Table of Contents Document Page 2 3 -Mar Draft PPP ... Involved/Update...1 1.0 PPP Agenda 3 2 3 -Mar...

Table of Contents

Document Page

1 1.0 PPP Agenda 32 3 -Mar Draft PPP minutes FINAL 53 3.1 - PPP Action Log May 2017 114 3.2 Extract Islington CCG Risk Register Complete_v60 135 6 - 20170504 PPP Committee report_Planned Care 156 7 - PPP Committee CHINS engagement May 17 docx 29

This page has been left blank

Agenda

Please look over the agenda and think about which of these topics might present an area of conflict for you.

This means an item where a decision or recommendation made may advantage you, your family, and your workplace or business interests. These advantages might be financial or in another form, perhaps the ability to exert unseen influence.

Where anything on the agenda has the potential to put you in such a position, or is raised during the meeting, you should tell us all about it. This means we can ensure that our decisions, recommendations or actions can be protected from the impact of any possible conflict you or others could have.

If you are unsure it is always best to raise the possibility with the Chair before the meeting, or at any point during the meeting.

This openness is important as we can all discuss how to manage decision making in a complex environment that involves public money.

Item Lead Timings Papers

1. Welcome and Apologies Chair 10:00-10:05 (5)

--

2. Declarations of Interest Chair 10:05-10:10 (5)

--

3. Minutes of the last meeting

3.1 Action Log

3.2 Risk Register

Chair 10:10-10:20 (10)

Item 3.1 and 3.2

4. Matters Arising Chair

10:20-10:35 (15)

--

5. Sustainability and Transformation Plan Update

Jo Sauvage 10:35-10:55 (20)

Verbal

6. Planned Care and VBC Becky Kingsnorth 10:55-11:15 (20)

Item 6

7. Care Closer To Home Integrated Networks engagement

Lizzie Stimson 11:15-11:35 (20)

Item 7

8. Committee Workplan Chair 11:35-11:55

(20)

To be tabled

9. Any Other Business -- 11:55-12:00

(5)

--

10. Date of next meeting: Thursday 6 July 2017 at 10.00-12.00 (TBC)

Deadline for submission of reports: 27th June 2017

Patient and Public Participation Committee Seminar Room, Ground Floor 338-346 Goswell Road EC1V 7LQ Thursday 4th May 2017 10.00-12.00

3 of 36

Item: 3

Minutes Patient and Public Participation Committee

02 March 2017 Seminar Room, 338-346 Goswell Road, London EC1V 7LQ

Members Present:

Sorrel Brookes SB Lay Member – Chair

Jennie Hurley JH Practice Nurse Representative

Kay Dixon KD Community Member

Pamela Moffatt PM Community Member

Ian Huckle IH Practice Manager

John Pritchard JP Communications Lead

In attendance:

Emma Whitby EW Chief Executive, Healthwatch Islington

Elizabeth Stimson ES Engagement Lead

Rebecca Mancy RM Engagement Officer

Rachel Lissauer RL Haringey Director of Commissioning

Apologies:

Marisa Rose MR Programme Director, Integrated Care

Deborah Snook IH Practice Manager Representative

Jo Sauvage JS CCG Chair

Dr Katie Coleman KC CCG Vice-Chair, PPP Committee Chair

Minutes:

Samantha Skinner SS Administrator

1. Apologies for Absence:

Apologies were received from Marisa Rose

2. Declaration of interests

No new interests were declared.

3. Minutes and Action Log & Risk Register

Accurate record Action log 16.02- 05 not actioned – request copy of PHB paper submitted to committee 07.04-10 ES to discuss with PS to confirm this action can be closed. Risk Register There were no new risks added to the register since the last meeting.

4 Matters Arising

None

5. Wellbeing Partnership

The committee referred to the Wellbeing Partnership report circulated prior to the meeting. This is a none agenda item and presented by Rachel Lissauer RL highlighted the following key points to the committee. The main focus for the wellbeing programme will be Population Based Approach, and will focus on how to reduce pressure on acute services by focusing on the population of Haringey and Islington patients who are putting

5 of 36

Item: 3

their health at risk through long term conditions. The Wellbeing programme have identified the following cohorts in improving outcomes and improving efficiency:

Frailty

Diabetes

Musculoskeletal (MSK)

Learning Disabilities (LD)

Mental Health

Intermediate Care

Children and Young People Leads have been identified to work with these workstreams, and have looked at what the model of care will look like and what the costs will be. RL updated on how the Wellbeing Programme has developed the a partnership agreement and what the aspirations on how we are going to plan services together; make decisions together; how we spend our resources; what degree of transparency will the Wellbeing Programme have looking at NHS and LA services. RL made it clear that decisions on programmes would still need to go through Local Authority cabinet meetings, CCG Governing Bodies and Trust Boards. It is hoped that in the future there will be delegated authority to make decisions. JH asked if the LD workstream within the wellbeing programme has patient or resident representation on them, and is this consistent. RL confirmed that the representation is not consistent. Although workstreams have had a lot of patient engagement, the programme has tended to use previous representatives who have been engaged who have provided feedback on what the priorities are, it was felt unnecessary to again ask following the feedback. JH is keen to ensure that LD patient representative is included at all levels and especially at the workstream. ES confirmed that a recent meeting with the LD lead has taken place and will help supportthe business case, and then work with the LD lead to plan a full plan of engagement with LD patient representatives once the workstream is in place. EW asked how the committee can be assured of how we are contacting patient representatives and the committee can be assured that language used is clear to patients and clear of the engagement around the workstreams. RL assured the committee that until the Wellbeing Partnership structure has been confirmed, engagement with patient representatives can start. EW informed the committee that Patient Groups will want to know about funding costs and will want to be involved and also asked that the CCG ensure patients are aware that correct terminology is used when discussing Haringey and Islington CCG as terminology such as merger, shared management level, collaboration have been used to describe CCG’s. KD raised a concern regarding accountability if something goes wrong and clarification is needed if accountability will be with the Trust, CCG, STP or Wellbeing Programme and this is not clear from a patient perspective. RL confirmed that the wellbeing programme is still working towards same outcomes for shared responsibility.

6 of 36

Item: 3

6. Wellbeing Partnership

The committee referred to the Wellbeing Partnership report circulated prior to the meeting. ES highlighted the key points from the report:

Item 6.3 Community Engagement and Development Plan – ES highlighted the engagement principles and objectives and current development. This includes information across Haringey and Islington workstreams to summarise of key points for shaping services and focus is now on next steps with programme leads to incorporate the already collated feedback to service design and development; identify gaps in research and undertake further community research to address gaps and exploring where individual engagement or community development might be appropriate.

