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Enfield CCG’s Annual Report
on its Legal Duty to involve Patients and
Public in Commissioning for
1 April 2015-31 March 2016
Final Version
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Contents 1.0 Introduction ..................................................................................................................................... 3
2.0 About Enfield CCG ........................................................................................................................ 3
2.1 About Enfield .......................................................................................................................... 4
2.2 Vision for Engagement ................................................................................................ 5
2.3 Structure and Resources ............................................................................................. 6
3.0 Developing the Infrastructure for Engagement and Participation (processes and
networks) Collective Participation ...................................................................................................... 8
3.1 Engagement Processes and Networks in place ........................................................... 8
3.2 PPG network ............................................................................................................. 10
3.3 Structures .................................................................................................................. 10
3.4 Partnerships .............................................................................................................. 11
4.0 Meeting the collective duty for Engagement & Participation Activity ................................... 12
4.1 Integrated NHS 111/OOH Services procurement ....................................................... 12
4.2 Improving Ophthalmology Services ........................................................................... 13
4.3 Safeguarding Conference – July 2015 ....................................................................... 14
4.4 For Third sector engagement in mental health: .......................................................... 14
4.5 Young Minds training ................................................................................................. 14
4.6 Stronger links with the Voluntary and Community Groups: ........................................ 15
4.6.1 Enfield Strategic Partnership’s Voluntary Sector Strategy Group ............................ 15
4.6.2 Enfield CCG Community and Stakeholder Reference Group .................................. 16
4.7 Learning from the yearly 360 Degree Stakeholder survey carried out by Ipsos Mori for
NHS England ................................................................................................................... 16
4.8 Further engagement .................................................................................................. 17
5.0 Meeting the Individual Participation Duty ................................................................................. 17
5.1 Supporting the self-care agenda ................................................................................ 19
5.1.1 Choose well Campaign ........................................................................................... 19
5.1.2 Stay well this winter ................................................................................................ 20
5.1.3 Other information provided to support the self-care agenda .................................... 20
5.2 Developing a new neuro-navigator post ..................................................................... 21
5.3 Patient feedback - Continuing Healthcare and Personal Health Budgets ................... 21
5.4 Care Plans- Integrated Care for Older People ........................................................... 22
5.5 Integrated Learning Disabilities Service ..................................................................... 25
5.6 Working with providers to deliver individual participation ........................................... 26
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5.7 Meeting the collective and individual participation duties: Recruiting an elected Patient
Participation Group Representative to our Governing Body ............................................. 26
5.8 Elected PPG Representative Statement .................................................................... 28
5.9 Meeting the collective and individual participation duty – Consulting on changes to
gluten-free prescribing ..................................................................................................... 29
6.0 Forward Plans for 2016-2017 .................................................................................................... 30
7.0 Healthwatch Statement ............................................................................................................... 31
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1.0 Introduction We are pleased to present our third Annual Patient and Public Engagement Report,
now called Enfield Clinical Commissioning Group’s Annual Report on its legal Duty
to involve Patients and the Public in Commissioning. This report describes how we
discharged our statutory responsibilities for patient and public participation during the
period 1 April 2015-31 March 2016 as described in the Health and Social Care Act
2012.
2.0 About Enfield CCG
NHS Enfield Clinical Commissioning Group (CCG) is a GP-led organisation that is
responsible for purchasing most of the healthcare services for residents of the
London Borough of Enfield. Enfield is a north London borough that is one of the
largest in terms of size (31 square miles) and the fourth largest in terms of population
(324,574 Office of National Statistics mid-year 2014 population estimate) amongst
the thirty-three London boroughs.
Our role is to plan, buy (commission), and monitor the quality of health services for
local people. We are committed to working together with residents and other local
stakeholders to improve the quality of local services and the health and wellbeing of
our community.
We commission services from three main local providers:
Royal Free London NHS Foundation Trust (including Barnet and Chase Farm
Hospitals* Enfield CCG is the lead commissioner for the Chase Farm site).
North Middlesex University Hospital
Barnet, Enfield and Haringey Mental Health Trust (including Enfield
Community services). We are lead commissioner for this Trust.
We also hold NHS contracts with a range of other acute, community and mental
health providers, which enables our local population to have a choice in delivery of
services.
We work closely with the four other CCGs in North Central London that is Barnet,
Camden, Haringey and Islington, to plan and improve services together where there
are benefits across a larger population. This includes delivering stakeholder
engagement together where appropriate such as the integrated 111 and out-of-hours
service.
In January 2016 local health and social care systems across England came together
to form 44 Strategic Transformation Plan (STP) “footprints”. These STP footprints will
plan future services based on the needs of local populations and support changes to
local services to make these more sustainable over the next five years. These plans
will ultimately deliver the Five Year Forward View vision of better health, better
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patient care and improved NHS efficiency. Our STP planning footprint is North
Central London so Enfield CCG has continued to work closely with neighbouring
CCGs as well as joining up with local Councils and NHS providers to develop plans
that we will start to engage on in 2016/17.
2.1 About Enfield
Over recent years the population of Enfield has been steadily growing. During this
year, we commissioned services for a resident population of around 324,574. Over
the next decade the population is predicted to steadily increase reaching 330,000 by
2018 and 340,000 by 2023. Between 2015 and 2023 the predicted population rise is
5% and by 2032 there will be a population rise of 10%. The predicted population
increase is partially due to:
new housing developments
population migration from other London boroughs
international migration
The population and in-migration trends are significantly changing the demographic
profile and diversity of the borough. The 2015 School Census shows the changing
nature of the population as Enfield pupils are from 22 ethnic groups. This census
shows that for pupils resident in Enfield and those attending Enfield maintained
schools, the proportion of white British pupils was 22.75% with other white groups at
25.39%, other ethnic groups were 15.88%, mixed groups at 10.01% and black
groups at 25.7%.
Enfield has a large population of 0-14 year olds and older people in comparison to the rest of London. Enfield’s population is also changing in terms of age. Age groups 55-59 and 85+ are rising the most at an average of 3.79% and 3.73% per annum respectively. 20-24 age-group and 45-49 age-groups are predicted to be shrinking by an average of -0.47% and -0.71% per annum (ONS).The proportion of under 15s (21.2%) is higher than both England (17.7%) and London (19%) averages. Enfield is a borough with a significant level of high deprivation. Enfield has the highest number (23,210) of children living in poverty within London. It is the 14th most deprived borough of the 32 London boroughs and the 64th most deprived local authority district in England out of 326. 25.5% of children under 16 years are in low-income families, which is the eleventh highest of all London boroughs. The three Edmonton wards, in the South East, are all within the most deprived 10% of wards in England, whilst 12 of Enfield’s twenty-one wards are in the most deprived 25% of wards in England. The population is also growing faster in the deprived wards. Overall, the proportion of Enfield’s population who are living within the most deprived 10% of areas throughout the country as a whole has increased from 7.0% to 10.3%. The financial challenge faced by organisations across the NHS is how to spend their budgets in a way that improves the health and wellbeing of the whole population while ensuring that services meet the needs of individuals and deliver value for
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money. Enfield CCG is a financially challenged CCG under legal directions as of August 2015 and the CCG was placed in special measures in 2016/17. Last year we invested £394.9 million buying health services for people living in Enfield. With a growing population, rising demand for services and a financial deficit the CCG, like other NHS organisations, has to evaluate every service it commissions. At the end of the financial year 2015/16 we reported a cumulative deficit of £33.4m. This was planned for and agreed with NHS England at the beginning of the year.
2.2 Vision for Engagement
Enfield CCG’s corporate objectives are determined by the health and wellbeing
needs of our local population. Our corporate vision states: “We are committed to
commissioning services that improve the health and wellbeing of the residents
of Enfield borough through securing of sustainable whole systems care.”
