NHS Thanet CCG Communications and Engagement Progress Report - March 2018


Here's a copy of the Thanet communications and engagement update that I will be presenting to my colleagues at the CCG Governing Body meeting this afternoon.

Many thanks to Emma Burns and Sara Warner of NEL CSU 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 Engagement Clive Hart has continued to promote and encourage public participation in local health matters.

Clive regularly attends Thanet Adult Strategic Partnership, Thanet Local Children's Partnership Group, and Thanet Health and Wellbeing Board, and thereby maintains close working relationships with third sector and statutory organisations supporting and caring for residents of all ages across the district.

Thanet Health Reference Group, which Clive chairs, continues to bring together the leaders of GP practice patient participation groups (PPGs) to support Thanet CCG and to help individual PPGs spread good practice through the regular networking opportunity. This two-way engagement process is proving beneficial to all parties concerned and is well attended.

Thanet Health Network is being used increasingly to inform members of the growing number of public engagement opportunities being planned as part of changes to local care and the wider work to transform health and care services in Kent and Medway. Clive also makes sure members are kept right up to date with fast moving changes through a monthly bulletin.

Since the last Governing Body meeting, Clive has attended and supported two local Esther Café sessions in Westgate and Birchington covering mental health issues. The informal Esther Cafes are proving to be a very informative form of engagement at a very practical and local level.

He attended the first Thanet public consultation meeting on the stroke service review, held at Margate Football Club on Monday 26 February – the day the snow began. Despite appalling weather conditions on the night, Clive was pleased to see a 'full house'.

At east Kent level, Clive met with fellow Lay Members from Canterbury and Coastal, South Kent Coast and Ashford CCGs and the new Managing Director for East Kent, Caroline Selkirk, to discuss engagement matters and local care projects.

Clive and Ana Nacif (Lay Member for Canterbury and Coastal) share attendance at East Kent Programme Board meetings in relation to engagement matters.

At Kent and Medway level, Clive attended meetings of the Kent and Medway Sustainability and Transformation Partnership’s Patient and Public Advisory Group meetings in Rochester and Faversham and now also supports the STP’s Communications and Engagement work stream.

The Kent and Medway stroke consultation is now underway and Clive is using social media to promote the project as a whole, the associated survey and the public listening events.

  1. Local care

The integration of health and social care has been acknowledged as the means of delivering better care and improving quality and outcomes for citizens, as well as efficiencies across the system.

Esther Cafés are relaxed and informal events which provide an opportunity to hear first-hand people’s experience of using local services, and a chance for them to contribute their ideas and feedback.

At the end of January, two Esther Cafés were held, one in Westgate-on-Sea and one in Birchington. These focused on mental health and were well attended, with representation from mental health organisations, carers and families who look after and support someone with mental health. There were also some representatives of GP practice patient participation groups (PPGs) and interested members of the public. We had some interesting discussions about mental health services, with the main focus being on communication, support and information for carers and families and local mental health services. Any feedback received will support the ongoing implementation and development of local mental health services.

Our next Esther Café will be in May and more details will be sent out soon.

All of the stories and insight we gather from local people will help staff to improve the delivery of local services and the Thanet local care model, as well as shaping the work of the Kent and Medway Sustainability and Transformation Partnership in east Kent. We would like to thank all those who took part: it was a helpful learning environment for everyone involved.

1.3 Thanet Health Reference Group (HRG)

The HRG met on 6 February 2018, when a presentation was given by Tracy Dumbarton, the mental health lead for local care. The main focus for 2018 is to employ five mental health workers to work with Thanet GP practices and to start to build multi-disciplinary teams, which will include mental health. The group also had a lengthy discussion about the proposed stroke consultation options. The main focus was travel times and William Harvey Hospital being the only option for east Kent. Two or three of the PPG representatives will be visiting the GP out of hours service/111 call centre, which is provided by IC24.

The next Health Reference Group meeting is on Wednesday 11 April, between 10am and 12 noon, at Thanet District Council offices. At this meeting it is hoped we will be able to discuss the local care model for Thanet.

