Listening. Responding....

Listening. Responding. Delivering.Listening and Engagement Strategy Update

January 2016

ContentsPage

Executive Summary 1The importance of clinically-led engagement 4Increasing our reach 5Active Listening and LEAPs 7Listening. Responding. Delivering. 10Listening to our staff 12“We come to you” 14Governance 15Appendix A: Our duty to involve 16Appendix B: Building on the 2013 Strategy 18

1 Listening. Responding. Delivering.

This document contains our updated clinically-led Listening and Engagement Strategy. It includes measures to build our overall capacity and approach as well as specific strands of engagement over the coming year comprising our 2015-16 Engagement Plan.

The update to the strategy continues the trajectory and builds on the foundations laid by our 2013-15 “Informing and Involving” strategy. That strategy put in place the fundamental building blocks of a modern and imaginative capacity for listening and engagement. In particular, by:

• organising and grouping all stakeholders into groups, so we could tailor and deliver focused listening and engagement to each;

• understanding their preferred methods of engagement and ensuring that our activities match these preferences;

• introducing new and innovative ways to ensure that the authentic voice of patients and local people are heard at the heart of our organisation, for example through our Listening Booth and introduction of Patient Stories as a standing item at the start of all our Governing Body meetings;

• setting out clear objectives, underpinned by specific activities and tied to demonstrable outcomes;

• ensuring that our listening and engagement is aligned with and reinforces the vision and values of our organisation;

• ensuring that the listening and engagement strategy delivers our legal requirements for equality and openness;

• ensuring the delivery and operation of effective governance and accountability for the strategy within our wider organisation; and

• managing the delivery of activities and support from external suppliers and partners, particularly through our Commissioning Support Unit.

The updated strategy responds to the clear and consistent message delivered through our 2015 NHS Ipsos Mori 360° stakeholder survey as well as views and opinions gleaned from our 2015 Summer of Listening exercise and at our 2015 Annual General Meeting.

These showed:• the fundamentals of our existing listening and

engagement activity are sound and fit for purpose;• there are areas of particular strength that are valued

by our stakeholders and partners;• we could improve some aspects of our activities to

deliver real excellence; and • a greater emphasis on demonstrating and

communicating specific feedback and responses to what we had heard would be particularly welcome and valued.

In all we do, we seek to increase both the reach and the impact of our engagement. In particular, we want to achieve four aims:

• increase the number of people with whom we engage within those organisations with whom we are already engaged;

• widen the range of organisations and individuals with whom we engage, in particular going beyond the normal NHS and social care ‘family’ to engage people in their wider lives and activities;

• increase the quality of our engagement and the experience of those with whom we engage; and

• increase the visibility of what we do with what we hear and improve the ways in which we provide specific feedback on specific topics.

The strategy also includes recent initiatives in relation to how we listen to our own staff, such as our Freedom to Speak Up programme and staff-led refresh of our organisational values.

Active Listening and LEAPs

At the heart of our new strategy lies the concept of Active Listening. This can also be described as “listening for a purpose”. As a membership organisation, this includes listening to the views of our local GP Practices, as well as our own staff, our patients and local stakeholders.

It means having a continual awareness that we don’t just listen and engage for the sake of it or as an end in itself, but in order to deliver - and be seen to deliver - concrete outcomes and improvements in our strategies and the services we commission for local people.

We look to deliver the concept of Active Listening in reality through the establishment of a series of Listening and Engagement Active Partnerships (LEAPs).

Some of these build on what we know works and what we have done hitherto, for example:

• our provider Quality Visits - both timetabled and ad hoc as required;

• our GP Practices’ mechanisms for hearing and engaging the patient voice, including Patient Participation Groups, and Patient Reference Groups;

• our own Patient and Public Engagement Group, comprising attendees from local voluntary sector organisations, PPG/PRG Chairs and local Healthwatch;

• our forums for engaging with particular groups of GPs and their staff working on the ground, such as our Locality Meetings, Practice Nurses Forum and Practice Managers Forum; and

• our existing relationships with local statutory bodies and elected representatives, for example through Health and Well-being Boards and Health Overview and Scrutiny Committees.

Executive Summary


We build on these foundations through a drive to establish new Listening and Engaging Active Partnerships, in particular:

• a review and refresh of our public membership scheme - recently brought in-house;

• strengthening and deepening our ties and planned activities with local Healthwatch and the voluntary sector - including Voluntary Action Leicestershire and Voluntary Action Rutland;

• strengthing our drive to engage seldom heard groups and ensuring that their voice is heard and acted upon;

• reaching out beyond our immediate and familiar networks in health and social care to embrace and engage with organisations and individuals involved in complementary networks and interests - for example in environmental, sporting, cultural and educational spheres; and

• our involvement in “Commissioning for better patient experience” - a national project with Macmillan Cancer and NHS England to develop commissioning tools and processes that support positive patient experiences of care.

Listening. Responding. Delivering.

The traditional way in which the NHS acts upon and provides feedback on what it hears is often branded as a ‘You Said, We Did’ approach. This typically involves collating a wide range of opinions and suggestions, analysing them behind the scenes and publishing a broad brush overall themed response, citing limited examples of specific items to illustrate the broad plan of action.

This has served the NHS well, but we know from our own recent listening activities during 2015 that our stakeholders feel they don’t have enough sight of what specifically happened as a result of specific views they gave.

