Appendix 1-Consultation Assurance Report

Respite and Short Breaks for People with Complex Needs and Learning Disabilities and/or Autism

A report of communications and engagement strategy delivery for the consultation process assurance

Author: Nicola Black – Senior Involvement Officer – North of England Commissioning Support

Executive summary

This paper is to provide Governing Body members with assurance that the consultation for the Respite and Short Breaks for People with Complex Needs and Learning Disabilities and/or Autism consultation is robust and rigorous. The paper sets out the NHS legal and policy context for significant service change in relation to public consultation and engagement, and the strategies, governance and subsequent activities that have been undertaken throughout the consultation.

It provides background to the communications and engagement subject specific expertise deployed, the governance and partnership arrangements established for consultation programme delivery as well as rationales for activities undertaken.

It demonstrates how the programme deployed a phase of pre-engagement and subsequent formal public consultation – and how the insights gained from the pre-engagement phase influenced the development of credible options for service change that were presented and open to influence during the public consultation.

It also demonstrates how adjustments to the consultation process were made, in line with consultations being a continuous dynamic dialogue and a self-correcting process.

It shows how targeted stakeholder engagement was conducted, in particular in relation to statutory duties to consult with overview and scrutiny committees, and how key stakeholders have been updated.

Finally, it highlights how learning from this consultation process will be carried forward and built upon in order to enhance future phases of significant service change, across the CCGs.

This assurance paper supports the consultation feedback report – which is the output of the strategies highlighted in this paper.

Background to the Respite and Short Breaks for People with Complex Needs and Learning Disabilities and/or Autism consultation

NHS North of England Commissioning Support (NECS) was engaged by the NHS South Tees Clinical Commissioning Group and NHS Hartlepool and Stockton-on-Tees Clinical Commissioning Group (CCGs) to provide expert strategic advice and operational delivery for a programme of engagement and consultation to support the Respite and Short Breaks for People with Complex Needs and Learning Disabilities and/or Autism consultation.

NECS have significant experience in providing end to end service transformation and public consultation, and adopt a continuous improvement approach to constantly learn and refine activity.

This is also in-line with the principle that consultations are a ‘continuous dynamic dialogue’ and are a self-correcting process.

This allows organisations that are consulting with the public to change consultation processes in response to what is heard about the process during the consultation period and to make adjustments.

A key requirement for NHS service change is to meet the NHS assurance framework, planning, assuring and delivering service change for patients.

By doing so, it also provides a robust planning process and NHS local system assurance.

‘Significant service change’ in the NHS must be compliant with specific statute on public consultation, case law, and NHS policy around involving patients and the public in NHS changes. This legal and policy context for the NHS is included in Appendix A.

The consultation plan and subsequent activity included the communications and engagement expertise, experience and skill mix required and budget recommendations to deliver a safe engagement and consultation process.

Safe refers to there being no successful legal challenge, no successful referral to the Secretary of State for Health and subsequent intervention by the Independent Reconfiguration Panel (IRP), and therefore delay to the implementation of service changes and damage to stakeholder relationships.

A communications and engagement plan was produced in summer 2017. It provided high-level NHS legal and policy context for significant service change, and allowed the NHS partners to consider the risks and mitigations involved for a programme of consultation.

There was a three month period of pre-engagement which concluded in February 2017 and the public consultation was due to start in April 2017. In May 2017 a snap election was called, which resulted in NHS organisations being unable to carry out public consultations in the pre-election period. Cabinet Office guidance (known as purdah), and the subsequent summer term holidays, delayed the consultation until the beginning of September 2017. Due to the length of the pre-engagement, the Joint Health Overview and Scrutiny Committee at a meeting in July 2017, agreed to a 10 week consultation commencing after summer term holidays. The formal public consultation period was able to start on 4 September 2017 and was planned to take place over 10 weeks.

Engagement and consultation governance

The development and implementation of the consultation plan and related consultation dialogue activity with the public and stakeholders, was overseen by the Respite Task and Finish Group (RTF), which is now known as the Respite Steering Group (RSG) and a consultation working group was set up to manage the development and implementation of the consultation process and related consultation dialogue activity with the public.