Enfield CCG recognises that engagement is one of the key enablers to deliver this vision. We will do this by:
Working in partnership with individuals and patient groups to ensure they are central to our work.
Working in an open and transparent way with our public and partners.
The Communications and Engagement Team plays a strategic role in helping to
ensure our organisation delivers high quality communications and to support
engagement being embedded across all our work.
We know that to achieve the very best health for local people, we need to listen, understand and hear what they are saying about their needs and their current experience of local services and reflect that feedback in all that we do to improve services. We also want to ensure that the services we commission are fair, equitable and do not disadvantage particular communities or groups. Our vision for engagement describes the principles of how we will deliver the
statutory collective and individual participation duties in the Health and Social Care
Act 2012.
“We are committed to delivering the highest standards of communications and
engagement and putting the patient voice at the centre of our organisation.
At every stage of our commissioning cycle we will work to ensure that the
services we plan, buy and monitor are all coordinated and tailored to the
individual needs and preferences of patients, their families and carers -
delivering a patient centred NHS.
We are committed to an open and active dialogue with our community. We will
always be honest about the challenges we face and ask patients, partners and
our stakeholders to help us find the best way to improve local health services
and get better value for money.
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We aspire to develop more creative and innovative methods of engagement to
get our whole community involved in the NHS and improving their health and
wellbeing.”
We also use The Consultation’s Institute’s definition of consultation to define the
principles of how we will deliver our statutory requirements to consult under the
Health and Social Care Act 2012.
“Consultation is the dynamic process of dialogue between individuals or
groups, based upon a genuine exchange of views with the objective of
influencing decisions, policies or programmes of action.”
2.3 Structure and Resources
During the year 2015/2016 Enfield CCG directly employed an in-house
Communications and Engagement Team. This Team provides comprehensive in-
house internal and external communications and engagement services for Enfield
CCG as well as strategic and professional advice to the organisation on
communications, engagement, media, reputation management and public affairs.
During the year 2015-16 the Head of Communications and Engagement reported
directly to the Director of Quality and Integrated Governance, whose portfolio also
includes: quality, governance, safeguarding and patient experience. Our team works
to the principles described on pages 10-11 of our Communications and Engagement
Strategy.
Following a review of the Service Level Agreement (SLA) with our North East
London (NEL) Commissioning Support Unit the following service lines were
decommissioned from January 2015: public affairs, media management (including
out of hours), strategic communications, marketing and reputation management.
Operationally, most parts of the standard operating procedures for these services
were already being delivered in-house. The decommissioning released some
savings which were planned to be partially reinvested this financial year in the
Communications and Engagement
Assistant
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creation of a new post – a Communications and Engagement Assistant. The post
was recruited to in September 2015 and reports to the Communications Manager.
The communications and engagement activities that are delivered annually in line
with constitutional requirements are three GP membership and three Patient and
Public Engagement events along with a limited number of other events and activities
(e.g. Patient Participation Group network meetings). These are still funded via a
small non-pay budget managed by the Head of Communications and Engagement.
Bespoke communications and engagement activities that support commissioning
programmes or projects are funded by the commissioner for that area through a
budget line approved in the Project Management Office (PMO).
Enfield CCG continued to commission smaller bespoke support service from NEL
CSU in 2015/16 which delivered the following services:
Management of Freedom of Information requests, which formed part of the
CSU’s new core offer
Web technical support and hosting of the CCG’s website as this offers value
for money and a service that cannot be delivered in-house.
Joint Health Overview and Scrutiny Committee (JHOSC) support in
recognition of the fact that this committee reviews work programmes
undertaken by one or more CCGs and therefore is best delivered at scale.
Additional services purchased from NEL CSU with SLAs
Equality and Diversity service – This was originally commissioned as a
specialist service line from communications and engagement and remains a
separate contract. This service provides specialist knowledge and operational
capacity that is unavailable in-house. This service was therefore
recommissioned in 2015/16
An SLA was set up with NEL CSU to deliver communications and
engagement on proposals to commission an integrated 111 and Out-of-Hours
service when the current contracts come to an end. This programme of work
is led strategically by Enfield CCG as the lead commissioner for the
procurement across North Central London. This need for additional resources
recognises that the communications and engagement function supports large
programmes of strategic change. Increasingly we are undertaking
communications and engagement with other CCGs and partners. It also
demonstrates the importance of consistent communications and engagement
activities across North Central London.
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3.0 Developing the Infrastructure for Engagement and Participation
(processes and networks) Collective Participation
3.1 Engagement Processes and Networks in place
Enfield CCG has an extensive list of stakeholders and takes a proactive approach to
networking to ensure that we keep everyone up-to-date on the CCG’s work and
enable them to get involved.
We run three corporate Patient and Public Engagement (PPE) events around our
commissioning cycle. These events are open to all our stakeholders and members of
the public. We provide BSL translators whenever our deaf community wish to attend
these events. We also accommodate any other needs as requested (e.g. large print
materials). The objective of these events is gathering feedback on our
commissioning plans, service developments and supporting quality improvements.
A report is prepared after every event based on clinician-led group work. The
attendees, who provide their details, become part our stakeholder network, receiving
regular email news and updates. Key outcomes from the PPE events this year have
included: improved patient information leaflets, improving the service specification for
integrated 111 and Out of Hours (OOH) services. Our PPE event reports can be
found on our website under Listening to You.
We work closely with patient groups and networks around service improvements
through a range of activities including workshops and steering groups, for example
patient involvement in the integrated 111/OOH procurement which was carried out
with the four other CCGs in North Central London (Barnet, Camden, Haringey and
Islington). Another example was the engagement and partnership working to deliver
Transforming Care for people with Learning Disabilities and/or Autism.
We also obtain patient experience through surveys which are used to support
service improvements such as the Urgent Care Review which ran from 19 February
– 3 April 2016. It was launched at the Over 50s Forum Winter Fair on Friday 19
February. Following feedback received at that event, the questionnaire was reviewed
and amended and then uploaded on the website and circulated to all stakeholders.
The Communications and Engagement Team supports the bi-monthly Governing
Body meetings which are attended by a number of members of the public. Written
questions can be submitted in advance. The public have an opportunity at both the
beginning and at the end of the meeting to engage with the Governing Body on
issues on the Agenda. The Team supports the delivery of written answers to any
questions asked, as well as hosting a tea and coffee session with the public before
the meeting. The Governing Body meetings are an important way for the public to be
kept up-to-date on the work of the CCG and the organisation welcomes participation
in these meetings.
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We hold an Annual General Meeting (AGM) at which we present our Annual Report
and Accounts. Our Constitution requires that we have attendance from our GP
membership to approve the Annual Report and Accounts. We also advertise the
event to the public and send invitations to our stakeholders. The format for our AGM
is presentation led and reflects the contents of the Annual Report and Accounts. It is
also an opportunity to provide details on future commissioning plans. This year we
held a question and answer session for the public on our challenges and future
plans.
We held patient events during 2015/16 which focused on particular projects or key
work programmes including integrated care and service redesign. These workshop
style meetings enabled patients to hear about proposals at an early stage and to
comment on the emerging plans. They also offered an opportunity for expert patients
to become more involved in long-term projects, taking the plans forward by sitting on
steering groups and by acting in an advisory role.
Patients and Healthwatch Enfield were also involved in commenting on key
publications including: the Equality Information and our summary Annual Report and
Accounts and patient questionnaires for the Community Services improvement
programme.