This means that when they are subsequently asked for their views on another topic, they can suffer from what they call ‘consultation fatigue’ - feeling that they repeatedly make the effort to provide their views without equal effort being made to give them specific feedback on their individual views and concerns.

Our own organisational ‘brand’ is centred on the strapline “Listening. Responding. Delivering.” This strategy sets out how we operationalise that strapline to place it at the heart of what we do. This includes an updated approach incorporating improved business processes and communication channels that address our stakeholders’ expressed concerns and increase our capacity for providing individual feedback where required.

“We come to you”

A key plank of our listening and engagement approach to date has been a determination to ensure that people shouldn’t be forced to come to us to give their views and opinions, nor to make their voice heard. Instead, we have made strong efforts to go to them.

This is the philosophy that underpins our Listening Booth, now in its second year of operation. In its first year, the Listening Booth travelled to over 25 locations, speaking to almost 200 people and allowing them to talk to us outside health locations, approaching them when they are feeling relaxed and have the time to talk about their experiences of healthcare.

The latest figures available show that between April and December 2015, the Listening Booth increased its reach and impact by hearing over 550 comments and pieces of feedback in just 9 months.

The Listening Booth asks people 3 simple questions:• Have you had a recent experience of the NHS or

social care? Tell us about it...• What stood out as really positive?• What could have been done differently?

The information collated through the Listening Booth is used to ensure that local people’s views are at the heart of our quality monitoring and decision making. It is also used to develop patient stories, spot themes and trends about local health and social care services, inform service improvements or make changes to the services we provide.

Our new strategy introduces further new ways in which we can communicate and engage with local people in ways that avoid them having to come to us - whether by letter, phone call or web - each and every time simply to find out if anything new has happened or anything new of particular interest to them is planned or happening.

We do this through imaginative investment in our web, digital and social media capabilities. In particular, we have introduced a facility via our new website called myCCG which we believe to be a first amongst NHS Clinical Commissioning Groups.

All registered myCCG users can opt to receive automatic alerts of material on our website comment on any item on our website and get involved in threaded discussions and questions and answers.


We are also looking to use social media in ways that go beyond merely using it as another publishing channel. Rather than using social media simply to tell the NHS, social care and the wider world what we are doing and what we are thinking, we are looking to use social media to give frontline staff, carers, patients and families their voice and their spaces to interact with us and each other.

We are using a specialist NHS Social Media tool called Find SoMeone in Health to identify and approach followers of Twitter accounts that demonstrate a relevance to our target areas but do currently follow our own Twitter account @NHSELRCCG.

This enables us to engage via Twitter with audiences who would not normally feature on our radar or whom may not be aware of what we do and/or hear messages and information from us that would be of use and help.

We have created a new podcast channel ELR CCG TV containing video news items from the CCG plus background films introducing our people and explaining what we do.

It is always available to anyone and always free. Any episode can be watched online or downloaded without subscribing. Subscribers automatically receive new episodes to their computer or mobile device.

Coming soon, we intend to produce regular podcast on items of interest plus material produced by our stakeholders and broadcast by us. We are asking them what topics they would most like us to produce with them or what programmes and material they would like to see.

We are also harnessing the power of mobile devices to

improve how local people can access local services at the right time and in the right place. Our new mobile App NHS Now allows users across East Leicestershire and Rutland to get self-care advice or find their nearest, most appropriate and most convenient local health service currently open to them at any time of the day or night.

The App is time and location aware. This means that users get real-world, real-time details, opening times and directions to a range of their local NHS services. Users can ask to see either all locations or those that are open for service at the specific time of using the App. The range of services include: GP Practices, Pharmacies, Dentists, Urgent Care and A&E. Users can choose to see all or only emergency pharmacies. For dentists, users can choose between all or emergency dentists and/or to see only those currently accepting new NHS patients.

It has been warmly welcomed by local Healthwatch and patient representatives, as well as staff working in our GP Practice membership. It can be downloaded free of charge by searching for “NHS Now” on the Apple App Store or Google Play.

New listening and engagement infrastructure

Supporting the development and operation of the new strategy are a series of new tools and infrastructure in which we have invested over 2015. These include:

• a significantly improved website; • a new GP Practice Extranet; • a new Staff Intranet;• an expanded range of social media channels; and• ELRCCG MOOD database – to underpin augmented

Listening Responding Delivering business processes and reports.

Specific engagement strands for 2015-16

Our main focus of specific activity is centred on 4 strands:• engagement on a future Community Services Model;• engagement on our Primary Care strategy and plans

for GP Federations;• engagement to feed into and support the Leicester.

Leicestershire and Rutland Better Care Together programme - in particular supporting the BCT workstreams on mental health, learning disabilities and older people; and

• engagement on our future commissioning intentions.


As an organisation, we are proud to say we are “clinically led” and praised by our local NHS England colleagues for visibly being so.

That’s not simply a phrase we use. It’s central to what we’re about and how we do things. It means that our aims and priorities are driven by local family doctors and other clinicians, rooted in their own local communities across East Leicestershire and Rutland. Clinicians are in the majority in our decision makers.

These people are respected and trusted by local people and their families to have their best interests at heart and deeply committed to helping them get healthy and stay healthy. Or when they fall ill, to make sure they get the very best treatment and care possible, in the right place at the right time, and delivered with compassion and respect.

