Healthwatch Stakeholders Event

6 February2015

Aims of the stakeholder event

  • Our partners understand, support and agree to respond to our programme for 2015/16
  • Stakeholders identify where Healthwatch can add value to existing patient experience and patient engagement programmes and tangible mechanisms for impact
  • Healthwatch is taken seriously by the statutory sector while also being recognised as independent and community led

Outcomes

  • Stakeholders contribute to the development of the Healthwatch work programme for 2015/16, identify areas of joint working and build in opportunities within their own organisations to ensure impact.
  • Named individuals from partner organisations have agreed to work with us on projects and to identify best mechanisms for ensuring impact.
  • Stakeholders endorse the community intelligence gathering programme and agree to a follow up workshop in August that would review the evidence gathered by the community and develop a joint recommendations report for the CCG, JSNA and Health and Wellbeing Boards and Health Scrutiny.
  • Organisations have agreed to support the CIB programme either in cash or in kind through supporting the peer researchers training
  • Stakeholders agree to promote the Healthwatch rating system, to put the widget on their own sites and to promote the widget to their service providers

Outputs

  • Draft work programme with activities for 2015/16 to sent to the Board next week for comment following input from event
  • Report from the event set out key agreement from stakeholders on how they will work with us and respond to Healthwatch workstreams and circulated to attendees for agreement
  • Community Intelligence Bursary (CIB) advertised in the next two weeks
  • Peer researchers project to be developed with additional input from event

Workshop 1Barts Health

Facilitators -Dianne Barham and Lindsey Williams

Current Project Idea

Proposed patient shadowing project involving patients filming their journey through a care pathway - a visual record of a patients experience focusing on barriers and blockages.

Display the final images in a poster format as well as animated style video. Possibly have a patient focus group and a staff focus group to reflect on the visual feedback and provide their own experience and comments on how they think things could be improved.

Key is being clear about desired impact at the outset. How will it/can it improve services/patient experience. Need to ensure good quality analyses of the results

Outcomes

Improve the clinical journey / Improve patient experience and outcomes
Streamlining the service to improve waiting times or quality of care, reduce the number of appointments needed etc., / Identify emotional barriers and blockages. Where is the tipping point where the overall experience becomes a bad one? Outcome is patients are happy, they understand what’s happening and why, they feel listened to. They have realistic expectations and those expectations are met.

Could feed into:

  • Staff training
  • Co-design of services
  • Patient video to the Barts Board and the CCG Governing Body

Stakeholder Input

CCG Look at how it feeds into patient CQUIN. Ask CCG programme leads for specific areasof focus. Requires good quality analyses and consideration of how it fits into the commissioning process

BartsNeeds to inform changes to services. Need to talk to CAGs and directors of nursing. Possibly look at outpatient areas and discharge. Learn from great expectations work.

Health and Wellbeing Boardconsiderhow we might develop patient measures for considering whether the system is ‘working well’ for residents.

HealthwatchTrying to identify the tipping points for patients? When does the experience become a bad experience? Where are the emotional barriers and blockages? Are they different for different members of the community?

Next Steps

  • Further develop the project in light of today’s feedback with examples
  • Circulate project proposal to key stakeholders – Barts, CCG, LBTH
  • Barts/CCG to review CQUIN for possible target areas
  • Final project proposal mid March
  • Meeting to align the needs and identify the impact

Current Project Idea

Analysis of patient feedback gathered through regular Royal London outreach sessions informs a focused Enter & View visit programme to service areas of concern

Healthwatch members felt that Barts staff were not welcoming to the Enter and View authorised members and tried to control how the visits were conducted.

Barts has different contractors for different departments so it is difficult to hold them to account e.g. Carillion.

Agreed that the Enter and View Programme might also focus on areas highlighted in the CQUIN Dashboard. Undertake more thematic visits across multiple sites and provide individual as well as thematic reports.

One suggestion was that we visit a range of wards and clinics within an 12 hour period to look at the issue of food and nutrition. Do people have access to adequate food when they need it?

We might also link the Enter and View visits to the video project to investigate key themes further.

Be clear about what we want to achieve from the Enter and View Visits.

