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Hounslow Clinical Commissioning Group Statutory obligations reporting (Participation Duties) 2015 – 2016

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Contents

Section 1 Context Setting Page 3 – 10

Section 2 Developing the Infrastructure for Engagement and Participation Page 11 – 24

Section 3 Meeting the Collective Participation Page 25 – 51

Section 4 Meeting the Individual Participation Duty Page 52 – 56

Section 5 Forward Plans for 2015-16 Page 57 – 58

Section 6 Healthwatch Statement Page 59 - 60

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HSCA 2015 Statutory Obligation (Participation Duties)

Name CCG: Hounslow Clinical Commissioning Group

Name person completed this report: Dilo Lalande, Engagement and Communications Manager,

Hounslow Clinical Commissioning Group

Internal sign off obtained from: Patient and Public Engagement Committee sign off by Clive Chalk,

Lay Member, Hounslow Clinical Commissioning Group Governing Body 11 October 2016

Healthwatch statement completed by: Tim Spilsbury, Chief Officer 10 October 2016

Date submitted to regional team: 19 October 2016

Covering the period 1 April 2015 – March 2016

Section 1: Context Setting Introduction

Hounslow Clinical Commissioning Group (CCG) is pleased to present their annual engagement statutory obligations report for 2015/16. The report describes the work we have done over the last year to put patients first and involve them in the planning and development of healthcare services to ensure that we commission the right services to meet local health needs.

Hounslow CCG is committed to effective two way engagement with the public and patients, who are central to all that we do; from setting our strategy and vision to procurement processes and contracting with our providers. They actively influence our decisions and provide an essential perspective on what works well and what needs to work better. This report shows how much has happened over the last year and how we have involved people and acted on the valuable feedback we have received.

Delivering our work is only possible with the help of the strong partnerships we have in Hounslow. We are encouraged by the huge commitment from all parts of the health and social care system in Hounslow to make a real difference to improving services and the quality of people’s lives.

Over the last year we have been actively engaged in social media, launching the Hounslow CCG Twitter account which now has over 700 followers. We sent letters to 110,000 residential households in Hounslow for local people to engage with the CCG. To date, we have received 1600 responses, with an increase to our stakeholder database from 300 to 1700 stakeholders we engage with.

As the CCG has grown and developed over the last year, we have embedded Patient Participation Groups (PPGs) within 45 GP practices including virtual groups, which meet regularly within practices and we will continue to engage with the remaining eight practices to ensure their PPGs are launched and active. We continue to develop the five Locality Patient Participation groups (LPPGs) within the borough. The work that the PPG’s will undertake, will feed in to the Locality Patient Participation Groups, where the Chair of each LPPG will be invited to join the CCG’s Patient and Public Engagement Committee which in turn reports to the Governing Body. Our continued focus for 2016/17, will be to strengthen our work with the public and act on the feedback we have received to date, such as our plans to deliver integrated services that focus on keeping people well and enabling them to better manage their own health and wellbeing and live independent and happier lives for longer.

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Demographics The London Borough of Hounslow is the ninth largest borough in London. Geographically, the borough is situated between the Thames, Heathrow Airport and central London. Both the environment and the population of Hounslow are diverse.

The demographics of an area are fundamental to the health needs of that the population. Through knowing the numbers of the population who are aged over 65, or the ethnicity of the population, or whether the population lives in a deprived area, we can begin to create a picture of their health needs, and therefore the challenges to the health and social care infrastructure in Hounslow. Each of the local wards and communities differ greatly in character, all with unique health needs, challenges and priorities. The percentage of the Hounslow population that identifies as ‘White British’ has reduced from 55.8 per cent in 2001 to 37.9 per cent in 2011. The second largest group in the population identifies as Indian or British Indian, making up 19 per cent of the population. Around 19.1 per cent of the population is under the age of 15, 7.7 per cent is under 5, 63-64 per cent of the population is aged between 20 and 64 and 5 per cent of the population is 75 and above.

Age bands in Hounslow borough

The Greater London Authority predicts an increase in Hounslow’s population between 2011 and 2031 of around 27%. The 2014 Joint Strategic Needs Assessment (JSNA) produced by the Public Health Department at Hounslow Council, in partnership with the NHS and community representatives is founded on a strong evidence base of need. The JSNA is scheduled to be refreshed in 2017. There are key factors impacting Hounslow’s health demographic for both Hounslow and the other West London Alliance local authorities. The majority of the population lives in areas that are more deprived than the national median. Hounslow is one of the most deprived boroughs in West London with areas of deprivation contrasting with more affluent areas.

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The map below show approximately 68% of Hounslow’s population live in areas more deprived than the national median, as demonstrated by the areas shaded darker red and purple in the map.

The key factors impacting Hounslow’s health demographic are:

• Language and cultural barriers • That the borough performs significantly worse than the national average in terms of alcohol-specific mortality and alcohol-specific admissions for males, and alcohol attributable admissions, which in 2012/13 were more common amongst males and amongst 45-64 year olds • Hounslow has significantly more deaths from heart disease and stroke than the England average • Obesity is prevalent in about 22 per cent of the adult population in Hounslow, significantly more are overweight (approximately 40 per cent) • Hounslow has an overall smoking prevalence of 16.9 per cent, equivalent to approximately 30,500 smokers • Hounslow has a higher proportion of adults in residential nursing home care than other areas. For more information on the JSNA health report ‘This is Hounslow’, visit http://www.hounslow.gov.uk/jsna_2014_this_is_hounslow.pdf

Health in summary The health of people in Hounslow is varied compared with the England average. Deprivation is lower than average, however about 21.5% (11,300) children live in poverty. Life expectancy for both men and women is similar to the England average. Living longer Life expectancy is 6.3 years lower for men in the most deprived areas of Hounslow than in the least deprived areas. Child health In Year 6, 23.9% (575) of children are classified as obese, worse than the average for England. The rate of alcohol-specific hospital stays among those under 18 was 33.3*. This represents 20 stays per year. Levels of GCSE attainment, breastfeeding and smoking at time of delivery are better than the England average.

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Adult health In 2012, 21.8% of adults are classified as obese. The rate of alcohol related harm hospital stays was 476*, better than the average for England. This represents 1,047 stays per year. The rate of self-harm hospital stays was 135.8*, better than the average for England. This represents 356 stays per year. The rate of smoking related deaths was 282*. This represents 253 deaths per year. Estimated levels of adult smoking are better than the England average. The rate of TB is worse than average. The rate of people killed and seriously injured on roads is better than average. Local priorities Priorities in Hounslow include oral health, smoking, child obesity, and alcohol. * rate per 100,000 population For more information on the JSNA health report ‘This is Hounslow’, visit

http://www.hounslow.gov.uk/jsna_2014_this_is_hounslow.pdf

In summary;

Hounslow’s population has grown between 2001 and 2011. An increase in dwellings has probably driven that change

The population is young >50% under the age of 35

Diversity is increasing

Deprivation is improving by this measure

Pockets with significant challenges in unemployment and deprivation It is the CCG’s aim to reflect this population in the way that services are commissioned as well as to ensure that information and opportunities for involvement are available and accessible for all. Vision for Engagement Hounslow CCG works in partnership with a wide range of organisations to ensure that local residents receive health and social care services that they need. These organisations include:

• Hounslow Council • Feltham and Bedfont Locality Limited (GP Federation) • Brentford Locality Limited (GP Federation) • Hounslow Health Locality Limited (GP Federation) • Chiswick Healthcare Locality Limited; (GP Federation) • Great West Road Healthcare Limited (GP Federation) • Individual GP practices • Imperial College Healthcare NHS Trust • Chelsea and Westminster Foundation Trust • West Middlesex University Hospital (01/04/2015 to 31/08/2015) • Chelsea and Westminster Foundation Trust, West Middlesex University Hospital site (01/09/2015 to present) • Ashford and St Peter’s NHS Foundation Trust • West London Mental Health NHS Trust • Hounslow and Richmond Community Healthcare NHS Trust • Voluntary/community organisations • The Metropolitan Police • Healthwatch Hounslow.

Of particular importance is the Hounslow Health and Wellbeing Board, of which the CCG is a member. The Board is a statutory body under the Health and Social Care Act 2012, which requires it to discharge a

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number of statutory functions including the publication of a Joint Strategic Needs Assessment, Joint Health and Wellbeing Strategy and Pharmaceutical Needs Assessment. The board is made up of representatives from the local council, the NHS and the voluntary sector and is the place for key partners to work together to improve the health and wellbeing of our local population. As well as feeling that they are being listened to, the CCG wants people to feel that their views are making a meaningful contribution in setting health priorities for Hounslow. Ensuring that the voices of seldom heard and vulnerable groups are heard is one of the key priorities for the organisation. The CCG not only works to ensure that wider, collective patient participation is embedded in the way that services are commissioned, but also that people receive the support and information which helps them take control of their own health and make informed decisions about their care. Placing patients at the centre of commissioning is at the core of Hounslow CCG’s values. It is also a statutory duty for the CCG to ensure that people are able to be involved throughout the commissioning cycle. In line with this view, the CCG shares responsibilities with the health system, individuals and communities who are often in a position to suggest action and interventions that are better suited for the local context and ultimately lead on to improved health outcomes. Meeting the participation duties We want local people to be involved in identifying problems and designing solutions. We want to listen to their feedback and act on it. Systematic involvement of patients and the public should lead to more joined-up, coordinated and efficient services that are more responsive to local needs. Furthermore, involving people and communities help people to understand and influence how heath and care services operate, how they can be accessed and used effectively and allows people to take greater ownership of this local provision and their own health. Our Patient and Public Engagement strategy addresses the requirements detailed under ’public participation’ and ‘insight and feedback’ in NHS England’s guide ‘Transforming Participation in Health and Care’. Our definition of PPE is “the involvement of patients and members of the public in the design, management, review and delivery of services‟, reflecting our ambition for people to be involved in commissioning all stages. We define individual participation as patients and carers being involved in and managing their own health, care and treatment by being involved in decisions about their care and having choice and control over the NHS services they receive. The CCG is committed to enabling individual participation and addresses these requirements through other core programmes of work. Working with our engagement partners in North West London Hounslow CCG works closely with our partner CCGs across north west London in the CWHHE collaborative (Central London, West London, Hammersmith & Fulham, Hounslow and Ealing). There is an ‘Embedding Partnerships and Engagement’ team responsible for patient representation, co-design and engagement activities in the programme. The Embedding Partnerships team responsible is responsible for ensuring that patient engagement and co-production sits at the heart of all key programmes and work streams within Strategy & Transformation. The engagement team carries out engagement activities across all eight boroughs in North West London in Hounslow. Their role is focussed on spending time in the community, engaging with people across North West London on a range of issues and ensuring that feedback is heard by the Strategy & Transformation team.

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Vision for engagement

This vision for Strategy & Transformation community engagement is to establish a programme of on-going pro-active engagement across a population of 2 million North West London residents that directly supports Strategy & Transformation objectives and is aligned with CCG plans and activity.

The engagement activities should be a two way process. The outputs of any activity will regularly feedback into the Strategy & Transformation workstreams, and the engagement officers will provide updates to the community groups they have spoken to. The vision for engagement includes;

To develop excellent relationships with diverse individuals and groups

To effectively develop advocates for the Strategy & Transformation programme

Embed mechanisms for capturing patient engagement feedback and insights so that it can be

utilised effectively and used to inform and guide work in NW London

To tailor local engagement activity so that it is aligned to and supports CCG plans and activity

To establish mechanisms for 360 feedback to patients that keeps them updated with programme

progress and clearly demonstrates how their input is impacting the process

To raise awareness and understanding of changes and improvements across NW London

To proactively address misinformation relating to NW London

CWHHE: Vision for lay partners

The need for patient involvement has been recognised across the whole of Strategy & Transformation, and, therefore, Embedding Partnerships is being extended so that patient engagement and co-production sits at the heart of all key programmes and work streams. The vision for Embedding Partnerships is:

Build on the success of Embedding Partnerships to date and develop lay partner involvement

across all Strategy & Transformation programmes

Support the Strategy & Transformation programmes in working with lay partners and in keeping

patients at the heart of all that we do

Ensure that lay partner insights are shared with the appropriate programme teams

Ensure that lay partners know where their insights are being shared

Ensure that the Lay Partners Forum and associated lay partner groups are representative of NW

London

CWHHE: Structure and resources

Within the CWHHE workforce, there is one full time Embedding Partnerships and Engagement Manager, one full time Embedding Partnerships Officer and two full time Engagement Officers. These roles report to the Assistant Director of Communications and Engagement.