ES also highlighted that work on the proposal for the Community Reference Group which is in the structure and is being produced in collaboration with Healthwatch and Islington Council. The proposal can be shared at the next Committee. The Group would be assuring that proper engagement is taking place on both collective and individual engagement and will include mixture of staff including Director level, HealthWatch, voluntary and patient representative. Councillors are not included in order to keep the group small and focused which would allow for community members to sit on the workstreams.

PM raised concerns as to whether Haringey patient engagement is as robust as Islington CCG as concerns have been made regarding this. EW confirmed that all NCL Healthwatch representatives hold a 5 way meeting, and confirmed that Haringey Healthwatch are seeking out views about hard to reach groups EW agreed to discuss further with PD and would also feedback to the committee providing an update from the next 5 way meeting on what engagement Healthwatch Haringey are undertaking. RL also confirmed that Haringey CCG runs a patient network meeting and would be more than happy for PD to attend. IH suggested there seems to be a lot of overlap with what the Patient Public Participation (PPP) Committee already provide and asked if Haringey also have the same meeting and asked if there are implications of the PPP Committee. RL confirmed that there should be one committee only for Haringey and Islington. The committee agreed there is a need to ensure there is no duplication in meetings, and will return to this subject in due course.

7. Communications Update Report

The committee referred to the Communications Update report circulated prior to the meeting.

JP highlighted the highlighted the key points from the report:

The Haringey and Islington Wellbeing Partnership will focus on staff engagement and will move to public and patients in a later date. JP is currently working on this with Caroline Rowe (Communications Lead at Haringey CCG) and Elizabeth Stimson.

7 of 36

Item: 3

Stay Well this Winter campaign has finished. Uptake was not as high as the CCG had hoped especially for Children. One issue that arose from the poor uptake related to an ingredient in the nasal spray that contained pork and would could account for the poor uptake.

EW would be keen to know if poor uptake was linked to specific community groups as well as misinformation that communities found. JP informed that public health will be engaging with the Finsbury Park Mosque to help encourage flu uptake in adults and children JP also informed the committee that the communications team is working on the annual report and accounts, and has now recruited a new member of staff who will be working on public facing campaigns and will be working on patient on-line to encourage patients to register for the GP on-line services. IH informed that the GP federation are also working on the GP on-line service update and asked that communications be more joined up with GP federation. JH asked if there is any data on the shingles campaign as uptake was low due to miscommunication on which age group should be invited to have the vaccine. EW asked if the CCG would be holding an AGM and if there will be an STP focus and asked if the next AGM will be more publicised. JP confirmed that no decision has yet been made on when we will have our next AGM nor the agenda items.

8. Healthwatch Report

The committee referred to the Healthwatch report circulated prior to the meeting. EW highlighted the following points for the committee:

Healthwatch have been looking in to how their recommendations on services are taken up, and the focus this year has been on Autism. Issues that have been highlighted from a patient perspective have been taken to the Autism Partnership Board, which is still in its infancy, but will ask how they can implement the changes needed.

Supporting PPP Committee in how they inform the public of issues such as STP.

Continuing the work on the uptake of interpreting in GP practices

Working with patients in care homes and access to services including GP’s

Working with patients who need information on iHub and what services they provide.

Engaging in Children and young people regarding STP and specifically care closer to home

Mystery shopping or check list for Autism accessibility

9. Quality Processes – Complaints Overview

The committee referred to the Healthwatch report circulated prior to the meeting. RM provided the committee with details of how patients can make a complaints and how they monitor complaints. These include:

8 of 36

Item: 3

Clinical Quality Review Meeting (CQRM)

Serious Incidents Monitoring (SI)

Quality Assurance visits

Quality and Performance Committee JH asked if there is a report from NHS England on the number of complaints regarding primary care. SB confirmed that the CCG have asked NHS England numerous occasions for this information, but this has not been received as it information captured is at a high level only. The committee were ASSURED about the CCG complaints process but were not assured about GP as they committee has no information and there is no evidence that there is an equal capacity for everyone to complain about GP services.

10. Committee Workplan

No comments provided

11. Sustainability and Transformation Plan

SB updated the committee on the following:

Helen Pettersen has been appointed Accountable Office for North Central London CCG’s

CFO interviews taking place today (2nd March) and interview for other senior NCL post taking place thereafter.

Interviews to take place for the Chief Operating Officer for Haringey and Islington will take place in April

Joint Committee have begun to meet in shadow form but this is in its infancy

12 Any Other Business

None stated.

13 Date of next meeting

Thursday 02 March 2017 at 10:00-12:00.

9 of 36

Appendix 3.2

Meeting

Date

Minutes

Reference

Action Description Responsibility Target Date Progress Details

04.02.16 16.02.-04 EV to consider Chairs points and look at patient outcomes. Emma Vince May-17 Work around self care agenda is being undertaken and

embedded in the activity of the planned care

committee. Emma Vince to report back as part of next

Planned Care update (May 17)

04.02.16 16.02.-05 AB will circulate the report submitted to EMT on Personal Health

Budgets to members of PPP.

Alison Blair Sep-16 02.03.17 Not actioned – request copy of PHB paper

submitted to committee

07.04.16 07.04-10

AB to discuss with Paul Sinden how we ensure the

implementation of accessability standards in to our contracts.

Alison Blair Sep-16 02.03.17 ES to discuss with PS to confirm this action

can be closed.

ES to discuss with PS and SD and arrange for

something to be brought back to a future meeting.

05.01.17 05.01-03 ES to look at how social isolation can be incorporated in to the

work of the committee going forward.

Elizabeth Stimpson Mar-17

ACTION LOG: Patient & Public Participation Committee

11 of 36

Version: 55 Islington CCG risk register

3 27/04/2017 11:39

ID, C

ategory

Heading

Objective

Programm

e affected

Principal riskWhat could prevent this objective being achieved?

Describe in terms of cause, event, effect.

Risk A

pproach

Proximity D

ate

Initial Consequence

initial Likelihood

Initial Rating

MitigationExisting mitigating controlsPlanned mitigating controls

Gaps in mitigation, and action plan

AssuranceExisting assurancePlanned assurance

Gaps in assurance, and action plan

UpdateMost recent on top

Current C

onsequence

Current Likelihood

Current R

ating

Date last review

ed

date of next review

Risk lead ( risk ow

ner where blank)

Risk ow

ner

Status

Com

mittee

320 R

Involvement w

ith patients and public

Statutory Obligations and C

ore B

usiness

Core B

usiness: Quality and Integrated

Governance

Involvement with patients and publicIf the CCG fails to engage effectively at a time of change the CCG may not meet its individual or collective* duties to involve patients, service users, carers and residents. This could damage the CCG’s reputation lead to legal action and impede the CCG’s effectiveness in planning and delivering high quality healthcare services to our residents.*Duties relate to• Individual: commissioning Self-care for individual patients• Collective: commissioning of programmes of work e.g. peer support, behaviour change and support for self-management

Mitigate

Ongoing

3 3 9

Current ControlsPatient and public participation (PPP) strategyPPP Committee Regular reports from programmes of the CCG on progress against the PPP StrategyParticipation & dialogue with groups• Twice-yearly Islington patient participation group• Voluntary sector forum• Last years of life patient group• We have patient and community representatives on CCG working committeesYearly programme of community research to support commissioning intentionsTargeted community research to support particular programmes and projects

Current assuranceThe reporting of progress against the strategy to the Governing BodyAnnual review of PPP committee terms of reference.Minutes and reports of the PPP Committee are presented to the Governing BodyReporting of qualitative and quantitative progress against PPP action plan.Assurance review by NHS England of the CCG's collective and individual dutiesAnnual Engagement report.

