Delivering on Engagement NHS Medway Engagement Annual Report 2009-2010
www.medwaypct.nhs.uk1
Feedback on this document It’s your NHS, and we would very much like to hear your views on our Engagement Annual Report. You can get in touch with us to comment on the report, get a copy in an alternative format, or get involved with helping NHS Medway shape health services for local people. Please email itsyournhsmedway@nhs.net, visit our website www.medwaypct.nhs.uk, call us on 01634 335173, or write to Engagement, Fifty Pembroke Court, North Road, Chatham Maritime, Chatham, Kent, ME4 4EL.
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Contents Introduction The Medway Health Debate Priestfields Stakeholder Event Medway Local Involvement Network (Medway LINk)
4 5 6 7
Consultations Cancer Survivorship Dementia Dermatology
8-11 12-15 16-18
Diabetes End of Life Eye Care Gynaecology Healthy Living Centres Learning Disabilities Lower Back Pain Lymph oedema Maternity Maternal Mental Health Mental Health Multiple Sclerosis Non Invasive Ventilation Personal Health Budgets Phlebotomy Public Health Speech and Language Therapy Wheelchair service Useful contact numbers
19-20 21-22 23-26 27 28-29 30-34 35-36 37-38 39-40 41 42-44 45 46 47-49 50-51 52-53 54 55 56
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Introduction NHS Medway is responsible for planning and paying for NHS healthcare for everyone who lives in Medway. To do this we assess the needs of the local population, engage with local people and commission a comprehensive and equitable range of high quality, responsive and efficient services. Our aim is to improve health outcomes, improve patient experience and improve value for money. This report explains how during 2009/10 we involved local people in the planning and buying of services. The report describes our annual cycle of engagement “The Medway Health Debate” which informs our plans and priorities. There is also more information about our work with The Medway Local Involvement Network (Medway LINk) and details about how people can contact us and get involved in shaping health care locally. The people who use the NHS in Medway have invaluable first hand experience of the service. We want people to feel better informed and supported to say what really matters to them. Understanding patients’ needs and wants will help us to improve health services and will enable us to be more responsive and accountable. In addition to our ongoing programme of public engagement, our aim is to work in partnership with local residents whenever we are reviewing or planning a service so we learn from their expertise. In 2009/10, we held a series of public meetings as we were developing our Strategic Commissioning Plan so we could take account of what the public told us about the priorities in their local area. We have involved people in a range of service reviews including end of life care, maternity, cancer, depression, lower back pain and respiratory conditions. Changes to services are often managed through NHS Medway’s Strategic Change Programme groups. These groups include patients and clinicians and there are several references to them and the work they have carried out throughout this document. We also work closely with organisations like The Medway Local Involvement Network, GPs and other clinicians, Medway Council and other NHS providers, and the voluntary and private sectors. This report sets out the essential role that all of you have had in helping us develop, design and improve services for everyone in Medway. We couldn’t do it without you. Thank you.
Denise Harker Chairman
Marion Dinwoodie Chief Executive
Dr Peter Green Professional Advisory Committee Chairman
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The Medway Health Debate NHS Medway’s Communications and Engagement Strategy identified the benefits of a programme of public engagement branded The Medway Health Debate to ensure that all of our engagement activity is co-ordinated, acted upon and meaningful and does not just involve the people that we usually speak to. It describes a “cycle” of engagement to inform all of our commissioning decisions. The Medway Health Debate started at the end of 2009 with a series of public meetings led by NHS Medway’s Chief Executive Marion Dinwoodie and Deputy Chief Executive/Director for Commissioning and Performance Helen Buckingham. The audiences were asked what they thought about health services locally and what they thought we should do to improve them. During the spring and summer of 2010 these public meetings were supplemented with meetings with local community groups and organisations, with a particular focus on groups which cover diverse and seldom heard communities. Drop-in sessions have also been held at venues like the Sunlight Centre where people can give their views individually. People also completed our Medway Health Debate survey online. We have been asking people for their opinions on health services locally and how they think they should be improved; what their preferred methods of communication are; whether they feel they have a say in how services are designed and delivered and how they would like to be involved in the future. Throughout the year commissioning managers also work with patients and clinicians on service specific subjects and involve them in the redesign of services from the beginning and throughout service change. Clinicians, Medway LINk representatives and patients are involved in all of our Strategic Change Programmes. The Medway Health Debate culminates in an annual “you said, we did” event to feedback on the progress being made as a result of what you have told us. This year this event will be held in partnership with Medway LINk at the Corn Exchange on 26 October 2010. Feedback from all of our engagement, including public events, national and local surveys as well as PALS and Complaints data, is taken to the Patient Experience Network. This group ensures that public and patient feedback is co-ordinated and acted upon. This could include changes to commissioning of services, changes to services we provide directly or changes to how we communicate or deal with people’s complaints, for example. The group is led by the Director of Clinical Quality/Executive Nurse and involves Medway LINk; NHS Medway’s lead officers on Patient Safety; Quality; Older People’s Services; Planned Care; Long Term Conditions; Practice Based Commissioning and Mental Health. For more information about The Medway Health Debate email itsyournhsmedway@nhs.net, visit our website www.medwaypct.nhs.uk, call us on 01634 335173, or write to Engagement, Fifty Pembroke Court, North Road, Chatham Maritime, Chatham, Kent, ME4 4EL.
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Priestfields Stakeholder Event Around 100 people attended NHS Medway’s Stakeholder Event held on 20 April 2009 at the Priestfield Centre, Gillingham. The event included presentations by Marion Dinwoodie, Chief Executive, Alison Barnett, Director of Public Health and Helen Buckingham, Director Commissioning and Performance covering subjects including public health and health inequalities, how funding is targeted and how delegates and the population of Medway are being encouraged to share their views of services and become involved in improving health and healthcare. Following the presentations, delegates were divided into groups and were asked to feedback on what they had heard and were asked the following questions: What do you think will make people change their lifestyles so that they lead healthier lives? What NHS Medway can do to help people change their lifestyles so that they lead healthier lives? How can we work with community organisations, e.g., Surestart Centres? Feedback ranged from suggestions about increasing the number of GP practices and NHS walk-in centres, the introduction of the NHS health check, the new chemotherapy unit at Medway Maritime Hospital and views about services for people with mental health problems. There were suggestions about how to promote healthy lifestyles and improve health education and how best to communicate and engage with the public including streamlining the message and being honest about health outcomes with everyone. Commissioning managers from NHS Medway led discussions on Urgent Care, Staying Healthy, Coronary Heart Disease, Long Term Conditions, Diabetes, Stroke, Older People's Services, Mental Health, End of Life Care, Maternity and Newborn and Children and Young People. The facilitators described between three and five headline development plans for their areas over the coming year. Delegates were asked their views on these developments, how they wanted to be involved in shaping services in the future and their preferred method of communication. The invaluable feedback from these sessions has been used to inform the work of the NHS Medway’s Strategic Commissioning Groups and was instrumental in influencing many of the projects in this document including the public health campaign A Better Medway; the mental Health Strategy Live it Well; and improvements to End of Life, Maternity, Diabetes among others. The responses included suggestions for a number of communications channels including email, internet groups and social networking sites like Facebook. There were many suggestions about how to involve people including running small events, user forums in the community and focus groups. Commissioning Managers are continuing to liaise with the people who attended and have looked at different ways of working with interest groups for their respective areas. NHS Medway Engagement Annual Report 2009/2010
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Medway Local Involvement Network The statutory duty placed upon Primary Care Trusts to involve patients in decisions made about health and healthcare has been ratified nationally by the implementation of Local Involvement Networks, replacing Patient and Public Engagement Forums. The Medway Local Involvement Network (Medway LINk) is an independent network of local people and community groups working together to influence and improve health and social care services in Medway. Medway LINk provides a forum to voice concerns about service provision and standards of quality and work with those who plan and run services to help make them better. By making recommendations to the people responsible for commissioning those services, real changes can be made in service redesign. Since its creation in January 2009 Medway LINk and NHS Medway have developed a close working relationship, to ensure patient and public involvement is embedded in the commissioning cycle. At a Medway LINk community event on 26 October 2009, The Chief Executive of NHS Medway, Marion Dinwoodie, discussed future plans with LINks participants and residents of Medway and responded to questions that they had. A similar presentation and discussion took place at the induction for the LINks Coordinating team and external representatives in April 2010. This gave them the necessary context and understanding of the role and functions that NHS Medway performs. This led to the recruitment of external representatives to five of NHS Medway’s strategic change programme groups. A grievances and non attendance policy was agreed jointly between NHS Medway and the LINk with a clear role description of what is expected of representatives and of NHS Medway in the way of support and transparency. Having external representatives on strategic change programme groups enables Medway LINk to directly influence commissioning decisions made by NHS Medway, alongside its ongoing involvement and joint working with us. To facilitate Medway LINk investigations and projects, NHS Medway’s engagement lead is responsible for coordinating formal responses to requests for information and project findings. When LINks members raised concerns over the waiting times and access to speech and language therapy, NHS Medway responded by reviewing the current services with the help of its providers, the public, patients and clinicians. Waiting time for assessment was up to 14 months with a further wait of up to 12 months for therapy. The waiting time is now 6 months with no wait for therapy after assessment. Other projects such as its Hygiene, Disinfection and Patient Experience in Hospitals and Access (Transport) to Health Services Projects have provided NHS Medway with useful insight and recommendations which will be used to inform service improvements.