1.4 Transforming health and social care in Kent and Medway

The independent analysts’ final report on the summer’s listening events has been published on the STP website and shared with all the work streams to make sure that patient and public views are able to inform and influence the work currently in development. To see the full report please use the link below:

https://kentandmedway.nhs.uk/latest-news/new-reports-published-listening-engagement-events

Better Together, a conference on mental health, is due to take place on Tuesday 13 March, from 9am until 4.30pm at the Mercure Maidstone Great Danes Hotel. Billed as a collective conversation transforming mental health and wellbeing, the conference has had a positive response: all 320 places are booked and there is a waiting list.

The Kent and Medway Patient and Public Advisory Group (PPAG) meets monthly. In February, Glenn Douglas, Chief Executive of the Kent and Medway Sustainability and Transformation Partnership (STP), came to update members on progress, hear our views and answer our questions.

He spoke about how the CCGs across Kent and Medway are considering how they might work more effectively together to support strategic work across Kent and Medway, and share learning - for instance, in west Kent the CCG has piloted a new contracting approach with NHS partners, called an aligned incentive contract, which could be an important building block for the Sustainability and Transformation Partnership.

He discussed the important role of local authorities, both at county and district level, in making transformation work, supporting the NHS to take a more holistic approach for individuals’ care, and for keeping communities active and well.

Most of the individual PPAG members have now joined one or more of the STP work streams to champion consideration of patients, carers and the wider community’s experiences and views within their work. Clive Hart recently joined the Communication and Engagement workstream, which is currently largely concentrating on the Kent and Medway wide stroke consultation.

1.5 Plans for east Kent

In east Kent, we are looking at how local health and care services can be delivered in a more joined-up way. These will help people get care that looks after them as a whole person, rather than treating their different conditions separately. It will also mean people can get more care and support in their local community, with more services provided at some GP surgeries, community hospitals or other bases.

A ‘Design by Dialogue’ event on Thursday 22 March at Spitfire Ground St Lawrence, Old Dover Rd, Canterbury CT1 3NZ will look at these questions in detail, listening to local people’s perspectives, and sharing ideas and information. Refreshments will be available from 6pm and the meeting will run from 6.30pm to 9pm.

The event will be led by Caroline Selkirk, the new Managing Director for East Kent, with a panel of leaders from across health and social care.

The aim is to create a shared understanding of the challenges and opportunities we all face around health and care, as a start of working together in a way that ensures collective action can make a positive difference to the health and care of people across east Kent.

To register for this event please email nelcsu.engagement@nhs.net

1.6 Stroke consultation across Kent and Medway, and parts of south London and East Sussex.

The clinical commissioning groups in Kent and Medway are leading a consultation on improving urgent stroke services.

It is asking for people’s views on proposals to establish new hyper acute stroke units providing 24/7 care from specialist stroke teams for people in the vital first 72 hours after their stroke. Where they have been introduced elsewhere, hyper acute stroke units have been shown to save lives and reduce disability. Each would have an acute unit (for care after the first 72 hours) and TIA clinic (for people who have had a “mini-stroke” or transient ischaemic attack) on site.

Currently there are no hyper acute stroke units in Kent and Medway. The proposed new units would be staffed by specialist teams made up of consultants, therapists and nurses, offering specialist care 24 hours a day, seven days a week with access to brain scanning equipment and clot-busting drugs (thrombolysis). The units would have enough staff to review scans and provide thrombolysis swiftly, with consultant ward rounds at least once a day, seven days a week. People would be admitted directly to the unit avoiding waits in A&E, meaning patients and carers get fast, high-quality care and the information and support they need.

The proposals recommend creating three hyper acute stroke units in Kent and Medway, and give five different options for where these three new units could be located. If the proposals go ahead, urgent stroke services would not be provided in other hospitals in Kent and Medway.