No change from previous meeting

3 2 6

01/03/17

01/06/17

PP

I & E

ngagement M

anager

Director of Q

uality and Integrated G

overnance

Open

Patient and P

ublic Participation

Com

mittee

321 R

Statutory duties around equality and diversity

Statutory Obligations and C

ore Business

Core B

usiness: Quality and Integrated G

overnance

Statutory Duty on Equality and DiversityThere is a risk that the CCG will not meet its statutory requirements on equality and diversity if it does not actively respond to inequalities existing within the health and care economy.This could lead to legal action, damage the CCG’s reputation and hinder the CCG’s ability to plan and deliver high quality health care services to our residents

Mitigate

16/11/2015

3 3 9

Current controlsEquality and diversity are part of mandatory training.Regular planned discussions on equality with PPP (Patient & Public Participation) Committee, Governing Body, patient groups, and staff groupsThe PPP Strategy has an explicit equality statement which has been shared with stakeholders and staff Staff equality objective has been setEquality and diversity objectives are part of the PPP strategy. Strategy).Use of workforce equality and race standard toolDelivery of unconscious bias training

Current AssurancesThe CCG has verified and reported on the achievement of equality objectives and is actively monitoring progress for 2016/17Equality Objectives report publishedThe staff organisational development group and has reviewed the equality actions that address concerns raised through the staff surveyOver 80% of staff throughout the last 12 months have been up to date with equality and diversity training.Equality Objectives of CCG meet the Equality Delivery standard.Progress on meeting equality Objectives is reported to Executive Management Team and PPP committeesPositive internal audit report Jan 16

No change from previous meeting

2 2 4

Patient and P

ublic Participation C

omm

ittee

Open

Director of Q

uality and Integrated Governance

PP

I & E

ngagement M

anager

01/06/17

01/03/17

13 of 36

MEETING: Patient and public participation committee

DATE: 4th May 2017

TITLE: Planned Care Programme & Value Based Commissioning update

LEAD COMMITTEE MEMBER:

Paul Sinden

AUTHOR: Becky Kingsnorth Jennifer Speller

CONTACT DETAILS:

[email protected]

Purpose

This report is for ASSURANCE

This report provides assurance and identifies any consequent risks to the Committee on the Planned Care Programme and Value Based Commissioning (VBC) work streams.

Overview:

This paper provides an overview of the programme of work relating to Planned Care, which incorporates Value Based Commissioning (VBC) workstreams, particularly highlighting the patient and public participation activities that currently form part of the programme. This includes a review of 2016/17 and details of the planned programme of work for 2017/18. Set out below is a description of the relationship of the programme of work to the strategic objectives of the Patient & Public Participation Strategy: To support people to look after their own health and build the number of people who self-care in Islington.

This is a key feature across the programme with strong examples within Value Based Commissioning for Diabetes, and the Musculoskeletal (MSK) services transformation programme in particular.

To involve and engage patients in all levels of decision making from commissioning decisions to service design to the delivery of community wellbeing projects.

Details are provided within this report of specific examples of this within the planned care programme – there is a concerted effort to include patients in all levels of service planning throughout most projects.

To ensure the local community are always informed and fed back to about the CCG's commissioning direction, and community and engagement work in Islington.

This has been a feature of work on both ophthalmology, MSK, and value based commissioning, with feedback given to local communities about how research has already been used to develop services or service change proposals.

To listen to, involve and consult individuals and groups that find it hard to have

15 of 36

mailto:[email protected]

their say because they are socially excluded, vulnerable or experience the worst health. To ensure that they are all treated fairly and equally and that Islington CCG is meeting its responsibilities under the Equalities Act 2010.

Value Based Commissioning work programmes have included significant involvement of services users in the early phases of the project as well as use of Patient Reported Outcome Measures in the delivery of the services.

The work undertaken on ophthalmology specifically focused on working with service users who are blind or have poor sight.

Structure of the report The report first provides an overview of the planned programme of work for Planned Care, articulating the strong overlap with the Planned Care workstream of the Sustainability and Transformation Plan for North Central London. Particular areas are then selected for focus to outline the patient and public involvement that has either happened or is planned. Issues to be considered This report highlights how the planned care programme are involving patients and the public in commissioning.

Key risks (including those on the Corporate Risk Register) No risks identified specifically for patient and public involvement.

Outline the impact and outcomes of public and patient involvement The CCG have engaged with patients and the public around design of services and commissioning decisions by:

- A commissioned piece of insight work with Healthwatch Islington - Engagement with community service user groups - Involvement of service users in designing models of care

Impact Assessments: As previously reported, Equality Impact Assessments have been completed for the value based commissioning projects for diabetes and people living with psychosis. As programmes develop and service models are proposed, impact assessments will be required for a number of work streams. Supporting papers to this summary Appendix 1 – Detailed information about the Planned Care Programme

16 of 36

Appendix 1

1 Planned care work plan

The Patient and Public Participation Committee previously received a report on the Planned Care Programme in February 2016. Since that date the programme has progressed through 16/17, and the planning process for 2017/18 and 2018/19 has been undertaken by the CCG and across North Central London. The process has been built around the development of the North Central London Sustainability and Transformation Plan (STP) so that the commitments and changes coming out of these plans translate fully into operational plans and contracts. It is assumed that the Committee has been briefed on the STP, and this is not covered in this paper. The programme of work undertaken locally for all areas of planned care therefore needs to respond to this context, similarly supporting the North Central London STP. This paper sets out in draft the proposed programme of work, responding to STP priorities and incorporating local priorities where required. This has previously been considered by the Planned Care Programme Board. To ensure successful delivery within available team capacity, consideration has been given to a) the phasing of the work, b) scope to work jointly with Haringey or for one CCG to lead on behalf of both CCGs, and c) scope to work at scale across North Central London. Where there may be potential to work with one or more CCGs this requires discussions with those CCGs to confirm this, however there is a need to prioritise further to allow sufficient focus on key priorities. The draft work plan is used as the structure against which patient and public participation activities that have been undertaken are reported, and planned activities are described. These are considered in further detail in sub-sections of the report. The following section provides some strategic context within which to consider the plan.