Workshop 2GP Access

Facilitators – Emma Cassells and Beverley Annan

Accurately understanding the issues

  • Do we understand the bigger picture e.g. Where access is poor, what are the issues behind that? Data we have can be anecdotal and not a true reflection of whole system.
  • Patient Participation Groups vary in quality- some active and some not so active, different levels of participation contribute to group effectiveness
  • Change of GP staff- practice managers, receptionists etc.- lack of continuity, understanding on issues at the practice
  • Varying perceptions of GP e.g. family GP- leads to lack of confidence around confidentiality for some people- affecting people going to GP
  • Lack of network cohesion between GPs- different operating systems may lead to one GP practice having better care than others
  • Lack of understanding of those with complex needs e.g. people with learning disabilities, LGBT community. People not getting the support that they need- 10 minute appointment not enough to understand, diagnose treatment.
  • Communication- those who can’t communicate are ignored e.g deaf, those who don’t speak English
  • Being registered to a GP but not in Tower Hamlets- have people been forced or is it personal choice to go elsewhere

HWTH adding value and avoiding duplication to ensure impact

  • Amend HWTH data collection forms to gather evidence- more scientific data from the community
  • Diversity data needed- help with cultural, inclusion issues- help identify where practices are failing and how they are failing
  • Move out of practice and into community and gather responses that way- need to get out of healthcare settings and into places people frequent often e.g post office, supermarket, launderette
  • Look at evolving patterns of GP registration- how has it changed in the borough? What is influencing people’s behaviours with their health. - What about those who choose not to access GPs? Those who are not registered- become bigger than not getting an appointment.
  • Collaborate with GP network- HWTH to participate more in the network. Find out what they are doing, what they need.
  • Possible data collection function of HWTH- how can HWTH get backing to do this?
  • Promote HWTH as a feedback vehicle
  • Create links with voluntary/ community sector to get involved with their discussions on access to influence commissioning.
  • HWTH to think about messages- can we get across a diverse message on how we can help people get their views across on access/inappropriate care? Empowering the local community.
  • HWTH, CCG, PPGs come together to discuss needs- work with the voluntary sector to discuss these needs. HWTH to work to broker relationships between GP, VCS and the community
  • Create common questions to ask on GP services- questions that can be adapted to ask diverse groups- work with voluntary sector on questions we can all ask diverse communities

How can HWTH hold people to account with findings/recommendations?

  • At least once, twice a year- meeting with HWTH, GP practices, NHS England and third sector- review policies on community diversity, diverse needs. Can use it to identify those practices that are failing or generate ideas to influence both successful and failing GPs.
  • Connect issues more- e.g. lack of access and overuse of A&E
  • CCG to tell us where they need more information- can help to broker relationship with NHS England if there is robust information- need to look at how that is collected e.g. resident survey- repeated information
  • Working with GPs at network level to disseminate data- find out what GPs want from the data
  • Work with VCSO’s on adding GP access questions to their existing questionnaires.

Actions from partners

  • Rainbow Tower Hamlets doing research on LGBT pop- can ask if people are registered with GP and what borough is the GP in?- send out article on HWTH and our function
  • CCG to help broker relationship between NHS England and HWTH- again needs more robust data
  • Resident surveys- working with public health on resident surveys- who owns the data though- HWTH or Public health

Follow up considerations for the Board

Ensure that we are promoting the feedback centre. Encouraging GP practices to put the Healthwatch widget on their website and have access to tablets or computer in the surgery to access information and provide feedback.

Healthwatch to attend all of the GP locality meetings over the next two months. Promote the website and the informatics function. Also to find out what they need.

As part of the Community Intelligence Gathering Bursary programme we look at how HWTH, CCG, GP Networks and PPGs could come together with the voluntary sector to discuss these needs.

Consider a common questionnaire that different VCS organisations to ask their members. Is the GP survey still being conducted.

Workshop 3Integrated Care

Facilitators –Kate Melvin

Current Project Ideas

  • Community Health Services – develop patient outcomes through patient interviews and focus groups
  • Develop patient engagement group of VCS Voice organisations and their users to support ongoing Integrated care development and changes to adult social care
  • Series of Enter & View visits to older peoples services with clear recommendations