Commissioners regularly undertake engagement as part of their work and embed the
feedback into service improvements. The Communications and Engagement Team
works with commissioners and project managers to design bespoke programmes of
communications and engagement using a corporate template. This ensures that a
stakeholder analysis is undertaken at the project initiation phase, key messages
developed, risks assessed and activities mapped to ensure delivery of the work
programme. Part of this specialist advice service involves testing the level of
engagement needed and whether a consultation needs to be planned into the project
timeline. Advice on Communications and Engagement at the beginning stages of the
project is complemented by an equality impact assessment (EIA) and Quality Impact
Assessment (QIA). All three documents are reviewed as the projects progress.
This also ensures that projects utilise the existing engagement structures such as
weekly e-newsletters to GP member practices and staff, our website, Smart Survey
and stakeholder e-bulletins, intranet and Twitter. It also ensures that managers
understand that activities and outcomes must be recorded to provide assurance to
the PPE Committee. We also share updates from our partners such as NHS
England.
The annotated commissioning cycle diagram (Appendix A) underpins our planning for our key corporate events, which happen at specific points during the year. We use “You Said, We Did” feedback to show how we have used the comments given at each PPE event to shape our projects and influence our future strategy.
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Our website, intranet and Twitter are key communications channels. We have over
2,000 followers on Twitter since starting our account on 1 April 2013. Our followers
include key stakeholders such as providers, partners, local MPs, councils and
voluntary sector partners as well as members of the public. We use Twitter to
promote our organisation but we also retweet information from other organisations
when they have news, healthy lifestyle information or campaigns that we feel would
benefit our patients. We regularly review our website and intranet statistics for
trends. We use e-communications channels to have an active dialogue with harder-
to-reach communities such as the young and working adults. For example, the
Patient Experience Tracker project which purchased tablets for practices allows
people to complete a questionnaire giving real-time feedback on patient experience.
We also use Smart Survey to create online surveys and are planning to expand the
use of this as other features are added to this product.
3.2 Patient Participation Group network
We host a network for our GP member practices’ Patient and Participation Groups
(PPGs). During this year PPG members elected a PPG representative to Chair the
network and to sit on the Governing Body. This network had previously been chaired
by two interim PPG representatives. The Network sets their own agendas, agree
their speakers and develop their own work plan. These meetings are organised and
administered by the Communications and Engagement Team. The PPG network
Chair also sits on the PPE Committee and provides reports on issues that arise at
these meetings. PPG members have their own email on the CCG website where
queries and concerns can be raised. Outcomes from this year have included: PPGs
advising the CCG on the election process, practices getting involved in the election
and inviting guest speakers including NHS England. Further information is provided
in sections 5.8 and 5.9.
3.3 Structures
In our first two years as a CCG our priority was to establish and embed the engagement structures that were laid out in our Constitution. Enfield CCG adapted the model CCG Constitution to ensure that it reflected the needs of our local population. The Communications and Engagement team ensure that structures are in place to support engagement work and that activities are planned, monitored and outcomes reported. Examples of this approach include: developing communications and engagement plans for Transformation programmes, recruiting volunteer representatives for service improvements e.g. ophthalmology and keeping the engagement log updated. We have developed a governance process for shared decision making enabling local GPs and their patients to have a voice in our organisation. Our Patient and Public Engagement (PPE) Committee was formally established in April 2013 and is one of five sub-committees of the Governing Body. The PPE
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Committee meets bi-monthly and has a strategic role in developing patient engagement and participation across the CCG as well as monitoring equality and diversity. The terms of reference for the PPE Committee are available on our website. The PPE Committee is chaired by the Governing Body Lay Member for PPE and members this year included two other Governing Body members – the Director of Quality and Integrated Governance and the Governing Body Practice Manager Representative as well as PPG representatives, the Head of Communications and Engagement, PPE Manager along with representatives from Public Health and Healthwatch Enfield. Two interim patient participation group representatives also sat on this committee for the early part of this year. During this year the PPE Committee completed the process of recruiting the elected PPG representative after receiving delegated responsibility from the Governing Body. In September 2015, the elected PPG representative took her seat on the committee. It 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 Better Care Fund.
Schematic Structure of feedback in Enfield CCG
3.4 Partnerships
Locally we have a vibrant and engaged population and we are committed to hearing
people’s views on the NHS and how we can improve it. At Enfield CCG we continue
to build partnerships with our local stakeholders as evidenced by our 360
stakeholder survey results for 2015 commissioned by NHS England. We developed
an action plan based on this year’s feedback to enable us to respond proactively to
the comments in the report. Further information is provided in section 4.7.
One of the key actions we took this year was to set up a Voluntary and Community
Stakeholder Reference Group. This new group, set up in September 2015, is made
up of local umbrella organisations that match the nine equality groups(protected
CCG Governing Body
Patient & Public Engagement Committee Patient
Participation
Groups Network
Equality Delivery System 2
Task and Finish group Groups
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characteristics) as defined by the Equality Act i.e. age, disability, gender
reassignment, marriage and civil partnership, pregnancy and maternity, race, religion
or belief including lack of belief, gender and sexual orientation This has enabled
these key stakeholders to get more involved in the work of the CCG and our
commissioning improvements.
We work closely with key partners including Enfield Council and local NHS providers
to improve local health and social care services and to ensure the long-term
sustainability of our health economy. This year we have continued to work with
Enfield Council on the Better Care Fund; on delivering the Joint Health and
Wellbeing Strategy, Joint Strategic Needs Assessment and developing joint plans for
integrated care.
We have continued to work in close partnership with the other four NCL CCGs
(Barnet, Camden, Haringey and Islington) to develop our strategic plans for
transformation and planning improvements for when there are benefits across a
larger population.
We took on larger joint co-commissioning primary care with the other NCL CCGs in
partnership with NHS England on 1st October 2015. We set up a Joint Primary Care
Commissioning Committee which meets in public. Another example of this
partnership engagement work across NCL is the joint commissioning plans for 111
and out of hours service under which a patient reference group was set up to
contribute to the service specification. Members of this patient reference group also
took part in the procurement process.
4.0 Meeting the collective duty for Engagement & Participation
Activity
Enfield CCG regularly undertakes activities to meet the collective engagement duty.
This duty places a requirement on CCGs to ensure public involvement and
consultation in commissioning processes and decisions. It includes involvement of
the public, patients and carers in:
planning of commissioning arrangements which might include consideration of
allocation of resources needs assessments and service specifications.
proposed changes to services which may impact on patients.
In this section, we will focus on examples that show how we have delivered the
collective duty across a number of key areas.
4.1 Integrated NHS 111/OOH Services procurement
During 2014/15 we began engagement on a major procurement for integrated NHS 111 and Out of Hours Services across North Central London. Enfield CCG works in line with our local Procurement Policy, which requires patient involvement and
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utilises specialist support from the procurement team at North and East London Commissioning Support Unit (NEL CSU). Nationally and locally, NHS procurement exercises can cause anxiety for local stakeholder groups who are concerned about privatisation. When the procurement exercise was announced, Keep Our NHS Public Groups in Camden and Haringey were vocal with their concerns. Both services originally had been commissioned separately – NHS 111 across five boroughs and GP OOH services for Barnet, Enfield and Haringey in isolation from Camden and Islington. Local commissioners had analysed the pattern of usage for both services. GP OOH services are only accessible through NHS 111. Commissioners were able to analyse when and where patients were accessing services and for what conditions. Data showed that patients often accessed services away from home but in the North Central London area. This, along with further analysis showing the types of illness and injuries people contacted NHS 111 about provided information to the commissioners about the improvements that could be made to the quality of services being delivered. By integrating services, the OOH service could work together with NHS 111 ensuring more clinical support and faster access to appointments. Other improvements planned during this procurement exercise included adding more pharmacy support and more support from specialist nursing e.g. contraceptive advice. We invited all the groups who had expressed concerns about the procurement to join a stakeholder reference group. This was an opportunity to discuss their concerns and to get patients and their representatives involved in developing the service specification. The group, which included representatives from all boroughs, positively contributed to the service specification ensuring that quality and patient experience was at the heart of the improvements. The group also nominated representatives onto the procurement panel where they took an active role in reviewing bids and scoring and questioning potential providers. The results of the procurement panel’s decision was announced in April 2016. All the patients involved in the stakeholder reference group were supportive of the decision.
