MARCH 2016 UPDATE - NHS THANET CCG COMMUNICATIONS & ENGAGEMENT


This is the Communications & Engagement update that I had the pleasure to introduce at NHS Thanet CCG Governing Body today. Many thanks to Steve James for compiling the report.

Introduction

NHS Thanet Clinical Commissioning Group recognises that listening to and acting on what matters to local people is key to the delivery of our commissioning intentions and plans.

Engaging and communicating with patients and local people to jointly design and commission services will make them a more active and powerful resource. It will also help us to gain a much better return on the money we invest in local services.

A summary of recent activity is included below.

  1. Patient and stakeholder engagement

Since the last Governing Body meeting in public, Lay Member for Patient and Public Involvement, Clive Hart has continued to promote and encourage public participation in local health matters.

He had a New Year article published in the Thanet Extra newspaper asking local residents to join our Thanet Health Network and also urging them to support their local Patient Participation Group.

He also helped to introduce our new Health Network Bulletin - a monthly update for members - and develop a new clearer format for future Health Network notifications.

Clive continued to meet Thanet GP practices respective patient participation groups. A very positive meeting was held in January with The Grange GP practice in Ramsgate and that now makes a total of nine practices visited over the past ten months.

PPG group chairs from numerous individual GP practices across Thanet came together at the QEQM hospital on 13 January for the inaugural meeting of the Thanet CCG Health Reference Group which Clive chaired.

At the first meeting there was an excellent presentation and detailed discussion led by the Head of Medicines Management at Thanet CCG, concerning processes and procedures relating to prescription drugs and medicines.

The event was well reported in the Isle of Thanet Gazette and the new group will supplement our 850-person strong Thanet Health Network and voluntary sector organisations in representing the interests and views of patients. It will also help to provide two-way feedback on health related practice in Thanet between the CCG and our local GP surgeries. The group will now meet quarterly, providing a forum to discuss and exchange local and national health initiatives, information, events, policies and practices in relation to health and wellbeing here in Thanet.

Clive continues to attend regular Thanet Adult Strategic Partnership meetings and is also working with the voluntary sector through the Health and Wellbeing Board Inequalities Group.

1.2 Integrated Care Organisation

The integration of health and social care has been acknowledged as the way forward, as the means of delivering better care and improving quality and outcomes for citizens, as well as efficiencies across the system. We are holding a public engagement event at the end of this month or early next to engage with the public about Thanet’s move towards integrated care (as we refresh our plan). The event will focus upon Thanet’s broader plan i.e. national context, vision/ thoughts on how we get there and what the public think).

The Thanet Integrated Health and Social Care Agreement, which captures our and our key partners’ commitment to partnership working to deliver improved integrated health and social care for the populations we serve, is now available on our website.

1.3 Personal Health Budgets

The Personal Health Budgets (PHB) and Self-Care workshop took place on 19 November 2015, at the Trinity Resource Centre based in Margate. Approximately 30 people attended the workshop including, a range of service users, carers and GP practices and voluntary organisations.

The objectives of the day were to share ideas on how the CCG and their partners could work together with local people to support self-care effectively and develop proposals to offer Personal Health Budgets from next April 2016 in line with government policy. Learning from the national pilots was shared, with examples of real patient stories who had received one, and a lively debate was had.

During the question and answer session some clear concerns emerged around Personal Health Budgets:

  • The scale of work around Personal Health Budgets.

  • The amount of money needed to support PHBs, including the cost of running scheme e.g. broker service.

  • Allocation of funds, and the potential for a phased approach.

  • Concern that this shouldn’t adversely affect the existing NHS services or the VCS.

There was also so some warm approbation for the idea as:

Important tool for giving patients choice.

  • Money should be targeted at specific groups.

  • Building in a review process as peoples’ needs may change over time.

  • As services become stretched or if there are pinch points this could be used to overcome short term problems for patients and carers.

Mental Health was chose by a clear majority as the most important area of care to support first with PHBs, as it was agreed a phased approach was best to manage the risks and develop a robust process.

There have been two further events in February one with service providers, and on the 18 February an event with patients and the public. To develop plans for how this could be delivered: how to determine who would be eligible, what would be the criteria used, how to determine what people could use the budget on, and what concerns need to be considered and addressed.