The RSG oversight included:

Overview of communications and engagement plan development including sign off
Equality impact analysis and assurance
Sign off of key documents including the pre consultation needs and responsibility document and consultation publications.

Consultation working group

A consultation working group was established with representation from the RSG to manage and oversee the development and implementation of the consultation process and related consultation dialogue activity with the public.

The scope of the consultation working group included areas such as:

Development and implementation of a communications and engagement plan
Budget oversight and management

Suppliers and resources
Identification, and mitigation, of risk related to consultation
Compliance to legal duties, local and national policy, guidance and mandated requirements
Dialogue communications and engagement activity
On-going equality analysis and assurance throughout the consultation.
Targeted engagement where necessary to ensure that people from groups with protected characteristics are fully engaged in a way that is accessible to them
On-going analysis and identification of under-represented stakeholder groups and targeted engagement to ensure they have the opportunity to participate.

Engagement and consultation methodology

Pre-engagement – December 2016 to February 2017

A communications and engagement plan was developed for the pre-engagement phase, often known as the listening phase and the objectives were to seek views of the following:

what respite means to different people (for example people with learning disabilities, families, carers and providers of services etc.)
who benefits and how
what works well with current services
what needs to improve
how could services be delivered differently in the future to ensure that they fully meet the needs of those using them, in the most appropriate way
how do people receive support in an emergency
how services work together (including transport)

Engagement activity included:

a work placement for two people with lived experience to support the facilitation of engagement and to aid the involvement of other people with learning disabilities
surveys for families and carers
discussion groups across the CCG areas led and facilitated by independent voluntary sector organisations, with expertise in supporting people with learning disabilities, their families and carers
collection of information about people’s experiences of respite
distribution of information and engagement materials to relevant stakeholders including stakeholder briefings sent to relevant stakeholders
CCG and NECS attendance and discussion at Learning Disability Partnership Boards and other relevant public meetings including Tees Valley Joint Overview and Scrutiny Committee

Provisions were made to ensure that engagement activities were effective and accessible to people with learning disabilities, their families and carers. This included working closely with local service user self-advocacy groups who have appropriate knowledge, skills and experience of working with people with learning disabilities, complex needs and families and parent carers. Information was produced in easy read format and made available in a wide range of forums.

The pre-engagement was also supported by two people with lived experience. The two roles were integrated into the project at different stages and their responsibilities included supporting the CCGs to involve people with learning disabilities, by interpreting feedback given by people with learning disabilities and their families and carers about the respite services they use. This was done by analysing the information and feedback to collate the main themes from the completed questionnaires that were given to service users and their families and carers as part of the pre-engagement activities.

Their full duties included:

Collating completed questionnaires
Inputting information from the questionnaires onto a database
Ensuring that the information was kept in order on the electronic system
Analysing information and developing main themes
Writing reports
Taking notes at meetings and events, which included people with learning disabilities and their families and carers talking about their experiences and what they think about respite services
Typing up the notes from meetings and events
Developing and implementing information and leaflets into Easy Read for people with learning disabilities

The individuals became active members of the Consultation Working Group supporting them with various programmes of work. They were able to provide advice on communication materials such as the pre-engagement findings report, produce a summary newsletter from the pre-engagement feedback report and email out to individuals who expressed an interest in the pre-engagement, by ensuring they were kept up to date on the progress of the project. They also attended and participated twice at the Respite Steering Group, multi-agency meetings and in addition worked on data for Transforming Care.

The placements were for 6 months and feedback from the individuals and their mentors was very positive, with one individual gaining the confidence to move into a permanent position within a GP surgery.

Inclusion North were commissioned to co-ordinate and quality assure a series of sessions which were facilitated by relevant voluntary and community sector organisations to ensure that the CCGs actively listened to the views of the people who participated.

Information from the pre engagement

In total 206 points of contact were made with individuals throughout the three months of pre-engagement with 86 people completing the questionnaire and 18 discussion groups held across the Teesside area. A breakdown of participants by engagement activity is shown below:

A full report on the feedback from the pre engagement was produced for the CCGs Executive group meetings and presented to the Learning Disabilities Partnership Board and various carers groups. It was also published on the CCG websites, shared with services users and their families and carers, together with key stakeholders and presented to the Joint Health Overview and Scrutiny Committee. A summary newsletter was also produced and shared with families and carers.