4.2 Improving Ophthalmology Services
We continued to work closely with Enfield Vision and other local experts to improve
ophthalmology services for patients. Local commissioners took part in a group set up
by the Thomas Pocklington Trust along with Enfield Vision, Healthwatch, Enfield
Council, Enfield Homes and other key stakeholders to discuss improvements we
could make to local services. We also held two workshop groups, facilitated by the
Head of Communications and Engagement which discussed improving the services
that the CCG commissions. A patient representative was recruited to take part in
these workshops. Outcomes included; clinical guidance has been improved, which
has led to better quality services being delivered by each provider and improved
patient outcomes.
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4.3 Safeguarding Conference – July 2015
We organised a Safeguarding Conference that was attended by 146 delegates. The
conference was chaired by NHS England and our safeguarding team invited experts
to present on a variety of topics that affect both adults and children. Topics covered
included the national Prevent strategy, child exploitation and female genital
mutilation (FGM). Delegates included local GPs, nurses, social services and
voluntary sector groups that are all directly involved in delivering care to patients.
While this conference was delivered to professionals, the objective was to ensure
that staff and community representatives can care better for our community. The
conference received overwhelmingly positive feedback. See Appendix B for more
details.
4.4 Voluntary organisations engagement in mental health:
We are members of the Enfield Voluntary Partnership Board chaired by London
Borough of Enfield, which includes all mental health organisations and healthwatch.
The Board meets to share and explore where voluntary organisations can make a
difference and to give details of what each other are doing.
We commission Nafsiyat, a voluntary organisation for additional Improving Access to
Psychologist Therapy (IAPT) treatments for difficult to reach ethnic groups as they
are multi-lingual, for example Turkish, Somali and Eritrean.
Enfield Mental Health Users (EMU), in collaboration with Enfield CCG and the
London Borough of Enfield, organised some mental health service user and carer
conferences/workshops in 2015/2016. The first EMU Service User Engagement
Conference was held on 4 September 2015 when 120 people attended. There was
also a Mental Service User Conference on 10 October 2015 about Mental Health
First Aid- Tips and Strategies to protect your mental and physical well-being. See
Appendix C & C1 for the EMU Service User Engagement Conference Report and the
agenda for Mental Health First Aid workshop. The second mental health service
user and carer conference was about suicide prevention and was held in April 2016.
EMU and Enfield MIND are standing members of our IAPT service improvement
committee. They represent the voice of service users and service users via EMU
were involved in the re-designing of the IAPT leaflet.
See Appendix D for details of the voluntary and community contracts monitoring list.
4.5 Young Minds training
Enfield CCG is the lead commissioner for Barnet, Enfield and Haringey Mental
Health Trust. We are aware of the impact that mental health problems have on our
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community. This is a particular concern of local people who regularly feedback that
they wish to see mental health high on the CCG’s agenda. This year we
commissioned Young Minds to provide training for our community focused Child and
Adolescent Mental Health Services (CAMHS). The training was free and aimed at
improving the skills of people who regularly interact with young people e.g. faith
groups and other community groups. This training also supported the delivery of the
Joint CAMHS strategy, which was developed with patient and community group
feedback. More detail is provided as an Appendix E.
4.6 Stronger links with Voluntary and Community Groups:
4.6.1 Enfield Strategic Partnership’s Voluntary Sector Strategy Group We are a member of multi-agency Enfield Strategic Partnership’s Voluntary Sector Strategy Group (VSSG), which provides the mechanism for strategic consultation and partnership working between the Enfield Strategic Partnership (ESP) and the Enfield Voluntary and Community Sector (VCS). VSSG members commit to the principles of the Enfield Compact, which is a local agreement that sets out the principles for positive partnership working across the statutory, voluntary and community sectors within a spirit of mutual respect and partnership. The aim of the Enfield Compact is to help create new ways of working together for the benefit of those who live, work, study and do business in Enfield. The terms of reference and membership list for Enfield Strategic Partnership’s VSSG are attached at Appendices G and H. Through the role of the VSSG, Enfield CCG and the Council have been working with the voluntary sector on re-shaping the role of the sector in helping deliver care and support in Enfield in light of the requirements of the Care Act, and plan to accelerate 2016/2017 progress. An invite for one of the collaborative events is attached- Appendix I (NB: Although this refers to the “role of Enfield Council”, the CCG was equally involved as the topics show). A key area for improvement recognised by all parties was to develop better relationships between health professionals on the ground, including GP practices, and the voluntary sector. Part of the re-shaping the CCG and Council want to promote, relates to development of VCS community navigators operating in GP localities to provide information, advice and support to individuals working closely with multi-disciplinary, multi-agency professionals. As part of this collaboration, the CCG (and its social and health care partners) worked with a voluntary sector partnership including Age UK Enfield, Enfield Community Transport, Enfield Asian Welfare Association, Greek & Greek Cypriot Community and Over 50s Forum to develop Phase 1 of a longer-term voluntary sector hub which will operate in health facilities, including GP surgeries. Phase I is currently being mobilised. It is a pilot looking at how the voluntary sector could become part of integrated multi-disciplinary teams working to support
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individuals. This is looking at two specific areas, which were identified as being areas of particular improvement by partners, including the voluntary sector representatives in their role in the Integrated Care Programme:
Post-diagnostic support for people with dementia;
Falls Prevention.
Phase II (2016/17) will extend the role of the voluntary sector in other areas of
primary and secondary prevention through a similar navigation model, but for a wider
number of issues than Phase I – priorities to be decided in dialogue with the sector
4.6.2 Enfield CCG Community and Stakeholder Reference Group
Enfield CCG set-up the Community and Stakeholder Reference Group in September 2015 to respond to the comments made in the 360 degree stakeholder survey 2015 concerning involving patient representatives on a regular basis with commissioning.
The CCG, following discussions with Enfield Council colleagues, agreed to select the members of the group to represent the nine protected characteristics under the Equality and Diversity Act. We wrote to the umbrella organisations that represent these groups to invite them to join. The group currently meets four times a year.
The group’s purpose is to provide the patient, service user and public perspective, as articulated by voluntary and community sector representatives on the development, planning, implementation and evaluation (success and challenges) of health services commissioned by Enfield CCG. The Terms of Reference for the Enfield CCG’s Voluntary and Community Stakeholder Reference Group is Appendix J.
The group has received updates on key pieces of work that the CCG is undertaking
including the development of the commissioning intentions and primary care
developments. The group is chaired by the Head of Communications and
Engagement and the agenda is set in agreement with all members, who often
request updates on key areas of interest. Outcomes during this year included
improving the way we collectively involve patients in our commissioning plans
through the involvement of umbrella organisations who brief their networks.
The Head of Communications and Engagement was the guest speaker at Enfield
Voluntary Action’s (EVA) AGM- Presentation, which is Appendix K. This was to
ensure that the wider voluntary and community groups were aware of this new
stakeholder group and to give them an opportunity to comment
4.7 Learning from the yearly 360 Degree Stakeholder survey carried
out by Ipsos Mori for NHS England
Following the receipt of the 2015 360 degree survey, we reviewed and developed a
targeted action plan, details of which are provided in Appendix L.