Embedding Partnerships

Embedding Partnerships works with our patient representatives or ‘lay partners’ to co-produce solutions to health and social care across North West London. This year we have invited our group of approximately 120 lay partners from across North West London to four Lay Partners Forum events. These events have:

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Discussion on Primary Care Transformation

Engaging online and maximising lay partner involvement

Co-Producing Patient Safety for older people with Dementia

Discussing the importance of Mental Health & Wellbeing and given training on how to improve

Wellbeing.

Presentation on how to improve self-management

Discussion on NHS 111 services

The outcomes of these sessions have been fed back directly to the Strategy & Transformation programmes to inform the development of their work. In addition to these events, lay partners sit on all of our Hounslow CCG boards to ensure the patient voice is heard throughout the planning and decision making process. Strategy & Transformation programmes sets up working groups as needed and lay partners are represented on these groups. In the last year, lay partners have been involved in the following groups:

Comms & Engagement Lay Partner Group

Expert Reference Group (Dementia)

Patient and Public Representative Group

Travel Advisory Group (responsible for producing the NWL Patient Transport Services (PTS)

Quality Standards, PTS Charter and in late 2016 a common clinical assessment process for PTS

across NWL.

WSIC Communications & Engagement Group

Joint Co-Commissioning Committee

ISA Governance Group

Lay Partners Advisory Group

Evaluation Steering Committee

We also have a group called the Making A Difference (M.A.D) Alliance, a group of 32 Mental Health Service users, who are responsible for co-producing the development and delivery of the North West London Mental Health Strategy (called Like Minded). To increase Lay Partner involvement, by the 3rd quarter of 2016, we are soon to have completed a Lay Partners Policy pack for all S&T staff, which clearly illustrates a step by step process for what they need to do to effectively involve lay partners within their work. Engagement

The engagement team take on regular proactive engagement to understand what the public think of their health care services. The feedback from these meetings is recorded and shared with the appropriate Strategy & Transformation team so that it can be fed into the development of work. In addition to this proactive work, project based engagement has taken place. In 2015/16 engagement activities were focussed on the closure of both Ealing Hospital’s maternity unit and paediatric unit which impacted on the Hounslow borough due to the cross borough services of Hounslow patients. A first phase of engagement for the closure of Ealing Hospital’s maternity unit had allowed us to understand what messages needed to be produced.

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For the closure of Ealing Hospital’s Paediatric unit, which was planned for June 30th 2016, the focus of our

Phase 1 Engagement (November 2015 – March 2016) was to:

Test the community understanding of the changes

Understand the travel implications of the closure

Dispel any misconceptions about the closure

Listen to any concerns and feed this back into the team developing the plans

Identify key topics to feed into the co-production of materials and the next phase of engagement

The information gathered as a result of these engagement activities was fed back to the appropriate

teams within Strategy & Transformation to help understand the impact of the closure on other hospitals

and the transport system and to shape the correct materials with our target engagement group (parents

and carers) required to properly communicate the closure of the unit to the public.

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Section 2: Developing the Infrastructure for Engagement and Participation Structures and Processes

Engagement principles

Working with our partner CCGs in the CWHHE collaborative (Central London, West London, Hammersmith & Fulham, Hounslow and Ealing), we have taken steps to align and forward plan our engagement activity. This includes a shared set of principles for all engagement activity:

Patients and public are at the centre of informing, influencing and shaping

CCG commissioning and development and we have on-going conversations

Agreement to align engagement mechanisms and share best practice where pragmatic and find common solutions to problems

Engagement and involvement is systematic and on-going, using both new and innovative methods as well as tried and tested techniques

We will change the culture about the value of engagement and involvement and how it will influence, ‘we asked, you said and this is how it was changed’

Ensuring key issues and insights are levered into strategic plans and acted upon, systematic feedback on how patient insights have been used to inform commissioning and influence process

Honest, open and transparent about patient experience and their stories

Actively listening, asking communities once, using plain language

Agreement to work on issues together whenever possible and to be planned and timely – and in partnership with other organisations where we can

Valuing the differences of the communities in each locality and between each locality and ensuring work is locality driven.

Hounslow has a diverse population, and the CCG aims to engage a range of people from all backgrounds, ethnicities, ages, genders and geographical locations ensuring all 9 characteristics of the equalities act 2010 are met. To do this effectively we use both established and innovative methods. The information provided in this report provides an overview of the approaches we take. This is not an exhaustive list and we continuously review how we are engaging and communicating with patients, carers and other stakeholders to ensure we maintain a dynamic approach.

We are committed to effective two way engagement with the public and patients. This commitment is reflected at Governing Body level with or patient and public involvement lead lay representative, Clive Chalk, Dr Parvinder Garcha, GP Member of the CCG and the clinical lead for public engagement. Our G o v e r n i n g Body receive a comprehensive report every six months on our public engagement activity undertaken and our future plans. We see effective engagement as everyone’s role within the CCG with expert advice and support provided by the communications and engagement team. It is intrinsic to everything we do. The communications and engagement resource in Hounslow has had a number of changes during 2014/15 and 2015/16. The senior manager responsible for engagement, the Head of Quality and Governance, went on maternity leave in August 2014 and returned in April 2015; the Lay Member for patient and public engagement left in October 2014 and a new Lay Member was then recruited and started in April 2015; budgets for two secondment posts were secured in July 2014 and recruited to by December 2014 and January 2015; the Engagement and Communications Manager left in August 2015 and an interim replacement was brought into place in September 2015. Subsequently, the Head of Quality and Governance restructured the communications and

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Engagement Database Engagement &

Communications Manager

Voluntary Sector Groups

Engagement and Communications Officer

Engagement and Communications Officer

engagement team in October 2015. The Hounslow CCG communications and engagement team and resourcing is illustrated in the chart below. The new immediate team has a more senior Engagement and Communications Manager, with a greater focus on communications; and two Engagement and Communications Officers, building on the strength of delivery and impact of the two secondment roles. The team were recruited in February, March and April 2016 and are working to consolidate and develop the good approaches and systems already in place, and plan public engagement and communications activity for 2016/17 onwards.

Hounslow CCG communications and engagement team structure and resource chart

GP & Clinical Lead for Engagement on Governing Body

Lay Member for Engagement on Governing Body

Head of Communications across

CWHHE

Head of Quality &

Governance

Assistant Director for Patient Experience,

Engagement & Equalities across CWHHE

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Systems and Processes

Setting the definition of Patient and Pubic Engagement (PPE) for Hounslow CCG, involvement covers a broad spectrum of activities and can mean different things to different people. Terms such as “engagement”, “consultation” “co- production” and “participation” are often used interchangeably with “involvement” as the meaning of all these terms overlap. However, each term has a slightly different emphasis: “engagement” has an emphasis on having someone’s understanding and interest in an issue or process, ‘consultation’ is often used to refer to a formal process where people are asked their views on a proposed decision, “co-production” has an emphasis on working in partnership from the very beginning of a project, and “participation” has an emphasis on behaviour and action. Hounslow CCG uses the term “involvement” to cover all these terms, and has defined PPE “the involvement of patients and members of the public in the design, management, review and delivery of services”. We have used a wide range of processes to involve patients and the public in our work. Hounslow CCG has approached PPE on two key principles: (1) We involve the right people for the purpose; (2) We provide clearly defined purposes to people, who are involved as appropriate to the purpose. The most appropriate process or processes are selected based on the principles stated. When planning and developing PPE activities Hounslow CCG will first define:

WHAT | What is our commissioning purpose? For example, to provide information, for needs assessment, services review, to decide priorities, services to design/re-design or to manage, monitor and evaluate performance.

WHY | Why people need to be involved? For example, do we want to give people information, get information from them, provide opportunities to work in partnership and influence decisions or to influence patient or public behaviours.

WHO | Who needs to be involved? For example, the public - broadly or specific groups, patients – broadly, specific service users and specific groups of people, carers – themselves and those they care for.

Once defined, we will then decide the most effective process or processes to achieve meaningful PPE. Patients and the public are often consulted for preferred methods of involvement. Processes are developed based on this steer. Hounslow CCGs overall approach to PPE demonstrates the ability to be tailored and bespoke based on the need, purpose of involvement and the needs of people involved. There are a number of processes that enable Hounslow CCG to engage with patients and public which enables us to provide feedback in a consistent and systematic way. To ensure that a broad range of patients and the public are influencing the development of models of care and redesign of services, we ensure different activities and approaches are used. For example, the CCG posted a stakeholder letter to 110k households in Hounslow, re-introducing the CCG and encouraging residents to get involved with their healthcare. To date, we have received 1.5% response rate which has increased our stakeholder database

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to over 1700 members that we will continue to engage with. The approach we use will depend on what we are engaging on and who we are engaging with. Examples include;

events

surveys

social media

website

focus groups

direct contact

through using partner networks. We have an established a Patient Carer Reference Group and we consider equalities throughout our approach to engagement and ensure representation from affected groups when engaging about service change, in order to promote equal access to services. Managing patient and carer feedback A key priority for the engagement team is to ensure feedback to stakeholders and that their views and comments have been fed into the decision making process of the CCG. Regular reports detailing communication and engagement activity have been provided and considered by the Governing Body. Details of how stakeholder’s views and opinions have been utilised in decision making, providing key evidence of how this information has been used.

We will continue to review how patient feedback has been managed and our Lay Member Chair of the PPE Committee will review the feedback, patient experience reports and concerns.

We note that:

A more comprehensive database holding feedback given by patients and the public is in place.

The introduction of monthly and quarterly reporting cycles with a more forensic

analysis of the feedback received.

We also work closely with Healthwatch Hounslow and through our quality assurance processes such as the Patient Public Engagement Committee, to consider patient experience and feedback received from a number of monitoring systems (i.e. complaints, key performance indicators, provider data, feedback etc.). This triangulation of information collection enables us to build up a comprehensive picture of patient experience of the services we commission and to use outcomes to feed back into our commissioning processes.

Patient and Public Engagement Committee The PPE Committee meets in public six times a year, offering opportunities for local people to engage with healthcare partners and help to shape local NHS services.

The Patient and Public Engagement Committee (PPE) meets bi-monthly at community venues such as local education centres or the local Gurdwara is one of our main conduit for monitoring engagement in Hounslow. The PPE Committee has oversight and input into our yearly engagement workplan and monitors any outstanding risks.

During this year, the PPE Committee received delegated responsibility from the Governing

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Body to progress the recruitment process of elected Locality Patient Participation Groups (LPPGs) representatives. Representatives from the LPPGs have the responsibility to collate information from their Patient Participation Groups (PPGs), share good practice, feed into their LPPG and also work with the other LPPGs across the structure (see below), so all are informed and engaged with, sharing local intelligence. The PPE committee will work with all LPPGS across the structure and into the Governing Body and back down through the structure to the PPGs on decisions and responses to questions asked. Therefore the structure is fluid and intelligence is gathered and shared throughout.

The PPE Committee has also discharged other key functions in line with its terms of reference such as: reviewing work programmes against participation duties, the publishing of Equality Information and advising on key partnership work such as engagement for the ‘Stay well this winter’ campaign, sign off leaflets and promotional healthcare material.

Patient and Carer Reference Group (PCRG) The Patient Carer Reference Group was established in 2014/15. The group met regularly and has extended its membership. Topics in 2015/16 discussed by the Group included the Personal Medical Services (PMS) review, integrated health and social care and a discussion around the mental health agenda in Hounslow. The Group will also attend a facilitated meeting to ensure the membership have the skills and confidence to meet the purpose of the group. During 2015/16 the Patient and Carer Reference Group has:

Had members involved in service redesign groups and procurement panels (e.g. procurement of the wheelchair service)

Represented patient and carer voice on the Whole Systems Integrated

Care steering group at local and North West London level and the

Dementia Pathway Steering Group

Contributed to developing the specification to the new Hounslow Wellbeing Service (a preventative health initiative) which commenced in

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November 2015

Reviewed and provided input for the refreshed CCG website

Input into the PMS Review (feedback given within this report)

Provided useful themes and direction for Key Performance Indicators

for the new Diabetes Intermediate Service

Contributed patient and carer voice to discussions around Primary Care Co-commissioning, Primary Care Transformation and Community Patient Transport

Following queries raised by members of the PCRG over a number of months about the role of the group and the extent of their involvement in the work of the CCG, it was recommended to Patient and Public Engagement Committee Chair, Clive Chalk, Lay Member for Patient Engagement that a PCRG review should take place to see if the group had progressed since its inception. The PCRG met on 22 March 2016 to undertake an evaluation and development session and decide on the future of the group. The session was well attended with 18 people taking part.