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Cancer Survivorship Living with and beyond Cancer
Status: Completed
Introduction More people are living with a diagnosis of cancer as improvements in treatment lead to reduced mortality rates. In England, there are on average 125,000 deaths and 230,000 new cases of cancer recorded every year. There are currently 1.2million cancer survivors within the UK. This figure does not include carers and other family members. The actual number of people affected is much higher. It is estimated that between 30% and 50% of cancer survivors will need some form of intervention to manage the consequences of the disease or treatment on their health and wellbeing effectively. There is currently a limited range, and access to, services for cancer survivors. The Cancer Reform Strategy published in December 2007, recommended that a national cancer survivorship initiative should be established to improve post-treatment care and support for people living with or beyond cancer. Who was involved and how? The Medway survivorship project is a collaboration between NHS Medway, Kent and Medway Cancer Network, Macmillan Cancer Support, Medway NHS Foundation Trust and cancer patients in Medway. To inform the NHS Medway Living With and Beyond Cancer project (which started in September 2008), an event was organised to gather the views of patients, carers and professionals on current services and how they should be developed in the future. The event took place on 1 December 2008. The day was split into two sessions. The morning session was aimed at patients and carers, and the afternoon session was designed to bring together those present in the morning with representatives of statutory, community and voluntary organisations who were invited to join the event at lunchtime. The aims of the event were:  To introduce the National Cancer Survivorship Initiative (NCSI) and the local work being taken forward as part of this  To start to hear views on the services that could be put in place to provide better support for people living with and beyond cancer locally  To identify some options for developing support in future, and to undertake further consultation. 70 patients and carers were invited, 43 attended. 30 professionals were invited,12 attended.
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What you said The main points identified: There is a need to improve the post-treatment care pathway so that people affected by cancer are clearer about what to expect The support options available (NHS, social care and voluntary) in the local area need to be set out clearly so that people know how to access services that may be of benefit to them Existing support groups play a very valuable part in helping people living with and beyond cancer. We need to find ways of offering groups that cater for a wider range of cancer types and circumstances Carers’ needs are different from patients’ needs and we need to make sure both sets of needs are met. Ongoing support is needed from both professionals and peers
Living With and Beyond Cancer ‘word cloud’. What people affected by cancer told us at the Medway stakeholder event, created using www.wordle.net What we did In response to the event a Medway Living With and Beyond Cancer project Board was established which includes NHS Medway commissioners, clinicians, social workers, GPs, local council officers, Macmillan Cancer Support representative and patients. To meet the challenges identified at the event the group identified key work streams to meet the needs of people living with and beyond cancer:
To develop a support and sign posting service that could undertake/review holistic needs assessments at the end of active treatment to sign post people to support that would meet their individual needs The development of a patient-led support service in the community – developed by people living with and beyond cancer for people who are living with and beyond cancer To work with the Kent and Medway Cancer Network to pilot holistic needs assessment and care planning tools
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 
To develop a cancer welfare benefits service in partnership with NHS Medway, Medway Council and Macmillan Cancer Support To map care pathways and undertake further patient interviews to inform any further gap analysis
What has changed? 1. Support and Sign Posting Service A working group including three patients, specialist nurses, NHS Medway commissioners, GPs and social workers was established to develop a service specification and business case. Following a review of funding, NHS Medway was not able to fund the business case, however an alternative approach was explored and funding has since been secured from Macmillan Cancer Support. The project will go ahead by incorporating the support and sign posting service into the hospital cancer information service. A Macmillan Cancer Information and Support manager has been recruited and once established will take forward the sign posting service. We have developed excellent partnership working, initially to develop the service but more recently to find alternative ways of delivering our objectives. The service is expected to start by the end of 2010 and we will monitor it for value for money and further development. A further bid is being developed with Macmillan Cancer Support for an additional post within the service to enable further development, ongoing Holistic Needs Assessment and care planning following active treatment. 2. Living Your Life Project - Sunlight Development Trust Patients and carers stated that peer support was essential, the Sunlight Development Trust, a local community-owned and managed charitable organisation, was commissioned by NHS Medway to support the development of a community-based patient led group. The overall aim was to improve health outcomes for people living with and beyond cancer by getting them involved in developing services that meet their needs and which are owned by them, reducing their need for, and dependency on, statutory health services. Regular meetings were held and those affected by cancer could share their experiences. The meetings became a regular occurrence and were very well attended. The group was an excellent way for those living with and beyond cancer to engage with others in similar situations, and social networking. Living Your Life (an informal group for those affected by cancer) evolved and ran for just over a year. The group developed marketing materials and made regular radio broadcasts through the Sunlight Development Trust’s own radio station. Although there was initial enthusiasm the group did not manage to gain any new members. The project relied on the members forming a constitution and management committee with the aim to evolve and become self sufficient. Members of the group, although supportive and genuinely wanting to give something back, either were not in a position or did not want to take on the full responsibility of sustaining the group. The difficulties in forming a constitution resulted in the group ceasing in April 2010. NHS Medway Engagement Annual Report 2009/2010
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The pending closure of this community based group was discussed at a Medway Living With and Beyond Cancer project Board meeting. Subsequently Medway’s Health and Lifestyle Team, which offers one to one coaching, tailored advice, behaviour change, motivation and practical support, are now developing skills on cancer issues and aim support the development of a community led cancer support group and self management courses. 3. Development of a Medway Cancer Welfare Benefits Service A joint group was established including NHS Medway commissioners, the Medway Council’s Welfare Benefits Service, Macmillan Cancer Support, hospital social workers and patients to respond to concerns around timely support and advice on benefits. Macmillan Cancer Support is supporting the development of a front line service for people diagnosed with cancer; to link services that currently provide welfare rights advice in Medway and provide additional capacity. NHS Medway and Medway Council have agreed to continue support after Macmillan funding has ceased. The operational policy and job descriptions have been developed and the service should start by the end of 2010. Evaluation and monitoring of the service is to be developed to ensure it is delivering identified health and social benefits and tackling inequality. 4. Holistic Needs Assessment (HNA) Pilot Prior to the development of this pilot, patients who had undergone recent chemotherapy, surgery or bone marrow transplants were interviewed by staff to learn about their experience and identify service improvements. Issues raised by patients included Coming to terms with their diagnosis The impact of their cancer on family and relationships Changes to lifestyle Coping with the unknown Things that helped them cope included Talking to others with similar diagnosis Talking to professionals who gave time to talk Proactive medical follow up A Holistic Needs Assessment using a method called the Distress Thermometer has been tested within chemotherapy and inpatient areas following diagnosis. Current resources have not allowed for testing for patients who have completed their treatment. This will now be incorporated into the new support and sign posting service. Testing has identified knowledge ‘gaps’ especially around psychological distress. A training session led by a psychologist was helpful for staff and identified the need for more structured support to be available in future. Testing new ways of working within an environment where other cancer initiatives are also being launched has proved a challenge. Dedicated project management support would be required to support further testing. Following the recent completion of the pilot a review of the process and tools used is being carried out and next steps agreed.
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Dementia Dementia Advisers/web/helpline
Status: Completed
Introduction Dementia is one of the most severe and devastating illnesses we face. In Medway it is estimated that the number of people suffering with Dementia will increase by 40% over the next 15 years. The aim of the project was to map the current service provision, understand the needs of our population and redesign services to ensure people with dementia maintain their independence and quality of life for as long as possible. The National Dementia Strategy was published in 2009 and identifies 17 key objectives to be delivered by health and social care organisations over a five year period. This engagement activity supported the development of services to meet these national objectives. Who was involved and how? As commissioners accountable for the quality of services for people with Dementia and their carers it was important to seek the views of local people who are affected by dementia. The aim was to help shape services that would provide the necessary support patients and their carers need to maintain their quality of life as they progress through the varying stages of dementia. An event “Medway’s Time for Action: Shaping the Dementia Care Pathway” was held in 2008, attracting 55 people from health and social care organisations, 3rd sector organisations, service users, patients and their carers. The input from patients with dementia and their carers at this workshop provided powerful real life stories that have underpinned our future work on dementia. A comprehensive analysis of the findings from this event was compiled into a summary report and given to all the participants. It resulted in the development of an Integrated Care Pathway for Dementia as part of NHS Medway’s Strategic Change Programme for Older People. It involves people from provider and voluntary organisations, clinicians, patients and carers as core members providing valuable insight into the needs of service users and in shaping the pathway. On 30 June 2009 a further event “Demystifying Dementia: Working Together to Gain Early Recognition and Timely Intervention” was held and involved GPs, nurses, care managers and staff from local care homes. Along with presentations about understanding dementia and the benefits of early diagnosis, an account of two true life stories were provided by a carer and a person affected by early onset dementia. They were asked to share with the audience their individual experiences and the impact this has had on their lives. What you said Experience of a person with dementia: “Dementia doesn’t just affect me; it affects the family as well……one thing that was hard to cope with was the time it took for me to get a NHS Medway Engagement Annual Report 2009/2010
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diagnosis………..every person with dementia needs different types of care and care needs to be tailored to individual needs…….” “suitable respite care is essential to give our carers a much needed break from the responsibility of caring without having to worry that we are being put in places that would make us feel worse because it was not appropriate” “by taking part in things like this to raise awareness, it makes me feel like I am doing something worthwhile and helping others in my situation while I still can.” Experience of a carer: David Prothero talked about how he cared for his late wife from the onset of her dementia about twelve years ago during her mid fifties; through to the beginning of late stage dementia and her subsequent death from a probably quite unrelated cancer last year. He talked about the experiences from those early years; from first signs of onset through to recognition, diagnosis and the initial acceptances of the necessary changes to come in life expectations for his late wife and himself. He shared with the audience the difficulties that a main carer experiences in navigating through the fragmented services that existed for dementia patients and their carers.
David Prothero (husband) Principal Family Carer
The late Christine Prothero
He also provided a diagram of how care may be improved for the benefit of the patient and the principal carer, over page.
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THE PRINCIPAL CARER’S DILEMMA
?
DIAGNOSIS
this is what is required
This is what is required to resolve the carer’s dilemma:
complication and confusion
Principal Carer
Patient
HEALTH SERVICES TEAMS
CARE SERVICES TEAMS
Assisting ‘Pilot / Guide’
PUBLIC SECTOR TEAMS
COMMERCIAL
SECTOR TEAMS various organisations
financial matters etc..
banks etc.
VOLUNTARY
and individual assistance & support
SECTOR TEAMS
care agencies & services etc.
integration and clarity
Overall, the outcomes from these important engagement exercises identified that service users wanted a person that would support them through the lifetime of the condition to help them access services. Service users needed more information about dementia, the services that are provided locally and how to contact them and a care system that would speed up early diagnosis and the ability to access support throughout the duration of the condition. What we did NHS Medway and Medway Council jointly commissioned a Dementia Adviser Service. Service user and carer representatives were on the interview panel for the Advisers. 15Jan09 A DP Kent and Medway-wide Dementia web site was developed, providing information on dementia and services available to support and care for people with dementia and their carers and a 24-hour telephone helpline for Kent and Medway was also commissioned.