There was a great deal of consensus between the two groups about: breadth of access to PHBs for service users, an understanding of the need for clear support for individuals to enable them to access and manage their budget and the importance of evaluating the impact of a budget.

Both groups also understood the need to ensure that all relevant services and support were considered so that there was a clear agreement on why a PHB was the best way forward for that individual and the benefit it offered. Real life case studies have been used to ‘test people’s perceptions and refine our thinking.

All of which will be used to develop the proposals, which will be taken through the internal decision making process and planning in preparation for implementation later in the year.

1.4 Re-procurement of integrated out-of-hours services – east Kent area

Over the last year, patients’ views and experience have informed a service specification for integrating NHS111 and urgent out-of-hours medical care. We are planning further engagement with patients about our plans which include using paramedics to support the out-of-hours home visiting service from 2016.

After a pause pending further guidance from NHS England, the procurement re-started in November. Patients continue to be part of the procurement dialogue and there is a commitment from all four CCGs involved to create a Patients’ Charter in the new year, working with patients and the public to set out their expectations for urgent care services. This will inform and influence the delivery of various services which offer patients help when they urgently need it.

1.5 Kent and Medway stroke services review

Thanet CCG is part of a Kent and Medway-wide review of stroke services, which is looking at the care that people receive immediately after having a stroke (the hyper-acute / acute phase).

The aim of the review is to deliver clinically sustainable, high quality, hyper-acute / acute stroke services for the next 10 to 15 years that are equally accessible to Kent and Medway residents 24 hours a day, seven days a week.

All the clinical commissioning groups in Kent and Medway are part of this review. A comprehensive and robust programme of engagement has been carried out with patients and carers, members of the public, and community representatives including voluntary organisations.

This culminated in deliberative events held in November and December when People’s Panels came together to look at and critically evaluate the work conducted to date, including patient and public priorities and feedback from the clinical group.

Deliberative events are a unique form of public engagement through which participants are recruited to explore an issue in greater detail than, for example, through focus groups.

Participants were presented with key information and evidence and required to scrutinise what they read and heard. And to ask questions of key people and specialists in the field, to give feedback and make suggestions directly to the people in charge of shaping the next stages of the review.

Overall, across all the different forms of engagement for the stroke review, which included listening events, focus groups, a survey and the deliberative events (as well as earlier work carried out in west Kent), people were generally shocked and surprised to find that stroke services in Kent and Medway do not already provide a full seven-day service. And that performance against the national standards for stroke is variable and inconsistent, with improvements not always sustained.

They recognised the importance of:

  • A solution to the current significant workforce shortages in the specialist multi-disciplinary teams.

  • Swift access to specialist high-quality care, seven days a week, across Kent and Medway – inconsistent care due to the time of day or the location of the person having the stroke is not acceptable.

  • Engaging staff throughout the process so they shape decisions about the future model of care.

From the start, some people have suggested there should be fewer sites admitting stroke patients in the hyper-acute phase, and that travelling further is acceptable, depending on how far.

The People’s Panels at the deliberative events, overwhelmingly recognised the need for a reduction in stroke units from the current seven. They voted 49 to 2 in favour.

They also rejected the potential options of: one, two or three sites, and agreed that six sites would not deliver the required improvements. Their preference was for a four or five-site model.

The Clinical Reference Group, which provides clinical guidance and assurance to the review process and its membership, represents all the K&M providers of acute stroke care, advised that models based on one, two sites for hyper-acute stroke care and the status quo should be rejected.

They also recognised that while it would be desirable to have 24/7 hyper- acute care on all seven sites, this was unlikely to be recruitable. So further detailed work should be undertaken on three, four and five site models.

The Stroke Review Programme Board, which oversees the stroke review, accepted this advice.

Work is now going on to evaluate three, four and five site models against key criteria including:

  • Can they recruit and retain enough specialist staff to deliver a seven day service?

  • What will the impact be on different populations? Are any groups likely to be disproportionately affected?

  • Are all three models financially viable and sustainable?

  • Do they support delivery of the national stroke standards for hyper acute and acute stroke care?

  • Can they provide a model that can work towards SSNAP level A.

Recommendations about changes to stroke services will be put forward by the Stroke Review Programme Board to clinical commissioning group Governing Bodies, which will take the final decisions.