The aim of the session was agreed as follows:

To consider the purpose and remit of the PCRG in the current context and to make proposals about the way forward and next steps.

The overwhelming feedback received from those who attended this meeting including service users, patient representatives and the CCG, led to the decision to disband the PCRG. Subsequently, a letter was been sent to PCRG members notifying them of the disbandment of the group. A copy of the report from the 22 March development session was sent alongside the letter. The Managing Director of Hounslow CCG also rang members to personally thank individuals for their participation and to answer any queries they may have about the letter.

The CCG has acknowledged that we do not want to lose the invaluable input from the members of the PCRG, therefore, the membership have been signposted and invited to join their practice PPG. The work that the PPG’s will undertake, will feed in to the Locality Patient Participation Group, where representatives will be invited to join the CCG’s Patient and Public Engagement Committee which in turn reports to the Governing Body.

Patient Participation Groups (PPGs) Hounslow PPGs meet on a regular basis to discuss the services on offer from their practice, and how improvements can be made. Patients can choose their level of involvement, from attending meetings to taking part in a ‘virtual group’.

We have worked with and supported PPGs over the last 12 months by:

Mapping which of our member GP practices have a PPG, so we can keep in touch

Providing training to PPG chairs

Personal Medical Services (PMS) review

Engaging with PPG members and chairs to get a patient perspective on the development of local health services such as end of life care, diabetes, urgent care and COPD

Attending PPG meetings to provide information about the CCG and patient involvement.

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Provided information for to PPG membership from the NAPP website http://www.napp.org.uk/ to support PPG engagement

One of Hounslow CCG’s priorities is to support the development of PPGs. From April 2015 it became a contractual requirement for all GP surgeries to have their own PPG. To this end we are helping support existing GP practices with PPGs and will be looking to help those without to set up new PPGs. In Hounslow there are 45 face to face and virtual PPGs. Some practices run both face to face and virtual PPGs. There are currently practices without PPGs. We are working with the GP practices to ensure that their PPG is setup and running and also take ownership to engage with their patients. This work is sighted on the 2016/17 PPE action plan.

Locality Patient Participation Groups The re five localities in Hounslow, Brentford and Isleworth, Chiswick, Heart of Hounslow, Great West Road, and Feltham. In November 2015, we held our first locality LPPG meeting in the Brentford and Isleworth locality. The meeting attracted ten PPG members from various GP practices and a lead clinician. The meeting discussed the Terms of Reference for the LPPG, membership, group expectations and how it would work and feed into the locality and CCG. We swiftly followed this up in December with a group exercise to help the group work together and to look at a vision and outcomes for the group.

In January and February 2016, we set up Locality LPPGs in Great West Road and Feltham. The other 2 locality patient groups will meet in the first quarter of 2016. From each of these locality groups, a representative will feed into the Public and Patient Engagement Committee on the LPPG work plans who in turn will report into the Governing Body on the engagement undertaken. Stakeholder engagement in collaboration with CWHHE

NHS Central London, West London, Hammersmith and Fulham, Hounslow and Ealing (CWHHE) CCGs have set up and coordinated a bi-monthly Engagement Leads Forum. This has been running for the last two years. The purpose of the forum is to create an open space for collaboration between the CCG Engagement teams, shared CWHHE Communications team and shared CWHHE Patient Experience and Equalities team. The Strategy and Transformation Engagement Team, which covers North West London, also includes the Engagement teams within Brent, Harrow and Hillingdon. Our standing agenda items include any shared working practice, Whole Systems Integrated care communications and engagement, winter planning, NHS England reporting and obligation duties, the potential for joint commissioning and shared procurements or service redesigns.

Our joint engagement plans have ensured that our patients and public are at the centre of informing, influencing and shaping local healthcare services. The engagement teams from each of the CCGs have an agreement to align engagement mechanisms and share best practice where pragmatic and find common solutions to problems and we will endeavour to change the culture about the value of engagement and involvement and how it will influence, ‘we asked, you said and this is how it was changed’

Healthwatch Hounslow

Healthwatch Hounslow works to give users of health and social care services a stronger voice, and we work closely together to identify problems and opportunities for improvement. Through our P a t i e n t a n d P u b l i c E n g a g e m e n t C o m m i t t e e a n d Governing Body, we respond to the quarterly produced patient

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experience reports from Healthwatch Hounslow. A key priority for 2015/16 will be to continue to strengthen the relationship and ensure joint working between Healthwatch Hounslow and the CCG. This will include Healthwatch continuing to attend the PPE Committee and LPPG meetings. The CCG and Healthwatch continuing to hold six weekly meetings, the CCG attending Healthwatch’s AGM and the CCG working closely with Healthwatch on various projects. Healthwatch Hounslow provides quarterly patient experience reports to the PPE Committee which feeds into our commissioning intentions and allows the CCG to make appropriate changes to healthcare services from patient feedback. In 2015, the CCG commissioned Health watch Hounslow to compile an evaluative review of the impact of the Prime Ministers Challenge Fund (PMCF) – improving access to general practice.

The objective was to assess the impact of the

implementation of the PMCF in Hounslow and to

support patients in gaining appropriate access to

GP practices away from emergency service

provision, thereby reducing instances of

inappropriate access to emergency services and

supporting appropriate health pathways to reduce

the cost impact of inappropriate access.

The work undertaken within this review helped to identify if the needs of patients from

diverse, hard to reach ethnic minority language groups and those with a need for British Sign

Language (BSL) or visual impairments are realised within general practice. This will enable

identification of measures to reduce health inequalities, remove barriers to health, cater for

diversity and help prevent people from such groups from becoming isolated.

To support better access and understanding, Healthwatch Hounslow engaged with general

practice surgeries to establish if:

Health information is produced in various ethnic minority languages

Interpretative services are available

Braille, large type, easy read communication is utilised

GP information reflects the needs of the locality

To what extent the community are involved in accessibility

Language needs are recorded

Accessibility options are publicised, if so in what formats

There is an accessible complaints service in place

The CCG also commissioned Healthwatch Hounslow to

undertake evaluative review of the Ambulatory

Emergency Care (AEC) service based at West

Middlesex University Hospital (WMUH).

The number of accident and emergency attendances

and of patients who are subsequently admitted to

hospital are rising, putting pressure on emergency

departments across the UK.

AEC is an emerging, streamlined way of managing

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patients presenting to hospital who would traditionally be

admitted.

Healthwatch Hounslow have engaged with the AEC service, patients and GP practices in

Hounslow to ascertain the impact of the service, understand patient experience and raising

awareness of appropriate access to service provision.

The work undertaken within this review will go some way to identify clinical and financial outcomes of the service, prevalence of conditions, prevention rates and of the needs of patients from diverse, hard to reach ethnic minority language groups and those with a need for British Sign Language (BSL) or visual impairments are realised. To better understand the efficacy of the service, HWH have:

Interviewed staff working within the AEC unit

Interviewed 20 GPs practising in the community

Interviewed 50 AEC patients

Reviewed admission and discharge data, identifying prevalence rates, financial impact indicators and speed of service.

Reviewed quarterly monitoring data

Identified referral routes

Reviewed information available to the community about the service. All reports produced by Healthwatch Hounslow are discussed at the PPE Committee and feedback collated by the PPE Committee which includes patient representation is fed back to Healthwatch for further review.

Use of information technology and social media to engage with patients Website

Along with others in the CWHHE CCG Collaborative, the CCG’s website was updated in 2015 and refreshed during the year, to make it more user-friendly, provide key information about our work and encourage people to have their say and get involved. Content was informed by engagement and information we have collated. We will make the information clear and accessible. We promote a range of information on our website about national and local health campaigns, how to keep well and where to find information to help you manage your health. We have also established our presence on Twitter and Facebook, and will combine these accounts with the other social media feeds.

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The Hounslow CCG website has a ‘Getting Involved’ page which explains how to get involved and give feedback on what we do. Our website is now easier to navigate and we respond directly to feedback and queries submitted through our ‘contact us’ page. http://www.hounslowccg.nhs.uk/your-voice/get-involved.aspx We monitor how many people are using our website and which pages they are looking at. This provides us with a better understanding of the most popular pages and the best place to upload content to increase readership and involvement. For example, as well as posting healthcare opportunities to attend events and how to get involved on our ‘Getting involved’ page we also highlight this information as a news story so that they appear on the home page of the site.

The website has allowed for clearer information to be available to people about local services and the results of their feedback which is available all in one place. Through local partnerships we are also able to post information about getting involved and the work we are doing on a range of other partner websites including the local authority, Hounslow Community Network including the voluntary sector, Healthwatch Hounslow and healthcare providers. Social Media In October 2015, we launched the Social Media Twitter pages for Hounslow CCG. The use of social media to engage with patients is an essential part of our communications and engagement approach. It provides us with additional techniques to listen and access people and communities who may have less time to get involved in more traditional ways due to family or work pressures. The social media ethos is about engaging, participation and relationship building. This makes it a strong vehicle for informing patients and getting their feedback. Our social media activity is focused on the use of Twitter. The CCG’s Twitter account @Hounslow CCG now has over 700 followers. Examples of how we have used twitter over the last year include:

• Promote opportunities to get involved in our work – surveys, meetings etc.

• Promote events.

• Healthy lifestyle information • Cancer screening • Recruitment of PPG members

Stay well this winter engagement campaigns – CWHHE Social media

CWHHE mounted an integrated social media campaign over 2015-16 comprising both paid-for advertising and free of charge messaging to promote ‘stay well’ themes to audiences active on social media.

Twitter accounts were set up for Central London CCG, West London CCG, and Ealing CCG, while pre-existing Twitter accounts for Hammersmith & Fulham and Hounslow CCGs were supported with content and promotion. Over 200 stakeholders were added to CCG Twitter accounts, and local influencers were engaged via Twitter. Twitter audiences were encouraged to engage with the more than 1000 messages that were posted on topics including staying well this winter, flu vaccinations, pharmacy services, extended GP services, corporate CCG news, and upcoming events organised by the CCG and by partners

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across the boroughs.

A new Facebook page @staywellnwl was set up to engage people in our local boroughs around stay well themes. Advertising campaigns were implemented to build over 1000 followers across the NWL area. 98% of people reached via this facebook page are women, with 52% in the 25-34 age bracket and 34% in the 35-44 age bracket. Posts covered topics such as sensible alcohol use, pharmacy services, extended GP services, and invitations to local events. The page was also used to share updates about paediatrics changes in Ealing, bank holiday health services, the importance of regular exercise and healthy eating, and other topics around health and services. 1289 messages were posted on Facebook and Twitter over the nine week campaign.

Public outreach

An external organisation was commissioned to provide outreach work around the themes of ‘Stay well this winter’ and appropriate use of local health services in the CCG catchment areas of Central London, West London, Hammersmith & Fulham, and Hounslow.

The strategy targeted over 65s, parents of young children & hard to reach communities. In the West London and Hounslow area, young men aged 18-35 were targeted as the group most likely to use A&E and Urgent Care Centres inappropriately for routine primary care and minor ailments and most likely to benefit from information about extended GP services in the area, while Polish language speakers were targeted in the Hounslow area. A follow-up survey was developed to aid evaluation of the work.

The Polish community known to visit GPs for antibiotics for flu or colds were targeted through a separate campaign via the local Polish radio station to redirect patients away from A&E and advise of local services including 111. A leaflet was produced in Hounslow in Polish and distributed to GP practices and local Polish venues.

A follow-up survey was developed to aid evaluation of the work. The outreach took place in A&E ‘hotspots’ – the post codes responsible for generating most visits to A&E and UCC as a proportion of their populations; high footfall settings - including supermarkets, shopping malls, high streets, football matches, etc; religious, cultural, and ethnic settings such as Gudwaras, churches, etc; and community groups for carers and 65+ populations.

Around 15 engagement venues were booked for each CCG between the months of October 2015 and March 2016. At each event, a team of outreach staff engaged with the public around winter health / stay well messaging such as flu jabs, keeping warm in winter, local alternatives to A&E such as 111 and pharmacy, 7 day services and GP registration, especially for 18-35 year old males and students in the Triborough.

Scratch cards with questions around which services to use for specific issues were used as intervention tools with relevant giveaways (first aid kits, thermometers) provided as incentives to complete the questionnaires. The outreach team provided participants with literature including further information on flu jabs, keeping well in winter, and local services.

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For the purpose of future analysis, respondents were asked to provide their residential post code address, second language spoken and email address. Those agreeing to share their email address were contacted later to complete a survey about the effectiveness of the engagement and of the broader stay well campaign.