A formal joint consultative committee with Bexley and High Weald Lewes and Haven has been set up with delegated authority from the CCGs to jointly consult and decide on the future of stroke services. This will be mirrored by a joint Health Overview and Scrutiny Committee to scrutinise the process and decisions made.

The consultation runs from Friday 2 February 2018 for 10 weeks until midnight on Friday 13 April 2018.

A wide range of information, including a full version and summary of the consultation document, details of public meetings and events, frequently asked questions, as well as detailed supporting documents considered in developing the proposals, is available on the website: https://kentandmedway.nhs.uk/stroke/

People can respond by completing the questionnaire online at https://kentandmedway.nhs.uk/stoke-consultation-questionnaire/

or sending in your views to km.stroke@nhs.net, attending a meeting, or inviting us to come to one of your meetings to listen to your views.

Printed copies of the consultation documents are widely available at GP practices, hospital waiting rooms, and community centres.

There are three meetings being held in Thanet (including one on Monday 26 February in Margate and one on 7 March at Minster Village Hall) as well as others across east Kent.

Events still to come are on:

Saturday 24 March, 10 am to 12.30pm at St Peter’s, Broadstairs, Thanet

Wednesday 28 March, 6.30pm to 9pm at Westgate Hall, Canterbury

Wednesday 4 April, 10am to 12.30pm at Singleton Environment Centre, Singleton, Ashford.

Friday 6 April 1.30pm to 4pm at St Mary's Bay Village Hall, St Mary's Bay, Romney Marsh.

Each of the stroke events will also include the opportunity to find out more about wider plans for east Kent, and to help shape a more joined-up approach to the delivery of health and care services in east Kent.

1.7 Proposals for acute (main) hospital services in east Kent.

Further priorities in east Kent are to improve urgent, emergency and acute medical care including specialist services, and planned orthopaedic surgery.

In November 2017, a joint committee of east Kent clinical commissioning groups agreed to evaluate two proposed options for the future of urgent and emergency care, and six for the future of planned orthopaedic surgery.

The second potential option for urgent, emergency and acute medical care has been included because a private developer has offered to donate to the NHS land and the shell of a new hospital, as part of a development of 2,000 new homes, which includes an access road from the A2. It would be subject to planning permission.

There is a lot of detailed work being undertaken to consider those potential options in more detail before they are assessed against a set of evaluation criteria, which have been developed and tested last year with a wide range of people.

To help influence the next stage of the evaluation process a brief, single question, survey was designed to allow patients and the public to tell us which of the set of six agreed evaluation criteria they believe to be the most important. This was to help those responsible for the final evaluation of the medium list of options to prioritise or weight the final criteria when establishing the short list of options to consult upon.

The link to the survey was shared with the Thanet Health Reference Group and Thanet Health Networks, and similarly in the other east Kent CCGs. It was also publicised through each of the four east Kent CCG websites and the Kent and Medway STP website. Our NHS partners in East Kent Hospitals University NHS Foundation Trust (EKHUFT) also cascaded the survey link to the patient governors, staff and their membership. All participating groups were encouraged to cascade this to their own social and professional networks.

Between Friday 19 January 2018 and Friday 16 February 2018, 600 survey responses were received, including 31 paper-based responses collected by EKHUFT. This is a good response rate for a survey or poll that is not aimed at a specific patient group, and does not ask respondents to comment on their personal experience of service delivery.

Over 97 per cent of respondents selected their top three evaluation criteria and indicated rankings.

Quality of Care for All was ranked as a first choice by 318 people, 54 per cent of those respondents giving rankings, with Access being the second highest ranked, and workforce third. These three criteria were consistently in the top three choices.

1.8 NHS England public consultation on reducing over-the-counter (OTC) prescriptions

On 20 December 2017, NHS England launched a public consultation on reducing prescriptions for 33 minor, short-term health concerns. It runs until 14 March 2018 and builds on the earlier national consultation on reducing spend on ineffective medication and medication which can be provided more cost effectively.

