Patient and Public Engagement Year Book Improving NHS health services in Kingston
Contents Foreword: GP Chair and Chief Officer Kingston CCG... 3 Message from Health Watch Kingston... 4 Case Studies... 5-9 Case Study One: Our Commissioning Intentions 2013-2014... 5 Case Study Two: The Kingston at Home programme... 6 Case Study Three: The Kingston Clinical Assessment System... 7 Case Study Four: Kingston A&E Survey... 8 Case Study Five: Freshers Fayre student s survey... 10 Looking forward... 11 Lessons learned... 12 Page 2
Foreword Kingston Clinical Commissioning Group (CCG) is committed to involving local people in how we plan, develop and deliver health services. We believe that only by involving the people we serve, we will truly be able to provide responsive, high quality services that reflect the needs of the people who use them. The case studies in this first Engagement Year book present a snap shot of the numerous engagement activities that we have undertaken over the past year and reflect the strong foundation for engagement in Kingston that we are working very hard to build. In the coming year, we plan to increase the scope of our engagement activities with a particular emphasis on harnessing your views and input to improve the quality of the services we commission. As we look for innovative ways to meet the needs of an ageing population with more complex health and care needs, we will need your continued support to make the right commissioning decisions for the population of Kingston. We would like to take this opportunity to thank you for engaging with us over the past year, and also renew our invitation to continue to work with us to ensure local health services are fit for purpose for ourselves and future generations. Naz Jivani (GP Chair) David Smith (Chief Officer Kingston CCG) Page 3
Message from Health Watch Kingston Healthwatch Kingston is very pleased to be working closely with Kingston CCG to ensure that patients and service users have a positive experience of the treatment and care they receive in both primary and secondary care settings. Engaging with patients and the wider community is vital if a culture of sustained improvement and better outcomes is to be maintained. Over the last year, Healthwatch Kingston, now on a statutory footing, has both increased its membership and raised its profile locally as a consumer champion. The active relationships we have with Kingston CCG colleagues at all levels is a fundamental component of our strategy. We aim where possible to dovetail some of our priority activities to match the CCG s own priorities. Through this we can provide an up to the minute and reflective commentary on how patients and service users experience our local health services. We look forward to continuing with this productive relationship in the next year. Grahame Snelling Chair Healthwatch Kingston Page 4
Case Study: 1 Our Commissioning Intentions In developing our commissioning intentions for 2014/15 we met with representatives of the GP Practices Patient Participation Groups (PPGs). We were told that PPGs need more information about the process and to be involved earlier and more fully. We also shared our thinking and early drafts about our commissioning intentions with Kingston Voluntary Action (KVA) and Age Concern Kingston. The comments received from both organisations reminded us of the range of existing partnerships and networks that are available for Kingston CCG to engage with. We also gave a presentation at KVA s Health Conference. Feedback from Age Concern Kingston endorsed the effectiveness of the Stay Well Model in supporting people with dementia especially on admission and/or discharge from hospital. We have incorporated key components of the feedback received into Kingston s Better Care Fund (BCF) Plan. Further to a number of patient/ public discussions, we have established a Patient Reference Group to help shape the Better Care Fund Plan and its implementation. KVA see important steps being taken by the CCG to engage with the Voluntary Sector. At the KVA Health Conference in January 2014, there was strong CCG representation. Delegates felt their diverse range of perspectives were listened to. We are working hard to strengthen the links between the CCG and KVA with the aim to enable local voluntary and community sector organisations to better operate in the new environment. Hilary Garner, Chief Executive, Kingston Voluntary Action Page 5
Case Study: 2 The Kingston at Home Programme The Kingston at Home (KaH) programme provides short term, health and social care services for older adults living in Kingston. The emphasis is on greater co-ordination (integration) and high quality health and adult care services to avoid hospital admissions or facilitate early discharge following admission to hospital. Patients are supported to have greater control over their life, live at home for as long they wish and is safe for them to do so. The service supports people who require on-going care following a hospital admission, through home based rehabilitation, to enable them to regain their confidence and independence in everyday activities. We set up a reference group made up of lay people including: patients, carers, members of the public and voluntary sector representatives to support the development and on-going work of KaH. The group meets bi-monthly. We have found members insights and opinions useful in helping Kingston CCG and its partners continue to shape the service. Key feedback from patients include the importance of continuity throughout the system, the involvement of patients in Page 6 Carers should be treated as partners in care. Supporting carers is vital to ensure that people live independently for as long as possible. Carers contribute around 1million worth of unpaid care per day, to the borough we can t afford for carers to stop caring! Involvement in discharge planning which includes giving information about health conditions, treatment, prognosis and care needs should be afforded to every carer. Kate Dudely, CEO, Kingston Carers Network
planning their discharge from hospital and the need for better co-ordination for a more effective transition of patients from hospital to the home setting. Patients affirmed that they want choice and control over the healthcare professionals and workers who care for them at home and that they preferred information about local services and groups to be easily accessible by elderly, frail people living at home and who want to be independent for as long as possible. The reference group is currently developing quality measures that the CCG will use to monitor the services it commissions for the Kingston at Home program. Case Study: The Kingston Clinical Assessment System (KCAS) 3 A review of the KCAS outpatient referral service was conducted in 2013. As part of this review, patients were asked to provide feedback about the service via Survey monkey. The survey consisted of 10 questions about the overall patient experience, the time taken to deal with the referral and the information provided about the referral process. 65 patients responded to the survey request, with varied levels of satisfaction. The responses regarding the referral process were generally favourable. In the instances where the referral process took longer than expected or where there were issues, these were noted to help improve the overall service. Other issues highlighted for attention include the booking of outpatient appointments and follow up information received by patients. Kingston CCG will be reviewing the responses in more detail, to ensure that the outpatient service is consistent and provides a high quality service to patients. Page 7
The national NHS Call for Action campaign by NHS England recommended moving the NHS towards 7 day working to improve patient case and ease the significant pressures on A&E. Case Study: Kingston A&E Survey 4 Kingston CCG ran a survey in December 2013 to ascertain why people attend A&E, and how they make the choice to go to A&E at Kingston Hospital instead of their GP or another NHS service that could assess and treat their condition. A total number of 364 forms were returned. Key results from the survey are summarised below: Page 8 50.5% of A&E Survey returns were deemed appropriate visits for A&E. Of the remaining 49.5%, the triage nurses reported that these could have been seen elsewhere such as by a GP (28.5%) or walk in centre (18.4%). This continues to highlight the need for patients to be signposted and encouraged to use alternative services to reduce the pressures on A&E.