This outreach activity achieved 4010 interventions across 4 CCGs including Hounslow. Survey respondents reported receiving useful booklets, leaflets or giveaways from our NHS Stay Well representatives. 67% of respondents reported arranging a flu vaccine as a result of the engagement, 67% of respondents reported having kept their house warmer as a result, 16% reported visiting the pharmacist for advice as a result of our intervention and16% reported their intention to act on the advice in the future.

Healthcare Kiosks Hounslow CCG presented at the Hounslow Health Overview and Scrutiny Committee in March 2016, promoting our health and social care kiosks. The 20 kiosks were purchased through the Prime Ministers Challenge Fund and are situated within GP health centres. The vision is that these kiosks become a point of information for patients to assist with illnesses they may encounter and/or assist with self-help groups and organisations. The kiosks will enable the CCG to increase involvement and gain greater insight into what patients and the public really think about health services. It also helps practices and providers meet NHS England guidelines for the Friends and Family Test. We are undergoing the recruitment and training of volunteers to support GP Practice staff that will direct patients to the health kiosks and guide them through self-care services, surveys and other healthcare services available to them accordingly. This will Support people who need extra support but based on what works for them, not what works for our systems. Quarterly reports will be produced to capture page visits, survey responses and overall evaluation of the kiosks.

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Hounslow Stakeholder Newsletter

We launched a quarterly stakeholder newsletter ‘Healthy Hounslow in 2015 for patients, the public, GPs and staff. This is distributed through member practices’ Patient Participation Groups, voluntary, community and faith sector organisations, MPs, Councillors and the newly compiled database of interested and registered patients. It is also posted on the CCG website to reach a wider audience. The content includes information about engagement opportunities, news, patient stories as well as being a valuable vehicle for delivering health messages and local updates. We will continue to develop the newsletter, gathering healthcare information and investigate the use of MailChimp to distribute the newsletter to monitor the readership. The Patient Carer Reference Group critiqued the newsletter we will continue to collect recommendations and suggestions regarding format, content and frequency of publication.

Forums The CCG regularly attends and supports local forums in Hounslow to listen to the concerns of local patients, service users and their families and carers. These forums promote issues of importance to older people, carers, mental health services users and users of maternity services. These forums allow the CCG to gather local intelligence on services and feedback where there may be service issues.

Stakeholder list The CCG has a well-established, wide ranging 1700 strong stakeholder list of local community groups, voluntary groups and organisations, including those that represent groups with protected characteristics. This is maintained and utilised to identify those people who may be interested in being involved in particular projects.

Volunteers We are committed to working with the voluntary sector to ensure patients have access to expert support and advice to help them with their day to day health and wellbeing.

Ealing Community Voluntary Service (ECVS) who manages the voluntary sector in Hounslow held a general workshop session with local patients to discuss and give their feedback on how the CCG and voluntary sector can work more closely together. Several questions were covered to include:

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how would organisations feel more engaged with CCGs

what can the CCG do more

what can organisations do more

would this be useful

what could such a group achieve for both the CCG and organisations? In 2015, feedback from the group discussions indicated that a closer working arrangement between the CCG and voluntary organisations was important. It was felt that organisations need to be part of the primary care sector, having more of a presence within GP surgeries with events that include representatives from surgeries, practice managers/PPG members to gain knowledge and understanding of what is available to patients. The CCG have commissioned discrete pieces of engagement work from local voluntary sector groups in 2015/16 as part of our commitment to improve services and to tackle inequities in accessing services within Hounslow. The Mulberry Centre interviewed Hounslow residents about barriers to taking part in cancer screening and Ealing CVS delivered a program to embed volunteers within GP practices to sign post and educate patients in self-care. This will continue in 2016/17 Speak Out in Hounslow (SoH) consulted with a group of people with learning disabilities to gather their experiences of going to the GP and their access to annual health checks.

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Section 3: Meeting the Collective Participation Duty Hounslow CCG’s aim is to deliver high performing, good quality and cost effective hospital and community based healthcare for our residents. Over the past year we have introduced many new services and progressed many programmes and initiatives that reflect our overall strategic intentions outlined under Shaping a Healthier Future (out of hospital and local service improvement) and Like Minded (improving mental health and wellbeing).

Improving local services

Primary care transformation – changing and improving GP services Primary care is at the centre of our ambitions to improve out of hospital care in Hounslow. As part of the Prime Minister’s Challenge Fund (PMCF) over 2014 and 2015, our patients now have weekend access to GP services. Many patients can now also book appointments online, access their records online, and benefit from alternative forms of access for consultations (including telephone, email and video consultations). Our GP practices have come together to form the Hounslow GP Federations to deliver higher quality services and more efficient administration, and to provide a strong voice for general practice within the developing Accountable Care Partnerships (ACPs).

Hounslow CCG made good progress locally with the national review of GPs' Personal Medical Services (PMS) contracts. Some GP practices under the PMS contract receive extra funding per patient that was not available to their colleagues who receive funding under different contracting arrangements.

The purpose of the PMS review is to ensure that this extra PMS funding is aligned to services which best meet the needs of all of the local population, and that where it isn’t, it is reinvested to the benefit of all GP practices and all patients across the Clinical Commissioning Group (CCG) area. Engagement information can be found on page 33/34 of this document.

Community recovery service As part of our work to empower patients by bringing care closer to home, Hounslow CCG launched a Community Recovery Service in 2015/16. The service is intended to support patients to become independent again as quickly as possible following acute illness or injury, or changes in life circumstances. Health and social care professionals from four different teams share resources to create one single talent pool, which includes physiotherapists, occupational therapists, social workers, support workers and rehabilitation assistants, and at least one specialist Parkinson’s nurse and one Multiple Sclerosis nurse plus a neuropsychologist. This model co-ordinates care in an efficient way, with the patient in control of their own self- management and with all information shared in a timely and secure way. The CCG have engaged with GPs and patients to inform the service with patient input via forums, newsletter and sign posting information,

Care Navigator service GPs can refer patients to the care navigator service which helps to direct people to all the health and social care support they may need. The service helps to prevent pressure on hospital and emergency services by directing people to alternatives services and catching issues early before they need acute care. Piloted in 2014/15, the service in 2015/16 with

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the addition of telephone and face-to-face appointments, increasing the number of people supported. Patients have been informed of the service via communication through Hounslow GPs.

Social workers in GP surgeries Building on work from 2014/15 we extended the presence of social workers in general practice to all five localities in 2015/16. The social workers in the localities are an integral part to the multi-disciplinary approach to care.

Increasing the number of services delivered in primary care Seven day access to a GP is one of the 19 services delivered by GP surgeries as part of the Local Services Strategy. The other 18 services include blood pressure monitoring, anticoagulation services for those on blood-thinning medication, complex wound management, electrocardiogram (ECGs), and some mental health services. All 53 GP practices in the CCG area will be working together to deliver these services to a common standard so that they are available to all patients in a convenient community setting. The CCG will engage with patients for their input on the 19 pathways as part of the LPPG work plans.

Patients get tailored help to beat Type 2 Diabetes Patients living in Hounslow at high risk of Type 2 diabetes are being invited to join a programme helping them avoid developing the condition as a new national scheme launches across the country. It is part of the national Healthier You: NHS Diabetes Prevention Programme, and looks to help people at high risk of the condition change their lifestyles. GPs across the area expect to begin to refer people they know to be at high risk during 2015/16. Those referred will get tailored, personalised help to reduce their risk of Type 2 diabetes including education on healthy eating and lifestyle, help to lose weight and bespoke physical exercise programmes, all of which together have been proven to reduce the risk of developing the disease. The nationwide programme will start this year with a first wave of 27 areas covering 26 million people, half of the population, and making up to 20,000 places available. This will roll out to the whole country by 2020 with 100,000 referrals available each year after. The CCGs engagement methods for Diabetes can be found on page 31.

Community diabetes intermediate care We commissioned a new Community Diabetes Intermediate Care Service with three distinct elements of service delivery that went live in May 2015. The service includes care for intermediate patients with diabetes, foot protection, and patient education. The service is providing patients in Hounslow with a robust, safe and reliable community-based diabetes care that meets their needs and improves their health outcomes. The CCGs engagement methods for Diabetes can be found on page 31. Care Plans Using IT systems that are integrated across services as a platform for care plans for over 75s and people with long-term conditions has increased their effectiveness. In 2015/16 we o f f e r e d these care plans to 7,000 local patients, supporting people more effectively and treating problems earlier to avoid hospital.

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Dementia diagnosis rate success Hounslow CCG is working hard with its partners to improve dementia diagnosis rates. Our work so far has included providing greater support for GPs in identifying and referring patients to memory assessment services, commissioning more frontline services, such as dementia-specialist nurses and ensuring there is sufficient post-diagnosis support in place so as to encourage patients to get help faster in the earlier stages of the condition. At the Hounslow Dementia Service User Review Panel monthly meetings which is led by Alzheimers UK, we discuss a wide variety of topics that directly affect people with dementia for example; leisure services, access to information and advice and improving access in primary care. The CCG then feeds back discussions to the local council, service or relevant organisation to guide, inform and influence local service developments. This is a great opportunity for people with dementia to get their voice heard and make positive changes within the community.

Primary care co-commissioning

Primary care is currently commissioned by NHS England, with very limited local influence. A number of options for co-commissioning were developed by NHS England and across North West London all eight CCGs opted to explore the potential of the joint commissioning o p t i o n . Co-commissioning brings CCGs into the commissioning process for GP services a n d provides the potential for its alignment to local plans. Only with expanded influence through co-commissioning can the CCG be sure that primary care can act as a driver for

our ambitious plans for transforming the local health and care economy.

By aligning this with the rest of our on-going transformation work, we believe that we can secure the following patient benefits:

Services that are joined up, coordinated, and easily navigated, with more services available closer to people’s homes

High quality out-of-hospital care Improved health outcomes, equity of access, reduced inequalities, and

better patient experiences Enhanced local patient and public involvement in developing services,

with a greater focus on prevention, staying healthy, and patient empowerment.

In March 2015 member practices voted in support of the CCG entering into joint primary care co-commissioning arrangements with NHS England.

We will also be sharing further information on our co-commissioning plans with the public, patients and carers through local Patient Participation Groups, community and voluntary sector groups and Healthwatch and by further updates on the CCGs website.

Improving care for adults and children with mental health needs

Transforming mental health and wellbeing services In 2015/16 we developed a strategic plan to transform mental health and wellbeing services across North West London. The plan involves partnership working across health and social care and other partners.

Improvements to mental health urgent care - Single Point of Access (SPA) A 24/7 urgent and crisis mental health Single Point of Access (SPA) support service was successfully launched in November 2015. The service is provided by West London Mental Health Trust. Staffed by mental health professionals with psychiatrists in support, the

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service gives advice and reassurance over the phone, books appointments for follow-up care and, when urgent care is needed, dispatch a rapid response home treatment team to be at the caller’s home within four hours. The model was developed with service users, commissioners, providers and partners including the Metropolitan Police. We have engaged with the Hounslow Community via the website, GP TV screens and via GP practices.

Improvements to mental health primary care West London Mental Health Trust’s primary care mental health service, Primary Care Plus, went through a second phase of development, becoming fully operational by the year end. Based in GP practices across Hounslow, the service provides recovery-focused support for people experiencing mental health problems in addition to the care they receive through appointments with their doctor. In this way the service is enabling more people to be looked after in primary care, instead of through specialist mental health teams, meaning that support is provided closer to home and joined up with physical health care. The Primary Care Plus service model was co-produced through the primary care service users forum (now known as the Wellbeing Exchange). Feedback from people who have used the service so far been highly positive, both in terms of their experience and the impact of receiving support. A linked development which continued to take shape during 15/16 is the Hounslow Wellbeing Network, which brings people to together to find out what’s happening in their area and share strengths, skills, knowledge and experience. The network started as a small group of service users, carers, friends and mental health professionals and is now open to all. The overall aim is to improve the health and wellbeing of local people by building a community, putting people at the heart of their own recovery and encouraging conversation around mental health. Feedback from service users are fed into the PPGs and LPPs for service development. £0.5 million boost to young people’s mental health services

In January 2016, £0.5 million was awarded to CCGs across North West London, including Hounslow CCG, to deliver their mental health plan for children and young people. The CCG’s plan for the cash aims to improve the quality of and access to mental health services for young people. The CCG have engaged with the community to include young people with mental health on access to services, media releases, face to face presentations and website information to inform and update on changes to services.