2 Strategic context

2.1 System wide working

The STP sets out a commitment by 22 organisations responsible for the provision and commissioning of health and social care services in North Central London; it is a plan shared by commissioners and providers. More locally, across Islington and Haringey, the Wellbeing Partnership is progressing a partnership approach to tackling local system issues, bringing together the local CCGs, Local Authorities and providers. Both approaches are introducing new ways of working together. Thus, where priorities are identified below, some will be led from within Islington CCG, and some will be led by partners with support from Islington CCG, with the focus in all cases on the impact of change across the system. The Planned Care team within Islington will, however, engage in all workstreams and ensure that patient and public participation, and a focus on self-care, are key features of the pathways or service models designed. The Urgent and Emergency Care work stream of the STP is to be supported by a partnership between the Health Watch organisations in North Central London, to support co-design of each project within Urgent and Emergency Care; this is an approach we in Islington would be supportive of adopting for the Planned Care elements of the STP.

2.2 STP Planned Care Workstream

The Planned Care Workstream of the STP has the following high level objectives:

Deliver the best value planned care services across NCL

Reduce variation for inpatients attending hospital for a planned intervention

17 of 36

Reduce variation in the number of outpatient appointments received by patients with similar needs.

Optimised pathways will ensure patient safety, quality and outcomes, and efficient care delivery.

Standardise criteria for Procedures of Limited Clinical Effectiveness, consultant to consultant referrals and referral threshold policy across NCL to ensure parity of care regardless of patient’s postcode.

Explore network creation and service consolidation opportunities resulting from workstream efficiencies.

The workstream has the following scope:

All providers and CCGs in NCL

All services undertaking planned care across NCL, with initial focus on MSK, Dermatology, Urology, Gynaecology, ENT, Gastroenterology

The provision of a clinical advice and navigation (CAN) service along pathways, linked to triage, variation reduction and improved quality

Providing support to primary care via close working with Care Closer to Home workstream

Repatriation of work from non NHS services

Network creation and resource sharing along defined pathways

Fragile service resolution and reprovision The following areas are out of scope:

Trauma Urgent and emergency services Emergency surgery

A multi-organisation steering group has been established to oversee the STP planned care workstream, and delivery groups are being established to drive individual initiatives. The Steering Group has in recent meetings specifically considered the need to plan key points at which patients and the public will be engaged, the questions we would be seeking to answer and messages we would be seeking to convey, and the need to coordinate this with other STP workstreams to ensure consistent messaging and to prevent consultation fatigue. This will be considered further with the central STP team as it is established, and is not considered in detail in this paper.

2.3 Key requirements of relevance to the Islington planned care work plan

The Islington CCG planned care work plan needs to respond in particular to the following key requirements.

Year-on-year activity reductions (STP interventions outweigh the impact of demographic and non-demographic growth) are planned in all planned care areas (follow up outpatient appointments, elective admissions and day cases) with the exception of first outpatient attendances. The pace of the STP interventions accelerates in 2018/19 compared to 2017/18;

The NHS England RightCare programme identifies a number of pathways or clinical areas where there is opportunity for action to improve outcomes or reduce spend. The CCG has selected areas of focus which align with those prioritised within the STP, but will be required to report on progress separately through this route.

The targeted reductions in outpatient follow-ups and elective activity referenced above are derived from the elective and consolidation workstreams and include the impact of RightCare initiatives;

18 of 36

The development of Care Closer to Home Integrated Networks (CHINs) will provide opportunities to provide planned care differently, within a more integrated and holistic, person-centred community model. This must go beyond a re-siting of traditional outpatient appointments into the community, and maximise the opportunities provided by technology, new workforce models and self-management by the person.

The CCG has also submitted performance trajectories against the NHS Constitution targets, which relate to planned care.

3 Work plan priorities The proposed work plan has been formed from a collation of STP priorities, priorities highlighted through RightCare, known local priorities and ongoing workstreams. Figure 1 below provides an overall list of workstreams, identifying where the initial prioritisation has originated and referencing any patient and public participation activities that have already been undertaken within Islington, or where activities are planned.

19 of 36

Area STP priority

Existing local priority

RightCare priority

Scope to work jointly with Haringey

Scope to work across NCL

Additional notes

Musculoskeletal services including Pain and MSK podiatry

Group 1

Patient and public participation activities undertaken as part of the Haringey and Islington Transformation programme, with further activities planned. See section 3.1.

Dermatology Group 1

Patient and public participation undertaken to support a local decision to recommission community dermatology activity in an acute setting. This was reported to the PPP Committee when it was in progress. Further details are provided in section 3.2.

Clinical advice and navigation

Group 2 Islington to lead on behalf of STP. In early planning stages. To be covered in future report.

Neurology Group 3

A group 3 workstream in STP. Delivery from November 17. Local work to be scoped based on RightCare data.

Urology Group 3 A group 3 workstream in STP. Delivery from November 17.

Ophthalmology Group 3

A procurement exercise was undertaken in 2016, which did not identify a successful bidder. This included patient and public involvement. See section 3.3. A number of issues to be resolved in Islington regarding provision of Minor Eye Conditions service and referral refinement scheme; monitoring of low vision service contract meetings. Further patient and public participation will therefore be required.

Gynaecology Group 4

There are currently discussions underway regarding the underperformance of the community gynaecology service procured in 2014/15. There was strong patient engagement in the procurement process for this service, and a patient representative remains involved in current discussions. There has also been a specific engagement exercise with patients at one of the clinics from which the service is provided to inform the service review.

Gastroenterology Group 4

A group 4 workstream in STP. Delivery from November 17. Local scheme to be scoped in response to RightCare data.

Colorectal surgery Group 4 A group 4 workstream in STP. Delivery from November 17.

20 of 36

PoLCE Group 5

Group 5 workstream, start date TBC. Standardisation of thresholds and policy across NCL to ensure parity of care provision. This will require substantial and formal public consultation.

Consultant to consultant referral

Group 5

Group 5 workstream, start date TBC. Standardisation of thresholds and policy across NCL to ensure parity of care provision.

Diagnostics Group 6

Group 6 workstream, start date TBC. Standardisation of diagnostics thresholds and ordering across NCL. Local monitoring of diagnostic contracts (InHealth and, new contract, Highgate) will continue.

Vascular surgery Group 7 (phase 2)

Breast surgery Group 7 (phase 2)

Hepatobiliary & pancreatic surgery, Upper GI surgery

Group 7 (phase 2)

Also of relevance to ICCG as highlighted through the RightCare Programme. Not currently being scoped.