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4.8 Further engagement
This year, some of the examples of how we have met our collective participation duty
include:
Delivering the cycle of corporate events described in our Constitution that is: 6 Governing Body meetings in public and three patient and public engagement (PPE) events.
Members of the public are invited to submit written questions to the Governing Body before each meeting. Responses to these questions are provided before the meeting. The public are able to confirm if they wish to discuss the responses received further.
We plan three PPE events to ensure early engagement opportunities on any of the commissioning services changes being considered. We issue a feedback form at every event and we encourage the public to suggest future agenda items. This year mental health and primary care developments were the most popular requests. Following public feedback these events are clinician led with short presentations and round table discussions.
We visit hard to reach groups to talk to them about the CCG, work being undertaken and to find out more about their needs. This year one of the groups we visited was the Deaf Forum, when the CCG gained a better understanding of barriers to access for deaf patients. We have used this feedback to work with NHS England and member practices to improve access to translation services.
We provide speakers on request for partner or voluntary sector events. This year our GPs and Governing Body members visited events such as Enfield Racial Equality Council’s Annual General Meeting and the Over 50s Forum.
Planning and delivering joint events with Enfield Council and NHS England including a Safeguarding conference.
There are many more examples in Appendix M, which is our corporate engagement
log.
5.0 Meeting the Individual Participation Duty
This duty requires CCGs to:
ensure they commission services which promote the involvement of patients
across the full spectrum of services.
Ensure collaboration between patients, carers and professionals, recognising
the expertise and contribution made by all.
We are committed to redesigning and commissioning services that enable patients to
take control of their health through individual participation in their care planning. We
want patients to be in control of their health and support them to achieve outcomes
that improve their wellbeing. This section provides some examples of how we met
the individual participation duty this year.
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The CCG has clear responsibilities in relation to commissioning for quality, informed
by the NHS Constitution (2011):
To ensure that services we commission are safe, effective, provide good patient experience and continuously improve
To secure health services that are provided in an integrated way, working in partnership with the Local Authority
To actively seek patient feedback on health services and engage with all sections of the population with the intention of improving services
As a membership organisation, working with NHS England, to support primary medical and pharmacy services to deliver high quality primary care
Appendix N describes how we monitor quality and the individual participation duty
delivered through providers during the commissioning cycle.
The key ways we monitor our contracts and services locally across the three quality
domains are:
• Our early warnings system – designed for reporting concerns from our GP members based on feedback from their patients. This system has been adopted by other CCGs.
• Providers send us patient experience reports that are discussed at the Clinical Quality Review Groups (CQRQ).
• Equality Impact Assessments of any planned change to services are reviewed to check that no community is being unfairly disadvantaged.
• Our patient enquiries service and our communications inbox and telephone numbers, often receive comments, complaints and concerns which we investigate, respond to and record.
• Feedback from Healthwatch Enfield • Monitoring Twitter. We have a standard response for complaints and feedback
received. • Collecting feedback directly from patient groups • Monitoring feedback on national websites such as NHS Choices, Patient
Opinion and other public comments • Viewing feedback from patient forums such as the Maternity Services Liaison
Committee (MSLC), the North Middlesex University Hospital Focus Group, Parent and Young People Participation Group.
• Evaluation of services we have commissioned such as the GP urgent access pilot.
Key outcomes included: • The early warning quality alerts received that were a result of patient feedback
to the GP. Themes and trends are reported to the CCG Clinical Reference Group and escalated to the Governing Body as necessary through the Quality and Safety Report.
• The views of patients have led to improvements such as: improving patient information leaflets and expanding service specifications.
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• Improved quality of care from individual providers. For example, the Care Home Assessment Team (CHAT) has continued with a number of care homes to improve the standard and quality of nursing care.
• Barnet, Enfield and Haringey Mental Health Trust (BEH MHT) Care Homes Assessment Team works closely with LBE’s and Enfield CCG’s Safeguarding Teams and Enfield’s safeguarding procedures (which include CQC involvement) to identify and address any provider concerns
• Quality issues identified or raised during via the quality alerts process go to the quality meeting for the contracts the CCG manages.
• More partnership working with Trust Development Authority, Care Quality Commission, and NHS England on quality issues.
5.1 Supporting the self-care agenda
5.1.1 Choose well Campaign
From April 2015 – October 2015, Barnet, Enfield and Haringey CCGs continued to
run the Choose Well campaign which started in December 2013. The Choose Well
North London app was part of a wider campaign by Barnet, Enfield and Haringey
aimed at relieving pressure on hospitals’ Accident and Emergency (A&E)
departments and highlighting the range of other local NHS services that are
available. Widely publicised information was available on CCGs’ websites and
leaflets.
The App was developed and promoted to help people decide what service they need
and where to go to get it. The names, locations and opening hours of every
pharmacy, GP surgery, walk-in and urgent care centre and hospital A&E in Barnet,
Enfield and Haringey was included on the App along with a locator map showing
where the nearest service was. The App was free and available to Apple and
Android users. It was also available in four languages – English, Turkish, Polish and
Somali – the App also included a game users could play to familiarise themselves
with NHS services.
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5.1.2 Stay well this winter
We supported the National Stay well this winter campaign which ran from November 2015 – March 2016. This campaign particularly targeted those people aged over 65 or older and people with long term conditions. It provided information about the flu jab, keeping warm; getting advice from pharmacists; what medications were needed in people’s medicine cabinets at home; taking medication as prescribed and looking out for others. The information was held on our website and was communicated via stakeholder lists and social media. Leaflets were provided at all events organised by CCG staff, including the PPG Network meetings as well events that CCG staff attended; leaflets were also sent to all GP practices for patients to be able to pick up.
5.1.3 Other information provided to support the self-care agenda
The Communications and Engagement Team provided information on a variety of issues from a variety of sources at all of the events or meetings attended e.g.
Choosing the right treatment- Choose well or stay well this winter leaflets
NHS call 111 leaflet
Improving Access to Psychological Therapies- Let’s Talk leaflets and cards co-produced by Barnet, Enfield and Haringey Mental Health Trust and Whittington Health
NHS Enfield CCG – Repeat Prescription? What you need to know Only order what you need
Age UK – Staying steady Keep active and reduce your risk of falling
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Minor Ailment Scheme
Get up and go - a guide to staying steady co- produced by Saga, in association with the Chartered Society of Physiotherapy and Public health England
Bowel Cancer Testing
Advanced Decision (Living Wills)
Preferred Priorities for Care Patient Information Leaflet A brief guide for patients
NHS England easy read Making health and social care information accessible Update July 2015- accessible information standard approved
NHS Complaints Advocacy
Promoting joining their own Patient Participation Group
5.2 Developing a new neuro-navigator post
During this year, we took a proactive approach to improving services for people who
have had a severe stroke or brain injury. Previously patients had received long-term
tertiary care but the transition to neuro-rehabilitation care in the community had been
more complex. Patients could access care and support from the neuro-rehab nurse
at the Royal Free Hospital, but we wanted to create a post based in Enfield to
improve local support to them.
The neuro-navigator coordinated a conference where patients and local stakeholders
including social services, nurses and patient groups come together and discuss the
current pathway and ways to improve it. Patients were represented by their carers
who had been through the pathway.
The feedback from the conference was used to:
to redesign the patient pathway
develop the job description for the neuro-navigator.
The outcome of this conference was that we were able to translate patient
experience into improving the pathway and the successful recruitment of a new
nurse who is based at the CCG and can directly assess and support patients and
carers.
5.3 Patient feedback - Continuing Healthcare and Personal Health
Budgets
This year we received very positive feedback in relation to our Continuing Healthcare
Service (CHC). Not all CCG’s have an in-house CHC team, but with Enfield’s ageing
local population, we place a high value on directly assessing and caring for our most
vulnerable residents.