IAPT Hounslow continues to improve mental health services access Hounslow continues to promote and invest in local talking therapies services through the IAPT (Increasing Access to Psychological Therapies) service for residents who are experiencing serious but non-urgent mental health problems such as anxiety, stress, sleep problems, and depression. The CCG has engaged with the Hounslow community through social media mediums, information within the CCG newsletter, Hounslow Council ‘Hounslow Matters’ magazine which is delivered to all Hounslow households on information for talking therapies which are delivered at a number of locations across Hounslow, including GP practices, health centres and community venues.

From 2015, the Joint Commissioner for the CCG and local council will develop joint commissioning plans for Hounslow Council and Hounslow CCG carers services, including services for mental health carers. To inform these decisions the joint commissioner will conduct analysis of the future support needs of mental health carers including;

Joint work with the CCG and other key stakeholders to review projected needs and how these can best be met;

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Analysis of current support options offered by the Mental Health Carers Service and the potential impact of the move to personalisation and personal health budgets

The proposed service redesign will support the CCG and Hounslow Council to engage with carers on strategic priorities, co-designing service provision and future proposals. The co-designed service specification will also include metrics to get carer feedback and qualitative case studies on the impact of support on their ability to maintain their caring role and improve health and wellbeing. Key requirements around public participation and patient engagement Providers of this service will be required to demonstrate levels of carer engagement and outreach in addition to:

Supporting Hounslow CCG to improve patients and service users experience of services and service provision by engaging with carers

Facilitating carers engagement in developing commissioning plans and strategies for carers of people with mental health conditions across Hounslow

Applying a wide range of approaches to engagement and best practice principles

Reporting on findings of consultation and engagement activities

Keeping the CCG and Hounslow Council informed with progress and key issues for service users

Training, education/research activities

Organising carer-specific awareness training packages

Working in partnership with other organisations to provide a programme of activities for carers during National Carers Week and World Mental Health Day

Complying with all local and legal equality and diversity requirements Improving care in our hospitals Development and Implementation of the children’s paediatric assessment unit (PAU) at West Middlesex Hospital

The Paediatric Assessment Unit (PAU) at West Middlesex University Hospital WMUH) has been operational since 21 September 2015. The PAU is a six-bedded unit that provides rapid assessment of children and young people, who require a length of stay in hospital of less than 24 hours, and aims to assess, treat and discharge home as early as clinically safe. In most cases, children are referred to the PAU from their local GP, the Urgent Care Centre (UCC) or A&E department at WMUH. Since opening, the PAU has seen over 2,300 children and young people. When the CCG is engaging in the community and working with parents of Hounslow, this service is promoted through website material, promotion through Hounslow clinicians and social media.

Social workers in emergency departments

In 2015/16 we supplied additional social workers in hospital emergency departments, available seven days a week, to ensure that people are discharged safely and effectively to their normal place of residence to reduce admissions and delays in transfers of care. The CCG has engaged with patients within GP practices through face to face updates, electronic kiosk information and leaflets informing of the service.

New wheelchair service to launch in North West London In 2016, Hounslow CCG will be one of seven clinical commissioning groups to launch an innovative new integrated community wheelchair service for people of all ages who have a long-term need for a wheelchair. This can range from people who need a chair occasionally to those who are fully dependent on a wheelchair for all their mobility needs.

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A broad range of wheelchair service users from across North West London were involved in designing the new provision. It was remodelled to ensure that people that need a wheelchair are able to access the right wheelchair quickly, and with appropriate support. Service users, lay representatives and key stakeholders have endorsed the approach the CCGs are taking which takes into account service users’ three key wishes:

• Users want a more personalised service that reflects their needs and allows

for choice

• Users want a fast and reliable service

• Users want excellent hardware and repair services.

The specifications and principles of the new service take into consideration the ten points of the Wheelchair Charter which was launched by the Wheelchair Leadership Alliance in July 2015. These include equality of access and provision irrespective of age or postcode; regular reviews with the wheelchair user or their carer; recruitment of qualified staff; and assessments for all wheelchairs within a nationally mandated timeframe.

For engagement information, please see pages 35/36.

Integrated patient transport service Working together with other CCGs, patients, and local community groups, Hounslow CCG has established a set of clear, enforceable standards for patient transport to hospital settings to ensure that quality is consistent regardless of where the patient happens to live, or where they need to travel to. The standards are known as the Quality Standards and Patient Charter, and were developed by a patient-led group called the Patient Transport Steering Group, and were also influenced by a survey of 700 patients. The Charter will be a mandatory requirement of all transport procurement going forward. A similar review of transport services to mental health and community settings is planned for the coming year. A spotlight on Self Care Reedless Park – Be Inspired - The Patient and Diabetes Engagement Officers and other colleagues were present at the “Be Inspired Festival” where they met and spoke to over 300 people. Distributing ‘Choosing the Right Care’, ‘NHS 111 pens and fridge magnets and array of leaflets on GP access, online GP services and opportunities for getting involved. There was face painting for young children and a raffle raising a substantial amount for Cancer research. Feltham Super Saturday - The event was for residents in Feltham to come along and enjoy sporting activities with local sport clubs and local organisations. We held a stall with detailed literature around GP online services, healthcare services in Hounslow and diabetic literature. Hounslow CCG Patient and Diabetes Engagement officers and other colleagues were present at this event to capture patient’s experiences and feedback of services. Altogether we engaged with 150 people on the day, gathered patient opinion and provided feedback.

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A spotlight on the Hounslow Dementia Service User Group The average London performance for diagnosis is 71.1%, with the average England performance being 66.4%. The Dementia Diagnosis rate in Hounslow for April 2016 is 80.0% (age 65+), putting us in the 6th position of London’s performance. The increase in dementia diagnosis in Hounslow between August 2014 and April 2016 is 27.2%, showing that HCCG has made an enormous effort to increase the diagnosis rate. Hosted by Alzheimer’s Society Hounslow and Ealing, the aim of the Dementia Service User Group is to provide a welcoming peer support group that is also a way for people living with dementia to become actively involved in shaping and developing dementia services locally. On the last Thursday of every month, a group of people living with early stages of dementia meet to discuss how services can be improved in Hounslow. Discussions can be on anything from how to make transport more accessible, to supporting the Mayor of Hounslow to raise awareness of dementia in the borough. Group members call it the chat show, and one recent quote from the group is: “Having a chance to make positive changes to dementia services locally is a really different concept from other groups around, I like the political spin and knowing that we are being consulted about important matters.” The group provided the following feedback during the sessions.

Analysis of Themes All data and feedback from the engagement is being used to develop an analysis of emerging themes. So far, the themes include: 1. Personal choice and feeling valued and understood 2. Services designed around local needs 3. Supported to live well 4. Good information and signposting 5. Sense of belonging in the community 6. Creating a better future for the next generation What have people told us so far? Patients

They don’t want to attend day services or go into residential care

That there are a lot of support services available but they don’t offer the right kind of support and you have to wait too long to access them

They feel unsupported and forgotten Carers

They need more support at home

There is a lack of understanding about dementia in the general community

They are worried about making the right decisions for their loved ones

They don’t like asking for help Professionals The dementia pathway is too complex Waiting times for services are too long

Feedback from the discussions is then passed to Hounslow CCG, council, service or relevant organisation to guide, inform and influence local service developments. This is a great opportunity for people with dementia to get their voice heard and make positive changes within the community.

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A local resident who attended the group noted: “When I was told that I couldn’t work anymore I felt very upset, I’ve always enjoyed working and being busy. This group makes me feel like I have a role again and I look forward to coming each month.”

Strategy and Transformation – working with North West London boroughs

Item 1: Ealing Hospital Paediatric Transition

Objective – what was the purpose of the engagement activity?

A period of initial engagement and information gathering took place between January

and February 2016 to gauge awareness and understanding of the changes to children’s

services at Ealing Hospital. In addition, the sessions were designed to understand how

the programme should carry out the next phase of engagement (May-July 2016).

Feedback will inform the communications materials and engagement activities required

so that the right messages are getting to the right people.

Activity - what was done?

Engagement activities mainly took place in Ealing. However, engagement officers also met

with groups in Hounslow/Hillingdon, based on postcode data that shows some people living

in Hounslow/Hillingdon use the services in Ealing Hospital.

The key community groups focussed on in this phase of engagement were:

Children’s centres

Libraries

Faith groups

Health & Social Care Forum/Information events

Ealing Hospital

Ealing and Hillingdon Healthwatch

Primary School Learning Alliance

The questions asked as part of this engagement were:

What do you think about the changes to the children’s ward at Ealing Hospital?

Is there anything else you would like to know?

How do you think we should get this information out to the relevant people?

What groups of people do you think we should be specifically targeting throughout

our engagement?

Our initial paediatric engagement took place across 39 groups in Ealing, Hillingdon and

Hounslow. Our engagement team spoke to over 275 members of the public and we

received direct feedback from 131 people.

The groups reached as part of phase 1 engagement have been mapped geographically

below (see appendix 1 for full list).

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Within our engagement we considered the nine protected characteristics included in the Equalities Act 2010. These have been listed below with a summary of how they have been shown due regard, as part of this engagement.

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Table 1: Paediatric engagement mapped against the protected characteristics

Protected characteristic Engagement activity

Age Engagement has been focussed on different ages groups including ones that are relevant to children – e.g. children’s centres,

Leisure centres- Northolt Leisure centre; Hanwell Community Centre

Youth centres: The vibe Southall Youth Project, Young Ealing, Slip Manor Youth Centre.

older people grandparents and carers: Ealing Family Information Services, Hillingdon Parent Carer Forum

Disability Engagement activities taken place with Ealing Hospital inpatient ward

Young people with additional needs- Ealing Town Hall

Gender reassignment Phone and online specific engagement activity undertaken: Spectrum - health & wellbeing for trans* and non-binary people

Marriage and civil partnership Younger LGBT groups in Ealing specific engagement activity undertaken with Young Mosaic.

Outwest- Ealing and Hillingdon LGBT groups (sent to all members and told not relevant).

Pregnancy and maternity Engagement activities taken place in children’s centres and young people sessions at local libraries across Ealing

Race Engagement activities have included interviewing: Arabic, French, Japanese, Polish, Somali, Ukrainian, Russian, Afghani, Iranian, white British and Europeans

Indian- Punjabi & Tamil speakers in Southall

Engaged with Ealing Council for Racial Equality

Information sheets have been translated and supplied in Arabic, Farsi, Gujarati, Hindi, Polish, Punjabi, Somali and Tamil

Religion or belief Engagement activities have taken place in faith groups: o Acton Mosque o North Hanwell Baptist Church o Polish RC Church o St John’s Church o Ukraine Orthodox Church o West London Islamic Centre o St Benedict’s Abbey o Ealing Synagogue

Sex All groups engaged have been open to all genders

Sexual orientation Specific engagement activity undertaken with all Heterosexual, lesbian and Gay and trans-gender and binary people.

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Who – who was involved in the engagement?

Two CCG staff members, Community Engagement Officers led all engagement activity.

They worked with local organisations and the CCG engagement lead.

Members of the public filled out feedback forms at community events.

How – how were the participants recruited and what were their roles and

responsibilities. See above.

Outputs, Impact & Outcome – what was learned? What changes were made as a

result of the engagement? Was this information shared with CCG partners? What

were the key messages for other organisations?

The feedback heard during the first phase of engagement has been shared with the NWL S&T communications team on a regular basis. As a result, the following recommendations have agreed and steps taken forward: Communications activities

Development of a paediatric booklet explaining the changes and addressing the

requests for additional information (particularly travel)

Development of travel sheets for healthcare professionals

Press release

Development of mailing list

Engagement activities

Development of a stakeholder spread sheet - detailed mapping of groups in and

around Ealing

Schedule meetings with key groups to begin in May 2016

User testing of materials

Healthwatch – Ealing and Hillingdon

MES led focus groups with children’s centres to co-produce materials for

parents/carers, who will be impacted.

Ealing/Hounslow – Ealing Hospital Maternity Transition

Objective – what was the purpose of the engagement activity?

In 2013 as part of the “Shaping a Healthier Future” programme it was decided to improve maternity services in North West London. This included consolidating maternity services onto six hospital sites and closing the maternity unit at Ealing hospital. Ealing CCG met on 18th March 2015 to discuss the timing of the closure of Ealing Hospital Maternity Unit, and agreed that further work needed to be undertaken before deciding a closure date. A phase of community engagement was necessary to:

a) Update people on the progress of Ealing Hospital Maternity Unit

b) Dispel any misconceptions

c) Listen to any concerns and feed this back into the team developing the plans

d) Identify key topics to feed into materials and the next phase of engagement

Activity - what was done?

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More than 480 people where engaged. This included 24 children’s centres,4 community organisations, 7 demographic groups.

Who – who was involved in the engagement?