Clinically-led engagement is all about harnessing that respect and trust and placing it at the heart of NHS decision-making and local strategies. We listen and learn using a wide variety of methods and channels. Then we collate what we hear and our clinical leaders, supported by our internal staff, decide how we should take action on what we have heard.

Right in principle. Right in practice.

We support clinically-led engagement because it’s the right thing to do in principle. But it also happens to be the best way in practice to engage local people and communities in local change and improvement. It’s what they want and prefer. And it gives the greatest guarantee of ultimate success.

The importance of clinically-led engagementA recent study by the NHS Confederation and YouGov asked people - ‘What would persuade you to support changes in your local NHS services?” The top 2 answers were:

• Evidence it will improve care; and• Support from local health/care staff.

These 2 factors were more important either than evidence it would save money or general communication or generic public engagement from and by the NHS.

Our clinical leaders therefore play a vital and visible leadership role in our engagement activities and processes.

We’re proud of our record to date in carrying out innovative clinically-led engagement. But we’re always looking for ways to get better.

We have major challenges and innovations we wish to bring forward in the coming year in primary care and community services.

We are also entering our third year of deciding and delivering our overall commissioning priorities.

We believe it’s crucially important to have clinically-led engagement at the heart of how we take this forward and just as important not just to do it - but to be seen to have done it.

We will, for example. be making much more use of web and video to raise the profile of our clinical leaders and explain the crucial leadership role they play in our organisation and its strategies.


We will also strengthen our drive to engage seldom heard groups and ensuring that their voice is heard and acted upon. Some of these groups may well prefer us to engage with a single named contact and to give us their views and experiences via face-to-face activities.

The important thing is for us to consciously be aware of and document these preferences, so we can ensure we are really meeting people’s preferred options.

We have set ourselves a target of at least doubling the total number of people with whom we engage within those organisations with whom we are already engaged

Increasing the numbers

To help us achieve our first aim, we have recently brought in-house and integrated the management and operation of the hitherto separate externally hosted databases underpinning our public membership scheme and our stakeholder groups. We have also completed a thorough data-cleansing exercise as a pre-cursor to introducing a new facility via myCCG allowing members to update their details online.

Bringing these databases in-house has given us greater ability to track and understand how many people we know about within each organisation with whom we engage.

This has shown, for example, that for the majority of our stakeholder groups, we have a single named contact or in some cases a generic e-mail account.

We will systematically work through these 1,300-plus organisations, using the named contact or generic e-mail account as a bridgehead into the organisation’s wider membership, offering them the opportunity to engage with us direct as well as via their organisational lead.

Hitherto, our reach has been built on the following main strands:

• our ‘Be Healthy, Be Heard’ public membership - with around 4,300 people who signed up at some point in the past to receive communications from the CCG and/or its predecessor the Primary Care Trust;

• a stakeholder database made up of 1,381 groups covering everything from local councils to schools and sports clubs - normally with a single named contact or e-mail address;

• a Public and Patient Engagement Group (PPEG) with quarterly get-togethers facilitated by the CCG; and

• a range of forums and/or groups with whom we interact as part of our day-to-day commissioning activities - for example Practice Managers Forum, Practice Nurses Forum, Locality Meetings and Protected Learning Time (PLT) events.

Our local stakeholders and those with whom we engage tell us that there is much we do which they like and value. In the most recent NHS England CCG 360° stakeholder survey, 76% of our stakeholders said they were Very or Fairly Satisfied with our engagement with them, a very slight increase on our score the year before. So we know that once we have succeeded in reaching to people and organisations, they like what we do.

As part of our Engagement Plan 2015-16, we want to increase both the depth and the width of our engagement reach. In particular, we have two aims:

• increase the number of people with whom we engage within those organisations with whom we are already engaged; and

• increase the range of organisations and indivduals with whom we engage, in particular going beyond the normal NHS ‘family’ to engage people in their wider lives and activities.

Increasing our reach


Increasing the range

Like most NHS organisations, the vast majority of our engagement takes place with people within the context of our day-to-day business or their own direct recent experience of the NHS - whether that’s a visit to their local GP surgery or care setting or receiving care in their own homes, for example through health visitors or care staff.

Our day-to-day engagement activities also tend to focus on these settings, through for example leaflets and posters available at the local surgery, meetings with primary care staff and patients, advice delivered via family doctors or via staff carrying out care in people’s homes.

This is - and should remain - the core of our listening and engagement activity. It enables us to understand the views and experiences of those currently using and experiencing our services. And it forms a vital part of our quality strategy.

We are strengthening the ways in which we can support our engagement with our frontline staff through, for example, creating a new GP Practice Extranet so that practice managers and clinical staff - including community nursing staff -working on the frontline can exchange views and opinions with us and more easily keep up to date with what we are doing.

Our work with organisations representing seldom heard groups will help us increase the range of those whose voices and opinions we hear, by taking advice from them on the optimum way to engage with their members and communities.

However, the people and organisations directly engaged through these activities during any particular period are only a sub-set of the overall population.

Our commissioning responsibilities are not just to deal with the here and now, but to engage and plan for the medium and longer terms. So everyone in our area has an interest in what we do and what we plan to do.

But there are plenty of people who neither participate nor wish to participate in organisations. We have been looking at how we can reach beyond our day-to-day operational contexts to encompass a wider cross-section of our population.