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The three services were launched in May 2010 and those involved in shaping the services were involved in the launch, as well as over 100 local people from Medway. The services are also featured on a DVD about NHS Medway and some of the services it commissions http://www.youtube.com/nhsmedway. These services are being evaluated by Canterbury Christchurch University over an 18 month period. Focus groups and service users will be involved in identifying the benefits to patients and the outcomes in terms of their own health and wellbeing. What has changed? Dementia Advisers are now linked to people for the duration of their condition, becoming a buddy to support them to access services and the information they need to help them live well with dementia. Public involvement is now embedded within the service: Many service users and carers attended the National Dementia Strategy workshops. Kent and Medway Partnership Trust host service user and carer groups and NHS commissioners regularly attend group meetings. The Older People with Mental Health Needs local implementation team has service users and carers as core members. Service users and carers provide input into clinical pathways. Service users and carers attend local consultations on joint commissioning strategies. Commissioners regularly attend voluntary sector groups to discuss people’s unmet needs and NHS Medway plans to continue to develop the work to meet their needs more appropriately. During its first 2 months the dementia website has had more than 10,000 hits. More than 200 people now have a dementia adviser through the Dementia Advisers Service. The work on the integration of health and social care services for Dementia in Medway continues with the support of our patients and the public.
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Dermatology (Practice Based Commissioning) Dermatology Service Pathway Review
Status: Started
Introduction GPs in Medway, on three locality boards, work with NHS Medway to commission services. The Chatham locality board decided to review dermatology services following increased pressure on Medway Foundation Trust’s waiting list. It was proposed that the Community Dermatology Service should be developed to cover a wider range of conditions and be provided closer to home. Who was involved and how? An event was organised on 13 October 2009 at the Holiday Inn, Rochester, to hear the views of dermatology patients and members of the public in Medway, West Kent and Eastern and Coastal Kent. They talked about how dermatology services could be improved. A total of 59 people attended the event, of which 24 were members of the public. The event was publicised through posters and flyers in GP surgeries, retail pharmacies, through the dermatology outpatients department, in children’s centres and through Medway Local Involvement Network (Medway LINks). Patient dermatology support groups were contacted and asked to email details to Kent members and put information on their websites. GPs were sent a letter asking them each to identify at least two patients from their surgery. A delegate pack was sent out before the event describing the current service and outlining the topics to be discussed. Patients and members of the public took part in the morning session which involved three presentations; an opening and introduction from Dr Mehdi Dabestani, Chair of the Chatham Locality Board, an overview of current services by Dr Nathan, Clinical Lead for Chatham Locality Board and an overview of different types of dermatology service models by Leo Sun, Pharmacist Consultant from Horizons PBS Ltd. Six work group sessions followed the presentations involving a mixture of patients, commissioners, GPs and staff from Medway Foundation Trust and the Community Dermatology Service. The purpose of the workshop sessions was to look at patient case studies to understand how the current Dermatology Service could be improved. Attendees were asked: What do patients want from dermatology services? Who should treat patients and where should patients be treated? The length of time taken for patients to be treated for dermatology conditions. In the afternoon clinicians continued to discuss the priorities and opportunities outlined by the patients and public and drew up recommendations which reflected both patient and public views and clinical appropriateness as a result of the day. What you said Access NHS Medway Engagement Annual Report 2009/2010
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o Improve timeliness of services by offering speedy accurate diagnosis/rapid or fast track access to a specialist for chronic disorders o Introduce a dermatology helpline for people seeking advice around disease management and access to support services o Maximise the potential of community services, expanding opportunities for a wider range of services and in doing so consider issues of transport and improved access Quality of Care o Providers should consider the wider needs of patients, develop personalised plans to meet the holistic needs of the individual, and where necessary carers, including their psychological emotional and social needs o Ensure continuity of care in GP practices or through links to a key worker for people with chronic conditions that they can contact when their condition flares up. Look at workforce development and education. o Pathways should be streamlined and should support initial triage by the people with the greatest expertise, speedy access and “red flag� access for chronic conditions o All services should be able to deliver against agreed quality markers, benchmarking, Key Performance Indicators o Patients need to be confident that they will receive services based on best practice and have access to the most effective treatment, knowing for some that there is no cure Sustainable Quality Workforce o Develop closer professional development between consultants, special interest GPs, pharmacists and specialist nurses o Secure workforce to maintain a wider distribution of services in the community, making best use of a scarce resource o Training of tier 2 practitioners to support improved access for patients o Consider introducing mandated protected learning time for GPs and other professionals, linked to continuous professional education Patient Information and Education o Sign posting high quality information to ensure better patient awareness and self management, think about non health care professionals who might have a role to play e.g. hairdressers. Involve pharmacists in supporting patient education o Consider the development of interactive access to information through choose and book o Access to high quality information following diagnosis and making sure patients have the information about who to call if their condition deteriorates Opportunities through Technology o Consider how to make best use of telemedicine o Establish communication links with patients through email services, virtual and telephone consultations Commissioning factors
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o Establish contracts that reduce unnecessary follow ups and reflect changes in secondary care as community services develop. A full feedback report from the event was prepared and sent to all attendees. What we did A new service pathway for dermatology services is being designed. The next step is to decide what conditions are treated where and depending on the cost, the location and number of potential sites. A clinical steering group has been set up to develop a business case for an enhanced community dermatology service integrated with primary and secondary care. What is changing? User involvement has driven the development of a revised service specification so that the service better meets the needs of patients with dermatology conditions in the community. The new service will be commissioned from April 2011. It will include a telephone helpline which can be used by patients and health professionals. Every patient seen by the service will have a personalised care plan which will include agreeing the most appropriate methods of communication. We will invite a range of providers to bid for this new service and the successful provider will need to demonstrate that they meet agreed quality standards and deliver best practice in care.
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Diabetes Medway Diabetes Pathway
Status: Started
Introduction Diabetes care has historically been provided by GPs or by referral to the consultant led service at Medway Foundation Trust and then on to the community-based Specialist Diabetes Team. Feedback from patients was that the service needed to be improved. Who was involved and how? In April 2009 a stakeholder event was arranged to discuss health and healthcare in Medway. Over 100 people attended, including members of LINks, Age Concern, Medway Access Group, Health Action Charity Organisation and Medway Council. Presentations were given by NHS Medway’s Chief Executive and the Director of Public Health covering health inequalities and public health. Following this several workshops were held in the afternoon to discuss strategic change programme areas, of which diabetes is one. The focus group discussed diabetes services in Medway and considered: 1) 2) 3) 4)
Improving management of diabetes in primary care Increased capacity for diabetes education programmes Developing an integrated and successful referral pathway Ensuring there is a fully developed transitional care package for adolescents with diabetes
What you said The group said there was a need for clarity about what every diabetes service delivers and to make sure services are integrated and effective. They felt the service GPs were providing should be improved, including the amount of time they were able to give to discussing the specialist needs of people with diabetes, and wanted to see the development of an integrated and successful referral pathway. What we did In September and October 2009 workshops were held with clinicians, patients and the charity Diabetes UK. Current services were mapped which highlighted that there was no clear referral pathway for diabetes. There was a need to be clear what each service should be providing for its patients. Following this exercise a revised local pathway has been published on Map of Medicine which shows referral pathways within Medway, and referral criteria for each service is being developed. This will provide patients with a more streamlined and consistent pathway of care. In particular it will encourage direct referrals to the Specialist Diabetes Team where appropriate.
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The exercise raised the awareness of GPs to the services already being commissioned and aims to bring care closer to home and into the community. A report was sent to everyone who took part. What is changing? As a result of this engagement health care professionals are now aware of the pathway which is clearly set out on Map of Medicine. The local pathway on Map of Medicine reflects what aspects of diabetes care should be offered at which service and includes guidance based on NICE guidelines. Patients with type 1 diabetes will still be referred to hospital but patients with type 2 diabetes can now expect to be treated mainly in the community by GPs or the Specialist Diabetes Team where they will receive annual reviews and support to self manage their diabetes and avoid unnecessary admissions to hospital. Use of the pathway is being monitored. We will work with the local Ethnic Minority Forum to ensure that the pathway is accessible to BME communities and in the near future will be looking to identify patients to help evaluate the pathway and make improvements where necessary.
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End of Life End of Life Care Strategy
Status: Started
Introduction The Medway End of Life Care Strategy was developed in response to the National End of Life Strategy and to ensure NHS Medway delivers on its pledge to improve end of life care services to the residents of Medway. The Medway Strategy proposes new and ambitious targets to improve the care and support offered to individuals who are approaching the end of their lives. Who was involved and how? In order to have a well informed document NHS Medway’s Strategic Change Programme Group for End of Life Care organised a series of events to obtain wider stakeholder participation. A draft strategy was made available online so that people coming to the event could read the document and its proposals. An event was held on 31 July 2009 and attended by more than 40 people representing service users, carers and clinicians from the Acute Trust, care homes, voluntary sector groups and private pharmacy providers. They discussed end of life care in Medway and shared their personal experiences about the care and support available and what improvements could be made. It helped NHS Medway determine whether the priorities outlined in the strategy were the right ones, and if not, to change the strategy whilst still at a formative stage. Presentations in the morning illustrated the key points of the strategy and proposals for change. Workshops were held so that everyone had a chance to fully take part. The workshops were repeated in the afternoon so that attendees had the chance to participate in two topic areas:
Primary and Community Care Acute and Specialist Care Carer Needs and Bereavement Services Community Care Homes and Voluntary Sector Primary and Community Care Professional Training, Education and Information Personal Health Budgets
What you said
Services need to be coordinated across all sectors There is a lack of care and support 24hrs a day, seven days a week There is no single point of access There needs to be better communication between agencies, particularly GPs, and acknowledgement of their involvement.
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Access to bereavement counselling needs to be improved irrespective of where care is being provided.
Carer Needs and Bereavement Services
Bereavement services received by the families and carers throughout the course of care, and following the loss of a loved one, are not of a consistently high quality. Those involved are sometimes completely unaware of the services available. Information packs may go a long way to solve this.
