Domain 2. Are patients and the public actively engaged and involved?

Domain 2 Are patients and the public actively engaged and involved? 1

Summary Collective duty We are stepping up to ensure engagement is undertaken systematically throughout the commissioning cycle We work with our PPI Reference Group to get feedback on our overall approach and on specific events and engagement plans We have a strategy for PPI on our Outcomes Based Commissioning programme for >65s, engaged with 400 people on setting the outcomes and are establishing a dedicated patient engagement group We engaged widely on our Mental Health Strategy and the associated strategies for CAMHS and MH for Older Adults We have held three large public events on developing our new Urgent Care Strategy Individual duty Our prevention, self-care, shared decision-making (PSSS) strategy is a top priority, with a communications and engagement programme and patient representation being arranged for the PSSS Board. We are supporting people with LTCs to self manage, with specific services in place, e.g. supporting people with musculo-skeletal conditions and with diabetes We have rolled out personal health budgets for continuing health care and children s health

Collective Duty A1: What activity has been undertaken to involve patients and public in each of the following areas of the CCGs business; and focusing particularly on the period since April 2014, for each how this is being demonstrated in outcomes Procurement Procurement of Diabetes Community Service The new service launched in April 2014. Patients were involved throughout the development of the new service, participating in the working group and as part of the procurement panel. Patients are continuing to contribute to enhancements and refinement of the service going as part of BAU. Diabetes is a major health issue with more than 19,000 people diagnosed in Croydon. The prevalence of diabetes in is increasing year on year at one of the fastest rates in south London. Many patients living with diabetes would benefit from improved education and support to manage their conditions better. There are significant numbers of patients who have undiagnosed diabetes. To launch a new community diabetes service; reduce waiting times for patient education, and increase uptake of self management courses. The new model of care has meant that: there is designated support to proactively work with GP practices to identify patients who are at risk of diabetes but are not accessing services. This includes those patients who are in nursing homes, have a mental health issue and other hard to reach groups. Those patients who are not able to be managed by their GP but do not need acute care can be seen in the community. The service also provides dedicated diabetes education for patients based on the nationally recognised DESMOND and DAFNE education programmes Re-procurement of vasectomy service To seek patient feedback on the service specification to re-commission the vasectomy service. Patient feedback was sought to finalise the service specification. The Project Manager responded to the queries raised about the service. The service was successfully re-procured and was able to demonstrate the issues raised were addressed. 3

Collective Duty A1: What activity has been undertaken to involve patients and public in each of the following areas of the CCGs business; and focusing particularly on the period since April 2014, for each how this is being demonstrated in outcomes Contract and service monitoring CReSS Croydon Referral Support Service Patients and the public raised concerns about the process, including poor communications. A specific engagement workshop was held with patients to gather their feedback and understand their concerns in more depth. Take account of patient and public feedback and amend communication material to give greater clarity and amend provider delivery model to reduce delays Provider has amended operational protocols to ensure that delays are reduced and phone line capacity was increased. Patient and public leaflets have been redesigned to communicate the process much more clearly taking account of patient feedback Implementation of new community based anti coagulation service To gather patient feedback following the implementation of a new community based anticoagulation service, which from April 2015, is delivered at six locations across the borough. The new service is being rolled out using a phased implementation from April to December 2015, which is being supported by a range of PPI activities including: a rolling programme of patient information sessions, held in partnership with the new provider, so patients have the opportunity to ask questions about the changes, and meet the new team who will be delivering their care, and a new range of patient information leaflets. To commission an anticoagulation service that can be delivered in more community based locations across the borough, and ensure the new service specification embeds patient feedback in the contract and service monitoring process, for the duration of the contract. The new service specification includes Key Performance Indicators, including to gather patient experience quarterly, for each site. The feedback will be reviewed at contract monitoring meetings, to ensure areas for improvement and good practice can be identified at an early stage, and integrated as part of the contract monitoring process. The feedback from our first patient information session is attached as Appendix 4. 4