This is, for example, one of the reasons why our Listening Booth goes out to speak to people directly and face-to-face in locations beyond specific health and social care settings - for example coffee mornings, libraries and shopping centres.

Over the coming period, we will look to be even more imaginative about the locations we choose to deploy our Listening Booth - for example by linking up with major sporting, cultural, environmental or tourism events across Leicestershire and Rutland. We will contact organisations organising such events to see what opportunities exist.

We also believe that social media can play a significant role in this regard. Millions of people across the UK use social media daily to find and interact with like-minded people and organisations who share their interests, concerns and priorities - for example young mums and dads, people interested in mental health issues, maybe even people interested in diet or alternative therapies.

Often, these people do not naturally come into contact with our organisation, but their voices matter. We believe we can identify and reach out to these people using social media.

For example, an insight into their interests can sometimes by gleaned the organisations and accounts whom they choose to follow on Twitter.

We will use a specialist NHS Social Media tool called Find SoMeone in Health to identify and approach followers of Twitter accounts that demonstrate a relevance to our target areas but do currently follow our own Twitter account @NHSELRCCG.


Initial analysis from Find SoMeone in Health has already identified:

• 504 people or organisations who follow the Twitter accounts of the Leicester Mercury AND NHS England but not NHSELRCCG, including ‘Active Oadby Wigston’ and ‘Rutland C Spirit – working to support people in rural areas’;

• 589 people or organisations who follow MIND and the Leicester Mercury, but not NHSELRCCG, including Action Homeless - a Leicester and Leicestershire charity tackling the causes and consequences of homelessness; and

• 1,150 people or organisations who follow MumsnetLeics but not NHSELRCCG.

We will also cross-reference and identify particular groups or individuals who are not currently engaged around a particular strategy, but whose profile or existing patterns of interest in a particular condition would suggest that they would naturally have an interest therein.


At the heart of our new strategy lies the concept of Active Listening. This can also be described as “listening for a purpose”. As a membership organisation, this includes listening to the view of our local GP Practices, as well as our own staff, our patients and local stakeholders.

It means having a continual awareness that we don’t just listen and engage for the sake of it or as an end in itself, but in order to deliver - and be seen to deliver-concrete outcomes and improvements in our strategies and the services we commission for local people.

We are building on strong foundations. During 2014-15 we made considerable progress in ensuring that we embedded effective systems to ensure that the CCG is able to monitor, challenge and scrutinise provider performance to ensure improvements in the quality of care commissioned.

We have developed ‘Patient experience dashboards’ for our main acute providers as well as the local out of county providers where our residents may choose to access hospital services.

Nine indicators have been developed, incorporating publicly available data and data sourced by contracting teams. Indicators include a selection of patient safety and patient experience indicators to provide a high level overview of the quality of care being provided at each Trust. The dashboards are reported to the ELR CCG Quality and Performance Committee on a quarterly basis.

Other examples of listening for a purpose include:• regular contacts through Quality Contracting Teams

with our neighbouring CCGs to monitor the quality of care being provided by our out of county providers;

Active Listening and LEAPs• Continued work with our local Healthwatch

organisations to act on intelligence received about provider performance;

• Understanding and scoping quality assurance systems within primary care;

• Development of quality schedules for Optometry, Pharmacy and General Practice Community Based Services contracts;

• Agreeing systems with NHS England to establish closer links and share intelligence of primary care quality risks including establishing systems of escalation where necessary;

• Development of a Care Home Strategy group to ensure all teams within the CCG whose work involves care homes is executed in a streamlined manner, to ensure quality care is delivered and compliance is monitored effectively by maintaining an overview of work streams to deliver a care home plan setting out aims, objectives, metrics, leads and time scales; and

• Systematic scrutiny and oversight of settings of care for people within inpatient settings in learning disability services to ensure that safe and effective discharge arrangements are in place.

We continue to review and refresh the data sets used against the domains of the NHS Outcomes Framework and ensure consistency and validation of data sources.

Alongside this we have embedded systems which allow for feedback from service users using Healthwatch members and stakeholder events as well as via our Listening Booth.

The Listening Booth

In its first year, the Listening Booth travelled to over 25 locations, speaking to almost 200 people and allowing them to talk to us outside health locations, approaching them when they are feeling relaxed and have the time to talk about their experiences of healthcare.

The latest figures available show that between April and December 2015, the Listening Booth increased its reach and impact by hearing over 550 comments and pieces of feedback in just 9 months.

The Listening Booth allows us to speak to the public, patients and carers outside of health locations; approaching people when they are feeling relaxed and have the time to talk about their experiences of healthcare.

The idea is to focus on how people feel and their attitudes and opinions. The booth is designed to complement the data already available through patient surveys and other large scale feedback mechanisms.

We collect both positive and negative feedback from patients. The Listening Booth asks people 3 simple questions:

• Have you had a recent experience of the NHS or social care? Tell us about it...

• What stood out as really positive?• What could have been done differently?


The Listening Booth also forms an integral part of specific consultations and engagement programmes. By accessing a wide range of locations with the listening booth, representatives of seldom heard groups are able to participate in these consultations and engagements.

