Introduction to engagement and consultation at NHS Norwich CCG
NCCG continues to strengthen the range of ways to ensure patients and the wider public have a much greater say in how health services are organised, and to support patients and their carers in having a greater say in how their personal care is delivered. The CCG will continue to consult with patient forums and local representative groups.
NCCG have developed an inclusive approach to decision-making processes through Board and public meetings and other stakeholder events. We continue to use a number of methods of involvement and consultation including the implementation of a new Patient and Community Advisory Group (PCAG). The members of this group will be integral to the way we engage with the wider communities in implementing our operational plan and the NHS England Five Year Forward plan for primary care. Members of the group will also be involved at a strategic decision making level within the organisation allowing it to influence the services we commission/decommission and change.
The CCG initially set up a Community Involvement Panel and a steering Group to manage the panel and engagement/consultation activities; during the last two years the panel and steering group have worked hard to ensure the CCG meets its legal obligations under the Health and Social Care Act 2010, but both the panel and the CCG recognised that they were ready to go on to the next stage in its development.
A number of members of the panel reviewed the way we interacted with the current structure and put forward a number of recommendations which included setting up a new group which would include patient members and third sector stakeholders. After recruitment process the new Patient and Community Advisory Group (PCAG) is now in talks with the CCG around how to involve patients and stakeholders in its commissioning intentions and our plans to implement NHS England’s five-Year-Forward View for Primary Care. Read more about the PCAG here.
What we have done in 2015/16
Wheelchair service redesign
Following concerns raised at HOSC by members of the public, NHS Norwich CCG held meetings with service users, a HOSC representative, a representative from Family Voice Norfolk and the current provider. As a result of the meetings changes to how the service interacts with users of the service has been changed.
Short breaks for children with complex health needs
In October 2015 proposals were made to redesign the delivery model for health funded short breaks for children and young people with complex health needs. The CCGs in Norfolk worked with Family Voice Norfolk to plan engagement activities in the form of workshops in central and West Norfolk. This was carried out in January 2016.
Discussion with families indicated a preference for a mix of residential and home based short breaks. There was a suggestion that the current service from 2 residential facilities (Squirrels & Little Acorns) could be consolidated onto 1 site.
The CCGs have continued to review this option, its viability and also the funding streams and responsibilities underpinning the service.
The main reasons why change is needed are:
- To better meet the changing needs of children and their families. Families are more frequently choosing to have short break care in settings other than residential units. As more children with complex health needs live longer, a wider choice of age-appropriate services is needed.
- Changes in national policy and best practice. The services currently provided are not in line with national guidance on how best to care for children with complex health needs. National guidance recommends that more care is available from a wider range of settings near to or at the child’s home.
- Demand for residential services has reduced. National changes mean that fewer children now qualify for the NHS funded services provided at the units. In addition, as parents are given greater choice about where to receive care, fewer are opting to use the residential services.
- Staff shortages and limited flexibility. There are problems in recruiting and retaining appropriately trained staff to work in the residential short break units meaning that the service offer cannot be guaranteed to be available when required. .
It has become clear that the current residential facilities, Little Acorns and Squirrels may become unviable and therefore may be subject to potential closure. In addition, legal advice has confirmed that CCGs do not have a statutory responsibility to fund residential short breaks; this responsibility sits with the Local Authority. The CCG does have responsibility in ensuring the most appropriate health care is made available for Children & Young People with complex health needs within a respite care package.
Any changes to the current residential short break service will affect in total 17 Children & Young People (CYP) in Central Norfolk. CCGs are therefore taking the following action:
- High level and urgent discussion with Local Authority Children’s Services to review impact and explore joint commissioned solution for the above identified cohort of children and young people and also to develop wider, more integrated/formal joint commissioning arrangements for all CYP c/o Children & Families Act 2014
- CCG communication with individual families with assessment of individual needs of each child undertaken. Alternative options to be considered and discussed with families
- CCGs to focus on opportunity to enhance community health service provision.
Discussions with the 17 families is continuing (August 2016)
Continuing Healthcare (CHC)
Over the past 15 months the central and west Norfolk CCGs have been carrying out stakeholder and patient engagement around the development of a local policy and guide for patients including Equal Lives, Opening Doors, individuals in receipt of CHC and the Carers Council for Norfolk.