Collective Duty A1: What activity has been undertaken to involve patients and public in each of the following areas of the CCGs business; and focusing particularly on the period since April 2014, for each how this is being demonstrated in outcomes Service planning, design, redesign and decommissioning Mental Health Strategy Following the engagement in 2013/14 on our Mental Health Strategy workshops were held in Q1 of 2014/15 to develop the community services business case and model. These included engagement with 10 community and patient and carer groups involving c. 150 people. Service users identified these objectives: Improve the quality of life of people with mental health needs and parity of esteem in commissioning Improve access to mental health services Strengthen partnership working Shift resources to community and primary care services and reduce reliance on inpatients The service model was co-designed with service users, based around four themes: Stabilisation Gatekeeping and demand management Capacity building in primary care and the community Relapse prevention for psychosis and mood disorders Urgent care redesign for 2017 An extensive programme of stakeholder involvement started in December 2014 at a roundtable patient and public forum. Stakeholders were asked to describe what a good service would look like and to feedback on what they consider which aspects in the current service model works well and what could be improved. Three stakeholder events with carers, service providers, patients and the public and clinicians have been held to date. To design a service that meet the needs of our patients in a more integrated way, taking into account our local financial and workforce challenges. The feedback has been collated and tested at subsequent events and will be used to inform the design of the new Urgent Care service to be implemented from April 2017. The feedback from our first event is attached as Appendix 5. 5

Collective Duty A1: What activity has been undertaken to involve patients and public in each of the following areas of the CCGs business; and focusing particularly on the period since April 2014, for each how this is being demonstrated in outcomes Service planning, design, redesign and decommissioning (continued) Child and Adolescent Mental Health Services (CAMHS) In partnership with Croydon Council we have been holding focused engagement activities about the future shape of CAMHS. We have already engaged with: Young People working with the Youth Offending out reach team Voluntary sector Croydon Youth Council Primary / secondary head teachers Unaccompanied minors Looked after children Young carers Clinicians and GPs Outcomes Based Commissioning of services for over 65 year olds Croydon CCG and Croydon Council hosted a series of events with local residents, clinicians and practitioners,who work in health and social care in Croydon, to discuss priorities for outcomes to improve the health and independence of older people. To design a service that offers better experiences and outcomes for children and young people. The CAMHS PPI Engagement Plan is attached as Appendix 6. To create health and social care services for over 65 year olds services that are more joined up, allow people to stay at home for longer and are better suited to the needs of the people who use them. To design a service that: Has equality of access Access to support before crisis point ensuring people with mental health problems can get help 24 hours a day and that when they ask for help, they are taken seriously. Urgent access to crisis care ensuring that a mental health crisis is treated with the same urgency as a physical health emergency. Quality of treatment and care when in crisis making sure that people are treated with dignity and respect, in a therapeutic environment. Recovery and staying well preventing future crises by making sure people are referred to appropriate services. Children & Young People are seen in the right place by the right person at the right time This is a new approach that Croydon is leading the way on. The intended outcome is to commission services on an outcomes based approach where providers will be paid based on the outcomes they achieve for patients rather than being paid for the amount of activity. Stakeholder events attended by 400 people identified their priority outcomes which have been refined and developed to take forward through the new style contract 6

Collective Duty A1: What activity has been undertaken to involve patients and public in each of the following areas of the CCGs business; and focusing particularly on the period since April 2014, for each how this is being demonstrated in outcomes Commissioning intentions Patient and Public Involvement Reference Group The draft 2015/16 Commissioning Intentions were shared with our PPI Reference Group. Work with the PPI Reference Group to review our processes to embed patient and public involvement in identified commissioning plans. The Reference Group members are local stakeholders, including patients, PPG members, representatives from Community and Voluntary Groups, HealthWatch and engagement leads from our provider organisations Patient and Public Involvement Forum The draft 2015/16 Commissioning Intentions were shared with the PPI Forum To work within our respective networks and organisations to develop creative means of engaging local people, including those considered seldom heard. Obtain feedback and refine our intentions to ensure they align with patients needs. To ensure patient and public involvement is consistently embedded in our commissioning plans and, to allow timely opportunity to gather and review stakeholder feedback. To seek advice and guidance from the Reference Group members, to help us identify gaps and opportunities in our plans for engagement activities. Comments taken on board, particularly with respect to prioritisation HealthWatch Croydon The draft 2015/16 Commissioning Intentions were shared with HealthWatch Obtain feedback and refine our intentions to ensure they align with patients needs. Comments taken on board, particularly with respect to ongoing communication and engagement 7