For example:• during 2014, it was used heavily for our Urgent Care

Consultation;• during 2014-15, it was used to inform our

engagement on the Planned Care strand of the Better Together programme; and

• even more recently, it was used heavily for our engagement on our Community Services Model

The feedback received has been broken down into themes and trends, with feedback also provided to providers of services. This information has been used to influence changes in the way we commission services, and also to influence improvements in the quality of care being provided, where patients have highlighted issues.

Moving forward, as part of this updated strategy, we intend to further develop the impact and efficacy of the Listening Booth in the following ways:

• we will incorporate the findings from Listening Booth feedback into our new ELR CCG MOOD Repository, increasing our ability to analyse and report on trends, themes and find examples of feedback to inform specific strategies;

• we will investigate how we can develop a virtual ‘Listening Booth’ available via our new website, so people can provide us with feedback even when we are not in their area;

• we will look to deploy the same Listening Booth question formats in paper form with our GP practices, providers and stakeholders;

• as previously mentioned, we will look to be even more imaginative about the locations we choose to deploy our Listening Booth; and

• Listening Booth feedback will be at the heart of our augmented Listening. Responding. Delivering process.

Patient Stories and ELR CCG TV

Patient stories have become an integral part of our public Governing Body meetings. We use patient stories to drive changes and influence commissioning decisions through clinical discussions in these meetings. We have been able to demonstrate meaningful changes arising out of the use of patient stories at Governing Body meetings. Our Patient Stories allow real patients to tell us their real-life experiences in their own words.

Some highlights include:• Improvements to managing the risk of clostridium

difficle infection; • Input into the acute mental health pathway redesign;• Focus on complex children’s care system; • the impact of fragmentation of pathways for patients

who live on borders; and• continuing challenges around the cancer diagnosis/

treatment pathway.

A large part of the power of Patient Stories derives from them being the authentic voice of real people captured on video talking about real life experiences and real examples in their own terms and their own language.

As part of this new Strategy we will significantly expand our capacity for capturing real voices through video and film. This will be done through a new service we are introducing called ELR CCG TV.

ELR CCG TV contains video news items from the CCG plus background films introducing our people and explaining what we do. It is always available, any time of the day or night. And it is always free - to watch, download or subscribe.

Material can be watched online at http://nhselrccg.podbean.com or via iTunes podcast (ELR CCG TV).

It can downloaded or delivered by subscription to PCs, Macs, laptops, and Apple and Android mobile devices.

We intend to produce regular podcasts on items of interest plus material produced by our stakeholders and broadcast by us.

Crucially, when we work with stakeholders to produce material giving their own views and those of their members, ultimate editorial control will remain with the stakeholder. not ourselves. In this way, we can ensure the patient and stakeholder voice remains vibrant and genuine.


Listening and Engagement Active Partnerships

We will look to further deliver the concept of Active Listening in reality by establishing a series of Listening and Engagement Active Partnerships (LEAPs).

Each LEAP partnership will be specifically defined and documented in terms of:

• its purpose;• its participants;• the outcomes it seeks to deliver;• the methods and timescale by which it will deliver;

and• the roles of each participating partner in its success.

The outputs from each LEAP will be incorporated into ELR CCG MOOD and integrated with other listening and engagement insights.

Some LEAP partnerships will build on what we know we have done hitherto, for example:

• our provider Quality Visits - both timetabled and ad hoc as required;

• our GP Practices’ mechanisms for hearing and engaging the patient voice, including Patient Participation Groups, and Patient Reference Groups;

• our own Patient and Public Engagement Group, comprising attendees from local voluntary sector organisations, PPG/PRG Chairs and local Healthwatch;

• our forums for engaging with particular groups of GPs and their staff working on the ground, such as our Locality Meetings, Practice Nurses Forum and Practice Managers Forum; and

• our existing relationships with local statutory bodies and elected representatives, for example through Health and Well-being Boards and Health Overview and Scrutiny Committees.

We will build on these foundations through new Listening and Engaging Active Partnerships, in particular:

• a review and refresh of our public membership scheme - recently brought in-house;

• strengthening and deepening our ties and planned activities with local Healthwatch and the voluntary sector - including Voluntary Action Leicestershire and Voluntary Action Rutland;

• strengthing our drive to engage seldom heard groups and ensuring that their voice is heard and acted upon; and

• reaching out beyond our immediate and familiar networks in health and social care to embrace and engage with organisations and individuals involved in complementary networks and interests -for example in environmental, sporting, cultural and educational


The traditional way in which the NHS acts upon and provides feedback on what it hears is often branded as a ‘You Said, We Did’ approach. This typically involves collating a wide range of opinions and suggestions, analysing them behind the scenes and publishing a broad brush overall themed response, citing limited examples of specific items to illustrate the broad plan of action.

This has served the NHS well, but we know from our own recent listening activities during 2015 that our stakeholders feel they don’t have enough sight of what specifically happened as a result of specific views they gave.

This means that when they are subsequently asked for their views on another topic, they can suffer from what they call ‘consultation fatigue’ - feeling that they repeatedly make the effort to provide their views without equal effort being made to give them specific feedback on their individual views and concerns.

Our own organisational ‘brand’ is centred on the strapline “Listening. Responding. Delivering.” This strategy sets out how we operationalise that strapline to place it at the heart of what we do. This includes an updated approach incorporating improved business processes and communication channels that addresses our stakeholders’ expressed concerns and increases our capacity for providing individual feedback where required.