Communication between GPs, hospitals and care homes needs to be improved to reduce the unnecessary distress caused to families when attending routine GP appointments. The proposed end of life register could prove to be the ‘missing link.’
Training and education services need to be improved. This not only includes the mandatory training undertaken by health care professionals to allow them to suitably deal with the spiritual, emotional and physical bereavement of families, but also for partners and families who wish to be the full time carer for a patient approaching the end of life.
Community Care Homes and Voluntary Sector
Continuity of medical care and treatment is needed across hospices, care homes and hospitals. Longer term care plans, specific to an individuals’ diagnosis and personal needs, requirements and wishes should be provided. Patients need to be aware of the services available.
Better education and training needs to be given to staff, to enable them to work considerately and sympathetically with patients and their families. Staff need to feel comfortable and confident caring for patients in the final stages of their life, to allow them to remain in a care home rather than being relocated into a hospital setting. Training in Gold Standards Framework and Liverpool Care Pathway should be mandatory. Implementation should be obligatory.
Increased support facilities need to be available. This may require additional government funding and may involve the commissioning of additional care services, including support from the voluntary sector. To ensure high quality care increased supervision and care home inspections may be needed.
Acute and Specialist Care
Training and education is an essential need for staff and health care professionals dealing with end of life patients and their families on a regular basis. Staff need to be fully capable of delivering high quality treatment and care, but need also to be fully equipped with a skills required to communicate sensitively and appropriately with patients, families and carers.
Responsibility and accountability needs to be more clearly specified for health care professionals and clinicians associated with delivering end of life care. If time was invested in specifying the roles and responsibilities of staff, NHS efficiency could be
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improved. One example could be nurses undertaking some of the responsibilities currently given to busy GPs.
Information made available to end of life patients needs to be better so they can make informed choices about their needs and wishes. Information sharing between GPs, hospitals and care homes needs to be more effective to ensure a more seamless transition for patients between acute and community care services.
Primary and Community Care
Nurses need skills that allow them to make the most appropriate choices regarding patient care and treatment and to allow them to communicate effectively and sensitively with patients and families. Coordinated training could benefit large numbers of people at relatively low costs.
Information regarding services is not communicated effectively between organisations. This has a detrimental knock-on effect upon the awareness of patients and the care they receive. Development of a Medway Health Service Directory could help to effectively sign-post and guide staff and patients.
Service design and care pathway development should be unique and should evolve with the individual and their personal needs and wishes. Care, treatment and service availability should be co-ordinated through a single point of contact.
Professional Training, Education and Information
Centrally commissioned training is required. It needs to be government funded, and cover the cost of training for independent and voluntary sector organisations. The variety of statutory and mandatory training currently received should be increased.
End of life care should be developed so that it accommodates a wide range of service users, including young, old, ethnic minorities, children and whole communities. The experiences and requirements for end of life care are specific to each individual patient, so care pathway design should reflect individual needs.
Employment of a Medway Education Lead is paramount in providing effective high quality end of life care. They should be responsible for co-ordinating training, providing information and guidance, and steering implementation of the End of Life Strategy.
Personal Health Budgets
It is essential to generate support from patients to increase their control over the care they receive.
Adequate support for patients, clinicians and other healthcare professionals is needed. Better information about service provision needs to be available.
Giving patients control over the care they receive will help reduce unnecessary administrative costs.
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This feedback was reported back to the attendees at the event and in a written report afterwards. What we did Feedback from the event was used to finalise the strategy and in making immediate improvements in local services where resources permitted. A final draft of the strategy was circulated in the autumn of 2009 and a commissioning plan developed outlining our intentions to improve access and integration of local services. The Strategy sets out the following improvements and initiatives planned for implementation by March 2012. These are: o The appointment of a Liverpool Care Pathway facilitator to support ongoing implementation of the framework across Medway. o Setting up a centrally held end of life register with professionals contributing to it. o Improving access to specialist palliative care advice and making sure this is available in the evenings and into the early part of the night. o Provide information and guidance to GPs and employees within nursing and residential homes. o Further roll out of ‘message in a bottle’ to communicate patient information to relevant professionals entering the patient’s home. o Rolling out of a bereavement support model to offer bereavement support to all families. o An information pack for GPs. o Adequate provision of equipment in patients home to prevent unnecessary admittance to hospital. o Staff supervision and support for people working with patients approaching end of life. o Encourage a change of public attitudes towards end of life through local media campaigns. What is changing? We have considered user and carer feedback and have included these in our implementation plan where resources permit. We have recently approved planned improvements to the Medway Hospital Bereavement suite which will provide a more appropriate environment for bereaved families and carers. Since we launched the strategy in 2009, there is greater understanding and awareness of end of life care issues. Partners such as Medway Community Healthcare and Medway NHS Foundation Trust are using the end of life care tools to improve patients and carers experience. We are also planning a further event in October 2010 jointly with Medway NHS Foundation Trust as part of our continuing awareness and education to the public and staff on end of life care issues. This will help more open conversation of death and dying between patients, their families and carers and clinicians.
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Eye Care (Practice Based Commissioning) Primary Eyecare Acute Referral Scheme (PEARS)
Status: Started
Introduction Sudden eye problems can be serious and need prompt attention. Currently a patient with sudden eye problems would usually make an appointment to see their GP for diagnosis and treatment. In the past GPs unable to diagnose or treat a patient with an eye problem would refer them to the Emergency Eye Centre, or to a consultant, at Maidstone Hospital. Appointments at Maidstone would need to be booked in advance, there was limited availability of appointments and patients would need to go back to Maidstone Hospital for a follow up appointment. Patients with eye problems would need to rely on friends or family members to help them attend a hospital appointment if they struggled with public transport. It was felt that a new service was needed that would provide care closer to home, wider choice and better access. Local GPs said the service should be redesigned to meet patients needs. Research showed that 45% of referrals could be dealt with by an optometrist, cutting waiting times for patients. A similar service being used in Wales had been very successful. Who was involved and how? A patient satisfaction questionnaire was developed and distributed to 400 patients who had previously used the outpatient service. 178 questionnaires were returned and analysed. 51 patients gave their contact details and wanted to be part of further consultation. A further event was held in August 2008, involving 12 patients. An overview of the current service and proposed service was presented, followed by a table top exercise where patients’ views and priorities were discussed. From this session it was clear that a pilot should be run to see whether it would be possible to meet patients’ needs and improve their experience by referring them to an optometrist rather than direct to hospital. We measured patient satisfaction by asking patients using the pilot service to complete a questionnaire. This new service became known as the Primary Eyecare Acute Referral Scheme (PEARS). What you said The patient satisfaction questionnaire undertaken at the beginning of the project showed that 33% of patients found it either difficult or very difficult to get to their appointment at Maidstone hospital. Many patients were travelling long distances to get to their appointment and due to the nature of their condition were having to rely on family, friends or public transport to get them to Maidstone Hospital. Satisfaction survey results from the pilot showed that 80% of patients seen through the pilot scheme were happy to be cared for by an optometrist.
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What we did The PEARS pilot was introduced in April 2009 and ran for six months. The pilot showed that that PEARS is feasible. During the pilot 233 people in total were seen and 206 people were treated and discharged through PEARS. The pilot achieved quicker access to care with 85% of patients seen within 24 hours of contacting a PEARS optometrist. Care was closer to home, access easier and travel time reduced. 96% of patients were happy with the speed and quality of care through the PEARS pilot. What has changed? As a result of the pilot and feedback from the questionnaires and the engagement event there will be eight PEARS accredited optometrists practising across Medway following assessments in early September 2010. This service is due to be rolled out across Medway in October 2010.
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Gynaecology (Practice Based Commissioning) Gynaecology Community Outpatient Service
Status: Started
Introduction A key objective for NHS Medway is to provide patients with choice and access closer to home. Increasingly gynaecology treatment can take place in an outpatient setting and consultation, examination and treatment can take place in one appointment. The Gillingham and Rainham Practice Based Commissioning locality board wanted to establish whether there was a need for the patient pathway to be reviewed. Who was involved and how? As part of a data gathering exercise to build a business case for a community based gynaecology outpatient service, a patient questionnaire was devised by the locality board and NHS Medway in October 2009 and sent via GP surgeries to 107 patients in November 2009 who had recently experienced the local gynaecology outpatient’s service. The questionnaire asked for people’s preferences about waiting times, appointment times, appointment days and appointment location. 43 completed questionnaires were received during November and December 2009. What you said People were generally satisfied with the level of care that they had received A waiting time for an appointment of up to 4 weeks was felt to be acceptable Patients were interested in early morning, evening and weekend appointment times. Patients were happy to be treated in the community and were keen to be treated where waiting times were shortest What we did As a result of the feedback, the service specification has been developed to provide a onestop shop approach, which was favoured by patients, and a range of appointment times in a variety of locations across Medway. What is changing? We will invite a range of providers to bid for this new service and the successful provider will need to demonstrate that they meet agreed quality standards and deliver best practice in care. Once the service has been set up patients will have wider choice, be able to access convenient gynaecology outpatient services that are closer to home and reduced waiting times. This will be monitored.
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Healthy Living Centres LIFT Architectural Competition
Status: Completed
Introduction NHS Medway has a programme of estates development to support the provision of health services in Medway. Three community Healthy Living Centres opened in Lordswood, Rainham and Rochester in 2007 and the fourth at Balmoral Gardens, Gillingham opened in August 2010. A further three LIFT developments are planned for Canterbury Street, Gillingham; Clover Street, Chatham and Alexander Road, Luton. To help find a high quality nationally recognised architect to design these three buildings, an architectural competition was held, involving significant public and staff engagement and consultation. Who was involved and how? 11 architects were invited to submit designs for the three schemes. Following scrutiny of these designs, three award winning architects were shortlisted. Three user groups were established to consider these designs in more detail:
A technical group A service user group, including GPs and service managers A patient representative group, including PALS, LINks, Medway councillors and patient representatives.