Collective Duty A1: What activity has been undertaken to involve patients and public in each of the following areas of the CCGs business; and focusing particularly on the period since April 2014, for each how this is being demonstrated in outcomes Strategy development Outcomes Based Commissioning of services for over 65 year olds Croydon CCG and Croydon Council hosted a series of events with local residents, clinicians and practitioners,who work in health and social care in Croydon, to discuss priorities for outcomes to improve the health and independence of older people. Urgent care redesign for 2017 An extensive programme of stakeholder involvement started in December 2014, stakeholders were asked to describe what a good service would look like. Three stakeholder events with carers, service providers, patients and the public and clinicians have been held and further events will take place during the summer. SWLCC 5-year strategy Croydon working with the other SWL CCGs has engaged extensively with the public on the strategy To create health and social care services for over 65 year olds services that are more joined up, allow people to stay at home for longer and are better suited to the needs of the people who use them. To design a service that meet the needs of our patients in a more integrated way, taking into account our local financial and workforce challenges. To develop a strategy that provides high quality sustainable services across SWL meeting needs and taking account of people s wish to remain independent and be treated closer to home This is a new approach that Croydon is leading the way on. The intended outcome is to commission services on an outcomes based approach where providers will be paid based on the outcomes they achieve for patients rather than being paid for the amount of activity. Stakeholder events attended by 400 people identified their priority outcomes The feedback has been collated and tested at subsequent events and will be used to inform the design of the new Urgent Care service to be implemented from April 2017. Public and stakeholder feedback was crucial in identifying the strategic aims and the delivery priorities for the 5-year strategy, and patient representatives are on many of the fora 8

Collective Duty A1: What activity has been undertaken to involve patients and public in each of the following areas of the CCGs business; and focusing particularly on the period since April 2014, for each how this is being demonstrated in outcomes Strategy development (continued) Integrated Mental Health Strategy The aim of the integrated mental health strategy is to create a shared transformational vision for mental health service provision in Croydon in the next 5 years. The mental health strategy steering group meets monthly and has service user representation. The steering group is the main driver to ensure delivery against the strategy action plan. The mental health strategy was the focus for our quarterly patient and public forum, in September 2014, when attendees were given an update on delivery against our priorities. Mental health has also been one of our case studies for our EDS2 assessment for 2014/2015. We have had two EDS2 stakeholder grading panel meetings and a further update will be provided to the PPI Reference Group on 25 th June. Special Educational Needs and Disability (SEND) service The CCG and Council together worked with children and families through a series of online surveys, at drop-in sessions and in schools to gather feedback on the strategy for the SEND service. To: ensure voluntary and third sector provision works alongside primary and secondary health care services Improve the quality of life of people with mental health needs and parity of esteem in commissioning Improve access to mental health services To develop our strategy to ensure services for children s occupational therapy, physiotherapy and special school medical nursing services work to the new Special Educational Needs & Disability (SEND) reforms (Sept 14) and deliver quality outcomes. Through continuing our engagement activities we aim to: Strengthen partnership working Shift resources to community and primary care services and reduce reliance on inpatients Ensure there is Education available on Mental Health awareness, for front line workers, families and carers. The feedback report from our September Quarterly Patient and Public Forum is attached as Appendix 7. We are continuing to engage with families as we develop the delivery model. 9

