From Patient to Purpose - one year on.

Transcription

1 From Patient to Purpose - one year on. Patient and Public Involvement in Wandsworth CCG Annual Report April 2015 Contact Colin Smith, Patient and Public Involvement Manager Dr. Sian Job, Clinical Lead for Patient and Public Involvement Daisy Camiwet, Engagement Manager Dr. Carol Varlaam, Lay Member, PPI 1

2 Summary This report summarises the Patient and Public Involvement (PPI) activity that has taken place over the past fifteen months (2014/15). The long-term vision for PPI and Engagement is that the partnership between the Wandsworth community and the Wandsworth Clinical Commissioning Group (WCCG) is evident in all its work. Background Our work is based on the CCG s PPI strategy. The eleven objectives are: Ensure CCG staff effectively engage with the public and local communities Develop PPI at Locality level Develop new modes of engagement (including through technology) Ensure engagement in pathways redesign and service changes Ensure involvement in strategy and priorities Engage hard to reach groups and vulnerable communities Reduce inequalities through greater involvement Promote and support self-care and self-management Develop effective partnerships with Healthwatch Work with partners (e.g. community and voluntary groups) to ensure active engagement of patients and carers in their own care Consider approach to co-production By involving patients, carers and the public in commissioning, we seek to use their insight and experience to both improve patient care and to support them in making decisions about their own health. Structure: We have developed a structure within the CCG that facilitates this course of action. Our PPI Reference Group (PPIRG) is made up of appointed patient and voluntary sector representatives, Healthwatch and staff and meets every two months. Its remit is to oversee PPI throughout the CCG, focused on the implementation of the action plan, submitted and approved last year. Under the chairmanship of the new Lay member of the Board, the PPIRG is now expanding its remit to take on a more objective and outcome focused brief. Members continue to be engaged in a wide variety of PPI activity across the CCG. We refreshed our membership with representatives from each of the three localities and recruited two new representatives from a very strong candidate field. To complement this membership and to ensure seamless working, we also have representatives from Healthwatch and Wandsworth Borough Council (Social Services and Public Health). 2

3 We will continue to develop the role of critical friend for the CCG, overseeing PPI in the organisation and ensuring more extensive connections with the commissioning agendas and clinical pathway developments both at board and locality levels. The PPIRG is the focus of an observational research programme on PPI engagement and its effectiveness in CCGs conducted by the Centre of Public Engagement, St George s University of London. Recently, members of the group participated in a focus group and have provided personal interviews to give more depth to the focus of the research programme. In December an internal reorganization relocated the PPI team to the stewardship of the Finance Directorate. Staffing The PPI RG is supported by a small PPI team who also provide support to all staff and commissioners so that PPI is incorporated throughout our commissioning activity. This team Includes: Chief Finance Officer PPI and E&D Manager (p/t) Engagement Manager Administrator Clinical Lead for PPI Lay member, PPI Our work this year has been constrained by long-term staff illness and the resignation of the Administrator. This stretched the team s ability to function fully and whilst work continued and all targets were met, it has not been an easy time. In March 2015 we completed recruitment for a new Administrator. This is worthy of note because of the recruitment process we adopted, with two lay representatives from the PPI Reference Group participating as full members of the interview panel. This worked extremely well. PPI Development in the Localities The Locality managers have embraced the PPI agenda and are supporting the development of a Patient Consultative Group in each locality. Each locality is working through a checklist to reflect their PPI activities. The Patient Consultative Groups meet on a bi-monthly basis. Each group has its own terms of reference, which relate to their Member s Forum activities. These groups are also able to feed in and assist in developing projects to help make a difference to health services in their area within the Locality Investment Budget Locality Managers have identified a number of achievements along with support needs in their areas. While several successful themes were noted across Wandsworth, there are variations in the development of PPI across the three localities. For instance Patient Groups in some surgeries are able to drive changes in the practices and are engaging a broad range of people and have also reviewed their terms of reference. There are some common issues that need to be addressed such as 3