As a result we have proactively provided a copy of the guide for patients in Easy Read and redesigned the assessment process to reflect national CHC guidance.
We also informed HOSC that Healthwatch Norfolk will be carrying out an evaluation of the CHC process in the autumn six months after it has been implemented.
The local policy, the process for assessing CHC and the guide for patients went to HOSC in February 2016. HOSC were happy with the papers and asked the CCGs to report back in 12 months.
OOH/111 (HealthWatch Norfolk)
NHS Norwich CCG is the co-ordinating commissioner the Out-Of-Hours/111 service. We have recruited a member of Heathwatch Norfolk to represent stakeholders on the Quality team meetings
The newly commissioned Wellbeing Service was launched in September 2015 and continues to grow from strength to strength. We currently have one of the patient representatives on the contract review panel that was also on the procurement panel to ensure continuity between the service commissioned and service delivered.
NHS Norwich CCG continues to support the B-ME magazine by placing full page information of how to use services responsibly. We are also looking at plans to run a series of articles entitled ‘A day in the life of....’
Electronic Prescription Service (EPSr2)
When we were in the process of planning the roll out of electronic prescription across our member practices we recognised that some communities needed to be informed in different ways so we put together two short videos; one for older people and one for people with a hearing loss to be played on the practice PIP screens as well as the more traditional information leaflet.
The videos have also been shared with the national team responsible for the roll out of electronic prescriptions for use across England. Link to Videos
Gluten free on prescription
As you will know we, as the NHS organisation responsible for commissioning services locally, are having to make some very tough decisions around what we can and cannot afford to pay for.
We decided to look at the cost savings around gluten free products on prescription; times have changed from when gluten free products were first made available on prescription due to the lack of availability of products to the plethora of items now available from supermarkets and other retail outlets.
We met with the Norfolk and Norwich Coeliac society, a representative from the NNUH Dietetics Departments and teleconferenced with representatives from Coeliac UK.
As a result of this meeting the Norwich CCG Clinical Reference Group, our Executive Committee (which includes clinicians from our member practices) and Governing Body considered the three options put forward in the business case regarding gluten free products on prescription.
Outlined below are the options discussed including the suggestion that arose from the meeting/tele conference); the identified options for this were:
• Do nothing – continue to allow gluten free products to be available on prescription.
• Partial withdrawal – continue to allow selected gluten free products to be available on prescription. Some stakeholders advocate retaining bread products for the young (under 16) and older people (60 plus).
• Complete withdrawal – to withdraw all gluten free products so none are available on prescription.
The decision was taken to withdraw all gluten free products from prescription for the CCG member practices, GP practices were sent letters to send to patients informing them of the decision and giving one month’s notice of the withdrawal.
Although the CCG is not responsible for the commissioning of primary care services; we worked with NHS England to ensure patients and stakeholders were involved in the re-procurement process for the new contract and the move to new premises.
Broadland and Norwich Youth Advisory Boards
The engagement lead continues to be an active member of the two youth advisory boards that covers our patient area (see photo, right).
Older peoples’ networks
The engagement manager is an active member of both the Norwich Older peoples Forum and the Norfolk Strategic Older Peoples Partnership
Equality and Diversity
The CCG continues to ensure patient, families and carers experiences are integral to the design and commissioning of our services. The CCG is committed to eliminating discrimination and reducing inequalities in care.
Every individual employee or user of services we commission has the right to be treated fairly and not be discriminated against, regardless of the individual’s ‘protected characteristic’, Equality Act 2010. We have worked with leaders our growing BME communities to understand why we are receiving anecdotal evidence of their lack of understanding of the NHS system in Norfolk; as a result we promote the use of OOH and urgent care services in a positive manner. We are a fully committed member of the INTRAN partnership; a membership organisation which commissions high quality interpretation and translation services for the public sector across the East of England. This ensures we have equality of access for all users of NHS services delivered in a cost effective manner.
NHS Norwich CCG continues to be a full and active member of INTRAN. We have worked with the partnership on a series of short video clips showcasing the outstanding work the partnership does in assisting the CCG meeting its legal duties under both the Equality Act 2010 and the Public Sector Equality Duties (EDS2). Watch this great video to see how it all works.