The findings from the pre-engagement report assisted with options development, in particular being mindful of ensuring options were credible, robust and presented to the public in the consultation at a formative stage and were open to public influence through the process of public consultation in line with Gunning principle one.

From the pre engagement report findings, people have told the CCGs:

Emergency situations mean that their respite stays are disrupted or sometimes emergency care and support has not been easily available
There needs to be a range of responsive options available for planned and emergency respite needs

Some people use bed-based respite services and day services at the same time. This duplication is costly to the NHS. We think that there is a better way to meet people’s needs to make sure that they have the best opportunity to achieve personal outcomes
We need to make sure that people get the support that they need to manage personal budgets and still create opportunities for people to access different types of service even if they do not want to take personal budget payments
Having access to some bed based respite services is important
Children and young people with learning disabilities and complex needs who are reaching adulthood have different expectations about options that should be available and need to receive services that meet their needs
Respite for people with learning disabilities and complex needs is limited. People have told us that there needs to be more choice and better facilities. More innovative options need to be considered and developed for individuals to make sure their needs are met with the person truly at the centre of their own support
It is important to have flexible and responsive services to meet the personal needs and preferences of the people who use them and their family Carer(s) and that this needs to be fair. Confidence in the qualifications and competency of staff is also very important
Transport between bed-based respite provision, day service facilities and home limit the options that might be available to people. People have told us that transport arrangements need to be improved.

How engagement phase feedback influenced options development

Feedback from what people told the CCGs in the pre engagement included the importance of choice and the flexibility of services to meet the challenging needs of individuals and to provided crisis and emergency responses was used to develop a number of possible scenarios for the provision of respite services for people with learning disabilities and complex needs in the future. The information, research on other models, market engagement and informal engagement findings were also utilised.

These scenarios were ideas about how Learning Disability respite services could be further developed or potentially delivered differently to best meet the needs of the local population and to support with delivery of collective commitments under the Transforming Care agenda.

There were seven scenarios which were evaluated, and the following table shows the appraisal criteria that was used to evaluate the seven scenarios.

Two scenarios met all the criteria and these were put forward as options and presented to South Tees CCG and Hartlepool and Stockton-on-Tees CCG, where it was agreed in principle that the options were likely to result in a substantial change for the provision of respite services for people with Learning Disabilities and complex needs. For this reason the CCGs confirmed that formal public consultation would be required.

Consultation phase communications and engagement plan

Drawing upon all the pre-engagement activities and findings, an underpinning communications and engagement plan was developed for the consultation phase and shared with Joint Health Overview and Scrutiny in July 2017. The objectives were:

To effectively engage the local population, partners and other stakeholders including people with learning disabilities, their families and carers
To give the local population, partners and stakeholders including people with learning disabilities, their families and carers, the opportunity to consider and comment on the options for change
To use the comments and feedback to inform consideration by the CCGs as to how they should provide respite services for people with learning disabilities, their families and carers
To inform CCGs commissioning responsibilities in relation to, and the procurement of, respite services for people with learning disabilities, their families and carers
To ensure that the consultation is accessible to local people, patients, partners and key stakeholders, and people with learning disabilities, their families and carers. That they are aware of the consultation and have the opportunity to participate fully, should they wish to do so.

Communications activity included social media, digital marketing, a dedicated stakeholder bulletin, media releases to support promotion of the consultation. Analysis of this activity is included in Appendix 1B.

Consultation phase methodology – March to September 2017

Building upon the plans developed in the pre-engagement phase, the respite steering group recommended that an accessible consultation methodology was used, with the specific purpose to ensure compliance with the Gunning Principles, contained in Appendix 1A, and ensure opportunities for the public to influence the outcome of the consultation.

Because of the change in timescales due to the lengthy pre engagement and delay due to the snap general election, the group recommended that the consultation period ran for 10 weeks, from 4th September 2017 to 10th November 2017, after the summer holidays. This was also to ensure there was ‘adequate time for the proposals and issues to be considered and responded to’ as per Gunning Principle three. This timescale was supported by the Joint Overview and Scrutiny Committee at a meeting in July 2017, where the communications and engagement plan together with the high level options for consultation in the form of a draft consultation narrative was shared for views and feedback.