4 groups not being representative of the local patient population, and some groups which meet regularly but where the membership has never changed or grown. PPI representatives attend the Members Forum in Battersea and one PPI representative attends the Locality Management Team. This ensures that the flow of information between the various groups maintains a patient centered focus. In order to ensure all projects had the direct input from patients, each project was discussed with the Battersea Patient Consultative Group as well as a number of focus groups. The development of the Citizen s Advisory and Community Referral Service to assist patients was initiated by patients and Patient Groups at Wandle Locality. The idea and need for this service was identified by patients who were very much involved in the development and its launch as a Wandle wide service. In West Wandsworth patient representatives from each practice attend the Members Forum. The patient groups help the members forum identify projects including the Mindfulness Project and the Sleep Workshop. The member s forum helps run these projects and kept the members updated throughout The Locality Managers identified the need for PPI training to support the development of patient groups. The incorporation of viable patients groups in practices into GP contracts means we need to ensure that practices have the appropriate support to enable this to happen. A major initiative in 2015 will be to address this with the PPI team, locality Managers and Healthwatch working together to develop support for developing patient groups in general practice. PPI in General Practice. Members Development Programme (MDP): The Clinical Lead led a half-day session on the MDP on PPI, in which the GPs reviewed and reflected on their PPI experiences to date, noting what worked well and where difficulties arose. They discussed their visits to Seldom Heard and Community organisations, validated these experiences with enthusiasm and a highly increased awareness of organisations that exist in the community. This led to a discussion on how to capitalise on these visits. The third element of the session was an experiential section envisaging how patients experience the Services provided at their surgeries. This led to identifying a broad selection of patient cohorts that could be included in their PPI activities, thus enabling the surgeries to understand how best to serve their registered community. This session was supported by guidance notes developed to be used as a tool in practices. Community and Seldom Heard Group Visiting Program: The third year of the GP visiting program is coming to its conclusion and again the completed templates demonstrates how much enthusiasm and increased awareness these generate in the clinicians. This complements the Grant scheme to Community and Seldom Heard Groups run by the CCG. PPI in Clinical Reference Groups (CRGs) 4

5 Throughout , staged work took place to support the CRGs to embed PPI into their work. Stage 1 was the Pre meet and preparation stage Stage 2 entailed PPI development sessions at each of the CRG main meetings Stage 3 included following up how progress is being made and support the broader agenda of involving our communities into our work in the CRGs. We have worked with eleven CRGs during 2014 and all have completed Stage 1 and Stage 2 meetings. PPI has, thus, been introduced in these CRGs and the essential tools are now in place for further development. Each CRG has a PPI Picking List, a template for their PPI Action Plan, which is embedded in the workbook of each of the managers. Stage 3 is in progress with the aim of identifying progress, any achievements and outcomes to date and supporting the development of action plans for next year. The CRGs have incorporated the embedding of PPI into their work and CRGs have identified patient representatives. However, due to the differing nature of CRG operations, there are variations in the level of the PPI activity in the different CRGs. The Community Adult Health Services 1 (CAHS) has strong patient and public involvement through the development of a quarterly Patient Experience Review Group (previously known as the Critical Friends Group); they are involved in the service review and re-design process. This ensures that PPI and engagement is embedded in the development of the service. In addition to this, the CCG has engaged with patients and carers through face-to-face Patient Discovery interviews, which seek the views of service users on the health and social care they receive. A number of initiatives have been commissioned to create community events for the end of life care, dementia and cardiovascular disease CRGs, including specific work with Lifetimes, a local voluntary organisation, The main challenge now is to demonstrate how the patient voice has truly influenced the work to improve care for patients. The patient voice contributed significantly to the Falls Group, which was initially established as a CRG., The need for services to work together and to look at bone health within the community was highlighted. In October 2014, the Falls and Bone Health CRG disbanded because the service development work needed was complete. Services commissioned within the pathway are now monitored within contract monitoring groups. All CRGs are developing their action plans for The CRG lead has expressed the need for support and resources for training and capacity building to enable them to continue to develop effective PPI. The PPI Team are currently in discussion with the PPI Reference Group about objectives and action plans for reflecting the continued support provided for the CRGs to enhance the effectiveness of PPI and achieve impact. 1 Although CAHS is not a CRG, this programme applies to this and similar projects 5