Collective Duty A2: How does the CCG transparently and systematically monitor and act on patient feedback, especially in identifying and addressing quality concerns across all sectors? And, focusing particularly on the period since April 2014, how has service quality been improved as a result of this? Reporting on patient feedback Providers are required to produce regular complaints and PALS reports which are reviewed at CQR meetings and actions are agreed and tracked Reporting on patient experience Providers report on patient experience in their quality reports to the CCG, and quality monitoring is also informed through quality visits by CCG staff, which includes specific assessment on feedback about patient experience, including speaking directly to patients. Provider performance reports include patient survey information including the Friends and Family Test and national surveys Quality concerns raised by patients are highlighted, themes are identified and actions are agreed to act on feedback received Patient feedback is analysed and action plans are produced to target issues raised To monitor provider patient experience through national data including the Friends and Family Test and National Patient Surveys, in conjunction with locally sourced information from Complaints and from the Patient Advice and Liaison Service Where themes are identified targeted action is agreed, e.g. complaints to SLaM about staff attitudes and treatment and care were higher from service users at one team and staff training was focused there, which resulted in a reduction in complaints. Serious issues of concern result in action, e.g. the UCC provider terminated the employment of a locum doctor following complaints about his attitude Action plans are agreed with providers, e.g. staff communications and attitude highlighted from national patient survey at CHS, and local survey results indicate some improvements in satisfaction. Information on safer staffing, infection rates, serious incidents and feedback from the Friends and Family Test is displayed on boards in each ward. This also includes actions taken to address comments made through the Friends and Family Test. 10

Collective Duty A2: How does the CCG transparently and systematically monitor and act on patient feedback, especially in identifying and addressing quality concerns across all sectors? And, focusing particularly on the period since April 2014, how has service quality been improved as a result of this? (continued) GP Amber Quality Alerts GPs raise quality concerns on behalf of patients through our Amber Alerts system. Clinical Quality Review Groups Regular programmes of Clinical Quality Review Groups (CQRGs) are held with acute, urgent care and mental health providers. A mechanism for GPs to forward quality concerns including those raised with them by patients to the CCG, and high risk issues are raised directly with providers to respond directly to the GP, and themes are identified to be raised at CQRGs CQRG meetings are chaired by CCG Clinical Leads, and provide a robust mechanism where commissioners and providers work together to identify opportunities for improvement that will ensure delivery of safe and effective services, and drive up quality. Quality issues impacting on the care of Individual patients are resolved, e.g. a patient with gall bladder pains had not been followed up twice by a provider and through the amber alert process the patient was given a further appointment and subsequently a date for a procedure. Themes are identified and actioned, e.g. GPs reported discharge information was missing or incorrect on discharge summaries, or where no discharge summary has been received, and an audit has been conducted resulting in an action plan to address issues identified Relationships have become well established to support local accountability and respond to local needs and requirements. 11

Individual Duty B1: How is the CCG developing its commissioning of person centred care; and what results can be demonstrated for each of the following attributes in terms of the numbers of patients impacted and their health outcomes and experience? Self management Community and Acute Integrated Musculoskeletal Service (CAIMS) The service was a focus at a PPI Forum meeting. Introduced self care education groups for back, hips, knees and shoulders. Locally bespoke self management plans and information leaflets produced and distributed. Links to self care and self management accredited online apps and websites. To support patients to take greater responsibility for their own care and treatment, and have the tools to enable them to self care and self manage their condition, and make informed choices about their treatment options. A list of our Health Apps library is attached as Appendix 8. We are promoting the Health Help Apps library to support and enable people to live well in Croydon. We link to clinically reviewed and approved sites, which help people to prevent and delay ill health, and manage their condition with the information and support needed if they are ill. Introduced weekly 2 hour education sessions, to support people with some back, neck, shoulder and hip conditions. Community Diabetes Service To raise awareness of DAFNE and DESMOND educational programmes plus service provision. Patients of mixed ethnicity, faith and gender engaged including South Asian community. To support patients to have greater responsibility for their own care and treatment, raise awareness of service provision and understand barriers to prevention. Presentations, Q&A, mini-workshops, in-depth telephone conversations. There has been an increased uptake of both programmes. The new provider has received funding for targeted work with high risk south Asian groups on awareness raising, to identify barriers to accessing services, education programmes and early identification of symptoms. 12