General surgery Group 7 (phase 2)

ENT Group 7 (phase 2)

Moved from a group 3 workstream to group 7 in STP. Delivery from 18/19. Community service in place in Islington with contract recently extended to March 2018. This may need to be extended further to align with the STP developments.

E referral Challenging target for 2017/18.

Obesity pathway

Transfer of commissioning of Tier 4 bariatric surgery from NHS England. Need to establish need for and model for Tier 3 services. Service design likely to be undertaken across North Central London.

Chronic Kidney Disease

Cancer services

New within Planned Care programme

Anticoagulation Action plan required following recent unsuccessful procurement process.

Liver Handed over from primary care, support to Liver working group

Maternity Steering group, service monitoring, linking into NCL work

Value based commissioning: Diabetes

At implementation stage: Held within the Planned Care Programme while implementation is established. To be taken forward under Integrated Care under long term conditions lead long term. See section 3.4.

Value based At implementation stage: To be

21 of 36

commissioning: Psychosis

taken forward under mental health commissioning team. See section 3.4.

Figure 1 – work plan overview

3.1 Musculoskeletal pathways Musculoskeletal (MSK) pathways have been identified within the STP as high volume pathways and an area where extensive work is underway across North Central London. The STP MSK work programme

1 will seek to achieve:

• Integrated pathways and services • Reduction in variation in Key Performance Indicators (e.g. LoS) • Standardisation of service and pathways across NCL • New financial models based on whole system design • Improved patient experience

Specifically work on MSK pathways will seek to achieve:

• New roles and service locations fitting with population needs • Integration with local authority keep fit and exercise programmes • Expert advice and triage at key stages in the pathway

Locally, MSK has long been identified as a priority due to service access issues, and is also highlighted in RightCare data analysis. Islington CCG is already undertaking a joint MSK transformation programme with Haringey, including Pain Services, under the auspices of the Wellbeing Partnership. This is specifically considering the MSK model being implemented in Camden CCG, which also aligns with that being seen in Enfield and Barnet, and so would support alignment across North Central London. The draft objectives proposed for the MSK programme are:

A) To articulate and agree a clear model of care across all aspects of MSK services across

Haringey and Islington. The model of care will:

a. Simplify the points of referral into the MSK service;

b. Enhance the management of patients within the community, and actively manage

the demand for secondary care services ensuring patients access to the most

appropriate settings of care the first time;

c. Deliver a model of care that makes efficient use of existing resources whilst

ensuring that high quality of care is delivered;

d. Provide clear, evidence based, agreed integrated MSK care and treatment

pathways across providers;

e. Achieve agreed waiting times from referral to appointment for urgent and routine

patients;

f. Reduce inequalities in access to, and outcomes from, MSK services.

B) To design and implement enhanced communication and education around MSK

conditions for healthcare professionals and patients, and within the MSK service.

C) To ensure that patient, carer and referrer feedback is central to the work of MSK

services across Haringey and Islington.

D) To co-ordinate and support the delivery of area specific improvement plans where

required.

1 Led by Fares Haddad, Divisional Clinical Director of Surgical Specialties at UCH, and Director of the Institute

of Sport, Exercise and Health at University College London, and a managerial lead

22 of 36

E) To establish the service as a key player with developed relationships with other local

and national organisations.

F) To ensure the MSK system is underpinned by effective IT systems.

G) To move to a system where we have joint visibility of the finance, activity and outcomes

relating to MSK.

H) To ensure all of the above objectives are supported by clear and effective commissioning and contractual arrangements

The transformation programme will be led by Becky Kingsnorth, Head of Service Transformation for Islington CCG, on behalf of the Wellbeing Partnership, with project management resource funded by the Wellbeing Partnership.

Patient and public engagement to date has consisted of a small survey, focus group and a recent report to the Haringey Engagement Network, with a need to plan in a similar presentation in Islington. In particular this responded to contributions from the Engagement Network regarding MSK services, at two previous meetings. However the programme will:

a) Build on and respond to the existing work undertaken by Islington CCG with Islington Council to understand the needs of people with long term conditions. In particular the following themes highlighted in previous reports about integrated care:

Local people particularly those with a Long Term Condition are highly supportive of services that are as integrated as possible including the sharing of information;

The need for consistent processes and systems across services;

The need for good communication and information both between services, from GP to patient and patient to GP, as well as between other services and GP practices;

The importance of self-care, peer support and a supported patient;

Idea of a “one-stop-shop” clinic which includes a lot of different services for patients so they can access all the ones they need at the same place; and

b) Develop an MSK specific engagement plan. This will benefit from the partnership approach being undertaken with Whittington Health, which will enable particular patient groups to be targeted for engagement. The professional lead for the project, an Advanced Practice Physiotherapist, is currently drawing up a segmentation of the patients seen within the services in scope, to enable targeted engagement.

This will respond in particular to the following objectives of the Patient and Public Participation strategy:

To support people to look after their own health and build the number of people who self-care in Islington. The redesign of the service model seeks to increase the level of support for self-care, with a focus on self-care videos, and group sessions, which have been particularly highlighted by members of the public as supporting motivation, and reducing social isolation;



23 of 36

To listen to, involve and consult individuals and groups that find it hard to have their say because they are socially excluded, vulnerable or experience the worst health. To ensure that they are all treated fairly and equally and that Islington CCG is meeting its responsibilities under the Equalities Act 2010.

24 of 36

3.2 Dermatology Dermatology has similarly been identified as a high volume specialty with work in train across North Central London. Work on Dermatology pathways will seek to achieve the same generic features listed above for MSK, and additionally develop new integrated teledermatology services. Locally, Islington has decommissioned the community dermatology service, delivered by

Whittington Health, with service provision ending in September 2016, and recommissioned this

activity in an acute setting. Engagement prior to this decision was underway when the Patient

and Public Participation Committee received the previous report on planned care. The details of

this engagement are set out below.

There was a 3 month patient consultation about the service via an online survey sent out by the CCG and Whittington Health. 48 patients responded, of whom only 8 had used the community dermatology service. Some words used by patients to describe the service were: Good service / attentive doctors; OK; Satisfactory; Horrid. The most important feature of a dermatology service was felt to be short waiting times and access to treatment and tests.

When asked for further comments on proposals to close the service, only 1 objection was received where the comment was: “This is too important for the Islington patients to close”; no other concerns were raised regarding the community service closing. Following the survey and taking other factors in to consideration, it was agreed that the community dermatology service would cease and appointments were moved back to the hospital clinics (at the Whittington and UCLH). This was through mutual agreement with the Trust that the following developments would add greater value:

An advice and guidance telephone or email for GPs to discuss referrals;

A weekly urgent clinic, where patients who require it can be referred to the next

available clinic and treated quickly such as; a flare of psoriasis, an acute rash or a flare

up of eczema.