Presentations were made to the user groups by the three shortlisted architects. Following the presentations, meetings of the user groups were held on 15 June 2009 and 6 July 2009 to identify any concerns about the designs and to determine to what extent they met the design brief. User group members completed an evaluation form that scored each design against the following criteria: • • • • • • • • • •
functionality of accommodation functionality of building entrances and circulation integration of services within building concept of wellbeing for users and staff overall design content fit into local environment potential to be a landmark building car parking landscaping
The public, GPs and their patients were invited to visit a display of the building designs and to say which one they thought was the best and why. Comments on the services included in the design brief for the Canterbury Street development were also invited. NHS Medway Engagement Annual Report 2009/2010
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The design consultation took place on 22 July 2009 from 3pm to 8pm in the Franklin Rooms in Gillingham. The designs were on display and the architects present to discuss the design and answer questions. Attendees were asked to complete the same evaluation forms that had been used by the user groups. All of these scores and other comments made on the designs were considered by an evaluation panel that then made a recommendation to the NHS Medway Board for the winning design. What you said Most of the evaluation feedback was very positive. All of the comments made from the evaluation forms were collated, together with those that had been made by letter or email. Areas of concern about the Canterbury Street development design brief included: limited car parking spaces the number of services included in the design brief leading to potentially cramped accommodation and more pressure on car parking spaces the need to phase the work to enable all identified services to be accommodated. the height of the building What we did Using the evaluation scores and comments made, the evaluation panel members were able to make a clear recommendation to the NHS Medway Board on the best design and which architects should be appointed. Areas of concern were considered and the changes to be made to the Canterbury Street design brief that would address these. The number of services include in the design brief was reduced. This meant that the planned height of the building was reduced, the need to phase the development was removed and the pressure on car parking spaces reduced. What has changed? Residents will benefit from new Healthy Living Centres, the design of which reflects their views and provides a focus for healthcare provision in their areas. Balmoral Gardens opened on 2 August, on time and on budget. The first floor houses three GP practices: the Kingsley House branch surgery of St Werburgh Medical Practice, Dr Raval’s Balmoral Road branch, and the St Barnabas House practice from Duncan Road. On the second floor are clinics for people with diabetes, heart problems, leg ulcers, other wounds and foot problems, as well as for people needing physiotherapy, family planning, continence care, occupational health, and community alcohol services. There will be speech and language therapy services for children and services to support children and young people’s emotional wellbeing, as well as antenatal clinics run by midwives and baby clinics run by health visitors. On the ground floor a pharmacy is open from 7am to 10pm Monday to Saturday and from 8am to 6pm on Sunday. NHS Medway Engagement Annual Report 2009/2010
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Learning Disabilities Big Health Check
Status: Started
Introduction The Government published Valuing People Now in January 2009. The cross government strategy laid out the vision that all people with a learning disability a people first have the right to lead their lives like any others, with the same opportunities and responsibilities, and to be treated with the same dignity and respect. People with learning disabilities, family carers, central and local government, the NHS, the voluntary and private sectors have taken up the challenge of making Valuing People Now happen for all people with learning disabilities everywhere. In Medway this work has been carried out in liaison with the Medway Learning Disabilities Partnership Board. One of the key focus areas was the Big Health Check (Learning Disabilities Self Assessment) 2009. This check will also be required during 2010/11 and 2011/12 although the approach and format will be adjusted based on lessons learned. Who was involved and how? The Big Health Check 2009 involved a wide variety of stakeholders including people with a learning disability, parents and carers, the public and health and social care professionals. NHS Medway’s Learning Disability lead carried out “getting ready” meetings with all of the groups mentioned above in order to inform them of the Big Health Check process and to answer any questions or queries individuals raised, so that everyone felt able to speak freely and openly at the Big Health Check event in January 2010. The Big Health Check Self Assessment was prescriptive in relation to the questions which needed to be answered. However a flexible approach meant that stakeholders could voice opinions on a variety of issues. Presentations were also made to the committee members of the main local self-advocacy group and the local carers group. What you said Transition Positive Negative Supportive teachers, Lordswood No set framework for transition in health and transition care manager very social care (pathways) supportive Joint working Allocated care managers working Not enough help to get a job with transition Resources focused on school age person. Getting a life project Nothing much for adults Bradfields was the perfect sixth Poor communication about what is available form. College would be perfect for Very scary experience the future; in college I would like to No specialist in adults (like in children’s i.e. hang out with my friends NHS Medway Engagement Annual Report 2009/2010 30
Staying Healthy Positive At the end of college day I walk to a bus stop to get a bus Horse riding/Walking helped me lose weight Exercise – physiotherapy, walking, gym, rambles, rock climbing Gave up smoking a year ago Good work going on with voluntary organisation A lot of information via the media on swine flu Good gyms and swimming pools Information on TV and magazines College courses give info in easy read on staying healthy Make new friends e.g. swimming gala Everything in moderation Parents, advisors, TV Medway Council not bad Specialist team (Lordswood) Positive Good support e.g. dental care The concept of integration is good (delivery poor) Speech therapists and community nurses They help you, talk to you like adults and give you good advice Friendly staff. I like Averil and Vikki, Val and Lucinda Through nursing side – teenage issues and education
paediatrics) at hospital – no handover if complex needs Families need sign-posting to services and how adult services work – central contact point No specific process for transition of equipment Lack of support and information for people leaving school and what clubs/support/information is available
Negative Information not always clear, leaflets not in easy read, including for swine flu Healthy eating is expensive Can’t afford to go to the gym Inflexible support – evenings and weekends Local clubs not helpful e.g. Weight Watchers No information for carers about keeping healthy Not enough motivation to do more People’s rights and choices can overshadow encouragement in eating/taking exercise Being healthy is overrated. Being happy is more important Lack of supervision in college in drinking or eating to maintain health
Negative Getting to (the community nurse) not so easy, limited health team Not enough clear information – makes us worry No Info on what they offer and how to refer Most people are unaware of a health action plan Too narrow a remit – need a general consultant Is not clear what the team should be doing (collaborative working) Not enough Lordswood specialists, no clinical psychologist, limited nursing input Waiting times (too long) Social workers (not enough) Not enough men in Lordswood Out of hours cover doesn’t provide any support Lack of staff/resources In an inaccessible area, poor knowledge of
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what’s offered and how to contact No specialist epilepsy nurse or OT Staff not replaced Unmet health needs Respond to demand in a reactive way Care/support hours reduced or stopped for more able clients so more vulnerable to abuse/ill health
Hospital Positive Negative Arrange regular appointments I want to be treated like a human being Checks dosage of medication Crowded, not open when we want them to be He makes me feel comfortable Difficult / impossible to find your way round Blood test clinics (nurses take time / Need more posters / information we understand have pictures) Discrimination and lack of choice A&E and ITU They talk too quickly More support given if carers aren’t Referrals to specialists take a long time present Families feel unable to leave loved one in Adaptation clinics good (wheelchair) hospital alone Close to London – treatment at Bad communication between hospital and Guys! social care Communication book (Sunderland Poor information before procedures ward) A&E waiting times too long Like the food (Bad) continuity in communication Some nurses and doctors are good Poor knowledge of the Mental Capacity Act (clinic) No copies of medical records People not listening enough Don’t understand a person with a disability GPs Positive Negative Makes sure I have no side effects Inconsistencies in service He gives me an examination and Inconsistency in GPs check-up Need longer time for consultation He speaks to me They talk to your carers Some GPs are good and do listen Some doctors not interested in listening Good time keeping Kept waiting in waiting room for ages Treat each other with respect Getting though receptionists to get appointments which are then too short Explained what will happen Treated me well Discrimination and lack of charm If registered as LD offered annual Don’t know what a health check is health checks (and can have talking Lack of knowledge about what is available in partners identified) Medway Offers health checks Like to see lady nurse / doctor Knows (us) as a family and Waiting for appointments recognises (our) expertise People with complex health needs passed to Good communication (letters and hospitals (if known to specialists) instead of GP admin) Lack of information which is easy to understand Some do easy reading and writing No easy reading NHS Medway Engagement Annual Report 2009/2010
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What we did An easy read action plan was developed from the feedback received at the event and has been fed back to all participants. This action plan has been reviewed by stakeholders and the LD Partnership Board Health Sub Group. The action plan says: It’s really important that everyone has good healthcare – this includes people with learning disabilities and their families. The Medway Big Health Check event took place to find out what health was like in Medway for people with learning disabilities. This report is a follow on from the Big Health Check issued in January and details the actions NHS Medway will be taking to make services better for people with learning disabilities. How are we going to work with GPs? We will: Help GPs to check that all known people with learning disabilities are on their register Provide GPs with training to help them carry out annual health checks Work with people with learning disabilities to make sure health check training is good Help GPs to produce easy read material – letters and posters How are we going to work with hospitals? We will: Make sure that staff know the Mental Capacity Act Help to produce easy read material – letters, information and posters Make sure that the contract with the hospital has ways of measuring how well people with learning disabilities are supported How we are going to work with the Lordswood Team? We will: Talk to the team about how information can be improved Review how the community team works and make sure that they are working in an integrated way Review what and how the team are doing and agree improvements Try to make it is easier to contact them Review where the team is based What we are going to do to improve transition from children’s to adult services? We will: Improve joint working and planning and find better ways of planning people’s transition including children’s services Improve information on what is available and how things work. Provide more easy read information for people and their carers The PCT and Council are already doing some things that will help: Making sure that all its contracts with hospitals and GPs include making services accessible for people with learning disabilities Reducing reliance on hospital services for people with challenging behaviour The Partnership Board is starting a health sub group Collecting better information about how easy it is for people with learning disabilities to use services Work force development plans are being reviewed NHS Medway Engagement Annual Report 2009/2010
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The PCT (NHS Medway) and Council know they need to do more to support people with learning disabilities in Medway. A detailed action plan has been prepared to make sure that we are doing everything that we should be doing to improve services. Later in the year we will have a meeting with everyone to hear whether things are getting better. What has changed? The Big Health Check process has represented a good learning opportunity for the organisation, has informed the corporate risk register and will serve as a trigger for change across the whole of NHS Medway’s business. A paper was presented to NHS Medway’s Board which sets out a summary of the actions required to raise the standard of health support offered to people with learning disabilities in Medway. Specific corporate actions include: Directors have committed to embedding access for people with learning disabilities across all commissioning groups as a key equalities issue. A Board level group will be supporting and monitoring achievement Working with Medway Council, the Valuing People Partnership Board has been invited to take a more formal role in monitoring NHS Medway’s performance A health sub-group of the Valuing People Partnership Board now needs to ensure that all NHS providers, including GPs, are making the right changes to their services to meet the needs of people with a learning disability. The group is chaired by the deputy Chief Executive of NHS Medway NHS Medway’s communication strategy will specifically include the provision of accessible information and consultation as a key equalities indicator In addition to the above, a range of more specific changes are being implemented or considered, including: Strengthening community psychological and behavioural support to people with a learning disability. Working with NHS Eastern and Coastal Kent and NHS West Kent to modernise the model of behavioural support (challenging behaviour) services commissioned from the local provider With partner PCTs, ensuring continuation of funding for a specific learning disabilities liaison post in the local acute hospital There is now a full time Learning Disability Commissioner in post, jointly funded by NHS Medway and Medway Council, who is driving forward the Learning Disability action plan based on the Big Health Check event and the wider Learning Disability health and social care agenda. Medway Council has a Learning Disability partnership co-ordinator working closely with NHS Medway. It will take time to make and embed the changes across health and social care in Medway but stakeholders are willing to work in partnership to ensure that services meet the needs of people with learning disabilities.