How – how were the participants recruited and what were their roles and

responsibilities

As stated in the report, this includes 24 Children Centres and 4 Community Groups across

Ealing, Harrow, Hillingdon and Hounslow and approximately 480 people were engaged.

The Children Centre meetings were conducted mostly on a one to one basis with parents, often yielding more detailed feedback. We focused on informing parents of progress to date - what is happening, why it is happening and how it will affect them; clarifying and answering any questions as well as correcting any misconceptions; Listening to their delivery experiences at NWL hospitals and how they want to stay informed of the changes going forward.

Outputs, Impact & Outcome – what was learned? What changes were made as a

result of the engagement? Was this information shared with CCG partners? What

were the key messages for other organisations?

Continue plans for simple booklet detailing the information a patient would want to

know on each hospital so they feel able to make an informed choice

o This booklet should provide support in choosing where to give birth and cover

topics including:

Where can I give birth?

How do I book?

What is the public transport access?

Languages – The booklet should be in simple, plain English as advised by community

leaders.

Easy Read leaflet - An alternative leaflet should be produce to highlight the key

messages and should be made available in Easy Read, Tamil and Punjabi.

Travel information – Develop a suggested advice sheet for midwives when having

initial conversations with patients around their travel arrangements for birth and prenatal

care.

Services – Information should include when you will need to travel and what is available

close to home

The outputs on the next stage of engagement were the following:

Development of FAQs for next level of engagement detailing what will be different at

each site answering the following questions:

o What does increased capacity mean?

o What can we expect in terms of our care?

o Will you increase the number of midwives and consultants at each hospital and if

so, by how much?

o How will you ensure the language capabilities of midwives from Ealing Hospital

are distributed appropriately across the sites?

Key Locations - Flyers and posters should be distributed as recommended below

because these locations have the highest footfall of:

o Maternity units

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o Children Centres

o Faith institutions

Certain groups require interpreters - the engagement team to work with groups in

advance to ensure that interpreters are available

Follow up meetings– the engagement team to follow up with groups where requested

and agreed in the meetings from this phase of engagement

All of the key themes and outputs of the engagement were shared with the relevant trusts

and members of the programme board, which included Healthwatch.

Procurement – NHS 111

Kensington & Chelsea, Ealing, Westminster and Hounslow.

Objective – what was the purpose of the engagement activity?

The current contract for North West London’s NHS 111 service is coming to an end and a

Board has been established with representatives from across the geographic sector to

oversee the commissioning of a future NHS 111 service.

The re-procurement of NHS 111 and Out of Hours Services provides an opportunity to

design and develop an integrated new model of care for the “front end” including Emergency

Departments, Pharmacy, Primary Care, Urgent Care Centres and the Ambulance Service.

Therefore the Board has agreed with NHS England to use this period to develop and

describe an innovative model of service for NHS 111 in the context of an integrated health

system.

The Strategy & Transformation programme has been asked to support the development of a

new model of care. In line with our principles of co-production, the team has co-produced a

vision with its lay partners in a series of focus groups. To support and develop this work, a

phase of community engagement was necessary to ensure that the thoughts of people not

actively involved in the programme are captured. The engagement activities aimed to

establish:

a) what people already know about the NHS 111 service

b) what current experiences of the NHS 111 services are

c) what people would like the service to look like in the future

d) what would people like the NHS 111 service to already know about them when they

call

Engagement activities took place in the week commencing 1 June 2015.

Engagement took place across 7 of the 8 North West London boroughs – Brent, Harrow,

Hillingdon, Kensington & Chelsea, Ealing, Westminster and Hounslow. A meeting set up in

Hammersmith & Fulham was arranged but cancelled by the group at a late stage. With

further localised meetings in Hounslow at the PPE Committee and LPPGs informing

representatives of the service development.

Activity - what was done?

Our engagement team:

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spoke to 202 people across more than 9 demographic groups

met with 17 groups across 7 boroughs

engaged parents, elderly and mostly well groups with people aged 16 to 75

Who – who was involved in the engagement? How – how were the participants

recruited and what were their roles and responsibilities

See above.

Outputs, Impact & Outcome – what was learned? What changes were made as a

result of the engagement? Was this information shared with CCG partners? What

were the key messages for other organisations?

The key themes we learnt from our engagement were: Access, Technology, Workforce,

Communication and Service Integration.

The results from this engagement helped us to embark on the following changes and pieces

of work with CCG partners:

Materials and messaging

Education and information

o Material developed to educate the public on:

What is urgent and non-urgent care

What care each of the NHS 111 services can provide

Languages

o Materials should be developed in additional languages

o Explore translation opportunities for NHS 111 services

Next stage engagement

Follow up meetings – meetings with these groups to talk about how their comments

have been fed into the development of a new service and to communicate what the new

service will look like

Primary Care Offer – Service Planning and Design

Across all 8 NWL boroughs.

Objective – what was the purpose of the engagement activity?

Who – who was involved in the engagement? How – how were the participants

recruited and what were their roles and responsibilities

The Strategy & Transformation primary care team is working to develop a new Model of

Care to ensure that GPs are placed at the centre of delivering local health services –

providing care and coordinating services seven days a week. This will enable local people to

receive care more closely tailored to their specific needs, with a focus on continuity and

accessibility where required. Services will be provided closer to home by a broad and flexible

team of clinicians supporting GPs across a range of settings. This is a key part of delivering

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on the CCGs commitment to improve health outcomes, to reduce health inequalities, and to

deliver a better patient experience.

For this to happen, primary care needs to:

have the right technology and information in place

have a workforce of the right size and with the right skills

be provided at scale through the development of GP networks and federations be

delivered in fit for purpose primary care estates

The CCGs will co-produce this new primary care offer with a range of its stakeholders, including clinicians, lay members, patients, the Health and Wellbeing Board, Healthwatch, and the London Medical Committee. Previous patient engagement has been carried out through the London-wide Strategic Commissioning Framework, Whole Systems Integrated Care programme, Out Of Hours business case, and via Healthwatch and Patient Participation Groups (PPGs). However, the primary care programme wanted to re-confirm what patients wanted to see from primary care services in North West London and, therefore, asked the Strategy & Transformation engagement team so undertake a short piece of community engagement. The engagement team was asked to hold meetings across all eight North West London boroughs and to focus their activities on the two main population groupings that the proposed care models have been based on – mostly well and elderly with long term conditions. The questions asked as part of this engagement were:

1. Do you think that your local GP services meet your personal needs?

2. What three things would you change about your GP services?

3. Access: What would make it easier for you to make an appointment?

4. Proactive care: What could GP staff do better to manage your health and any

conditions you may have?

5. Coordination: What could be done to better coordinate your care across different

settings?

Activity - what was done?

This engagement took place from 22nd July to 17th August 2015.

Outputs, Impact & Outcome – what was learned? What changes were made as a

result of the engagement? Was this information shared with CCG partners? What

were the key messages for other organisations?

What did we learn:

What three things would you change about your GP services?

When asked what three things people would like to change about their GP service, our

engagement team received a variety of responses. These have been themed and included

below.

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Access

Many people discussed their desire for online and electronic services – sign in machines in surgeries, electronic repeat prescriptions, online booking for doctor and nurse appointments. In addition to online services, many stated that would like their GP phone service to be improved to reduce the complexity of booking and the long wait times. Our team also heard that they would like to increase GP time – to extend opening hours to include evening and weekends and also to increase the length of appointments.

Training/staff

Through the engagement activity, our team heard that many people would like to see a change to some of the behaviours exhibited by staff. To improve patient experience, it was suggested that GPs and receptionists receive training on customer services and people skills. In additional to suggested training, it was mentioned, particularly at the carer groups, the importance of those working in GP surgeries to better understand the role of the carer so the practice is able to provide the correct care and support for these individuals.

Specialist services

Our team heard from those engaged that they would like more specialist knowledge and services available at their GP practice. One group visited was the HIV group XXX. They said that they would like GPs trained in HIV diagnosis. Other requests for in house specialist knowledge included learning disabilities, mental health, women’s health and diabetes. However, there was some acknowledgement from some people that specialist knowledge doesn’t need to come from the GP. One group said they would like the community based HIV clinical nurse specialist restarted. Our team heard from another group that they had great experience with a nurse with specialist diabetes knowledge.

Communication

Some of those interviewed expressed a desire for better communications. There was a need identified for better communication between the GPs and other members of staff in the same surgery as well as better communication between hospitals and GPs. Our team also heard from individuals that they would like language/interpretation services in appointments.

Appointment/care

When asked about what they would change about their GP service, many of those engaged suggested changes relating to GP appointments. Much of this engagement was focused on groups that represented elderly with long terms conditions. As a result, many people wanted proactive check in calls from GPs and home visits for the frail and housebound. In addition to this, patients mentioned the desire for longer appointment times as well as the ability to discuss multiple problems in one appointment.

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Outcomes

The Primary Care team will:

Incorporate community feedback into the design and visioning work

Continue to test developments with patient groups as applicable

Continue to involve lay partners in governance meetings

Commissioning Intentions – Like Minded Better Health for People with Mental Health

People from across NWL attended all events. However, most events held in Central or

West London

Objective – what was the purpose of the engagement activity?

In developing our understanding of the challenges we have listened to our residents, professionals and other interested parties. We have been heartened to hear great examples of sensitive care where our teams go the extra mile. Our plans described here draw on these great examples to help us improve where we can do better. We will continue to listen to feedback to make sure that we have identified the right issues and ambitions to be able to improve mental health care and support in North West London. Below is a list of the pieces of engagement we have done, as part of the Like Minded programme. Please follow the links for more information:

Activity - what was done?

Perinatal Mental Health workshops Like Minded brought to together a range of key stakeholders across Central and West London, to develop an agreed path of care to meet the perinatal needs of the local population, and to identify any gaps/barriers. The Perinatal Mental Health workshops were held on 16 December and Tuesday 19 January 2016. You can find out more about the perinatal mental health workshop here. Written records of past Like Minded workshops Who – who was involved in the engagement? How – how were the participants recruited

and what were their roles and responsibilities

Clink links associated with each workshop above for more details.

Like Minded Children & Young People Workshop - 30 April 2015

Like Minded Socially Excluded Group Workshop - 6 May 2015

Like Minded Children & Young People Workshop - 14 May 2015

Like Minded Mental Health Needs Workshop - 20 May 2015

Like Minded Children & Young People Workshop - 16 July 2015

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Like Minded Serious & Long Term Mental Health Needs Workshop - 2 September 2015

Like Minded Innovation Lab Workshop - 22 September 2015

Like Minded Serious & Long Term Mental Health Needs Workshop - 25 September

2015

Outputs, Impact & Outcome – what was learned? What changes were made as a result of

the engagement? Was this information shared with CCG partners? What were the key

messages for other organisations?

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Further examples of the CCG’s Patient and Public Involvement during April 2015- March 2016 are detailed below.

Projects/Initiatives Examples of the CCG’s Patient and Public Involvement during April 2015 - March 2016 are detailed below. Some of this work has started in 2015-16 and continues into 2016-17. 1. Patient and Public Involvement Committee and Programme Board Representatives April 2015 – on-going Aim The Patient and Public Engagement Committee is a part of the CCG’s formal engagement structure. The aim of the committee and the representatives is to ensure that patient and service user voice is embedded in the way the CCG commissions services. The committee currently has 23 registered members. Activity The Patient and Public Engagement Committee meets bi-monthly to discuss local and national issues relating to commissioning, service changes, consultations and wider NHS issues. The agenda is focused on allowing the committee to effectively input in the commissioning cycle and represent the interests of the people in Hounslow. The representatives sit on the PPE Committee as well as the PPGs and LPPGs in Hounslow Who The membership of the PPE Committee Listed below are some of the national and local issues the committee has discussed during April 2015- March 2016. The outcomes have informed discussions at the CCG’s Board meetings. • Social Prescribing • Commissioning Intentions • Personal Health Budgets • Healthwatch Hounslow report on Ambulatory Care • Patient and Public Involvement Newsletter • PMS Review • Mobilisation of the new Out of Hours contract in Hounslow Wheelchair services procurement • Winter Pressures

Self-care

Interlink local patient participation groups, Patients Network, service user group for people with long term conditions and Alzheimer’s Society, carers, Healthwatch Hounslow, LD groups etc. and chaired by a Hounslow Governing Body Lay representative. In the year ahead the CCG hopes to review and expand the membership to ensure it is representative of the local population. The CCG wants to in particular work towards increasing the representation from children and young people. How The PPE Committee was established during the first half of 2013. Recruitment and advertising took place in the local community. Currently, communication with the committee members and the patient representatives takes place at the monthly committee meeting, and between the meetings via email and telephone as well as through the CCGs website and social media. Outcome The PPE Committee representatives have become a formal part of the CCG’s engagement structures and as such, the CCG routinely works with the committee members in order to commission and get feedback on local services. The agenda for the committee meetings is set to enable members to input into the commissioning cycle and it includes regular updates from the CCG’s working committees such as quality, finance and primary care. conditions – “How do you look after yourself if you suffer from a long term condition such as…” People were also able to take part in online discussion and leave comments on four Call to Action Notice Boards specifically developed for the consultation.