Last autumn, the four east Kent CCGs responded to the national consultation to tighten guidance on prescribing in primary care on 18 specific items, including medicines which are widely available to buy without a prescription from shops and pharmacies.

The CCGs ran a public survey between 11 September and 2 October 2017 to inform their response to the national process. In total, 378 responses were received, 288 via the on-line survey and 90 as paper-based responses posted to the Freepost address.

Eighty six per cent of the 361 people who gave their opinion strongly agreed or agreed with the proposal to restrict prescribing medicines that are widely available through shops and pharmacies without prescription and only four per cent strongly disagreed. It was noticeable that the proposal was supported strongly by 84 per cent of respondents who currently receive free prescriptions.

Ninety three per cent of 300 respondents agreed with the proposal to change guidance for medicines that are ineffective or can be dangerous, or where other more effective, safer or cheaper alternatives are available.

The qualitative data or comments submitted also showed strong support for the proposals and that generally, where items can be bought more cheaply than paying a prescription charge, they should always be bought.

There were some specific personal examples given where that was thought not necessarily to be the case: where either the need is repetitive and for long-term use, and/ or where these items are costly, for example, certain skin creams and eye drops.

Background

Last year in just six months, the NHS spent approximately £569 million nationally on prescriptions for medicines for minor conditions, which could otherwise be purchased without a prescription from a pharmacy and/or other outlets such as petrol stations or supermarkets.

These prescriptions include items for conditions:

  • considered to be self-limiting and so not needing treatment as they will heal or be cured of their own accord

  • which lend themselves to self-care.

The spend also includes items:

  • that can be purchased over the counter, sometimes at a lower cost than that incurred by the NHS

  • for which there is little evidence of clinical effectiveness.

By reducing spend on treating conditions that are self-limiting or which lend themselves to self-care, these resources can be used for other higher priority areas that have a greater impact for patients, support improvements in services and deliver transformation that will ensure the long-term sustainability of the NHS.

To find out more please follow this link: https://www.engage.england.nhs.uk/consultation/over-the-counter-items-not-routinely-prescribed

1.9 Care closer to home

The east Kent clinical commissioning groups’ (CCGs) strategic vision for the prevention and management of long term health conditions is to have integrated ‘Tiers of Care’ pathways across east Kent. This is to ensure that patients have continued access to combined services, including prevention for those at risk, diagnosis, complex management, management of complications, inpatient care and end-of-life care; with an aim of reducing both the current increasing prevalence of long term conditions and the negative effects of these conditions on the lives of patients.

The intention is to shift the balance of how some of these services are delivered so there is a more effective use of the expert staff in all of the tiers of care (set out below), so that overall the NHS provides a more joined up service closer to home for patients and their families.

  • Tier one – primary care

  • Tier two – community services/secondary care/GPs with a special interest

  • Tier three – acute services

The first services to be piloted are rheumatology, respiratory and cardiology.

The “Care Closer to Home” survey was developed with commissioners to evaluate service change. The first round of data collection will establish a baseline of patient experience of existing services, before any changes are implemented. A second survey will be run in six months’ time, once changes are made and new services are in place, to evaluate the impact in terms of patient experience of care delivered differently.

The survey was completed by patients while attending a variety of outpatient and follow up appointments from late October to December 2017. The survey was also available via an online questionnaire and a freepost address provided – should patients prefer to complete it at home. The survey consists of 17 questions focusing on the quality of service delivered, important aspects of their care and what (if any) improvements patients would like to see.

In total, there were 210 responses from patients across all three services in east Kent. In the main, patients are very happy with the current level of service provision and praised the professionalism and friendly attitude of staff. They also commended the information given and the time staff gave them to discuss issues such as medication.

When asked about improvements to the service: in cardiology the start time of the clinics were questioned, in rheumatology, 53 responses were received. The majority of comments mentioned the punctuality of staff, and the waiting time in clinics. Another common theme was the amount the healthcare professional knew about their specific history, with some comments mentioning new or temporary staff knowing little about their state of health. Thirty two people commented upon respiratory services: the most common theme was the waiting times for outpatient clinics and the length of time from referral to appointment bookings. Also notable was the dissatisfaction among respondents about how long they waited for test results.