52% of patients attended A&E based on their own decision or after seeking advice from somebody else. Only 2% of patients consulted NHS 111 and 10% consulted a GP first. If patients can be encouraged to use NHS 111 (a 24hr service) or seek advice from their GP first, a proportion of A&E attendance may be avoided. The main reason for patients deciding to attend A&E was that pain/symptoms became worse or were not going away. However, a significant number (46) stated that their GP Practice was closed or they could not get an urgent appointment. This raises the issue of GP accessibility to reduce the overall A&E burden. As a person who has been involved in statutory and voluntary sector participation and engagement over many years, it is heartening to experience greater opportunities to participate than hitherto. Kingston Clinical Commissioning Group has opened its Board Meetings to the public for a variety of issues to be brought before Members that affect health and Wellbeing where time has allowed. The Patient and Public Forum also provides this opportunity, not only to tinker around the edges of service provision but to be involved in supporting areas of policy and strategic engagement that are crucial in the making of major service transition. Involvement on the Forum, not only as a participant but as a lead, on an occasion when Personal Health Budgets were in the spotlight, begins to feel that contributions, skills and expertise are valued. Ann MacFarlane local patient advocate and lay representative SWL Collaborative March 2014 Page 9
Case Study: Freshers Fayre Kingston University Young people told us that to be considered successful, the NHS would also have to deliver Page 10 5 In September 2013, Kingston CCG ran a stall at the Kingston University Freshers Fayre to raise awareness amongst the university students and staff about the CCG and its role in commissioning local health services. We also invited students to contribute to the NHS England national campaign A call to action - about the future of the NHS in England. 49 students completed a short survey on the NHS and we held conversations with numerous students, staff and other visitors, listening to their views and concerns about the National Health Service and their local health services. We heard strong views about key values that the NHS should always retain. These values included that health services remain free at the point of use; that patients regardless of age, ethnicity, gender or sexuality should have equal access; that healthcare provision should remain of high quality and easy to access. The health issues that were reported as most troubling to young people included, stress related mental health, obesity, anorexia, sexual health, abuse of alcohol and drugs, smoking and the privatisation of the NHS. top quality care; better funding and staffing levels; shorter waiting times for appointments and treatment; equal standards throughout the country; effective communications; clean, organised care environments; the use of up to date technologies; dignity: health professionals enjoying their work and (allowed) to get on with treating people.
Looking Forward We have established an Assurance For Engagement in Commissioning Team (AFECT) that currently comprises of Kingston CCG representatives, Health Watch and other key partners. Through AFECT, we aim to ensure that we are engaging in the right way, at the right time and with the right people. We have established a Patient Experience Group which includes providers of health care services, Health Watch, lay representatives from the voluntary sector. The membership is currently under review and will be extended to other key partners. The group will work towards improving quality in the delivery of health services using patient experience feedback. We are working with partners to further develop engagement activities related to our Strategic Work Streams (Integrated Care, Older people and those with long term conditions, Mental Health, Children and Young People, Unscheduled Care, Socially excluded and disadvantaged groups). We are aiming to pilot a Patient Leaders Program to train and support patients, carers and members of the public to get involved and to influence the commissioning of local health care services and the decisions we make as a CCG We are piloting an Awards scheme to recognise the added value, commitment and expertise that GP Practice Patient Participation Groups bring to the commissioning of health services. Page 11
Lessons learned During 2013-2014, we held conversations and engagement events with a wide range of local patients, carers, lay people, partners and other stakeholders. Some lessons we have learned to help us engage with our local communities even better include: Kingston Clinical Commissioning Group Third Floor Guildhall 1 Kingston KT1 1EU We need to give local people more information about NHS changes and what these mean for them. We need to become more proactive in our engagement and refresh our local partnerships. we need to involve key partners more effectively from the outset of service design. We need to engage with more diverse communities and young people better. To influence the commissioning of your local health services and get involved in Kingston CCG s engagement activities please visit us on www.kingstonccg.nhs.uk email: communications@kingstonccg.nhs.uk Follow us on twitter: @kingstonccg