The Health Overview and Scrutiny Committee for Kent and Health and Adult Social Care Overview and Scrutiny Committee for Medway have formed a joint committee to review the plans and process used by the stroke review. It met for the first time in January when it approved the work carried out so far. It is expected to meet again in April.

1.6 Community mental health and wellbeing service

Following a joint procurement led by Kent County Council, Porchlight has been appointed the strategic partner for mental health support provided by voluntary organisations in Thanet. It will work with other voluntary organisations to co-ordinate the support available for people with mental health needs.

We are liaising with Kent County Council which is overseeing the mobilisation and communications plans provided by Porchlight. It is very important that people with mental health needs and health professionals such as GPs are provided with the information they need about the new service.

1.7 Wheelchair services

Following a survey with users of NHS wheelchairs which gathered important intelligence about people’s experience of the service, a Kent and Medway wide procurement of the NHS wheelchair service is getting underway. It is overseen by a Wheelchair Project Board, which will include patient representatives.

The draft service specification is being shared widely with wheelchair users and their carers, user groups and clinicians, for their comments and input. The Board intends to ensure that users are consulted, included and engaged throughout the procurement process, which is likely to start formally in April 2016. The new service is expected to start in April 2017.

1.8 Patient Transport Service

We are working with G4S, the new provider of the non-emergency Patient Transport Service for Kent, to assure their communications and engagement plans.

A patient representative from east Kent is part of the steering group, overseeing this work.

1.9 Spreading the word through the media and other communications

2.0 Coverage of the CCG’s work continues to be positive and illustrates the CCG’s wider commissioning intentions.

Since Christmas, the priority for the CCG has been to emphasise that patients shouldn’t use A&E unnecessarily, when other options are available.

There have also been wider communication messages on Twitter, advising people that they should seek other alternatives to A&E if their health concerns don’t represent an accident or an emergency.

The CCG has received other positive coverage in the local media, since the appointment of Dr Jihad Malasi and Dr Sabin Kemal to the governing body.

And in a recent press story about the suicide rate in Thanet, Dr Malasi highlighted the CCG’s mental health work and the he also offered advice to patients about where to seek therapy and emergency support.

Health Help Now, the Kent and Medway vascular review have all received good publicity in the local print, broadcast (radio) and social media.

2.1 Urgent care communications

The CCG has a national requirement to produce an operational resilience and capacity plan. This is to help manage seasonal pressures. As part of the plan for 2015/16, the CCG has developed a communications plan to support key messaging around use of A&E. We are working closely with providers of NHS services and Kent County Council communications on delivery of the plan, and are seeking innovative ways to engage with other organisations in Thanet to spread the word.

A key part of this for us is Health Help Now, the mobile optimised website and app for Kent and Medway.

  • As of 19 February, the Health Help Now web app had been used 106,913 times by people using 80,860 devices (such as smartphones, tablets or computers). Users stay on for two minutes on average. Forty per cent of users are aged 18 to 34, 23 per cent are 35 to 44, 17 per cent 45 to 54, 11 per cent 55 to 64, and nine per cent 65 plus. Two-thirds of usage is by women.

  • The downloadable app, which launched on 9 December 2014, had been used 13,617 times and downloaded 8,358 times. People typically stay on for just over three minutes and look at nine screens.

During the winter break, several press releases were sent advising people to use alternatives to A&E if they had a condition that was not life threatening or an emergency. Press releases were also sent out that advised people they can also receive advice from pharmacists about minor illnesses.

This message was also sent out using Twitter.

The CCG always sends out such releases during peak holiday times (such as Christmas) and bank holidays.

2.2 Dementia awareness

Dementia diagnosis is still a big priority for NHSE and CCGs are still under significant pressure to deliver the 67 per cent diagnosis rate.

In Thanet, as in February 2016, the diagnosis rate is 58.6 per cent.

A press release will be sent W/C 22 February, raising awareness of dementia. The next patient newsletter will feature a lead article on dementia awareness.

Thanet and SKC diagnosis are particularly low, and extra communications emphasis is needed.

2.3 Medicines waste

An audit on the repeat prescriptions service is being prepared by the CCG, and a sub-group of CLT will report on this in March. The Health Reference Group is also being consulted.