A full report will be reviewed by the commissioning leads.

2.0 Patient and Community Engagement Indicator

Over the summer, NHS England undertook a desktop review of clinical commissioning groups’ work to engage with the people and communities they serve.

This review consisted of assessing CCG websites to see how accessible and clear the information and layout are. This assessment was carried out as part of the Patient and Community Engagement Indicator.

NHS Thanet CCG did really well by achieving a rating of green, and was the only CCG in the county to achieve this.

2.1 Market engagement event: the future of children and young people’s emotional wellbeing and mental health collective and collaborative models in Kent

On Monday 29 January, the East Kent Children’s Team ran a market engagement for voluntary and community organisations which work with children and young people. The focus of the event was emotional wellbeing and mental health and to look at ways of collaborative working.

This was the beginning of working together and the hope is to continue the discussions and to engage more with the schools across Kent.

2.2 Looked After Children and Community Paediatrics Development Days

Last year, the East Kent Children’s Team asked the Royal College of Paediatrics and Child Health (RCPCH) to assess the services for children and young people across east Kent, specifically looked after children and community paediatrics. They found there needed to be more collaborative working between provider and commissioner.

The East Kent Children’s Team response to this was to run two development days, one focusing on looked after children and the other on community paediatrics. Both of these were attended by staff from across the NHS and local authorities. The biggest challenge highlighted at these events was communication. There were examples of poor communication between organisations due to differing computer systems, and of poor communication between staff and families. It also identified that families aren’t aware that NHS and local authorities have different computer systems and find it frustrating to tell their story more than once.

The next steps are to continue these open discussions and to work through the recommendations made by the RCPCH.

3.0 Spreading the word through the media and other communications

Since the last report, the work of the media and communications team focused heavily on winter messaging via social media, the CCG website and news releases. This included promoting self care such as having a stocked medicine cabinet, getting repeat prescriptions in plenty of time and speaking to a pharmacist to get the best help and advice, signposting where minor injury units are in east Kent, reminding people to think twice before going to A&E, publishing and promoting the east Kent winter patient newsletter which highlighted how to stay well during the winter months, promoting the Stay Well This Winter campaign and urging Thanet residents to take up their flu vaccinations especially for those in at risk categories.

In addition, there was promotion of the antibiotic resistance campaign, One You Kent including local health walks and staying fit generally, Dry January, Stoptober, Time to Talk Day and mental health in general and Kent Community Health NHS Foundation Trust’s Home First scheme.

The stroke consultation and the proposed £6.5million extension to Bethesda Medical Centre in Cliftonville to create a state-of-the-art health centre for Margate have been the focus of much of the media and other communications work this year so far.

Planning permission is currently being applied for the work at Bethesda from Thanet District Council and, if approved, it is hoped the new centre will open in two years’ time, in 2020.

The plans are to create a new “one stop shop” for people in Margate which can cater for up to 32,000 patients, allowing them to get all the medical and nursing services they expect in much more modern and accessible space.

Looking forward, work is underway to put together a local care story for east Kent which Thanet will feed into. The plan is to have a video aimed at the public, to give the local story showcasing initiatives and services in each CCG’s area. As part of this work, a wider narrative around local care is being developed looking at where we are now, where we want to get to and what needs to be done to get to that point.

All media releases and other communications continue to be shared with partner organisations as we move towards greater integration of care.

The promotion of the Health Help Now website and app continues in both traditional media and social media.

3.1 Urgent care communications

The CCG has a national requirement to produce a system resilience plan. This is to help manage seasonal pressures. The communications element of this plan aims to encourage people, particularly people over 65, to seek early advice from their pharmacy, based on the national Stay Well This Winter campaign messaging. It also promotes flu vaccination, and the use of Health Help Now, our mobile optimised website and app which gives clinically approved advice about self-care and which service to use for a range of common conditions, with links local services and opening times, based on the NHS 111 Directory of Services. Health Help Now links through to WaitLess, another local app that shows waiting times for locations that can treat minor injuries.

