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A conversation about commissioning intentions

- NHS South Tees CCG working with our local

community – summary report

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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.

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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.

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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 8th 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 8th 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 8th August. Topics of discussion

included CCG commissioning plans, carers, health and wellbeing, mental health and

learning disabilities, urgent care and planned care.

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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.

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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.

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

Health and Wellbeing

Cancer

Fear is a barrier to screening. Target those people who would not

usually attend

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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.

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

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)

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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

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.

Better quality discharge information required when leaving hospital

Need for alcohol screening team at A&E and associated 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

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

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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

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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 21st 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

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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.

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:

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:

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

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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 Cleveland-

www.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.

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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

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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.

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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:

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

No:

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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