A single referral point with a triage process of all referrals into appropriate clinics,

allowing some patients to be seen within a target of 6 weeks and some patients to be

seen in dermatology specialist nurse led clinics i.e. eczema and psoriasis clinic.

These developments will now be considered as part of the STP, for which Dermatology is an

early priority. The first planning meeting is taking place on May 4th, with a view to implement

changes from August 2017. It is proposed that local developments are taken forward alongside

the STP process, ensuring alignment between both sets of proposals.

The STP workstream will be led by Lance Saker, GP in Camden.

Work to date has responded in particular to the following objectives of the Patient and Public Participation strategy:


25 of 36

3.3 Ophthalmology Ophthalmology is in the third group of pathways to be taken forward under the planned care STP but has been a local priority over 2016/17, on which work continues. This has been driven by a continued growth in demand for services at Moorfields Eye Hospital and a need to ensure that this tertiary provider is able to meet the needs of those patients in clinical need of their services specifically, with patients with less complex needs receiving more appropriate alternative services. Islington CCG worked with City and Hackney CCG during 2016 to develop a service specification for a Minor Eye Conditions service to be provided in the community. This was subject to a procurement exercise, however this failed to identify a successful bidder. Work now continues with local providers to find a negotiated solution. This will be informed by the STP pathway development when this begins. Patient and public participation has formed a central part of the local work on ophthalmology. Islington and City and Hackney CCGs commissioned the local HealthWatch organisations to undertake specific engagement with residents regarding eye care services. This comprised of structured interviews and focus groups with 51 service users. The research was carried out in partnership with the Thomas Pocklington Trust who facilitated access to the service users and to community venues using relevant services.

The findings from this work, presented in a report, was that community services would be better suited to minor eye conditions rather than urgent or complex cases. Overall, there was not a huge amount of appetite for eye care services to be delivered in the community, with concerns around staffing, access to diagnostics and consultant input into care and treatment. Respondents valued the accessibility and familiarity of the hospital services stating there were good transport links to all the local hospitals. One patient wrote: ‘I would rather go to hospital. I have no problems travelling to whichever hospital I need to get to. The most important thing for me is to see a person that is medically and clinically qualified to look after my condition - who knows about the specific disease I suffer from.’ Another wrote: ‘Nothing they could do would change my mind from going to Moorfields.’ However, people did recognise that a community service could provide access to services closer to home, shorter waiting times, ease of booking appointments and continuity of care. There was a sense that community services would be more welcoming, encouraging better communication by not having to keep telling your story and providing a less medical and more social model of care. Four recommendations came out of the HealthWatch report. These were:

1. A move to more community based services would need to be clearly communicated to patients emphasizing the benefits of a more local service and reassuring about the quality of the service

2. Prioritising moving the services that patients felt would be best suited to the community such a minor ailment treatments

3. Community services should be located on main transport links and easily accessible from any part of the borough

4. The community service would need to include highly trained staff including consultant optometrists to provide confidence amongst patients using the service

Following these recommendations the CCG came up with 3 options. These were:

1. To commission a consultant-led community ophthalmology service that would run a number of eye clinics (this option in itself would meet recommendation 4);

26 of 36

2. To commission discrete services (such as cataract assessments prior to surgery) from community optometrists, with consultant oversight (this option in itself would meet recommendations 2, 3 and 4);

3. To commission a minor eye service which could be delivered across the borough through community optometrists, with consultant oversight (this option in itself would meet recommendations 2, 3 and 4).

Islington CCG together with City and Hackney CCG held a clinical design workshop and with information based on both the workshop and the HealthWatch report agreed on option 3. HealthWatch were provided with a progress report explaining how their report informed this decision. When the procurement was unsuccessful, HealthWatch also received an update. We will seek to build on this engagement as we move forward local discussions. Work to date has responded in particular to the following objectives of the Patient and Public Participation strategy:



To listen to, involve and consult individuals and groups that find it hard to have their say because they are socially excluded, vulnerable or experience the worst health. To ensure that they are all treated fairly and equally and that Islington CCG is meeting its responsibilities under the Equalities Act 2010.

3.4 Value based commissioning projects The Value Based Commissioning programme for Psychosis is now entering year 2 of service implementation, is being embedded within contracts and responsibility will now transfer to the Mental Health commissioning team with links being maintained by Planned Care for maintaining the learning from this project regarding new models of commissioning. Islington CCG is acting as the integrator for the Value Based Commissioning programme for Diabetes and work has commenced to implement the service model. There are some strong success stories from both programmes and it is recommended that these are reviewed in detail in a separate paper.

4 Conclusion

This draft plan sets out proposed priorities for planned care for 2017/18, aligned primarily to the North Central London STP, but maintaining focus on existing local priorities. Specific areas of engagement are highlighted, however as individual areas of work are planned in more detail, patient and public participation will form a core part of those plans. This will include active promotion of Islington CCG’s approach to patient and public participation in all aspects of the STP, as this develops. The Patient and Public Participation Committee will be kept informed as this progresses and are asked at this stage to comment on plans to date.

27 of 36

MEETING: Patient and Public Participation Committee

DATE: 04 May 17

TITLE: Care Closer to Home Integrated Networks engagement

LEAD COMMITTEE MEMBER:

Dr Katie Coleman

AUTHOR: Elizabeth Stimson

CONTACT DETAILS: [email protected]

Purpose

This report is for ASSURANCE

This report provides assurance and identifies any consequent risks to the Committee on the

Context: Care Closer to Home Integrated Networks (CHINS) are key to delivering local healthcare to the Islington community. They are part of the North Central London Sustainability and Transformation Plans and although rooted in primary care with GP leaders, the focus is on delivering high quality health and social care at a very local level. The report gives a summary of how it is envisaged CHINS will work and how they will develop over the next year in Islington. As they are focused on such a local community (there are likely to be three across Islington) with plans to work closely with patients and the voluntary sector there are real and exciting opportunities for engaging with local people and community development projects. This report explores practically how this might work and what support and guidance can be given to each CHIN area to ensure robust engagement happens across Islington, and takes into account the current financial climate and resources that the NHS and Sustainability Transformation Plans are working within. Issues to be considered The Committee is asked to discuss and assure the approach outlined. Key issues to address are:

Do the proposals lay out a robust and thorough way of ensuring ongoing engagement with local people and voluntary sector

Do the proposals ensure that there are appropriate links to the CCG’s partners?

Do the proposed plans make both realistic and best use of resources available?

Are there any gaps? Outline the impact and outcomes of public and patient involvement The report highlights how patients and publics may be involved in future plans and work.