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Lower Back Pain Lower Back Pain Pathway and Patient Consultation Exercises Status: Ongoing Introduction Lower back pain affects around one-third of the UK adult population each year. Around 20% of people with lower back pain will consult their GP. Appropriate management has the potential to reduce the number of people with disabling long-term back pain, and reduce its personal, social and economic impact. One year after a first episode of back pain 62% of people still have pain and 16% of those initially unable to work are not working after one year. Helping people to manage their back pain and return to normal activities is a key focus. Current services provided for lower back pain in Kent and Medway were felt in be inconsistent across Kent and Medway in the light of new guidelines and a new pathway published by the National Institute for Clinical Excellence (NICE). The three Primary Care Trusts in Kent and Medway agreed to carry out similar engagement events to discuss with patients their experiences of the current service. Who was involved and how? The Medway event was held on 12 November 2009, at the Lordswood Healthy Living Centre. A flyer was used to promote the event in GP practices, the Orthopaedic Clinical Assessment Service and the out-patient orthopaedic department at Medway NHS Foundation Trust. Questions asked: What was your experience of local services and the quality of those services? What are your experiences of accessing the service? How much advice was your GP or other primary care team able to give you about services provided in this area? Describe any positive and/or negative elements of the service you have experienced? What would make the current service better for you? How would you improve it? Out of the improvements you have suggested, which do you think is the most important? If you were given the choice of a primary care treatment programme what would your reaction be? Why? If you needed to have surgery on your back would you be prepared to travel to a hospital in another area? E.g. elsewhere in Kent, London? The NICE pathway was outlined for participants so they could see what the current service model should be. Participants were asked the following questions: Do you think there are there any gaps in this model? If so, what are they? Which elements of this model do you see as critical to improve the service and why? Are there any elements of the model that you do not like? Any that you think will make the service worse? Why? NHS Medway Engagement Annual Report 2009/2010
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If we had to explain the pathway/model more widely, what key messages do you think we should try to get across and why?
What you said Two patients attended the event. Despite the small numbers, a wide ranging discussion and experiences were shared. Patients felt that although all the pieces of the pathway were in place, the service provided was not joined up and often meant that treatment throughout Medway was not consistent. Even though waits were long, GPs were generally very helpful, although no literature, advice or guidance was currently being offered in relation to self management or painkillers. The NICE guidance was clear that GPs should be providing information and guidance to help patients self manage their condition where possible. One of the next steps identified by the group was to provide access to relevant information. A second Kent and Medway wide event took place on 25 March 2010 in Larkfield, Kent. The aim of the event was to: Give people with lower back pain the opportunity to influence how services for lower back pain will be delivered in the future across Kent and Medway See how their feedback has been considered and used to make changes to the proposed new service Consider what patient friendly information should be given to patients using back pain services Adverts were placed with the Kent and Medway Local Involvement Networks and posters were also displayed at public events run by Medway Patient Advice and Liaison Service. A total of 12 patients attended this event from across Kent and Medway. During the session, examples of patient information were circulated to attendees who were asked: Which services were they familiar with? How could they be improved? They were also asked to evaluate leaflets and suggest good practice examples. What we did In Medway we did not need to commission new community based services for lower back pain, as these were already in place. However we did need to do more to make sure that GPs and patients understand them fully. We worked with Practice Based Commissioning colleagues to ensure that GPs are aware of the range of services available and a new patient leaflet has been developed called Top Tips for Back Pain, based on patient’s experiences and advice. What has changed? Two GP practices across Medway are now piloting this information with their patients. Guidance notes for GPs have been developed to ensure information is consistent and aligned with NICE guidance. The pilot is expected to run for three months. Patients using the new information are being asked to evaluate its usefulness and content. Following evaluation information will be rolled out across Kent and Medway, although further work beyond this point is yet to be agreed. NHS Medway Engagement Annual Report 2009/2010
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Lymphoedema Lymphoedema Service Review
Status: Completed
Introduction Lymphoedema is a chronic swelling due primarily to failure of lymph drainage, either from a congenital abnormality or from damage arising from inflammation, infection, tumour, surgery or radiation. It is essentially incurable but the major manifestations, namely swelling and infection can be improved and controlled. It is estimated that for every Cancer patient with Lymphoedema there are three non-cancer related Lymphoedema. Their condition is often left undiagnosed and untreated and therefore deteriorates greatly affecting their quality of life. This group of patients are at increased risk of infection, frequently resulting in expensive and avoidable hospitalisation. Most of the underlying causes of Lymphoedema are irreversible and there is currently no known cure however, appropriate treatment can reduce the swelling and keep it to a minimum. Who was involved and how? Between 2005 and 2007 Macmillan Cancer Support funded a project to analyse and report on the current provision of Lymphoedema a services across Kent and Medway. The final report from this analysis concluded that there was evidence of unmet patient need and that the current provision of services for Lymphoedema patients was inadequate. A gap analysis found that services available are for breast cancer patients only and are run by and within Medway Maritime Hospital. Patients with Lymphoedema due to other causes have no local access to dedicated services. It is difficult to be accurate about the prevalence of the condition as there such poor health care provision to treat it across the UK. It is estimated that the number of patients within Medway with Lymphoedema is around 371. The Macmillan report highlights that only 173 patients (breast cancer patients) have access to a service through Medway Maritime Hospital. In February 2008 patients with Lymphoedema were invited to a patient forum to discuss local services. Patients talked of a lack of clinical support and knowledge, the pain and disabling effects of the condition and its psychological impact. What you said At the patient forum each patient gave an account of how they developed Lymphoedema, how it impacted on their lives and what services had been available to. All patients described the detrimental psychological impact of Lymphoedema, most but not all had suffered ongoing pain with a number finding the condition disabling. The consistent message they gave was the need for rapid access to a clinical service when symptoms are first developing to minimise the impact of the condition. None of the patients had experienced this rapid service provision and most had experienced a lack of clinical knowledge, with very little information given.
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Those that had developed Lymphoedema not as a result of breast cancer had to wait considerable lengths of time to access any service. In all cases, non-breast cancer patients once given access to a service had to travel over 40 miles to the clinic and had resorted to paying for private care whilst waiting to access NHS treatment. All patients said that once they used a service their symptoms had either been relieved completely or had improved their pain and mobility considerably. In conclusion patients described the service that they needed as being local with rapid access that could not only offer treatment but also ongoing advice and support in being able to self manage their condition. What we did A service specification was developed using the information from patients at the forum and clinical leadership from the Macmillan Lymphoedema project manager. A procurement group was established to take the service through the competitive tendering process. The group consisted of:
The lead commissioner A specialist Lymphoedema nurse A Lymphoedema patient Procurement consultant Lead NHS finance officer
The group refined the service specification, agreed the evaluation criteria, evaluated the tender submissions and formed a panel to interview potential providers. The group ultimately scored the tenders and agreed the preferred bidder. The service has now been put out to tender, a contract agreed and the service is due to start late 2010. What has changed? Medway will now have a dedicated Lymphoedema service for both primary and secondary Lymphoedema regardless of the cause.
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Maternity Maternity Services Liaison Committee
Status: Completed
Introduction NHS Medway’s Strategic Change Programme for Maternity was established to deliver the Department of Health’s framework for maternity services Maternity Matters and ensure the six pledges for maternity and newborns in the regional strategy Healthy People, Excellent Care are met. To do this we planned to set up a Maternity Services Liaison Committee in consultation with Medway Foundation Trust and Medway Community Healthcare. Who was involved and how? The first meeting of the Maternity Services Liaison Committee in April 2008 was attended by four service users. Throughout the first year membership grew to nine full members and two associate members. From October 2008 three user representatives took on the role of jointly chairing the committee, ensuring that the agenda was really user led. During its first year the committee sought to raise its profile amongst both professional staff providing maternity services and other service users within the community through engagement events, publicity, training and visits to the maternity unit at Medway Maritime Hospital. A “Maternity Matters” event in September 2008 was attended by representatives from the committee, NHS Medway, Medway Council, Medway NHS Foundation Trust and local community services. The day was divided between presentations and workshops, with the workshops looking at how to improve services in antenatal care, postnatal care and breastfeeding support. Some of the recommendations from these workshops have been fed into NHS Medway’s Maternity Action Plans. What you said
Consider user forums in the community Drop-in antenatal clinics in supermarkets etc More information on the SoS bus Hold small events for different communities Post natal engagement with antenatal groups Support for vulnerable groups Specific antenatal groups for teenagers Coffee mornings/events/drop ins at children’s centres Look at ‘buddying’ scheme for expectant mums particularly for marginalised groups
What we did The foundation of the committees work has been the Maternity Matters agenda which focuses on choice, access and continuity of care in a safe service.
