education about urgent care services and what is available when, using varied communication campaigns to educate patients, the public and staff (including information about 111) 7
Better quality discharge information required when leaving hospital Need for alcohol screening team at A&E and associated services We are in the process of developing our urgent care strategy. The implementation of this is a commissioning intention for urgent care for next year. The strategy will identify key drivers in addressing some of the challenges identified above. This will include communication campaigns to increase awareness of 111 and directing people appropriately to existing services Planned Care Skin and Musculoskeletal Good that pathways are being streamlined and value for money is being sought Heart function Important to provide care within the community setting General Look at services that could be provided in the community i.e. scans, maternity services Need better integration between NHS services Integration between NHS organisations and social care organisations is a priority for the CCG. The Better Care Fund; a government led initiative; is a budget to improve the ways health services and social care services work together, starting with services for older people and people with long term conditions. The Better Care Fund is a real opportunity for change, so that people receive the right care and support at the right time, in the right place. The planned care workstream have a commissioning intention to improve skin services. The new model will bring existing community skin services together to form an integrated skin pathway. The pathway will bring skin services into the community, leaving only complex/specialist management in secondary care. Mental Health and Learning Disabilities Timeliness of access to treatment is an issue Publicity to raise awareness of Improving Access to Psychological Therapies (IAPT) Support for carers Importance of participation and engagement with communities Joined up working with partners and the voluntary sector 8
The CCG is working closely with IAPT providers to make improvements, particularly around access to services. Additionally the CCG has a draft commissioning intention to improve transition arrangements from Child and Adolescent Mental Health Service (CAMHS) Adult Mental Health Service (AMHS) as well as a spate CI for the development of the No Health without Mental Health Implementation Plan 9
Conclusion/Recommendations As part of the planning process for the commissioning intentions and with contributions from this and other engagement events, NHS South Tees CCG plans to take forward issues highlighted at the event either through existing commissioning intentions and associated work plans or by developing new commissioning intentions. However, we need to prioritise what we focus on and this may mean we can t take all the suggestions forward. Where this is not possible we will feedback at a planned event. A further You Said, We Did event is planned for November 2014 when feedback from this event will be given and a number of our commissioning priorities will be discussed in more detail. Our commitment is to run these events to ensure patient and public participation is embedded in our current and future work programmes. The engagement event provided an opportunity for stakeholders, clinicians, NHS staff and members of the public to feed into the CCG. Next steps A follow-up event will be arranged for 21 st November 2014 at Tuned In in Redcar to share how the feedback from the event will contribute to the proposed commissioning intentions for 2014/15. To register your attendance please email 10
Evaluation of the event All participants were provided with a feedback form asking them to comment on the event. Not everyone completed the forms. General comments received included: Thanks it went well but general feedback that the 15 min was not really enough to explain the CIs and get any in depth feedback. One lady suggested that at future events it would have been helpful to have a short summary before the meeting and then they could have considered some questions/concerns. Other main comment back was re Community assessment unit. Superb great idea, but as well you should be investing in the staff in practices upskilling Drs and Nurses to deal with frail elderly. Feedback on implementing the commissioning intentions is essential Difficult to get to building Not enough parking Following on from this feedback we will ensure that in future we allow a suitable amount of time for agenda items and we will where possible get information sent out to attendees in advance of the engagement events. We have reflected on the use of this venue, and though the venue had good transport links there was an issue with parking. We will ensure that future venues better meet attendees needs. How to keep involved We are working hard to include local people in the shaping of our health services. We want to do this because it helps us to make sure we are improving our services in ways that meet your needs. It is really important for us to hear local people s comments, ideas and suggestions about ways in which we can make services better. If people would like to get involved in the development of new and existing services and share their experience, then they can join our engagement database MY NHS. We contact people on this database when an opportunity arises for them to get involved. This can range from being part of a discussion group, completing a questionnaire, joining a service user group or telling us what they think about some of the documents we produce. There are also other ways for people to get involved in local health services and to share their views, including: 11
Patient Participation Group (PPG) and CCG Meetings - acts as the link between local PPGs and the CCG. Healthwatch - an independent organisation. Its role is to represent the views of local people. We have two organisations that work closely together: Healthwatch Middlesbrough- www.healthwatchmiddlesbrough.co.uk Healthwatch Redcar and Clevelandwww.healthwatchredcarandcleveland.co.uk Partnership working with community and voluntary groups; Regular CCG engagement events - wider engagement events with local people on health care related topics. 12
Appendix 1- About our CCG NHS South Tees CCG is made up of 47 doctors practices in the area and together with its member practices, is committed to working with patients, the public, local hospitals and partner organisations. The CCG is coterminous with two Local Authorities; Middlesbrough Borough Council and Redcar and Cleveland Borough Council serving nearly 280,000 patients We serve the populations of Eston Langbaurgh Middlesbrough We are committed to continue to talk to patients, carers and the community to understand their needs and work to prioritise and deliver these through the CCG s strong clinical and multi-professional team. Our priorities are to improve the health of local people by designing new and effective ways of working, tackling health inequalities of our local population and ensuring the right access at the right time for everyone regardless of where they live in the South Tees area. This work can t be done in isolation which is why we are working hard to develop our relationships with local partners including our member practices, local authorities, Healthwatch and the local voluntary and community sector (VCS). Workstreams In order to deliver our plans for improving people s health and local services, we have established a number of clinically-led groups known as workstreams which will lead improvements in local services. Our workstreams are: 1. Health and Wellbeing 2. Urgent Care 13
3. Care Closer to Home focusing on mental health and learning disability, planned care and Integrated Management and Proactive Care for the Vulnerable and Elderly (IMProVE) 4. Medicines Management 5. Quality Improvement in Primary Care These groups are led by local GPs working with doctors, nurses and practice managers from our member practices along with local NHS and local authority partners to understand how services need to change. Workstreams will then work together to develop and implement new ways of working to ensure the best use of NHS resources and the best outcomes for patients. 14
Appendix 2 - Event Feedback Evaluation sheet The comments in this section were recorded from the evaluation forms. Did you like the format of the event? Yes: Yes, no negative comments Good 15 minute sessions The event went well but more time for each topic would have been helpful Well structured Format OK Good idea No: Location not conducive to easy discussion too noisy Not really. Too short a time and the audience needs better selection Poor venue/parking restricted. Acoustics poor (missed much) The only issue was very rushed Would have perhaps, been good to move half participants around as well to allow in depth discussions with different people It would have helped to have a short brief on each topic prior to discussion Sessions too short to feed back Did you get the information that you needed? Yes: No: Yes, got some new things Some Very informative I think for future events, participants should be briefed on topics before Mostly Very interesting conversations and opinions around the table Could have been more in depth but a good overview of key plans discussed Difficulty with several people and short 15 minute sessions. Overall yes some of the others around the table may assume a different point is being made and not allow it to be clarified because of concentrating on relevant time frame and whether things turn out to be urgent 15
Would have liked more time Should have had the information in advance to digest and discuss with our communities so we could come with valuable feedback Very little information provided Not enough time for in depth understanding Would have been good to have a copy of the commissioning intentions Not enough time to get through each topic Would like to see a document of commissioning intentions publically available No Only because I was too quiet Did you speak to everyone that you wanted to speak to? Yes: Some perhaps would have developed discussions if time given No: Would have been helpful to send out workstream lead contacts or sign post to link Was hard to hear people around the table as the room was a bit small 16