29 of 36

mailto:[email protected]

Community engagement and development proposal Care Closer to Home

Integrated Networks

Introduction

The Care Closer to Home Networks (CHINS) are new ways of working across community and primary care

services and at a very local level. They offer new and innovative ways to really work with local communities

and meet their needs. THE CHINS design document states there would be a team working within the CHINS,

and they would be supported by the CCG teams.

There is already a lot of work across Islington in terms of both gathering community research and

community development whether this is funding from large funders such as Islington Giving, the rich

voluntary sector or some of the signposting and social action projects commissioned by the CCG and

Council. The CHINS offer a great opportunity to engage, where appropriate, on an extremely local level,

shaping services for geographical populations with those communities and building on the strong work

which already takes place.

There is clearly little resource in the system so the below approach lays out a way to maximise on the work

which already takes place – and highlights where the CHINS can build on this work for their local

populations.

The CCG engagement team will support the CHIN teams to deliver effective engagement and community

projects. They will be the first point when planning this work.

CHIN leads and teams would be expected to factor in engagement activities as part of their project planning

and role and work with the engagement team to determine the most appropriate plan. Some resource

should be set aside to undertake engagement activities. It is suggested that there will be £50k per CHIN for

community development initiatives, however, this should be used specifically for these types of project and

not routine engagement – this resource should be found within CHINS budget – and will be supported by

staff both working in CHINS and within CCGs.

Each CHIN will need a yearly community engagement and development plan that seeks to compliment the

work already undertaken by the CCG engagement teams, HealthWatches, local Councils and voluntary

sector and public health data. They will utilise research already gathered and only go to speak to people

where there are gaps or significant service changes / developments or closures.

Each CHIN would report to the PPP Committee to assure the CCG on the way in which they are engaging

their local populations.

There will most likely be three CHINS across Islington. They will start by focusing their development on one

clinical area and as they develop this will expand out to the whole community. There are two assured CHINS:

South West whose focus will be Long Term Conditions

North (also covers some of Central Islington) whose focus will be Frailty

The final CHIN is likely to cover South East and the rest of central Islington.

Proposed approach for CHINS:

1. Contact CCG engagement team

2. Each CHIN should look at the extensive community research which is already available for Islington

residents and the summary research reports.

30 of 36

3. Look at public health population data

4. Identify gaps in research and gaps in specific community understanding

5. Identify key groups already working with / available to work with

6. Engage CHIN population on key themes (targeting gaps). Engage by:

i. Utilising existing routes and projects which already occur

ii. Commissioning local organisations to work with their client groups

iii. Additional outreach

iv. Survey through practices

7. Ensure there is representation on any working groups or procurement panels

8. Feedback to local community how their views have helped shape services and CHIN offer.

These steps would form the basis of the engagement plans for the year.

Included within the plans would be a community development element, looking at how to support

community projects for the CHIN populations (please see below for more details on work already occurring

across Islington).

Engagement Structure:

Below I have laid out mechanisms which already exist and would be useful places for CHINS to tap into. The

Islington wide work should support the CHINS development.

Involved as part of strategy / operational groups

Community members: The CCG already has a range of community members - volunteers who sit on their working groups and Committees – they would continue to do this, and provide external comment to CCG plans. Where the CHINS present plans to Strategy and Finance, PPP Committees etc – they will already be part of the decision making or assurance process. However, the Quality Improvement Support Teams (QIST) hold meetings as they plan and develop their structure; 2 local patients should be invited to sit on any groups, to carry out a similar role to the current community members who sit on the CCG Committees and working groups. Islington wide PPGs

The CCG commissions Health Watch Islington to carry out Islington-wide Patient Reference Groups and

community outreach with groups who do not speak English as a first language or experience high health

inequality. These groups could be utilised to take a wider role in supporting CHINS development / support

CHINS engagement – and could be a forum to take development plans with questions for the local

community.

Practice level: There are practice patient groups affiliated with practices. These can be time intensive to set up and do not

always have a good representation of local communities. However, wherever there are strong PPGs within a

CHIN area this could be utilised (similar to the Islington wide Patient Reference Groups to share plans and

key findings from community research), and all groups can be engaged with no matter what their

attendance. Although these must not be the only method through which the local community are engaged.

Practices all have PPGs to some degrees.

Each practice could potentially collect emails of interested patients – so that online surveys could be carried

out gathering information on local CHIN resident’s experiences of services and health priorities. A survey

could be sent out each year which covers key areas.

Third Sector forum for community and voluntary sector organisations:

31 of 36

We currently hold a third sector forum twice a year and the plan is to continue to do so. This is another

avenue by which the CHINS could engage with the Islington wide voluntary sector sharing plans – and letting

them know how to get involved or any commissioning / partnership working opportunities coming up. A

section of this meeting could be dedicated to CHIN development – as the proposed way of working has such

an emphasis on the community. I think it’s a good forum to utilise – because as previously mentioned most

voluntary organisations work across Islington representing specific communities (i.e. Somali community),

although there are some which are geography specific.

Rather than a forum per CHIN it would be suggest CHIN leads attend this forum to hear directly from

community organisations and develop relationships with local groups.

Community research and support project and Diverse Health Communities Voice

Running for two years now – the CCG works with the local community and community organisations to

engage upon the key commissioning priorities and issues of the CCG. This research is fed into the

Commissioning Cycle. This year the project was developed – to further build on a newly commissioned for

outcome – so that the CCG not only hears from hard to reach communities but enables small and local

community organisations and community researchers to properly signpost and support their clients / people

they speak to information and services.

Diverse Health Voices is a consortia with HealthWatch and 9 refugee and migrant community organisations

across the borough. They have delivered this project for the last two years (in conjunction with Help on Your

Doorstep for the second year)

Gathering community research and population data

CHINS community research although needs to work on a very local population basis also needs to be careful

not to duplicate community research already carried out.

I think it is important to map what channels the CCG, Council and voluntary sector already use, ideally the

CHINS would tap into these engagement channels initially and from here on a yearly basis determine where

there are gaps. This would be set out through a CHINS engagement strategy and plan.

Current routes:

As mentioned above the HealthWatch Patient and Participation Groups would support some

engagement.

Community support and research project: This project could work to gather key information on

CHINS development / areas of need. We could also look at whether we re-create this project to

work across CHINS – thus gathering community research and supporting communities that face

specific barriers into services and signposting across all three. There may need to be some

additional resource if it was targeted in this way.

Sustainability Transformation Plan or Wellbeing Programme workstreams targeted engagement

carried out

Current service user groups or projects carried out by the Council.

Information and research carried out by HealthWatch as part of their yearly planning.

Information gathered through the Community wellbeing project on New River Green estate,

Andover and Caledonian road area – these projects will also have significant implications for local

CHIN community development work.

32 of 36

Linking people to local community support services through CHINS and prevention

opportunities

CHINS offers a real opportunity to more easily link local people to the holistic help they need to look after

their own wellbeing. There are already some projects being commissioned by the primary care team which

supports this way of working.