6 Equality and Diversity Equality and Diversity is a fundamental principle of the CCG. This work is now more closely aligned with the work of the PPI Reference Group. The Thinking Partners Group is our key forum for developing issues related specifically to Equality and Diversity with membership drawn from community and seldom heard groups as well as CCG and Social Care representatives. It meets every two months and is proving a popular vehicle for bringing community organisations we work with together to share and explore issues important to the CCG them and the communities they serve. Members offer their views, experiences and expertise on a range of healthcare issues in a forum, which can mainstream their concerns into the CCG. The Thinking Partners Group reports through the PPI Reference Group to ensure key messages are formally acknowledged EDAY (Equality Delivery Action Yes), this year was held in October 2014, and was incredibly successful. EDAY brings together staff and communities to ensure that E&D principles are embedded throughout commissioning with community representatives discussing, supporting and sometimes challenging staff on their E&D activity. This year forty staff and patient and community representatives took part, with the CCG s Chief Officer opening the event. One major exercise for the Thinking Partners group has been to take information from EDAY and use this information to develop equality objectives for the CCG. This has been a significant piece of work for the group, and is almost ready for presentation to the CCG. These equality objectives are a statutory requirement for CCGs. The Seldom Heard Groups scheme (SHG) is in its fourth year of operation with increasing success. This year we funded fifteen organisations, ranging from conditions groups, support and advice bodies, to BME community and faith organisations. The projects they have undertaken include raising health awareness, promoting healthy eating and exercise, tackling female genital mutilation, and evaluating the effectiveness of falls prevention measures. Many of the groups have developed projects, which go beyond simply raising health awareness among their members, and these projects look to develop a community input into health services. One recent new initiative that has come from the scheme is for groups to present their work at an open learning lunch, before the Thinking Partners Group, so that other patient representatives, organisations and staff can attend and learn from their experiences. The first presentation from Safeground, an organisation that is operating in Wandsworth prison, was so successful it has been agreed to roll this approach out over In the four years the scheme has been running, we have given small grants to more than forty organisations and helped to open up communications between them and health care providers. As a result many of these bodies have been brought into the decision- making processes of the CCG. Many more representatives of the groups have attended Thinking Partners meetings than in previous years and more have become involved in patients groups. This has been of great benefit to Thinking Partners, the CCG and other NHS bodies, as their informed views have helped shape services for the better. It has been a fruitful example of co-partnership working in the borough. 6

7 Wandsworth Men s Health Forum was set up in February 2013 to get men in the borough to be more aware of health issues. Over the year the group has focused on prostate cancer. It was proving difficult to get men to actively participate in the group, so the group is working in partnership with organisations like Wandsworth Public Health and Paul s Cancer Support Centre, which has been more promising. Following some successful meetings on prostate cancer with groups in the Asian community, the group then ran a stall at Roehampton University s Freshers fair, and followed that up with a meeting on the campus in November, as our contribution to the Movember campaign on prostate cancer. That has now been followed up with two more meetings with Asian Elders in Tooting, and pensioners in Roehampton. This increase in activity is encouraging and shows we are becoming better known. Feedback from community groups and the doctors who have been our speakers is equally rewarding. A small steering group (SG) has been set up to plan the next steps, but it needs strengthening if the group is become self-sustaining. The SG decided to widen the focus this coming year to include Mental Health as well as prostate cancer. It gives the group the opportunity to work with new people and to go back to the community groups we have already contacted to hold a new series of meetings in CCG Strategic Plan Building on the principle of ensuring timely engagement and embedding the patient voice within the commissioning process, a programme of engagement was undertaken during 2014/15, which included Healthwatch, Voluntary Sector groups and Patient Forums, to raise awareness and ensure that the input of stakeholders, patients and the public could be used in the development of the 2014/15 Operating Plan and the development of CCG priorities. This process was supported by a web-based survey to provide an opportunity to input and receive feedback on priorities and commissioning initiatives for the WCCG in 2014/2015. A number of key themes emerged from this process, which influenced the development of initiatives and priorities within the Operating Plan. During 2014 we also worked to review and define our shared aims, approach, principles and priorities in light of emerging changes in the commissioning landscape. A series of patient workshops were held throughout the autumn and the feedback from this process has been intrinsic to the development of the four Strategic Priorities outlined in the Operating Plan in 2015/16. Wandsworth Youth Health Jury. Youth Health Jury members are highly motivated young people, aged between 16-24, who are relishing the opportunity to learn about the NHS, health issues as they relate to themselves and how they engage with their peers to share their experiences and knowledge. 7