In the meantime, it’s hoped that an article on medicines waste will appear in the local press, highlighting medicines waste to Thanet’s population. Similar articles by clinical leads have been well received in the Canterbury and Dover press.

The latest patient newsletter featured an article on medicines waste, from the medicines management lead, Dr Mark Elliot.

The ‘only order what you need’ posters and stickers are still being distributed, and there is no need for extra supplies at this stage.

A leaflet is also being prepared for the CCG, for printing and distribution, that’s designed to advise patients about medicines and how to avoid waste.

2.4 Patient newsletter

The four-page patient newsletter was distributed in January and contained a lead article from Dr Tony Martin about how the CCG is leading on integrated care and its vision for an integrated future.

The newsletter also featured an article about mental health, from Dr Andy Walton, which raised awareness about IAPT and talking therapies. The article also gave contact numbers and advertised the ‘Live it Well’ website. The text also impressed up those who experience depression to be aware of excessive alcohol consumption.

Other text within the newsletter featured advice on COPD from Dr John Neden and an article about medicines waste from Dr Mark Elliott.

The Lay Member for Patient and Public Engagement, Clive Hart, also submitted an article about the importance of PPGs and how to get involved.

The spring newsletter will lead with an article about dementia diagnosis.

2.5 Digital and social media

The CCG continues to use new technologies to better engage and communicate with patients and stakeholders.

The CCG’s Twitter account @NHSThanetHealth now has 2,253 followers, and the quality and quantity of tweets has increased. This has generated more ‘likes’ and re-tweets. There has also been a greater use of more pictures linked to tweets, generating more interest.

Recent tweets include:

Inspiring meeting with Thanet GPs today, working on integration of health and social care, real sense of urgency and passion @ThanetHealth

@ThanetHealth leading the way with #NHS#PersonalHealthBudgets. ow.ly/XTrAj ow.ly/i/gqkge

Don’t let an illness get in the way of Valentine’s Day. Use @NHSHealthHelp Now if you need health advice #Kent#Valentines

Pharmacists can advise you on common problems such as coughs, colds, aches & pains #StayWellThisWinterow.ly/i/gDWx4

Experiencing #depression and #anxiety? Check out the winter @ThanetHealth newsletter for #NHS help and advice. ow.ly/XBcn8

@ThanetHealth - #Ramsgate GP Dr Malasi joins NHS#Thanet CCG - a warm welcome. ow.ly/Xuu1j

We continue to promote Personal Health Budgets with a banner linking to a page with details of our engagement events. A banner has been added to the home page to promote the most recent Health Network newsletter.

3.0 Public affairs and stakeholder management

3.1 Health overview and scrutiny

We regularly update Kent County Council’s Health Overview and Scrutiny Committee (HOSC) on progress. The HOSC oversees the planning, provision and operation of health services under Section 244 of the National Health Service Act 2006 and amendments contained in the Health and Social Care Act 2012.

At the HOSC meeting on 27 November, NHS England and CCGs in Kent presented a report on NHS winter preparations.

Joint overview and scrutiny

A joint Kent and Medway NHS Joint Overview and Scrutiny Committee was held on Friday, 8 January, 2016 to discuss the Specialist Vascular Services Review and the Hyper Acute and Acute Stroke Services Review.

Emotional and wellbeing services for children, young people and young adults

The HOSC has requested an update on the draft service specification for emotional and wellbeing services for children, young people and young adults (0-25) on behalf of all CCGs in Kent.

The update is to include an executive summary of the specifications, key performance indicators within the contract and details of how these would be measured to enable the committee to determine if this is a substantial variation of service. It will be discussed when the HOSC next meets on Friday 4 March.

East Kent Strategy Board

A written briefing was submitted to the 29 January HOSC on the work of the east Kent Strategy Board following a meeting with the chair, deputy chair and group heads in November.

A further update will be provided at the 4 March meeting.

Planning

Along with other accountable officers in Kent, we will be meeting members of the HOSC informally on 2 March to discuss both our 2016/17 operational plan and the development of the Kent and Medway Sustainability and Transformation Plan.

This meeting will help to inform the HOSC work programme for the remainder of the year and beyond.

3.2 Stakeholder briefings

There have been no requests for MP briefings since the last meeting.

Clive Hart