This year we sent out 225 surveys asking patients and their carers who had been
through the CHC service what their experience was. The feedback was overall
positive and there were comments about the professionalism of staff that had
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conducted the reviews. The feedback from this survey was used to improve the CHC
services.
From 2 November 2015, the Continuing Healthcare Survey (CHC) went out both as
an online link and a hard copy with all continuing care decision letters. Responses
were collated and are included within the CCG’s performance reporting on a
quarterly basis.
The surveys are hosted by Quiq Solutions Ltd as part of the online NHS England
Continuing Healthcare Assurance Tool (CHAT). Enfield CCG is part of the pilot
project for this tool. The CHC patient survey template and the results to date are
given in Appendix O.
There were 35 individuals receiving all or part of their care through a personal health
budget in 2015/16; of these 24 were Continuing Healthcare funded, two were shared
funding with Enfield Council and the remainder were Mental Health funded.
The quarter one (April 2015-June 2015) Continuing Healthcare Funded Care Spend
and Activity benchmarking report (Somerset return) for Enfield showed that there
were 18 CHC Personal Health Budgets. This was the third highest number in London
region with only Greenwich & Kingston CCGs having more.
Personal health budgets are run either through the local authority direct payments
team or through our own brokers ‘My Support Broker’ and their payment
management arm ‘My Support Money’.
5.4 Care Plans- Integrated Care for Older People
The aim of the Integrated Care for Older People Programme is to provide better coordinated, holistic health and social care services for older people with frailty, emphasising the need for a greater focus on prevention, early identification and coordination of assessment, care planning & case management. Its objectives are to:
Identify people as early as possible;
Assess, care plan and provide interventions with patients to enable patients to be stabilised;
Ensure that the patient is at the heart of care planning & delivery;
Make system components act as a single system and include carers, as well as the voluntary sector;
Deliver care in the most appropriate setting;
Avoid unnecessary activity and costs incurred in the system to achieve long-term sustainability
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Interrelated component parts of the programme aim to work together to provide seamless, person centred and holistic services for Enfield’s older people who are frail or pre-frail. One of the pivotal components of the overall Programme is the delivery of Primary Care Management function in the integrated care network. GPs, as Lead Accountable Professionals, are at the heart of care planning and care delivery supported through 4 multi–disciplinary Integrated Locality Teams (ILTs) consisting of social care, community health and geriatricians. GPs and these teams develop and update joint care plan summaries as part of the requirements of NHS England’s Enhanced Service for People at High Risk of Unplanned Admissions (“Top 2%”). Our providers of our risk stratification intelligence provide information about the number of such plans agreed and an extract (for end Jul-15) is shown in the table below on page 22 (NB: Practices have been anonymised; all but two practices have signed up to the service). For the period 1st April 2015 – 31 March 2016, we provided the following care packages for:
562 Continuing HealthCare
492 funded nursing care
29 for other funded individuals
267 mental health individuals
This means that we funded a total of 1,350 care packages.
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Health and social care partners were also set to launch an updated Care Plan Summary as part of the further development of the ILTs for April 2016. The proposed Care Plan Summary template is Appendix P. This will be available to all health and social care partners in Enfield via the development of a Shared Record System scheduled for quarter one of 2016/17 (Partners include: GP practices, Barnet, Enfield and Haringey Mental Health Trust (which run Enfield Community Services), Enfield Council, North Middlesex University Hospital and Royal Free London Hospitals). This Shared Record System will have a professional and patient portal to be delivered in 2016/2017.
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5.5 Integrated Learning Disabilities Service
The Government and leading organisations across the health and care system are
committed to transforming care for people with learning disabilities and/or autism
who have a mental illness or whose behaviour challenges services.
The national plan, Building the Right Support that has been developed jointly by
NHS England, the Local Government Association and Association of Directors of
Adult Social Services is the next key milestone in the cross-system Transforming
Care Programme to reshape local community services to focus on personalisation,
health and wellbeing and prevent crisis. This is supported by a new Service Model
for commissioners across health and care that defines what good services should
look like. The plan builds on other transforming care work to strengthen individuals’
rights; through the roll out care and treatment reviews across England, to reduce
unnecessary hospital admissions and lengthy hospital stays; and test a new
competency framework for staff, to ensure we have the right skills in the right place.
NHS England, the London Borough of Enfield (Enfield Council) and the CCG are
committed to transforming care for people with a learning disability and/or autism
enabling people to live successfully in the community and move out of long term
hospital care. We are working together with North Central London to develop a high
level plan to transform care for children, young people and adults with a learning
disability and/or autism in line with Building the Right Support. A first draft of this
plan was submitted to NHS England in February; a final draft of our NCL plan was
submitted at the end of March 2016.
We are also committed to involving people with learning disabilities and / or autism,
families and carers in the development of services in response to delivering the New
Service Model. We are currently considering how we engage with people and their
carers to help us co-design our plans and services, with a range of stakeholders. As
we develop our plans, we will make them available on our website.
In Enfield we have established a community intervention service that focusses on
supporting people falling into crisis to remain healthy and well in the community. We
have seen a significant reduction in the number of community admissions to
hospitals.
In February 2016 there were a total of 6 people in Enfield with learning disability
and/or autism in hospitals or secure settings. There were 3 people receiving short
term assessment and treatment services funded directly by us. The 3 people were in
secure settings funded directly by NHS England. The excellent care being delivered
by the integration of these services to deliver was recognised by Jane Cummings,
Chief Nursing Officer, NHSE- Appendix Q.
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5.6 Working with providers to deliver individual participation
We work with providers using the levers provided by the standard NHS Contract and
other local quality indicators to continuously improve patient experience.
We undertake a wide range of activities both through contract management and
through governance as well as quality and safety measures to regularly monitor
provider data. We have a positive dialogue with providers about continuously
improving quality but we also vigorously challenge when we believe services could
be improved. Both Patient Experience Reports and Healthwatch’s Enter and View
reports are discussed at our Quality and Safety Committee meetings as well as the
relevant provider’s Clinical Quality Review Group (CQRG). Progress on the
recommendations made is monitored by the respective CQRGs. Our Quality and
Safety Committee also require assurance on the implementation of commissioner
recommendations for the provider trusts. Healthwatch Enfield is a member of our
Quality and Risk sub group which reports to the Quality and Safety Committee.
An example of improving the quality of care from individual providers is the local
Care Home Assessment Team (CHAT) team, which has worked directly with a
number of care homes to improve the standard and quality of nursing care in Enfield.
5.7 Meeting the collective and individual participation duties:
Recruiting an elected Patient Participation Group Representative to
our Governing Body
When our GPs designed our Constitution they embedded the values of patient and
public engagement in the governance of our organisation by having a co-opted
elected representative from member Patient Participation Groups as a non-voting
member of the Governing Body.
By June 2014 all our member practices had PPGs. Practice Managers were
supported by our Governing Body Practice Manager lead. They were given a toolkit
to help setup and manage the group. During 2013/14 we recruited two interim PPG
representatives through an advert and interview process. The successful candidates
signed a one year voluntary contract and sat on the CCG’s Governing Body and
PPE Committee as well as helping us to start up our PPG network during 2015/2016.
Our PPG network met quarterly during 2014/15. PPG Chairs, PPG members,
practice managers and staff that support PPGs all attended this meeting. The
network was supported by NHS England engagement funding. Money was spent on
training for PPGs including: developing mission, vision, aims and objectives,
governing documents as well as sponsored membership of the National Association
of Patient Participation.