8 Over the last 12 months the Youth Health Jurors have continued to have regular monthly sessions. The Jurors have been involved in a number of projects including a presentation at Ernest Bevin College, an online group and Youth Health Jury blog, development of a monthly newsletter, a website workshop and a new leaflet as well as ongoing recruitment of Youth Health Jurors to refresh the group. The Youth Health Jury has been working with the Wandsworth LGBT Forum to identify the barriers for young LGBT people in accessing sexual health services Customer Relationship Management system (CRM) and related activity Our CRM system continues to make a considerable difference to how we communicate. Last year we reported we had more than 1500 contacts on our database. This year we have registered on the system over 4000 contacts. We use our WHIZ events to recruit people and organisations to the CRM. Social media: We continue to regularly use Facebook and Twitter. PPI Newsletter: - Newsworthy Monthly e-bulletin for patients, public, staff and stakeholders on commissioning, raising awareness on health issues and promoting campaign s and services - Latest News: - One topic bulletins go out regularly to keep people informed of issues and events coming up PPI Projects In addition to the body of work outlined above, the PPI team has led on a number of key initiatives across the CCG: Community Roadshows - WHIZ events (Wandsworth Health Involvement Zone) - are held bimonthly, in public centres and supermarkets. Their aim is to increase interest in the work of the CCG and each has a clinical focus. The team has supported the development and implementation of monthly market stall events which display commissioning areas of work or projects to both staff and patients The team administrator led on a work experience programme which brought into the CCG its first student on a two week work placement The Lay member PPI continues to be a key link with the South West London Collaborative Commissioning Initiative the aim of which is to develop a joint 5 year plan to improve healthcare across South west London. The PPI manager supported the PACT and Self-Management Programmes by participating in interview processes to recruit new staff, and led on the redevelopment of the EPP programme in the CCG, which culminated in new tutors being trained, and a series of news courses successfully implemented. The PPI Toolkit/resource centre is live on the CCG website so that patients, public and staff can access it as needed to facilitate PPI activity for use as needed. 8

9 A successful thank you event was organized in December as a way for the CCG to recognise and value the input and support patient representatives give to the organisation. Working with Healthwatch: On April Healthwatch Wandsworth was established as the statutory organisation to champion the voice of patients, service users and carers, independent of the CCG. Healthwatch are members of both the PPI Reference Group and the Thinking Partners Group. Healthwatch and the PPI team and PPIRG strive to work together where possible, to maximize the impact of our input. One example of this is partnership working with Healthwatch to deliver the seldom heard voices scheme. Healthwatch Wandsworth has stated that the CCG demonstrates a strong commitment to public and patient involvement in Wandsworth, built up over a number of years by the Primary Care Trust (PCT) and the Clinical Commissioning Group (CCG) and that the CCG has put in place a strong governance framework with a clear programme and action plan further to develop patient and public involvement. Healthwatch has also commented that a clearer link needs to be demonstrated between the CCG s strategic objectives and PPI work, and that more analysis of the impact of PPI and a greater focus on outcomes is needed, as well as a more pro=active role for the PPI Reference Group in setting the agenda. These points are reflected in this report and will be developed further in our action plan for 2015/16. Next Steps Our plans for 2015/16 are currently under development. Over the past year we have continued to build the foundations for integrating the patient voice in the CCG s on-going practice and we aim to support the CCG to build on these foundations to embed collaborative practice throughout commissioning and service delivery. Patient and Public Involvement will continue and expand. But there is an imperative to move beyond involvement and consultation. We are now working to increase the focus on outcomes, with clear lines of monitoring and accountability within the CCG for PPI and to begin evaluating the impact of PPI on service delivery We will continue to build on the work of the Clinical Reference Groups in developing their partnership with their patient and carer cohort ensuring strong and effective involvement in developing pathways. Support will be put in place for the participating patients and carers to enable them to participate to their best advantage. Our Equality and Diversity work will continue to develop in liaison with our PPI activity, and will focus on health inequality and inequity of access. A wheelchair user has offered to do a wheelchair health check on the CCG building. This is being arranged for April/May Community connections and involvement are fundamental to the partnership between the CCG and the population of Wandsworth and we will build on the work put in place over the last year to consolidate this partnership, using technology to its best advantage. Significant inroads have been made over the last year in establishing the patient voice in the work of the organisation. Processes and plans have been put in place, which are now beginning to reap tangible rewards. The ultimate goal for PPI is that the patient voice and the principles of equality and diversity are heard, visible and effective throughout the organisation and that the impact can be evidenced. 9

10 The PPI RG is considering the following themes as the backbone of our work for the coming year and will be working to develop operational plans. More and better involvement with/by the public. With a focus on good health and well being and to improve public understanding of a range of health issues. Enabling people to make better informed choices e.g. differential costs of GP appointment / visit to A&E / Pharmacy advice by providing clear information about aspects of the commissioning process Sustaining successful work and projects. This might need some hard-nosed prioritising, as it will probably be impossible to sustain everything, particularly if we want to bring new initiatives and projects. Embedding patients voices and involving patients and the public at strategic and operational levels Improving public understanding of the Care Act, This is an important one-off for the coming year. We need further thought to what we can do in practical terms to achieve this and how best we can work with the local authority. 10