Currently Islington CCG commission:

Navigation and signposting:

Help on your Doorstep to sit in GP practices and offer face to face and telephone service. GPs can

refer their patients to them. They provide holistic support and signposting for a range of holistic

issues including housing, employment and financial management as well as health concerns. They

are also commissioned by the Council to deliver the connect service (a similar service with offices on

local estates).

Age UK are commissioned to deliver Health Navigators, these perform in a similar way to help on

your doorstep, however, they are much more involved with patients who have complex health

problems.

These functions will continue to support local people, however, with CHINS we could begin to monitor

the need on a CHIN population level – addressing specific concerns for that local community.

Community Wellbeing Projects:

The project works with the local community, gathering insight on their needs and skills, to deliver a huge

range of wellbeing interventions to support improved wellbeing in the local community which include

volunteering, working with isolated residents and developing residents skills so that they are delivering

activities (i.e. football coaching). All activities are free or subsidised and have a focus on health and

wellbeing. The project employs local people from the estates to coordinate. The projects also provide

statutory services with a link to residents and vice vs. Thus, community safety have been involved as have

Expert Patient Programmes, Arsenal in the community and employment services. The Council is now using

this project as a model for further community development work and we will be piloting the same method

on the Andover, with a possible additional location by the end of the year.

As mentioned earlier, the CCG, Cripplegate (local large funder), Peabody (local housing association) and

Council have commissioned community development projects on four estates in Islington:

New River Green estate – longest running and most well established – is the model for the other

projects (CCG and Cripplegate funded)

Andover estate

Bemerton estate

Caledonian road area

Prevention Strategy

Work is also taking place within Islington Council and the prevention workstream about how we develop this

approach across Islington. The CHINS offer a unique opportunity to further develop this work for a smaller

geographical location.

St Luke’s Community Centre – this is a thriving community centre which offers a lot of subsidised and free

activities to support the local community. Its model, although different to Community Wellbeing project,

33 of 36

works on a very similar ethos of supporting and helping to build wellbeing opportunities with the local

community, as well as improve their wellbeing.

This demonstrates there is already a huge amount of work underway in the borough and CHINS should

initially look to build on some of the projects which are taking place, looking to widen their reach rather

than starting from scratch – which would waste resources.

The CHINS offer further opportunity to support social prescribing and better links to voluntary organisations.

Although initially I think we will want to focus on the Islington-wide projects we have commissioned. There

are potential long term to use the CHINS as a way of supporting local people to voluntary sector services

such as:

Social prescribing to local services – paying organisations per referral, to build up capacity in the

voluntary sector and begin to create a viable social prescribing model.

Working with voluntary sector and supporting community development As mentioned above there are Third Sector forum and diverse community health projects, as well as the

work we undertake with Help on Your Doorstep on the Bemerton and Calle Road estates, Andover and New

River Green estate.

This crosses over with the above area. The Islington voluntary sector has a rich wealth of community insight,

as well as offering support to local people. Its important we continue to work with them and stay engaged

with them.

There are also some key grant funders such as the local Council, Islington Giving, Richard Cloudesley and

Cripplegate in the borough which we would want to continue to work with and perhaps there would be

opportunities to deliver joint projects on CHIN population base. They design innovative grant funding

opportunities based on Islington need and to support local populations to have improved wellbeing.

Lastly, we want to ensure we are utilising the community centres / hubs and tie into the Community Wellbeing projects and their development.

First steps: Both CHINS that are already formed (South West and North) have already begun to look at their engaging with their local communities. Reports which have been compiled on all of the current Islington wide community research we have that directly relate to each CHIN’s area of focus which they are in the process of looking through and applying to the CHINS development. South West CHIN is also holding an introductory event for all residents in its area. This will introduce the CHIN as well as talk through how they might address Long Term Conditions, sense checking the community research already gathered and ways of working that are currently occurring across practices. Alongside they will begin to explore further community research and outreach that can delve deeper into the community insight we have. North CHIN is currently in the process of utilising the community research already gathered. They are also dedicating a meeting in May to exploring how they will plan engagement for the next year. This meeting will be led by Islington CCG engagement lead and HealthWatch Senior Responsible Officer. From initial discussions they plan to utilise the current research and from here identify which local communities they need to do further work with.

Self care: These plans do not specifically address self care – however, this is clearly a key part of looking after people with more complex needs – and would need to be addressed as part of CHINS development.

34 of 36

Appendix 1 Points in the Design Brief which specifically relate to community engagement or development:

An annual budget of £50,000 per CHIN is delegated by the CCG to enable them to commission

specific services, such as third sector or social marketing services to meet the wider needs of their

specific communities.

Facilitate and strengthen links with other partner organisations such as community trusts, acute

trusts, local authorities, education providers and third sector. These organisations, particularly in

the voluntary sector will be key to CHIN success, particularly in the prevention and early

intervention roles.

Provide support to CHINs to communicate and engage with local communities and particularly with

marginalised communities and people who find public services “hard to reach”. CHINs will need

help to understand their communities’ needs and what is effective in meeting their needs, from

research, from representatives of the people and from the people themselves.

A coproduction of plans and targets and shared monitoring with local communities with an

understanding of barriers to progress and responsibilities of all parties to help deliver the

improvements.

A system wide understanding of where the biggest challenges are to justifiably marshal resources to

those areas, to address inequalities and test innovative solutions.

A grip on the management of individual patients to prevent deterioration and crisis wherever

possible, harnessing all resources across system and demonstrating the value of a system wide

integrated and proactive approach.

Monitoring:

Coproduction of planning, delivery and monitoring of services with local people

A shared commitment to address inequalities in health and care and to direct

resources to the areas most struggling to meet needs

An enthusiasm for innovation as well as evidence based best practice and to

systematically encourage these through the commissioning approach

Based on health and care outcomes, patient/service user experience and system

efficiency outcomes which link in with the STP aims

Working with the voluntary sector to understand what opportunities there may be to support

patients/service users through social prescribing, volunteering opportunities etc – and whether

CHIN resource should be refocused to support eg. service navigation, peer support groups or health

champions.

CHINs could work closely with social housing to improve health and wellbeing of tenants – this could

include bringing health promotion activities to local estates or by providing on site provision to

tenants in supported housing

Exploit opportunities to develop better links with Children’s Centres and schools so that health

promotion and access can be improved for children and families

35 of 36

Table of Contents Document Page 2 3 -Mar Draft PPP ... Involved/Update...1 1.0 PPP Agenda 3 2 3 -Mar...

Documents

Transcript of Table of Contents Document Page 2 3 -Mar Draft PPP ... Involved/Update...1 1.0 PPP Agenda 3 2 3 -Mar...