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Utilising healthcare kiosks in GP Practices

PPE Newsletter January 2015 – on-going Aim As part of its on-going commitment to support the practice-based patient participation groups, and in order to ensure that people have the opportunity to be informed about the CCG’s work and involvement opportunities, the CCG is developing a patient and public involvement newsletter. Activity CCG’s patient representatives and a member of communications team took part in a focus group hosted to discuss the development of the newsletter. How Using the feedback and comments, the Engagement Officer and the communications team developed a template for a newsletter. The newsletter is available electronically and as a printer friendly version. It will initially go out quarterly and cover the following topics: news, programme board updates, what’s on, spotlight on and key information. Who The newsletter will go out to the 52 GP practices in Hounslow, the CCG’s stakeholder list to include: MPs, Councillors, Patients and local voluntary and community sector organisations. For accessibility, the newsletter will be available electronically as well as hard copy. Copies of the.

newsletter will be available at GP surgeries, key providers and through the PPE Committee and its patient representatives Outcomes On-going

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Diabetes Patient Reference Group Aim The group provides a way to capture their views and ensure that they are used to influence and shape decisions on the design and delivery of diabetes services in the Hounslow. Activity A local Hounslow clinician, Dr Raquel Delgado is the Diabetes Lead for Hounslow CCG; the group meet quarterly in the year at different location throughout Hounslow.

How In June 2015, we held the first patient meeting - for all newly recruited members to receive an induction, agree timings and agenda for future meetings. The group members are made aware of how the CCG objectives and initiatives, the purpose of the patient group and the expectations from the group in terms of involvement.

The group discussed the stigma around diabetes and shared their views and personal experiences. The group suggested inviting an organisation or the Mental Health Lead for CCG to discuss the implications of how depression and anxiety can often have an adverse effect on some diabetic patients. This has now been embedded into the groups action plan and will be monitored by the PPE Committee. In September 2015, the group were involved in the designing and re-structuring of the Central London Community Health (CLCH) patient leaflets and self-referral form for local patients living in Hounslow. The group provided constructive suggestions and ideas for CLCH to consider what needed improvements from a patient perspective. The group was asked to consider; what the group’s objectives were and how as a group they wanted to influence change moving forward. In December 2015, the group appointed a Chair and Vice chair and suggested other platforms for engaging with stakeholders such as a virtual group. CLCH made changes to the recommendations given by the group to improve the patient leaflets and

Who The Hounslow Diabetes Patient Reference Group has a membership that includes patients, carers and community leaders/representatives. Outcomes A number of themes can be identified through the engagement process: •The existing programme appears to be popular with patients. •While the majority of people are offered the type 2 diabetes programme there are a number of people who are not given this opportunity. A number of people who completed a survey were already attending the programme; it is fair to say that could have hidden the number of people who are not aware of the programme. •The majority of people would like to attend sessions during working hours between Monday and Friday but offering access outside these times could improve uptake. •People want to attend sessions in their local community. •People want the sessions to be delivered by a professional, preferably a dietician or nurse. •A peer-led approach might be successful in some circumstances and some patients would value the opportunity to meet other people with the condition on an informal basis. Feedback from patients and professionals suggested that they were generally happy with the content and delivery of the current X-PERT diabetes programme in Hounslow. A number of patients were not aware that the programme existed.

A further review to be undertaken in 2016/17

“We are a small group with great aspirations. Our main targets are to support and assist the Hounslow Borough residents who have either type 2 or type 1 diabetes or who have moderate or high risk for this condition. We particularly try to reach small minorities so that they can make their voices heard. We also try to have a constructive liaison with the CCG to achieve better

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provided gave an update on the number of people attending the Patient Education Programme.

services for everyone” Julia Tyson, Diabetes Patient and member of the Diabetes Patient Reference Group

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Hounslow Referral Facilitation Service (RFS) Procurement Objective – what was the purpose of the

engagement activity?

To involve service users in the

commissioning and procurement of an

RFS contract.

Activity - what was done?

2 service users were invited to participate as active voting members in the steering group and procurement evaluation panel.

Who – who was involved in the engagement?

Healthwatch Hounslow, Service Users:

Padma Prethibhkumar & Tracy Ryan

Hounslow CCG: Farah Irfan-Khan & Vince

Makin

How – how were the participants recruited

and what were their roles and responsibilities

Both service users were

recommended to the CCG by

Healthwatch

As part of the Steering group they

were active voting members to

oversee the processes of the

procurement and to approve essential

project documentation.

As part of the Evaluation Panel they were required to evaluate the bids submitted by providers, which in turn contributed to the award of the contract to the successful bidder at the end of the process.

Outputs, Impact & Outcome – what was

learned? What changes were made as a

result of the engagement? Was this

information shared with CCG partners? What

were the key messages for other

organisations?

A full brief was provided to the service users before they started the process. Opportunity to ask questions about their role was also given. This brief was comprehensive and included a lot of information. Next time we would provide some training to the service users on the evaluation of provider bids.

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Hounslow PMS review and implementation Objectives– The purpose of the PMS review is to ensure that this extra PMS funding is aligned to services which best meets the needs of all of the local population, and that where it isn’t, it is reinvested to the benefit of all GP practices and all patients across the Clinical Commissioning Group (CCG) area. Future investment will:

Secure services or outcomes that go

beyond what is expected of core general

practice

Help reduce health inequalities

Give equality of opportunity to all GP

practices

Support fairer distribution of funding

How - The five patient voice indicators we are able to choose from are:

Overall how would you recommend

your experience of your GP surgery;

Generally how easy is it to get

through to someone at your GP

surgery on the phone;

How convenient was the

appointment you were able to get;

Overall how would you describe your

experience of making an

appointment;

Percentage of patients who would

definitely or probably recommend

their GP

Outputs, Impact & Outcome –

The key themes emerging from these meetings have been:

Patient Voice Indicators:

A general feeling that the optional indicators were not specific with regards to what they were measuring

That the CCG should have an understanding of the current baseline performance of every practice to set the targets to be achieved year on year

Activity

Following the 12th January 2016 Governing Body meeting which requested HCCG conducts a Patient Engagement process on the PMS Review, HCCG have attended the following during the last two weeks of January 2016 and the first week of February 2016 (to fit into the original timescale of PMS Review being undertaken by 31st March 2016):

Two meetings with the Patient and Carers Reference Group

Meetings with 6 Practices’ local Patient Participation Groups

Meeting with the Brentford and Isleworth Locality Patient Participation Group

Meeting with Healthwatch

Meeting with the Chair of the Adult Health and Social Care Scrutiny Committee and the Lead Member for Adult and Social Care at London Borough of Hounslow

These meetings were attended by the CCG’s Managing Director and Lay member for Patient Experience.

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Saturday Opening

Concern expressed over the financial viability of Saturday morning opening for every practice in Hounslow

Continuing with the locality hubs but including routine appointments

Ensuring the CCG advertises the weekend working service

Additional Technology

Concern was expressed that the use of telephone appointments to support increased access would have an effect on blocking the telephone appointment line

When reviewing technology for access, the CCG takes into account the demographics of its local population to ensure that all patients have ease of access

The Patient and Carer Reference Group on the 4th February 2016, agreed the following Patient Voice KPIs:

Generally how easy is it to get through to someone at your GP surgery on the phone

Overall how would you describe your experience of making an appointment

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Integrated Wheelchair Service Objective – The CCGs involved in the service re-design and re-procurement for a new wheelchair service include Central London, West London, Hammersmith and Fulham, Hounslow and Ealing (collectively known as CWHHE), Barnet and Brent. The service is designed to meet the needs of people of all ages who have a long-term need for mobility assistance in the catchment areas. The priority for this redesign was to ensure those with complex, long term conditions, are able to access the right wheelchair, quickly, and with appropriate information and support. The new service covers:

Assessment, prescription and supply of

powered and manual wheelchairs and

associated postural seating accessories

(WCS)

Rehabilitation Engineering facilities (RE)

Service and Maintenance Packages

(AR)

How - The service re-design was undertaken with a committed group of service users, clinical advisors, independent standards body for disability equipment and wheelchair services and NHS quality improvement programme for which we have been selected as an exemplar site.

It was primarily driven by the need to improve quality and meet the needs of people of all ages who have a long-term need for mobility assistance in the catchment areas. Furthermore the service redesign and has been underpinned by The Wheelchair Leadership Alliance 10 point charter: Right Chair, Right Time, Right Now (July 2015) which pledges to support the development of an NHS wheelchair service that can really deliver a fair and effective service for all people who need to use it.

Activity

Service users have also been strongly represented on key strategic programme groups and were extensively sought during the service re-design process and were reflected in the service specification. Service users and carers representatives also evaluated the bids. Outputs, Impact & Outcome The new provider for Hounslow wheelchair services is Central London Community Healthcare NHS Trust (as the Lead Health Provider with Hounslow & Richmond Community Healthcare NHS Trust delivering the clinical assessment service and Kings College Hospital NHS Foundation Trust delivering the equipment maintenance and repair).

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AQP audiology

Objective – Five CCGs were involved in the Audiology AQP procurement; this service went live in April 2016 and lasts three years. The CCGs involved in this procurement included; Hammersmith and Fulham (as lead CCG) Central London, West London, Ealing, and Hounslow (also known as ‘CHHWE’). How - Before undertaking the procurement process for the Audiology AQP, Commissioners undertook a review of existing Audiology services commissioned by other CCGs. Commissioners noticed all North West London CCGs provided a service to the over 50’s with the exception of Ealing who already provided the service to over 18s. The other CHHWE CCG’s noticed that this increase in age range had a positive effect on the borough and patient outcomes. The new procurement aimed to follow suit and provide an over 18 service provision. This allowed service users over 18 to access Audiology services closer to home, with only patients with complex ear problems being referred to the secondary care. Activity

An existing service user helped Commissioners

to develop the service specification for the new

Audiology service, and was a key part of the

tender evaluation panel. This patient

representative was also the carer for his

partially deaf son, and also represented his

son’s interests during the procurement. The

lead CCG (Hammersmith and Fulham) was

involved in an Audiology focus group run by

NHS England and supported and respo0nses

fed back to Hounslow CCG as part of this

procurement. The timeframes of this focus

group ran parallel to the service evaluation and

procurement.

Outputs, Impact & Outcome The aim of this group was to review the existing Guidance to Commissioners around commissioning Audiology services, resulting in NHSE issuing the following guidance in May 2016; Audiology Services; Action on Hearing Loss. During this review, Commissioners worked closely with the following groups in order to help develop this guidance; advice and learning from these groups informed the Audiology AQP Service Specification. All Audiology Providers are required to survey patients regularly (at 3, 6, and 9 months) regarding patient satisfaction around their hearing, with the Provider’s services, and whether the patient is still wearing the hearing aid. Providers are required to present their findings at quarterly contract monitoring meetings with Commissioners.

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Section 4: Meeting the Individual Participation Duty As well as ensuring that collective engagement and involvement takes place, the CCG has a duty to support patients and enable them to be in control of their health and the choices they make. This means ensuring information, tools and support are available, so that people can make informed decisions about their care. Although during April 2015- March 2016 work has been focused on establishing the patient and public involvement structures and working towards embedding them in the CCG’s culture, projects promoting the patients in control-agenda have also started to emerge. In terms of assurances for involving providers in helping patients feel in control of their condition and their care, the CCG: Commissions and contracts in line with NHS Policies and regulations including National Outcomes Framework (e.g. Supporting people with long term conditions feel in control of their care) Integrated care

Our Whole Systems Integrated Care (WSIC) programme is about giving people more say over their care, when and where they receive it, so that care is planned jointly between patients, their carers and the teams that support them.