This was the most striking finding from the “Our Engagement with you” survey we carried out as part of our 2015 Summer of Listening exercise:

• 39% of respondents said they had never seen feedback from the CCG on a specific strategy or plan;

• 42% said they had never seen feedback on general topics or themes; and

• 70% said they had never received personal feedback on something they had said.

Comments received included:

“We tell you what we want but you don’t listen - it appears that your consultations at times are all about ticking the boxes ”

“Look for a wider breadth in your dealings with voluntary sector organisations”

“I have heard Healthwatch on local radio but not you”

“Maybe make inroads into your ‘clients’”

The danger of such an attitude being prevalent amongst our stakeholders is that when they are subsequently asked for their views on another topic, they could suffer from what they call ‘consultation fatigue’ - feeling that they repeatedly make the effort to provide their views without equal effort being made to give them specific feedback.

Listening. Responding. Delivering.


Our updated strategy seeks to address this challenge through improved business processes and communication channels built on the “Listening. Responding. Delivering” approach.

With these improved business processes:• each specific item of listening and/or engagement will

be individually logged;• all items will be collated into one central repository

(ELR CCG MOOD) and analysed across our range of listening activities and channels;

• each item will go through a structured process, asking;

1. is something specific being suggested?2. do we do it already?3. if we don’t, is it something we could/would do?

• where requested, each individual will receive specific feedback on their specific item, even where the response is simply to thank them and confirm action is already in hand to address their specific concern; and

• a searchable anonymised directory of all listening and engagement items received and our specific responses will be published on our website and made available for download.


During 2016, we will develop a programme of work to identify areas in which we will embed the values, for example, values based leadership, values based recruitment and appraisals.

We will then roll out this programme of work to embed the values and Incorporate the values into the CCG’s Constitution.

Listening to our staffOur listening and engagement activities don’t just cover our external members and stakeholders. They include the staff who work for us.

During 2015, we were delighted to receive recognition by Health Service Journal and Nursing Times in its new ‘Best NHS places to work’ Award described as “acelebration of NHS organisations that have worked hard to promote great staff engagement and create an environment where people can enjoy their work”.

Knowing we are building on firm foundations, during 2016 we will be completing work on two key initiatives in relation to our continuing listening and engagement with our staff.

In February 2015 the Freedom to Speak Up report was published by Sir Robert Francis QC. The report outlines the findings of an independent review into creating open and honest reporting cultures in the NHS. Many of the recommendations of the Freedom to Speak Up review relate to the creation of an open, honest and transparent culture within NHS organisations, with a focus on ownership from staff across all levels.

In response, the CCG formed the Freedom to Speak Up Steering Group (F2SU) and a Staff Focus Group to address the issues identified in the Freedom to Speak Up report.

One of the first pieces of work for both groups was to determine the appetite of staff to refresh the ELR CCG values, to reflect these recommendations and ensure that the culture of the CCG is in line with this vision.

Refresh of organisational values

An organisational value is ‘a belief that a specific mode of conduct is preferable to an opposite or contrary mode of conduct’. More and more studies show that successful organisations place a great deal of emphasis on their values which represent frameworks for the way we do things.

Values usually underpin an organisations vision and strategic aims. They relate to how organisations deal with their beliefs about people and work and define non-negotiable behaviours.

Values also provide a framework for achieving an organisation’s vision and increasing the effectiveness of the organisation.

In July 2015 at the CCG’s Time Out event we facilitated a session with staff groups to review the values and asked if the time was right to review them as part of the Freedom to Speak Up action plan.

The output from the day was used by the Freedom to Speak Up Focus Group to develop a new set of values and descriptions.


Freedom to Speak Up Action Plan

The refresh of the ELR CCG values is just one initial output from the F2SU Group and its agreed Action Plan.

Other items included in the Action Plan, that will be brought forward during 2016, were broken down into categories, with specific questions about culture, monitoring providers, policies, recruitment and also the Governing Body ensuring ownership of the plan.

Culture and workforce are also included in the action plan.

Teams in the CCG have already undertaken personality tests in the form of Myers Briggs to help understand how colleagues and teams can work together in an open and respectful culture.

There is a specific section for Primary Care in the plan to support primary care colleagues. The CCG is also offering support to nurses to raise concerns.


A key plank of our Listening and Engagement approach to date has been a determination to ensure that people shouldn’t be forced to come to us to give their views and opinions, nor to make their voice heard. Instead, we have made strong efforts to go to them.

This is the philosophy that underpins our Listening Booth, now in its second year of operation. In the past year alone the Listening Booth travelled to over 25 locations, speaking to almost 200 people and allowing them to talk to us outside health locations, approaching them when they are feeling relaxed and have the time to talk about their experiences of healthcare.

It is also to philosophy that underlies our Patient Stories - by us going out to record real people and bringing their voices to the heart of our decision-making at our Governing Body.

Our new strategy introduces further new ways in which we can communicate and engage with local people in ways that avoid them having to come to us - whether by letter, phone call or web - each and every time simply to find out if anything new has happened or anything new of particular interest to them is planned or happening.

We do this through imaginative investment in our web, digital and social media capabilities.

In particular, we have introduced a facility via our new website called myCCG which we believe to be a first amongst NHS Clinical Commissioning Groups.

Using myCCG, anyone can create their own free myCCG Account. When they do so, they can select to receive via e-mail either Instant Updates or a Daily Summary.