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Committee representatives sit on all of the key governance groups overseeing the maternity work programme of NHS Medway, the Foundation Trust and Medway Community Healthcare. The committee has produced leaflets and posters to promote itself and aims to continue to recruit new members. Members were recruited from a range of sources but predominantly through direct involvement with the maternity service, i.e. new mums and dads. The committee has nine user representatives in total, making up half of its membership. It is very much led and driven by the users and meets quarterly, with strong representation from commissioners and providers of the service. What has changed?
The Maternity Services Liaison Committee will be taking forward engagement and information work streams within its work plan for the current year, including looking at how and where to effectively engage with families. NHS Medway already operates a Supporting Young Parents Programme which includes operating dedicated midwifery services for teenage parents. A One Stop Teenage Parents Antenatal Screening Service is in place and offers dedicated support. Children’s centres are now operating across the area and offer a range of drop in services for families both antenatal and postnatal. NHS Medway is looking at options to develop a buddying scheme for vulnerable mothers, although this will need to be considered within existing resources. The committee representatives directly influenced the introduction of a revised debriefing system within the Foundation Trust which means that routinely all women should now have a conversation with the Consultant Midwife and the opportunity to discuss her labour and birth and any other issues The attendance of the committee chair at NHS Medway Strategic Change Programme group meetings has resulted in users influencing the development of the draft breastfeeding strategy in Medway. This will help to ensure that the strategy reflects the needs and wishes of local women and their families. Maternity Unit visiting hours have been amended to make them more family friendly and accessible for new mothers and their families.
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Maternal Mental Health Developing Perinatal Mental Health Services
Status: Completed
Introduction One of the six pledges in the regional strategy Healthy People, Excellent Care states that by 2011 all pregnant women and new mothers will be able to get the help they need with mental health problems. In response to this, NHS Medway and NHS Eastern and Coastal Kent jointly established a Perinatal Mental Health Clinical Network, commissioned more mental health services for mothers and drafted a Perinatal Mental Health Development Document to improve services. Who was involved and how? The Medway and East Kent Clinical Network was established in May 2009 to ensure the delivery of high quality, effective, fair and accessible perinatal mental health care services to people living in East Kent and Medway, across primary, secondary and specialist services. It brings together clinicians, service providers, commissioners and service users to ensure that perinatal services are needs lead, provide patient choice and recognise the diversity of patients and acknowledge their role in the process of planning and developing services. A draft Kent and Medway Mother and Infant Mental Health Services (MIMHS) Development Document was produced, with extensive consultation with service providers and users, through the local Maternity Services Liaison Committee. What has changed?
An additional £157,000 a year has been invested in developing extra Mother and Infant Mental Health Services in Medway, with the recruitment of a consultant psychiatrist, a clinical nurse specialist and a medical secretary. The new team started in April 2010 and is working in the community providing training to identify perinatal mental health needs. Engagement from service users on the Maternity Services Liaison Committee ensures that services that are developed and delivered to women and families are sensitive to the needs of those using the service. The MIMHS Development Document took account of the views of service users This new service will enable women to access a specialist community based service to improve their health outcomes. Due to early identification and referral more women will receive appropriate care.
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Mental Health Live It Well – Mental Health Strategy for Kent and Medway
Status: Started
Introduction As the lead commissioner for mental health and wellbeing across Kent and Medway, NHS Medway committed in 2009 to leading the development of a joint five year strategy to improve the mental health and wellbeing of the Kent and Medway population. This is the first local mental health strategy and was developed with substantial engagement to ensure that it took account of local needs and will meet them as effectively as possible. Who was involved and how? The strategy began by setting a vision for improving mental health and wellbeing, developed with input from clinicians, service users and carers. Having developed ten commitments, with associated actions to deliver the strategy, we then carried out a very wide engagement exercise from 2 April 2010 to 7 May 2010. People were asked to give their view on the vision and commitments in the draft strategy and to list their three “must-dos” for improving mental health and wellbeing in Kent and Medway. Every household in Kent and Medway was notified about the strategy and the opportunity to comment on it through the residents' magazines Around Kent and Medway Matters, which go to every home. We prepared a summary, which was made available for comment on the websites of the five commissioning organisations (The three primary care trusts, Kent County Council and Medway Council). Participants were asked: 1. Does the vision say what it should? If not, what would you add, or take out, or change? 2. What do you think of the ten commitments? Is there anything you would like to add, or take out, or change? 3. Do you see all of the commitments as equally important? 4. If no, what are your top three? 5. Do you agree with the actions for each commitment? Is there anything you would like to add, take out, or change? 6. What are your three must-dos to improve mental health and wellbeing? 7. Any other comments? We printed 5000 copies of the summary which were sent out to GP surgeries in Kent and Medway, libraries, contact points and Gateways, to Drug and Alcohol Action Teams, Medway NHS Foundation Trust members, Kent’s gypsy and traveller unit, social care service users, Kent and Medway NHS and Social Care Partnership Trust and Kent Council on Addiction service users, local mental health partnership boards, community development workers and to other organisations on request.
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The opportunity to comment on the draft strategy was widely publicised in the local media and through all the statutory agencies in Kent and Medway as well as universities, business groups, the Local Medical Committee and the voluntary sector. Many of the agencies contacted took steps to publicise the Live It Well strategy in their newsletters, on their websites and to their staff, adding it to staff briefings and to their intranet. Many also sent it to the agencies and individuals on their engagement databases. We also produced an ‘easy read’ version which was circulated to the KCC Challenging Behaviour Network and to the Medway Valuing People Partnership Board What you said NHS Medway received 92 online responses and 26 paper responses. Several email responses were also received that commented on parts or all of the strategy, from both internal and external sources but these did not respond to the structured feedback questions. 57 of 118 agreed that the vision said what it should say, without further qualification. Many of the other responses confirmed that it did but added their own emphasis and a few pointed out what they thought were gaps. Less than 10% of comments about the vision were negative. Many comments were made about the positive impact of the vision and the commitments. The vision was variously described as ‘highly laudable’, ‘impressive’, ‘long overdue’, ‘ambitious’, ‘optimistic’, ‘positive’, ‘challenging’ and ‘fab’. A couple of helpful suggestions were made on rewording the vision. The strategy was described as ‘articulate’, ‘innovative in places’, ‘joined-up’, as having ‘a coherent continuum of interventions’, and expressed in simple everyday language. ‘The commitments are awe-inspiring.’ ‘The ten commitments are a great idea. It breaks the service commitments down into bite-size pieces so you can see what to expect from your NHS.’ One respondent implored – ‘please don’t just raise our hopes’. There were few negative or sceptical comments about the vision or commitments. Some said the vision was vague; and the strategy overall was too ambitious for some and not ambitious enough for others. There were single comments such as ‘lip service’, ‘motherhood and apple pie’, ‘a pipe dream’, ‘too long and bureaucratic’, ‘weak’ and ‘written in ‘strategy-speak’. One said the money spent on publishing the document was wasted and should be spent on frontline services. Some comments asked who and particularly how the strategy would all get delivered. And if there would be specific targets set within the strategy. One respondent suggested we should try to do less but do it more effectively. A full report on the strategy and the engagement process and the changes that will be made as a result of engagement, is available under item 14 here: http://www.medwaypct.nhs.uk/Agendas_minutes_and_reports/Wednesday_28_July_2010/ind ex.html NHS Medway Engagement Annual Report 2009/2010
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The largest number of comments about a group whose needs the strategy should address better were those with learning difficulties, followed by 16-18 yr olds and students, and for homeless people. The national picture of over-representation of ‘Black’ and ‘Black British’ ethnic groups among inpatients and among those compulsorily detained is reflected locally. No other specific groups were mentioned more than once. There were two comments requesting more support for people having marital difficulties or relationship breakdown, and also for new mothers. There were single comments for those with physical disabilities, those with autism, those with Aspergers, commuters, those in the armed services and ex-servicemen, the recently bereaved, refugees and asylum-seekers, and those in rural areas. What we did The revised strategy is currently being considered by the five commissioning organisations. A formal launch accompanied by wide publicity is planned when the strategy is approved. What has changed? The strategy is more robust and more comprehensive following engagement and will make a more effective difference to people in Kent and Medway as a result. The next step is delivery of the commitments in the strategy and plans are being developed to achieve this. The support that is available to people in Medway with mental health problems, and the mental health equivalent of “5 a day”, is included in NHS Medway’s Your Guide to Services which was sent to every household in Medway in September 2010.
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Multiple Sclerosis Measuring Success: a review of Services in Medway
Status: Started
Introduction An assessment on progress in implementing the National Service Framework for long term conditions for people with Multiple Sclerosis was required. Who was involved and how? This was a joint piece of work carried out with the MS society using a toolkit called Measuring Success. It was proposed by the MS Society and NHS Medway enthusiastically agreed to carry out this joint piece of work. The audit had two parts. The first part was engagement with clinicians working within the local health and social care economy including a physiotherapist, occupational therapist, speech and language therapist, care manager and MS specialist nurse. The second part was engagement with people with MS drawn from membership of the local MS society. The purpose of the audit was to assess Medway’s progress on implementing the National Service Framework for Long Term Conditions and looked specifically at the 11 quality requirements:
A person centred service Early recognition, prompt diagnosis Emergency and acute management Early and specialist rehabilitation Community rehabilitation and support Vocational rehabilitation Providing equipment and accommodation Providing personal care and support Palliative care Supporting family and carers Caring for people with neurological conditions in hospital or other health and social care settings
Attendees were invited by letter setting out the purpose of the consultation. Understanding how the local health economy is progressing on implementing the National Service Framework will allow services and service users to understand which areas to focus on in improving in the future and allow us to understand which areas have already made good progress. What you said The results of the engagement are at the time of writing with the MS society. NHS Medway Engagement Annual Report 2009/2010
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Non Invasive Ventilation Non Invasive Ventilation Service Review
Status: Started
Introduction Non Invasive Ventilation is currently provided for a small group of patients through specialist respiratory services including the Brompton Hospital and the Lane Fox Unit at St Thomas’ Hospital. The patients who receive these services are often unwell and travelling from Medway to London is both time consuming and difficult for this group of patients. Through engagement with clinicians, notably physicians and specialist respiratory physiotherapists and nurses, a need to deliver this service has been identified. Who was involved and how? Patients who are currently accessing specialist respiratory services were identified. A small focus group of patients met on 25 November 2009. The aims of the focus group are to talk about their experience so far and future service development. This was a joint activity between Medway Foundation Trust and NHS Medway. The event asked a number of questions: What does the group think of the current service that they receive What do current patients attending tertiary centres like and dislike about the current service? Would they like to see a domiciliary service at Medway Hospital? What would the advantages be of such a service? What would the disadvantages be? If a service was developed locally what do they think it should look like? Should it be hospital or community based? What are the advantages of either service. What sort of service would they expect to receive? How much input would they like at home? In hospital there may be a team of nurses and technicians whereas in the community they may be visited by just the nurse. What do they feel about this? Does anyone have regular input from the community respiratory team would they like to see this service provided by them? What you said The group felt the service they currently received from St Thomas’ Hospital was good however they did want to see a local service in Medway as it would be more convenient. The group spoke highly of the local respiratory consultant. The group identified that there were some other needs that the local service might provide including support and training for family and carers on using Non Invasive Ventilation, telephone support and some other issues were raised around related issues such as transport and parking for people with disabilities. What we did This feedback is being considered by NHS Medway’s Respiratory Strategic Change Programme group. A much more detailed needs analysis will need to be carried out and clear national guidelines on the provision of non invasive ventilation considered.