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During the year the PPG network shared good practice and strengthened their
working relationships with each other and their practices. Guest speakers presented
to the networks on topics of interest such as: primary care estates and Care.data. An
update on PPG network development was a standing item at both the Governing
Body and PPE Committees throughout the year.
During 2014/15 the PPE Committee planned for the recruitment of the elected PPG
Body representative. The Committee reviewed and updated the process used for
advertisement and selection of the interim PPG representatives. This included
revising the role description and voluntary agreement based on the learning of the
interim representatives as well as updating the recruitment pack. It was agreed that
the recruitment process would be an application form and interview before the
candidate was put forward for election. The PPE Committee also discussed a
proposed voting process for the PPGs.
The PPE Committee received delegated responsibility from the Governing Body in
November 2014 to proceed with the election. It was agreed by the PPE Committee
that the Electoral Reform Services would manage the process independently from
Enfield CCG, in line with other elected Governing Body posts. The election
recruitment pack, role descriptions and voluntary descriptions were all discussed
with the PPG network who were able to amend the documents and comment on the
process. The PPG network agreed that each PPG should get one vote and that
groups would meet to agree which candidate to vote for. The election process was
an online, first past the post system. Provision was made for postal votes if the
person asked to vote on behalf of their PPG did not have an email address.
Two candidates came forward for election from two different localities. Having
successfully completed the application process, each candidate was invited for
interview. The CCG invited two PPG representatives from other London boroughs to
sit on interview panel. The patient representatives gave an independent view to
Enfield CCG about the role. Following the interviews, both candidates were put
forward for election.
The majority of PPGs in Enfield took part in the election process and Electoral
Reform Services confirmed the appointment of Litsa Worrall. She took up her new
role as elected PPG representative in May 2015. The role is a three year
appointment in line with other elected Governing Body positions.
During this year, Litsa Worrall took over chairing the PPG network meeting. The
network still sets its own agenda and has developed its own work plan. The quarterly
network meetings are supported by the CCG Communications and Engagement
Team. Key areas that PPGs have focused on this year include:
reducing the number of do not attends at GP appointments
promoting health and wellbeing
promoting PPGs membership
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providing information about
- Electronic Prescribing
- On line booking
The number of patients attending the network has been steady, with a consistent
number and geographical spread of groups involved. This year, we have also
attracted new groups to the network.
The elected PPG representative attends the PPE Committee and the Governing
Body and gives direct patient feedback to both on issues raised at the PPG Network
meetings.
The network also appointed four patient champions representing each membership
locality. The champions will work within their localities to encourage groups to
develop. Not all membership practices are represented at the network meetings, so
the champions will be contacting each practice to encourage attendance. PPG
members have agreed that some of the work that happens at the network meetings
such as sharing best practice can also be delivered on a one-to-one basis with a
buddying approach. The locality champions’ role will continue to develop in 2016/20.
5.8 Elected PPG Representative Statement
This year we have asked the CCG’s elected representative to contribute to this
report. We would like to congratulate Litsa Worrall on her election as the CCG’s first
elected PPG representative and invite her to comment on her experience and plans
for the future.
‘I was very pleased to be elected by the Patient Participation Group in Enfield in May 2015 to be the PPG members’ voice on the Enfield CCG Governing Body as well as the Patient and Public Engagement Committee. I am proud to support the development of PPGs in Enfield by chairing the PPG quarterly network meetings. Our priorities in our first year have been:
Encouraging the PPGs attending the Network meetings
Developing an agreed workplan for 2015/2016 with the local PPGs groups
Encouraging the agreement of PPG Network to the recruiting of 4 Locality Champions
Communications between PPGs and Enfield CCG
Learning from good practice across PPGs In Enfield
Gaining the views of PPGs – use of Smart Survey
Development of a PPG logo
Implications for the Accessible Information Standards – how PPGs can help
Requesting speakers to attend to provide information and updates to PPG members e.g. Chief Officers of CCG, NHS England and Healthwatch
The PPG is looking forward in 2016/17 to working on:
further developing support for the PPGs Network
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reviewing and agreeing the workplan for 2016/2017
Developing a PPG leaflet
Agreeing and finalising Aims, Objectives for PPGs that could be used by all PPGs in Enfield
Requesting that NHS England attends to explain what are their expectations of PPGs and gain updates from CCG colleagues on ongoing developments
Continuing to share good practice
Developing the role of the Locality Champions’. Litsa Worrall Elected PPG Representative 8 October 2016
5.9 Meeting the collective and individual participation duty –
Consulting on changes to gluten-free prescribing
Enfield CCG is committed to consulting patients when we propose to make changes
to services. This year the CCG undertook its first consultation on changes to gluten-
free prescribing. The CCG wrote the local Health Scrutiny Workstream describing its
proposals and plans to consult local patients and stakeholders. The CCG took a
planned approach to proactively contacting stakeholders and affected patients. The
CCG received over 130 responses to the consultation, receiving responses from
approximately a quarter of the affected patient group. The CCG produced a report to
all the responses received. These were carefully analysed and the feedback was
reviewed by the Clinical Reference Group along with the Quality and Equality Impact
Assessments. The CCG agreed to recommend to GPs to stop gluten-free
prescribing. This decision enables the CCG to reinvest this money in funding
treatments for the benefit of more Enfield residents.
Lessons learnt from the first consultation included:
ensuring that the pre- engagement for any future consultations is as widely
publicised as possible
consider having an on-line survey for those people who were not in a position
to attend any public meetings
ensure that the time period of the consultation period is appropriate to the
changes in services being proposed following consultation with the local
Health Scrutiny Workstream
ensure that the consultation period is well advertised and consider using local
stakeholder networks more in publicising the consultation
consider whether a local voluntary or community organisation could run and
engagement events to help reach a wider audience
review and agree the areas to be covered in the final consultation report
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6.0 Forward Plans for 2016-2017
Although we are proud of what we have achieved in 2015/16, we know that we have
a lot more work to do to embed participation throughout the organisation. We also
need to continually review our methods of engagement to improve how we reach all
sections of our population.
Here are some of our forward action plans for improving and increasing participation
in 2016- 2017.
• Supporting the Enfield PPGs Network - We will support the PPGs network
to develop further now that the elected representative is in post. We will
continue to fund and facilitate four network meetings a year as well as provide
administrative support where possible.
Recruitment of more volunteers to support more involvement in the
Commissioning cycle- We will review the way we recruit and support our
volunteers. The Head of Communications and Engagement and the Patient
and Public Engagement Manager have attended specialist courses run by
Enfield Voluntary Action. Currently the Head of Communications and
Engagement meets regularly with the Elected PPG representative to discuss
what is needed by the PPGs and how the CCG can provide support. Those
volunteers who become involved with the service redesign projects are given
a role description and are supported by the commissioner.
Continuing the development of Voluntary and Community Stakeholder
group- In 2016/17, we will work with the members of the Voluntary and
Community Stakeholder Reference Group to agree what areas, they would
like to provide their feedback on to support the development of strategic
change programmes.
Promoting the Sustainability and Transformation Plan for North Central
London – This plan is currently in its early stage of development. During
2016/2017 we will work with the Programme Management Office
Communications and Engagement lead as well as our colleagues in Barnet,
Camden, Haringey and Islington CCGs to promote and inform patients, public
and our stakeholders about this plan
Working with other groups to support engagement on a variety of
issues- We know that it is difficult for us to reach to all the population of
Enfield, so we will look to asking our voluntary and community organisations
to deliver some engagement activity on our behalf as well as encouraging
groups to contact us for speakers at their events or meetings. This will help to
ensure that we gain views from some hard to reach groups.
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Supporting the self care agenda- working in collaboration with Haringey, we
will develop an information leaflet that provides details of local services
available while also supporting the national campaign Stay Well this Winter.