By involving patients and carers on the journey from day one, we have a much better chance of achieving our vision: care that enables each of us to help ourselves. And by widening access to services that aren’t necessarily provided by the NHS, such as local exercise groups run by third sector parties, we can better support people to maintain independence and lead full lives as active participants in their communities. This work and the progress in integrating service design and delivery over the last 2 years demonstrates the benefits that can be realised from a fully joined up approach. But pockets of excellence do not necessarily translate into sustainable transformation and we believe that the best way to truly embed the progress being made is through the development of implementation of Accountable Care Partnerships (ACPs). The membership of the Hounslow Integrated Health and Social Care Steering Group includes representation from Patients and Carers, Hounslow and Richmond Community Healthcare NHS Trust, Healthwatch Hounslow, Hounslow Community Network, Integrated Neurological Services, Social Care, London Borough of Hounslow and CCG Joint Commissioning Team, West Middlesex University Hospital and North West London Strategy & Transformation. Please see diagram below outlining the governance structure for the Hounslow CCG Integrated Health & Social Care Steering Group, which meets monthly:

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In April 2016, Hounslow CCG commissioned West London Mental Health Trust to deliver the

Wellbeing Network. This is a new model of care that was co-produced by local practitioners

and local service users in order to address gaps in provision, prioritising social isolation and

poor physical health among people with long term mental health needs across Hounslow.

Co-production philosophy of equal partnership sits firmly at the heart centre of the Wellbeing

Network and is driven by a holistic and person centred approach.

The Wellbeing Network offers an exciting new way of working which introduces the use of an

innovative Social Wellbeing Network Mapping tool that has been created with a view to

supporting individuals on their own path towards recovery, both physically and mentally. The

aim of the Wellbeing Network model is to realise the valuable assets of its members, thus

developing their own new sense of hope, opportunity and control. It aims to complement

existing NHS provision and will work closely with the enhanced primary care services across

Hounslow.

Figure 1 – Example illustration of a Wellbeing Map

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Here are some highlights from our co-production journey:

Apr to Oct 2015: Co-Production of Wellbeing Network Animation, various job descriptions, website, logo and brand design brief and recruitment process. Feb to May 2016: Design and development of logo, brand and website for the Hounslow Wellbeing Network. These workshops were arranged as part of the co-production journey, to engage with key stakeholders at the very beginning of the design and branding process. 24 people attended, 19 of who were service users and carers. Self-Management: Patient Activation Measures Hounslow CCG is one of the national pilot sites for Patient Activation Measures. We plan to roll out Patient Activation within long term conditions care packages, and also to support evaluation of self-care and self-management interventions. These packages will support patients to explore self-control methods so that they feel empowered to manage their own health and care and secondly, to support people to improve their health to prevent long-term hospital admissions. The voluntary and community sector has been approached to explore their ability to support people in disease management. The pilot will continue in 2016-17, where the voluntary sector organisations selected will deliver programmes together with local providers. Hounslow CCG will actively commission partnerships where there is strong emphasis on co-design with patients. Diabetes We support people to live well with diabetes by investing in innovative and high quality interventions that take a holistic view of the person living with this condition. In addition to commissioning patient education that has seen a significant increase in participation, we have also developed community based support to help people and their families self-manage. Designed by patients, these interventions include: Patient Education Results of patient focus groups and a patient survey have fed into the commissioning process for diabetes patient education groups so that:

Sessions are now held at an increased number of venues and at different times of day.

Referral pathway has been simplified

Education sessions are held over one afternoon instead of two afternoons

Uptake of diabetes patient education sessions has increased.

In a sample of 50 patients attending patient education sessions(conversation maps) - 98% found the session useful and informative - 88% felt that they were very prepared or prepared to make improvements in their diabetes. Diabetes Community Champions Results of patient focus groups and a patient survey indicated that patients wanted to have peer support in managing their diabetes. Hounslow CCG has recruited 11 Diabetes Champions to hold events and support people living with type 2 diabetes across Hounslow working in partnership with Diabetes UK

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Development of Health and Care Integration with the Local Authority:

Supporting everyone to be healthy and have a high quality of life for as long as possible is a core aim for the CCG and its partners. Integrating health and social care so that care is person centred, joined up and meets their needs is core to that vision. We established a health and social care integration programme in 2015 which builds on the strong relationship between the CCG and the council and is an important step towards delivering integration. The establishment of this joint programme will help us to be able to plan care more effectively for people in Hounslow. A number of projects come under this programme and aim to deliver the agreed integrated care vision, including the Better Care Fund, Value Based Commissioning and the Transformation of Children and Young People’s Mental Health services (CAMHS). We mention it here because we have really invested in this programme, including appointing a joint programme manager to lead this work; integration is crucial so that people will experience joined up, person-centred care

Supporting the Nepalese community

After reviewing activity data for UCC/A&E, it was identified that members of the Nepalese community were frequent users of urgent care. After discussions with community leaders to support the Gurkha community in using health services, there has been a significant change in patient behaviour within the community. The Nepalese community in Hounslow are now more willing to engage with their GP and use pharmacist advice as a first point of call – who they historically viewed as shopkeepers selling medicines. Given the specific feedback from patients and community leaders, Hounslow CCG has now embarked on a

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community outreach programme to educate patients and give them tips on self-care and utilising healthcare services appropriately. Next steps is to work with the Nepalese community and joint working with Age UK Hounslow on exercise classes, self-care education and a large-scale healthcare information event in 2016.

Providers and Quality

Patient and Public experience is a component of the regular report which is presented to the Clinical Quality Group for review on a quarterly basis. There are a number of key performance indicators relating to patient experience included in contracts with our commissioned providers. The CCG also continues to work with GP Practices to improve the quality of primary care.

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Section 5: Forward Plans for 2016-17 Over the past year we have continued to build the foundations for integrating the patient voice in the CCG’s on-going commissioning intentions, service delivery and objectives. Patient and Public Engagement will continue and expand. But there is an imperative to move beyond involvement and consultation. We are now working to increase the focus on outcomes, with clear lines of monitoring and accountability within the CCG for PPE and to begin evaluating the impact of PPE on service delivery Hounslow CCG has set out key engagement objectives and priorities to complement the CCG’s overall vision of transforming healthcare in the borough; enabling patients access to right care, in the right setting by the right person (most appropriately skilled clinician). As part of the CCG’s wider transformation programme; placing prime importance on effective patient and public involvement acts as a golden thread, through which all the initiatives sit beneath this ambitious project. To facilitate this process and meet its goals for the coming years, the CCG has planned to develop the PPE Team and further extend its activities and reach into the Community. Significant inroads have been made over the last year in establishing the patient voice in the work of the organisation. Processes and plans have been put in place, which are now beginning to reap tangible rewards. The ultimate goal for PPE is that the patient voice and the principles of equality and diversity are heard, visible and effective throughout the organisation and that the impact can be evidenced.

Priorities 2016/17 Hounslow CCG’s priorities for 2016/17 have been agreed in partnership with a wide range of stakeholders. They focus on the areas of greatest need detailing how, where and when

services will be commissioned. The main priority for 2016/17 is to commission care that is personalised; localised; integrated; and specialised. Others are detailed below:

Approving the new model of primary care through the joint co-commissioning committees in common and implementing this across North West London and ensuring that this is a fundamental part of an integrated care offer for patients.

Working to ensure that all necessary enablers are in place to support the new model of care rollout (including workforce, technology and contracts).

Putting the right support in place to nurture and grow GP federations so they are able to deliver sustainability in the long term as part of Accountable Care Partnerships (ACPs).

Progressing with the primary care estates strategy that takes into account the development of local services hubs across Hounslow. The long-term plan is to develop multiple hubs at a number of locations including Heston Health Centre, Brentford Health Centre, Chiswick Health Centre and Feltham Health Centre to increase accessibility. These hubs will provide a range of integrated services, closer to people’s homes.

We have the following plans in 2016/17 to further develop our capacity and capabilities to meet the participation duties which will be monitored with feedback by the PPE Committee:

Review engagement within the CCG’s governance arrangements as part of a wider governance review.

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Refresh the CCG’s communications and engagement strategy to reflect current CCG priorities and plans, and changes within the local health and social care system.

Further development and integration of the patient participation group network within the CCG’s governance arrangements. We have reviewed all the CCG’s patient groups and networks, including the LPPGs in order to understand how we can maximise their effectiveness. During 2016/17 we will implement the recommendations of that review.

Introduce a patient stories programme pilot – to capture patient experiences of local services to enhance existing patient experience channels and raise the profile of the patient voice within CCG governance arrangements.

Implement the NHS equality delivery system 2 and a rolling programme of engagement with identified seldom heard groups within the local population.

We also have the following aspirations to: Consider a programme of training to empower patients to be involved in CCG decision making.

Explore opportunities for local organisation(s) to support specific elements of the CCG’s patient and public Engagement activities.

Patient and Public Engagement Committee: we need to ensure that we engage and consult with as many patients, families and carers as possible, to understand their opinions on health planning and redesign. To enable us to increase the opportunities we have to do this, during 2016/17, we will continue to invest in the Patient and Public Engagement Committee. We will • Ensure that we are reaching groups sometimes missed, by offering alternative formats for all of our communications materials • Ensure that patient, public involvement and engagement forms part of our organisational values and all strategic plans for going forward • Ensure that our Duty to Involve responsibilities are carried out appropriately and proportionately • Encourage co-design by ensuring that business cases and programme plans are not approved unless they include an equality impact assessment, patient involvement at design stage, an agreed engagement plan and a consultation plan, where appropriate The Consultation Institute to ensure our engagement and consultation programmes are critically assessed • Continue to build on and create new links with the third sector and community groups, through our community development programme. This will ensure that we use their experience and strengths to regularly engage with those people whose views are seldom heard • Produce an annual patient engagement and involvement report, including the outcomes of any consultations and engagement activity, to demonstrate the work we have carried out over the previous 12 month period • Always ensure that we provide timely feedback to individuals and groups who have contributed with their input

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Section 6: Healthwatch Statement Healthwatch Hounslow welcomes the efforts of Hounslow Clinical Commissioning Group during 2015/16 to develop an effective infrastructure to engage and increase patient and public participation in the area of local health and social care. We have been monitoring developments and working collaboratively with the CCG, local commissioners of health and social services and local providers. We can, therefore, confidently say that the CCG has made considerable progress during 2015/2016 in reaching out to the local people of Hounslow combining diverse and collaborative approaches. The CCG has progressed the development of Patient Participation Groups (PPGs) across the borough, which is evident from their successfully embedding PPGs within 45 GP practices. This leaves eight practices outside this network. However, we are pleased to note the CCG had clearly stated their intention to make sure similar PPGs are launched and are active across all GP Practices in the borough. HWH look forward to the CCG’s work as it continues to develop the five Locality Patient Participation Groups (LPPGs) so that they become stronger and start to feed effectively into the CCG’s Patient and Public Engagement Committee, which ultimately reports to the Governing Body. Using demographic information is bound to prove useful to the CCG in gaining a better understanding of the local people and their health and social care needs, the diversity of the local population including information about new and emerging communities and for addressing health inequalities within the borough. Another area of the CCG’s work that we commend is their intention to focus, during the coming year, on the work already done with the public and to act on the feedback received from them, such as its plans to deliver integrated services for keeping people well and enabling them to self-manage their health and wellbeing and live independently and happier lives for a longer period. Our collaborative work in the interests of patients and the public has served to further strengthen our relationship and deepened our mutual understanding and trust and also clarified how we can work together to promote patient and public health and wellbeing. At the same time, we have continued to play a positive role of “critical friend” for local commissioners including the CCG. This has resulted in our carrying out evaluative reviews of some key NHS services for the local people during 2015/16. Each of our reports had a section in which we made practical recommendations based on feedback received from patients/carers and service providers. We are pleased that our offer to assist service providers to implement our recommendations was also well received. HWH produce quarterly Patient Experience Reports on all health and social care services and those commissioned by Hounslow CCG, which, as acknowledged by the CCG, have enabled them “to build up a comprehensive picture of patient experience of the services” and “to use outcomes to feed back into our commissioning processes.” We are pleased to support the public in realising a voice and that the CCG clearly utilise our patient experience feedback in a constructive and transparent approach. The CCG has listed a clear set of priorities for 2016/17 and we will continue to work collaboratively with the CCG as they endeavour to move towards the implementation of these priorities, in particular we look forward to working collaboratively to support the implementation of the upcoming sustainability and transformation plan for Hounslow. Our aim during 2016/17 will be to further strengthen the relationship we have developed and to make sure we continue to work collaboratively in promoting the health and wellbeing of the patients and public in Hounslow. As in 2015/16, we will continue to attend the CCG’s PPE Committee, LPPG and other meetings and also work in partnership with the CCG on

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various projects and to improve services for patients, increase their participation and strengthen their voice in developing and responding to services available to them and to raise their awareness about preventative health and self-care.

Tim Spilsbury, Chief Officer 10 October 2016