All registered myCCG users can also comment on any item on our website and get involved in threaded discussions and questions and answers.

We are looking to use social media in ways that go beyond merely using it as another publishing channel. Rather than using social media simply to tell the NHS, social care and the wider world what we are doing and what we are thinking, we are looking to use social media to give frontline staff, carers, patients and families their voice and their spaces to interact with us and each other.

As previously explained, we are using a specialist NHS Social Media tool called Find SoMeone in Health to identify and approach followers of Twitter accounts that demonstrate a relevance to our target areas but do currently follow our own Twitter account @NHSELRCCG.


Our new podcast channel ELR CCG TV will contain material produced by our stakeholders and broadcast by us. We are asking them what topics they would most like us to produce with them or what programmes and material they would like to see.containing video news items from

We are also harnessing the power of mobile devices to

improve how local people can access local services at the right time and in the right place.

Our new mobile App NHS Now allows users across East Leicestershire and Rutland to get self-care advice or find their nearest, most appropriate and most convenient local health service currently open to them at any time of the day or night.

The App is time and location aware. This means that users get real-world, real-time details, opening times and directions to a range of their local NHS services. Users can ask to see either all locations or those that are open for service at the specific time of using the App. The range of services include: • GP Practices;• Pharmacies; • Dentists; • Urgent Care; and • A&E .

Users are able to choose to see all or only emergency pharmacies. For dentists, users can choose between all or emergency dentists and/or to see only those currently accepting new NHS patients.

It has been warmly welcomed by local Healthwatch and patient representatives, as well as staff working in our GP Practice membership. It can be downloaded free of charge by searching for “NHS Now” on the Apple App Store or Google Play.

“We come to you”


GovernanceThe importance of getting communication and engagement right to ensure we are truly listening, responding and delivering are reflected in the arrangements we have put in place for governance and accountability.

While the CCG Governing Body retains overall responsibility for delivery, we have implemented structures and practices which encourage close and regular scrutiny of public involvement and engagement.

The following committees of the Governing Body have a remit to seek assurance in respect of patient involvement and engagement:

• the Strategy, Planning and Commissioning Committee - ensures patient involvement and engagement forms part of the business planning and commissioning processes and plans; and

• the Quality and Performance Committee - has oversight for the development of and monitoring of patient engagement plans and activities.

The clinical members of the Governing Body for part of the membership of these committees. This approach is aimed at instilling the principles of good engagement and communication throughout the organisation whilst demonstrating our commitment to clinical leadership.

Furthermore, on a project-by-project basis, the Executive Management Team and clinical members of the Governing Body oversee the communication and engagement activity in conjunction with the Head of Communications and Engagement.

The CCG hosts Patient and Public Engagement Group (PPEG) meetings with representatives from Patient Participation Groups, local Healthwatch organisations and other key local patient group. PPEG is chaired by the CCG Deputy Chair.

PPEG contributes to the development of engagement plans for the CCG’s commissioning intentions; communication and engagement plans for ELR CCG projects and assists ELR CCG in promoting opportunities for patients and the public to be involved in shaping commissioning plans and influencing CCG decisions.

Additionally, it is important to note that representatives from Healthwatch Leicestershire and Healthwatch Rutland sit in attendance at ELR CCG’s Governing Body meeting and add extra scrutiny, challenge and support to our work.

Further support for Governance in the updated strategy

Whilst the fundamentals of our governance arrangements remain unchanged, this new Strategy introduces further support to enhance them, particularly in the ways in which data, information and knowledge is collated, reported on and made available.

The new ELR CCG MOOD Repository will now bring together and integrate for the first time in-house data and knowledge that previously was held either externally or in separate locations or business processes.

This will include:• our Be Healthy Be Heard public membership -

previously stored and managed externally, now brought in house and data cleansed;

• workflow management and reporting on each item in our augmented Listening Responding Delivering business processes;

• outputs and summaries from our Locality Meetings;• outputs and summaries from our Listening Booth;• insights from our Patient Stories; and• project and programme delivery of the various strands

of this Listening and Engagement Strategy.

The MOOD Repository will underpin an intuitive web interface to the data and knowledge held therein. It also will be configured to provide regular reports and analyses through a series of web-based dashboards.

We will initially look to make these available internally to management and staff to support the governance structures described here..

In the medium term, we will investigate the feasibility and efficacy of making as much of the information as is practical and reasonable - taking into account Data Protection, privacy and commercial considerations - freely available to the wider world via the web and mobile devices.


Appendix A: Our duty to involveELR CCG is committed to involving and informing local people but it is also important to note that we are also legally obliged to do so.

The statutory duties are described below. Over and above these, we are also mindful that the Francis Report (2013) strengthens the patient voice and we will ensure all responsibilities passed to CCGs are included in our plans. The NHS Constitution

The NHS Constitution came into force in January 2010. It places a statutory duty on NHS bodies and explains a number of rights which are a legal entitlement protected by law. One of these is the right for people to be involved directly or through representatives in:

• the planning of healthcare services;• the development and consideration of proposals for

changes in the way those services are provided; and• the decisions to be made affecting the operation of

those services.

The Equality Act 2010

Section 149 of the Equality Act 2010 states that a public authority must have due regard to the need to a) eliminate discrimination, harassment and victimisation, b) advance ‘Equality of Opportunity’, and c) foster good relations. It unifies and extends previous disparate equality legislation. Our plans for adherence to this legislation and our commitment to ensuring equality for all are set out in section 8 of this document.