We have been working with all our partners this winter in a more co-ordinated way than ever before to ensure people get consistent messaging from all our channels, and reduce pressure on the east Kent Accident & Emergency departments.

NEL Commissioning Support Unit successfully obtained funding from NHS England to support this work. This was spent on:

Use your pharmacy campaign:

Facebook advertising - 64,000 people reached

Twitter posts - 93 posts to 10,672 audience, 39,000 impressions on Google marketing.

Adverts across Kent Messenger print series: four weeks advertising, six editions, total circulation 90,136.

Bus adverts: 40 bus rears across east Kent

Practical Guide to Healthy Ageing in East Kent – booklet with advice and directory for older people in east Kent which is currently being finalised prior to distribution.

We also produced a:

  • GP resource pack: posters and digital assets sent to 82 east Kent GP practices

  • east Kent winter newsletter in GPs surgeries: 5,000 copies across 82 GP practices.

East Kent Hospitals ran a campaign to promote use of minor injury units, which we and other partners supported, further distributing their leaflet and messages.

A key part of our work to help people understand which service to use is Health Help Now, the mobile optimised website and app.

As of 4 March 2018, the Health Help Now web app had been used 333,333 times by people using 279,304 devices (such as smartphones, tablets or computers). Users stay on for just over one minute on average. Forty one per cent of users are aged 18 to 34, 25 per cent are 35 to 44, 16 per cent 45 to 54, 10 per cent 55 to 64, and eight per cent 65 plus. Just over 70 per cent of usage is by women.

The downloadable app, which launched on 9 December 2014, had been used 68,431 times by 25,538 visitors. People typically stay on for almost three and half minutes and look at 12 screens.

3.2 Patient newsletter

The spring patient newsletter is being drafted.

3.3 Digital and social media

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

Website use:

  • Page Views – 8,655

  • Unique Page Views – 6,452

  • Organic Search – 1,222

  • Direct search – 566

  • Referral – 55

  • Social - 38

Top 5 pages

1. http://www.thanetccg.nhs.uk/contact-us/

2. http://www.thanetccg.nhs.uk/about-us/

3. http://www.thanetccg.nhs.uk/about-us/governing-body/

4. http://www.thanetccg.nhs.uk/services/

5. http://www.thanetccg.nhs.uk/health-network/

Web Updates

• Papers for Kent and Acute Stroke Services Joint Committee - News Article and Amended Stroke Review section with link to papers

• Fair processing notice - Updated information on respective sites

• Stroke Review - Amended pages with updated information

• Contact us page - Restructured page with new Google Maps and child page for Thanet GP Practices

• Stroke Services Web Banners

• Stay Well Campaign Report - Provided stats from Google Analytics on how well the Stay Well Campaign performed

4.0 Public affairs and stakeholder management

4.1 Health Overview and Scrutiny

At the HOSC meeting on Friday 26 January we presented briefings on transforming health and care in east Kent, financial recovery in east Kent and east Kent out of hours GP services and NHS 111.

At the HOSC meeting on 2 March we were due to present briefings on children and young people’s mental health services, all age eating disorders service, patient transport service and the Kent and Medway integrated urgent care service procurement.

There were also to be written briefings on the Kent and Medway strategic commissioner and a further update on the east Kent out of hours GP service and NHS 111.

However, because of bad weather, the meeting was cancelled and the agenda will be carried forward to the next HOSC meeting on Friday 27 April 2018.

4.2 Stakeholder briefings

There has been one request from the Department of Health for a briefing since the last governing body report. This related to individual funding request (IFR) processing and whether there were any delays. Having checked with the IFR team we responded by saying that we were not aware of any backlog in the IFR system for any of the Kent and Medway CCGs.

Clive Hart