KEY POINTS

Clearly areas of confusion and different definitions including

  • The difference between the 'integrated care pathway' and 'integrated care' per se
  • Also not clear what is being 'integrated'? Pathways? Services? Health and social care? Care for particular patients eg those with long term conditions?
  • Key issue is working together thus reducing duplication but different sectors approach it in different ways compounding the confusion
  • Needs to be patient-led, defining their needs but:
  • Commissioners stress the need of the importance of services working together, with patients having one point of contact etc but message in the community is that it is being done to save money. Thus whether it is a patient centred service for the welfare of the patient or whether it is designed on the basis of financial/demand management is a key question. Hence need to emphasise to the commissioners that they need to live up to their promises
  • Patients also do not understand terms such as 'patient centred care' but do need to influence the process and make decisions. This will be become more pertinent when patients are put in the position of making decisions with personal budgets.
  • HW also needs to increase their profile
  • Generally little awareness of HW in workshop. CCG representative, for example, was not aware that HW might be able to provide community feedback re children with complex needs
  • Concern that website is not used sufficiently
  • Awareness that new services (such as that offered by HW) take some time to 'register' with GPs. CCG could help promote HW to GPs and support the notion that it is independent and patients can go to them. Also an issue about the relationship between GPs and the voluntary sector which still might need some 'work'
  • HW needs to reach professionals more generally as well as the community
  • But
  • Remit of HW is huge and small capacity.
  • Concern the HW is only and can only 'skim' the surface
  • HW tends to be dealing more and more with 'complaints' since PALS is not functioning and needs support in doing this from the community
  • Some discussion about the role of HW and in particular:
  • HW needs to be represented not only on the CCG Board but also on the Programme Boards. Issue that the community is only 'engaged' to 'inform rather than contribute to the decision making process. Thus, community engagement remains a 'whitewash'. There was an acknowledgement from the CCG that this is the case since they do not 'think about' the patient voice before the service is commissioned.
  • It thus remains a contradiction that HW is supposed to have this great function of the patient voice but, in fact, has no real voice at all at the decision making stage. The CCG also still gives the impression that they are not interested in the 'patient voice'
  • The issue of 'representation' remains problematical not simply in terms of the difficulties of 'lay person' sitting on Boards but also in terms of 'who' and 'what' is being represented. Further, how are patient reps chosen? How did the patient rep at Barts get the job?
  • HW also needs to be feedback the work that is done in the community eg when feedback from user groups re particular services etc and to work with all their partners. Co-ordination was considered hard, given the different streams of money. HW has and should have a role in 'collating' all the information such as from PPG groups, GP surveys and possibly the GP appraisal forms. There will soon be weekly data made public from the Friends and Family Test
  • HW should also have access from information (eg both quantitative and qualitative data) stored in Public Health
  • Key issue., too, is that HW should be wary of duplicating information and should perhaps have a role in elucidating the often quantitative feedback from the above
  • Qualitative work (eg by Barts) seen as very positive but it remained a point of emphasis that there should be a variety of methodological tools used. Also need different people with different experiences involved in seeking out information. It was also emphasised that since many people/patients don't use/attend 'groups', then HW should stretch beyond this resource
  • Key role for HW was to 'fill' the gaps in knowledge
  • Key is that HW may need to be more proactive rather than reacting to information and particularly in terms of being involved in the decision making processes as noted above
  • Patient voice is needed at all stages of the process -
  • Needs assessments
  • Supporting and informing patients
  • Evaluating and monitoring - measuring impact and reporting back to patients was seen to be crucial
  • Assessment of impact
  • But key is to set up the steps whereby HW can be 'taken seriously'. What are these steps?

More specifically:

  • Understanding of and support for patients who will have personal budgets. It is unclear whether they know where to go for help or whether they know what help is there. They will also need to know what services are available more generally. If, for example, people are only asking for the 'minimum', the programme may look successful but actually it may be they did not know about any other options and so on.
  • Should undertake more Enter and View visits
  • Feeding into commissioning services such as children with complex needs
  • HW also needs to play a role in 'empowering' patients and educating to take greater control over their own health to lessen their reliance on services. It may be useful to look at the Patient Activation Measure and explore the feedback. Also need to inform patients about 'process' of care and manage their expectations
  • But again an emphasis that all work has to come with additional resources including costs

Workshop 4Mental Health

Facilitator – Shamsur Choudhury

Current Project Ideas

  • Older people and mental health – better understanding of social isolation and developing a broader community response.
  • Co-production of services with service users and the community
  • Physical and mental health. Emphasis on integrated care with social workers and psychiatrists having better understanding of physical health and social isolation.

Feedback on projects ideas

Isolation and Older People:

Nicola Donnelly (LBTH Public Health) said that Public Health are in the process of commissioning a similar project Tackling loneliness and isolation in neighbourhoods for older people.Shesuggested that Mental Health Task Group members could possibly be involved in this project. The project seeks to activate the local community within neighbourhoods to contribute to the mental wellbeing of local older people at risk of loneliness and isolation. It will actively recruit volunteers and develop support networks, which will be able to perform outreach functions and organise groups. This will be done in conjunction with existing community links within localities.