Individual Duty B1: How is the CCG developing its commissioning of person centred care; and what results can be demonstrated for each of the following attributes in terms of the numbers of patients impacted and their health outcomes and experience? Shared decision making Prevention Self-care and Shared decision making Strategy Croydon CCG has a three year Prevention, Self-Care and Shared Decision making strategy. To implement the strategy through three identified work streams: 1. An education and training programme for clinicians and wider workforce 2. A communication and engagement programme 3. Embedding shared decision making in all care pathways for both physical and mental health. An increase in the number of patients and clinicians who work together to select tests, treatments, management or support packages, based on clinical evidence and the patients informed preferences. 13

Individual Duty B1: How is the CCG developing its commissioning of person centred care; and what results can be demonstrated for each of the following attributes in terms of the numbers of patients impacted and their health outcomes and experience? Personalised care planning and personal health budgets Implementation of the Prevention, Self-Care and Shared decision making strategy Children's continuing health care Personal Health Budgets There has been increasing interest in Personal Health Budgets for families with children who are eligible for continuing care. One family has a PHB in place, with a further one about to go live shortly. To support, inform and empower clinicians and patients to have a collaborative partnership approach to the planning and treatment of care Ensuring that children with complex medical and nursing needs have the care they need to live at home go to school and access the community. To offer families choice and control to allow them to achieve family goals. We anticipate a minimum of 3 families having a PHB in place by March 2016, or around 10% of the children s CHC cohort. To increase the number of patients with a care plan in place. A collaborative process with child, family/carers as they are the experts in the child s needs. A tailored personalised service from the outset where we work with the family to decide what level of service is required. Assessments take place in the home. 34 children with personalised care packages and 8 with equipment only packages. Parents and carers feel empowered to meet family goals and see the child meet their full potential. Conversations are underway with relevant families, to clarify their rights and to help and support them to make the best decision for their families. We currently have one family who have taken up this model so far. The CCG continues to encourage participation in PHB discussions during home assessments and other opportunities so that families are aware of the choices available to them. 14

Collective and Individual Duties C1: How is information technology, including social media, being used to improve engagement activity, and what benefits can be demonstrated from this? CCG website To raise awareness of the CCG, to promote campaigns and increase public involvement SWLCC website To raise awareness of the work on the SWL 5 year strategy development, to inform the public about how to become involved Twitter The CCG uses the website and twitter to publicise opportunities to get involved, and uses key partner communications tools to cascade tailored messaging and refer people back to the CCG website. Recently we have published details of surveys and reviews on our website, and created home page banners to increase interest and take up of opportunities to engage. We nurture strong relationships with key partners, and maximise opportunities to share and strengthen messages, and feedback. To promote campaigns, share information on CCG meetings and events. We commission the children and young people s asthma service. To engage with these traditionally harder to reach groups, who are sometime non-compliant with their medication and struggling to manage their health, the service uses a number of social media channels such as Facebook and Twitter, to cascade health promotion literature, information, and text appointment reminders. To provide an accessible means for stakeholders to find information and give feedback on services we commission and on commissioning strategies and intentions, we are seeing greater numbers of people attending events / public forums. Patient representatives have come forward to join many of the fora including at strategy boards, ensuring the patient voice is part of the governance The Twitter account has shown a sustained increase in activity since April. Friends and family test feedback has been positive about the children and young people s asthma service, and its impact in terms of engaging with children, young people and their families. This approach is being shared across the CCG, and similarly tailored approaches will be adopted in the future across other commissioning areas. 16

Collective and Individual Duties C1: How is information technology, including social media, being used to improve engagement activity, and what benefits can be demonstrated from this? Community and Acute Integrated Musculoskeletal Service (CAIMS) Links to self care and self management accredited online apps and websites. To support patients to take greater responsibility for their own care and treatment, and have the tools to enable them to self care and self manage their condition. Patients now have access to a range of self care tools to aid them in self managing their condition. 17