The Health and Social Care Act 2012

The Act sets out the Government’s long-term plans for the future of the NHS. It is built on the key principles of the NHS - a comprehensive service, available to all, free at the point of use, based on need, not ability to pay. I

It sets out how the NHS will put patients at the heart of everything it does, focus on improving those things that really matter to patients, empower and liberate clinicians to innovate, with the freedom to focus on improving healthcare services.

It makes provision for CCGs to establish appropriate collaborative arrangements with other CCGs, local authorities and other partners, and it also places a specific duty on CCGs to ensure that health services are provided in a way which promotes the NHS Constitution.

Specifically, under Section 242 CCGs must involve and consult patients and the public::

• in our planning of commissioning arrangements• in the development and consideration of proposals

for changes in the commissioning arrangements where the implementation of the proposals would have an impact on the manner in which the services are delivered to the individuals or the range of health services available to them, and in decisions affecting the operation of the commissioning arrangements where the implementation of the decisions would (if made) have such an impact.

The Act also updates Section 244 of the consolidated NHS Act 2006 which requires NHS organisations to consult relevant overview and scrutiny committees on any proposals for a substantial development of the health service in the area of the local authority, or a substantial variation in the provision of services.

ELR CCG has made a firm commitment to fulfil and embrace our legal duties regarding public and patient involvement by ensuring that involving, listening to, and acting on the views of local people, are at the heart of delivering our vision for local healthcare.

ELR CCG will comply with all current legislation and policy in delivery of this strategy.

Equality and diversity

ELR CCG will champion equality and human rights in all that we do. This is especially important for communication and engagement activities.

Communicating to our diverse audiences is a mainstream activity for ELR CCG and we will ensure we assess the equality impact of our work, assessing projects on an individual basis. This will ensure that all our communication and engagement activities meet with the necessary guidance and address key needs as far as possible. Our equality assessments will not only form part of the planning process, but will also be undertaken during evaluation to ensure that lessons are learned, good practice is noted and findings are shared widely for the benefit of future activities.


Ensuring that we meet equality and human rights needs will include, but not be limited to:• Availability of materials in different languages and

formats• Targeted marketing for greater impact –

understanding those receiving the message and how they would like us to communicate with them

• Engaging and involving people using multiple approaches that meet the needs of individuals and groups and where possible taking a direct and personalised approach

• Reaching people where they congregate and when they are most interested –in health settings, shopping precincts, libraries, community interest group meetings, places of worship, school activities and meetings, seasonal events, charitable activities, local neighbourhood and council-run events


Appendix B: Building on the 2013 StrategyThe starting point for designing this clinically-led Listening and Engagement Strategy was to build on what we know works - both from within our own direct experience and from experience across the wider NHS.

In particular, we have built on the foundations laid - and lessons learned - by:

• Our original strategy - refreshed in September 2013 strategy - “Informing and involving – our approach to communications and engagement”;

• Our highly successful engagement during 2014 underpinning creation of our new Urgent Care Service and Urgent Care Centres;

Informing and involving – our approach to communications and engagement (2013)

Our 2013 strategy explained our legal duties to involve people and/or their representatives in our decision-making through:

• The NHS Constitution;• The consolidated NHS Act 2006;• The Equality Act 2010; and• The Health and Social Care Act 2012.

The Informing and Involving strategy focussed on 3 objectives and associated outcomes, which remain the foundation of what we will do.

These are:

Objective OutcomeTo fully embed the patient voice within our commissioningdecisions in order to deliver im-proved patient outcomes

People in East Leicestershire and Rutland feel they have a voice inthe decisions made by the CCG and can see how they haveinfluenced local NHS services.

To facilitate ongoing and meaningful dialogue with local people

The people of East Leicestershire and Rutland will be well informedand will have a good understand-ing of services available to them.People will have the information they need to help them to improve their own health and well being and how their voice can be heard.

To manage and safeguard ELR CCG’s reputation and statutoryduties

The people of East Leicestershire and Rutland are confident that ELR CCG is a trustworthy and credible organisation which is acting with a mandate from the public and is meeting legal requirements and standards.


These KPIs will remain and be augmented by further engagement KPIs as a result of our refresh of our Service Level Agreement with our Communications and Engagement provider.

The 2013 strategy grouped our stakeholders into 6 groups - set out in the centre of this page. These remain at the heart of our strategy.

We are carrying out systematic refresh of our named lead contacts within each of these groups to ensure our records are completely up to date. Where we have only small known members of a particular group, we will use our lead contact as a bridgehead to attract further members.

The 2013 strategy set out 5 Key Performance Indicators, to be used to measure the effectiveness of the strategy and its implementation. These are:

• Public Awareness (e.g. website hits, social media reach);

• Patient and Public Engagement and Formal Consultations (e.g. number of surveys produced, number of people reached by engagement/ consultation, response rates, public views on effectiveness of consultation and engagement);

• Media Relations and Reputation Management (e.g. media enquiries handled, proactive releases issued, media coverage generated);

• Stakeholder Management (e.g. number of briefings produced, response rates to engagement);

• Membership (e.g. number of bulletins, magazines, membership events and response rates); and

• Internal communications (e.g. staff survey results, practice engagement activities).

Listening. Responding....

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