Development of the CCG’s strategy and commissioning plans- We will
continue use the three corporate Patient and Public Engagement events a
year to inform and support engagement on the development of the CCG’s
strategy and commissioning plans. We will also look at more ways that we
can increase engagement on these plans.
Engagement and Consultation- We continue to carry out targeted
engagement and consultation, where necessary. At the same time we will
review the processes currently in place to improve the delivery of both, so that
we can increase stakeholder involvement
Feedback development- We will continue to work on improving the feedback
we provide to our stakeholders by further developing more You said, We did
outcomes from engagement; improving the information on our website;
increasing the use of social media such as Twitter.
Learning from the yearly 360 Degree Stakeholder survey 2016 carried
out by Ipsos Mori for NHS England - How to take forward the results of the
360 degree stakeholder survey 2016 will be discussed and agreed by the
directors.
Making our Patient and Public Events more effective- Following the
request form the public that all events are GP-led, we will endeavour to
ensure that we have a GP lead, where possible, at events or meeting we are
asked to attend. We have also listened to views concerning venues for these
events and will ensure that we do not book those venues which our public do
not like.
Developing skills and competencies of CCG staff- We will continue to
invest in corporate membership of the Consultation Institute, along with
buying specialist training courses for the Communications and Engagement
Team and other senior leaders in the organisation.
Embedding Participation across the CCG- We will continue to encourage
colleagues to report engagement activities that they undertake by recording
these in our engagement log that is regularly viewed by the PPE Committee.
7.0 Healthwatch Statement
Over the year we have worked with our local healthwatch, although we have not
commissioned them to undertake any engagement work for us. We meet regularly to
discuss issues as well as share reports and information sent to us with our staff and
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our stakeholders. Healthwatch Enfield colleagues also members of the Governing
Body, Patient and Public Engagement Committee, Quality and Risk sub group and
the Equality Delivery System 2 Task and Finish Group.
7.1 Healthwatch Enfield Statement:
Healthwatch Enfield welcomes the effort that Enfield CCG (ECCG) puts in to
trying to engage with patients and the public, but continues to have
concerns over the lack of a coherent strategic approach across the
organisation as a whole.
During 2015-16, ECCG has maintained a strong working relationship with
Healthwatch Enfield. We have felt able to pass on important public feedback
on local service quality in the knowledge that it would be taken seriously by
ECCG. ECCG staff have joined us in contributing to the local Quality
Surveillance Group, where sensitive matters, including information gathered
from the public, can be shared confidentially among a number of different
players in the health and social care system.
Some key staff and Governing Body members in ECCG value the critical
importance of patient and public views in gaining an understanding of the
quality of local services. They also understand how such feedback can
occasionally act as an early warning of potentially wider quality problems
with a service or provider.
During 2015-16, ECCG has continued to work hard on its patient and public
engagement work, to which it shows commitment. It continues to support
the GP-based Patient Participation Groups in their development, while at the
same time allowing them great autonomy to develop their own agendas and
work plans. It also continues, unusually among CCGs, to have a PPG
representative as an Observer Member of its Governing Body.
Healthwatch Enfield welcomes the fact that ECCG has continued to improve
its set-piece engagement events in response to feedback, securing better
attendances at some events, and more meaningful engagement. ECCG tends
to commit very good clinical and staff involvement to these events, and the
public welcomes this type of interaction and discussion with ECCG Governing
Body members and senior staff when they are aware of the event and what is
to be discussed. However, attendance at engagement events remains
extremely variable, with members of the public sometimes out-numbered by
staff. Although some events will always be better attended than others,
Healthwatch Enfield remains of the view that much better advance notice of
each event, its focus and purpose could help to improve public attendance at
some of these events.
Healthwatch Enfield is pleased to recognise good work done by ECCG, for
example, around the re-commissioning of the 111 and Out of Hours services
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across North Central London (NCL), for which ECCG was lead commissioner.
The creation of a Reference Group involving patients and the public was
welcome, although its members were few and drawn from a small pool.
Nevertheless, this group and other engagement work successfully influenced
the service specification, and the NCL clinical leads for the recommissioning,
supported by ECCG staff, were extremely open to receiving this input and
incorporating it where they could. ECCG also benefited from considerable
outreach engagement work done with a range of community groups by
another CCG in NCL. We hope that this engagement work will enhance
111/OOH as the service now gets up and running and starts to develop. We
also hope that ECCG will recognise this as a positive experience that it can
learn from and build on in order to further develop its public and patient
engagement work going forward.
Over the past couple of years, Healthwatch Enfield has given ECCG a
considerable amount of feedback and advice on how it might become more
strategic in its approach to engagement work. We have seen some steps
forward; for example, all ECCG staff are now ‘encouraged’ to inform the
Communications and Engagement Team when they undertake any
engagement work. We do not, however, see this sort of basic exchange of
information as a substitute for a coherent strategic approach.
Healthwatch Enfield still believes that a strategic approach to public
engagement across the whole organisation would arguably entail people from
across all teams coordinating together to ensure that public involvement and
engagement are planned early, systematically, and implemented at the right
time and with the right target communities so as to be able to influence
specific commissioning intentions in a timely fashion. Healthwatch Enfield
would argue that “Right Engagement at the Right Time”, is necessary in
order to make “Right Care, Right Time, Right Place” a reality.
For example, despite ECCG having the best of intentions, its consultation on
discontinuing prescriptions for gluten-free food created friction locally.
Healthwatch Enfield received a number of concerns from members of the
public who were not happy about the way the consultation was being
conducted, and very quickly alerted ECCG to these concerns. People felt
dissatisfied both that they had not been directly informed of the
consultation, despite assurances by ECCG, and then also with the final
decision made by the CCG. In particular, they did not feel that the
objections they had raised had been fully answered, with some specific
suggestions not being mentioned or responded to in ECCG’s response
document. There was also a strong suspicion among those affected that the
consultation had not taken place early enough and was not “genuine” with
ECCG having already made up its mind beforehand. We welcome the
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learning points that ECCG has identified from this exercise. We hope that
they will apply this learning and undertake public engagement and
consultation much earlier and more effectively in any future similar process,
particularly as there are many more “difficult decisions” to be made in the
near future, in terms of allocating scarce resources as effectively as possible.
Also during 2015-16, ECCG involved one patient with diabetes on its Diabetes
Stakeholder Group. It is always good to have patients involved, even if it is
only one person. But a more truly strategic approach, which we urge ECCG
to develop over time, might also have seen ECCG representatives visiting
community groups of people likely to have or to be at risk of developing
diabetes in the future, such as South Asian groups or groups of older carers,
earlier in the commissioning process. Hearing from such groups at an early
stage about their awareness of diabetes, about what they would expect a
diabetes pathway to look like, and what additional information or support
they would need to prevent or to manage diabetes could have been
potentially very helpful to ECCG’s wider work on diabetes. Some such work
could perhaps be conducted with Public Health colleagues for a more
integrated approach to prevention and treatment. Healthwatch Enfield
continues to be very willing to work with ECCG on developing initiatives such
as this.
Healthwatch Enfield recognises that NHS resources are limited. But that
makes early public involvement in changes and developments even more
important. We see a willingness in ECCG to develop fuller public engagement
and, in line with our previous input, we hope that a more strategic approach
to engagement will see ECCG adopt an integrated, coherent approach across
all its major work strands. Healthwatch Enfield will continue to advise and
support ECCG in the development of its engagement work, and we hope that
a more strategic approach can increasingly be adopted by ECCG as it
develops its future commissioning intentions in partnership with the other
CCGs, providers and local authorities of North Central London as part of the
local Sustainability and Transformation Plan.
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