Collective and Individual Duties C2: How is the CCG systematically and transparently holding providers to account for patient and public engagement, and what improvements to care have been made as a result of this accountability Contract review meetings and Clinical Quality Review (CQR) meetings PPI Reference Group Provider engagement leads are members of the group To ensure services are being delivered to agreed service specifications, that providers are seeking the views of patients and carers about service delivery, responding to complaints and redesigning the way services are delivered in response to patient feedback The patient reference group gains a complete overview of engagement across Croydon, and can influence providers as well as the CCG CQRG meetings are chaired by CCG Clinical Leads, and provide a robust mechanism where commissioners and providers work together to identify opportunities for improvement that will ensure delivery of safe and effective services, and drive up quality, including through reviewing themes raised in patient complaints, surveys and through engagement events. The results and feedback from the national surveys and the Friends and Family Test are reviewed at the CQRGs, and providers are required to produce action plans to address issues of concern e.g. CHS was required to produce an action plan to address all the areas where it is an outlier in the inpatient survey Patient reference group members have the opportunity to scrutinise both provider and commissioner engagement plans and activities which also enables shared learning across organisations (the Council is also represented) 18

Collective and Individual Duties C3:What plans does the CCG have in place for the further development of engagement and participation on 2015/2016? What steps have been taken to ensure that plans are robust (e.g. level of governance approval, evidence of funding and/or other resource commitment)? PPI Reference Group Development session to strengthen the role of the Group in the CCG. Outcomes Based Commissioning Prevention Self care and Shared Decision Making (PSSS) strategy To establish a more partnership based approach to implementing patient and public involvement, and for the Group to be recognised as an integral part of the CCG governance structure. To establish a patient forum for the current phase of the outcomes based commissioning programme To have patient representation on the PSSS Board The Groups ToRs have been redrafted to include a more robust feedback structure, and ensure that a work plan is agreed and actioned To ensure patient and public involvement is an integral part of the outcomes based commissioning programme To ensure patient and public involvement is an integral part of the strategy development and implementation Urgent Care Redesign for 2017 To use the feedback gathered to inform our continuing programme of engagement activities, specifically targeting groups that are seldom heard. To ensure we commission a service that reflects the feedback of our local people, we will continue the engagement programme to refine the strategy and the subsequent re-procurement taking account of the input of the public and other stakeholders 19

Collective and Individual Duties C3:What plans does the CCG have in place for the further development of engagement and participation on 2015/2016? What steps have been taken to ensure that plans are robust (e.g. level of governance approval, evidence of funding and/or other resource commitment)? (Continued) PPI in the commissioning cycle Croydon Patient and Public Involvement Forum To ensure patient and public involvement is included at all stages of the PPI in the commissioning cycle To increase public involvement and enable the public s views to influence commissioning strategy development The Service Redesign Team has identified two leads, to work with the PPI manager, to embed a more coordinated approach to PPI in all service redesign projects. The Service Redesign Team, have identified 17 current service redesign proposals that require patient and public involvement, a work plan for this is in draft including the support the team needs to make good PPI a reality, and the PPI Reference Group on 25 June is inputting to development of the work plan and co-designing the engagement activities. The CCG hosts the Croydon Patient and Public Forum each quarter at which members of the public are updated on developments and invited to input to strategy development and development of commissioning intentions 20

Croydon specific KLOEs 21

Collective Duty How the feedback in our 2013/2014 annual report has influenced our commissioning plans Quarterly public forums To increase public involvement and enable the public s views to influence commissioning strategy development At the December forum stakeholders were asked to describe what a good service would look like and to feedback on what they consider which aspects in the current service model works well and what could be improved, which has fed into the strategy. Patient and public reference group PPI in commissioning programmes PPGs Stakeholder database To establish a more partnership based approach to implementing patient and public involvement, and for the Group to be recognised as an integral part of the CCG governance structure To support, inform and empower clinicians and patients to have a collaborative partnership approach to the planning and treatment of care To support GP practices to involve their patients and act on their feedback to improve service delivery To increase public involvement, to ensure that citizens are informed and enabled to become involved on an ongoing basis The Group has fed into the design of engagement activities and now has a broader membership Patient and public involvement is an integral part of the commissioning cycle, e.g. the engagement of 400 people in designing the outcomes for the OBC programme The CCG has funded training for PPG facilitators to increase their skill base to improve the effectiveness of PPGs More people are attending our events and patient forums 22