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Personal Health Budgets Personal Health Budgets Pilot
Status: Started
Introduction The introduction of personal health budgets is a national initiative, supported by research which drew on stakeholder experience. This is a pilot project that is being evaluated to see the impact of personal health budgets in terms of health outcomes, finance and impact on NHS services and workforce. Evidence in social care was that the introduction of individual personal budgets had a generally positive impact and any problems faced in implementing healthcare direct payments will be considered through the national evaluation process and local monitoring. Personal health budgets aim to give people greater control over the health services they use. This new way of delivering health care represents a major cultural shift which needs to be evaluated before decisions to extend it are made. Who was involved and how? In March 2009, NHS Medway expressed interest in being part of the Department of Health project to evaluate personal health budgets. A bid to participate in the pilot project was made with the full support of NHS Medway’s Board. A Project Team and a programme to engage with stakeholders was put in place. Internal stakeholders included NHS Medway Board members; commissioners for dementia and long-term conditions, the continuing care team and the organisational development and workforce planning team. User groups involved in the project include: Wisdom Hospice patients Medway Carers Medway Links Multiple Sclerosis Society Motor Neurone Disease Association Shoutout (Medway learning disabilities self-advocacy group) Wheelchair Users Group Physical Disabilities Partnership Board (led by Medway Council) along with clinicians and partners: Medway Community Healthcare specialists including those from the Wisdom Hospice, Cardiac and Chronic obstructive pulmonary disease Specialist Nurses MS Specialist Nurses Kent and Medway Partnership Trust Medway Foundation Trust Medway Community Healthcare Practice Based Commissioning Clusters NHS Medway Engagement Annual Report 2009/2010
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Providers – NHS Medway Provider open day breakout session Medway County Council
As the project recruits patients, feedback will be given to provider organisations on the choices users make about the services they wish to purchase with their budgets, stimulating the market and ensuring providers respond to service users. A focus group of users and carers has been set up to help develop user-friendly processes and information. As we recruit service users they are invited to be part of a focus group to help NHS Medway produce a user guide and to support new users as they join the pilot project. What you said The feedback was generally very positive. Personal health budgets are accepted as offering patients more choice, control and independence:
Some patients have indicated that, whilst their current interventions are meeting their health needs (physiotherapy etc) they can see the benefits of being able to purchase the same service at a time and location that is more convenient. They indicate they are happy to use the current provider but, if flexibility is not offered, then they would seek alternative providers. The opportunity to try alternative treatments is also being seen as a benefit of having a personal health budget. Early suggestions have included aromatherapy, swimming, and gym membership. There have been indications of patients wanting to purchase “social” activities to meet their mental health needs, e.g. attending art classes. Patients have also welcomed the opportunity to directly purchase items from suppliers (e.g. continence products) rather than having to order through the current NHS process. The parents of a continuing health care patient would like to use the funding that the NHS would spend to employ a carer to accompany them on a holiday. The parents would pay for the holiday costs and the personal health budget would fund the cost of the carer.
However, there were some concerns raised:
Some NHS professional expressed reservations about patients choosing clinically unproven interventions.
Health care plans will be developed by individuals and there are few exceptions to what services can be chosen. Personal health budgets may be spent on anything that the person believes will meet their heath and well-being needs and which are agreed by NHS Medway. Unusual requests will not be excluded without examining the proposal on a case-by-case basis as these may have significant benefits for people's health and wellbeing. However, the health care plan must be signed off by an appropriate NHS health professional and, if the professional opinion is that the intervention would have an adverse effect, that particular service will not be included in the plan.
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With patients purchasing some services from the private sector, it was felt that personal health budgets were a “backdoor” privatisation of the health service.
The project will be evaluating the impact on the provider market and we will feedback to the current providers on the services users wish to opt out off and the reasons behind their choices.
Individuals may spend their budgets on non-health care purchases i.e. purchasing services that are “social services” as opposed to “health services”
There is evidence that the social well-being of an individual impacts on their health and personal health budget users will be allowed to purchase what are seen as social services. The Government’s policy is to integrate health and social budgets so that individuals can develop a social and health care plan. We will identify users who receive both social care and personal health budgets and develop holistic care plans. What will change? This is a national pilot project. NHS Medway is one of 22 sites evaluating how personal health budgets benefit users. The introduction of personal health budgets aims to make the service more responsive to individuals’ needs, leading to better targeting of resources, less waste and duplication and improved patient outcomes and satisfaction. Personalisation may also improve value for money by ensuring waste is reduced. Personalisation could encourage clinicians and care co-ordinators to have better informed discussions with individuals. Potentially personal health budgets offer significant advantages. The project will run until April 2013 and the evaluation will assess where personal health budgets show benefits against the current provision and individuals health needs.
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Phlebotomy Services Phlebotomy services in the community Status: Started Introduction Phlebotomy services are provided for patients who need to have their blood taken for a pathology investigation. The current service sees both adults and children over two years of age. NHS Medway currently commissions phlebotomy services from Medway NHS Foundation Trust, Medway Community Healthcare and 23 GP practices. Services are provided in various locations across Medway including community healthy living centres, GP practices and Medway Hospital. There is disparity within the current service and patient’s can experience poor access and choice, long waiting times and limited opening times. A review of service is currently underway to improve patient experiences and bring services closer to home. A petition received from the Grain Carer’s and Disabled Group in April 2009 also highlighted the lack of services on the Isle of Grain. Who was involved and how? A patient survey was carried out in June 2010. Patients were asked if they had regular blood tests, how often, and where they usually choose to have their bloods taken and why. Travel times and waiting times for treatment were also included and patients were able to comment on whether the current clinic and waiting times were acceptable. They were asked what times they would prefer clinics to be open and how important these times were. The survey also asked whether a bookable appointments system would improve their experience of using the service. The questionnaire was developed in conjunction with local GP leads and key partners from both Medway Community Healthcare and Medway Foundation Trust. Over 280 questionnaires have been completed by service users attending Medway Community Healthcare, Medway Foundation Trust and GP clinics to date. Members of the Grain Disabled and Carer’s Group also completed the questionnaire and copies have been made available at the two GP practices in the Grain area. Both the Commissioning Manager who is leading on this work and NHS Medway’s Engagement Coordinator have been in direct contact with the Grain Disabled and Carer’s Group to discuss their issues. What you said The outcome of the questionnaire will help to inform and shape the final configuration of phlebotomy services in Medway.
Most of the respondents are older people (mainly women) Most respondents attend the clinic closest to their home
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Most respondents think 30 minutes is the maximum acceptable waiting time to have their blood taken Most respondents would prefer to have their blood taken between 8.00am – 10.00am.
The majority of respondents would prefer a pre-booked appointment. Currently some patients living in remote areas of Medway (e.g. Hoo Peninsula and the Isle of Grain) have restricted access to local services. The Grain Disabled and Carer’s Group said many of the Isle of Grain residents who use the phlebotomy service on a regular basis are elderly; many have long term conditions and a number of those elderly patients do not have access to their own transport and have to rely on infrequent public transport which is both costly and time-consuming. The closest clinic to the Isle of Grain is the Walter Brice Centre. The Patient Advice and Liaison service say that patient complaints or queries concerning phlebotomy show waiting times for phlebotomy and a lack of service provision, particularly on Saturdays, are common themes. What we did The aim of the review is to develop more community clinics in locations where gaps in provision have been identified e.g. Isle of Grain, Stoke and Chatham, bringing services closer to patient’s homes and offering a better patient experience. A pilot service is being explored for the Isle of Grain. Two branch surgeries (one on the Isle of Grain initially and another in Stoke) will be used for three months and uptake from local residents will be monitored. What will change? The petition from Grain Carers and Disabled Group has led to investigations into Phlebotomy services in Grain. The proposed pilot will demonstrate whether there is enough uptake of the service for NHS Medway to consider commissioning a permanent clinic on the Isle of Grain. The results of the wider patient questionnaire will be incorporated into the long term plans for the service. Several patients who have completed the questionnaire have expressed an interest to be involved in further work. Following the approval of a new model for phlebotomy services, a working group will be established including these patients. They will be involved in discussions with providers about the service model, new contract and service specification.
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Public Health A Better Medway campaign
Status: Completed
Introduction The Joint Strategic Needs Assessment (JSNA) for Medway identifies a number of areas where health outcomes in Medway are below the national average. There is a wide gap in health inequalities in Medway. If you live in Medway you are more likely to die young, smoke, be overweight and consume less portions of fruit and vegetables a day. Who was involved and how? In order to inform the profile and identity of the campaign Medway Council, NHS Medway, Medway Community Volunteer Service, Racial Equality Forum and Homestart were consulted. This was followed up with research conducted by The Hub social marketing agency and included 273 quantitative interviews with the public, 24 x qualitative interviews with the public and stakeholder interviews. The questions asked included: 1. What do you understand by the term ‘healthy living’? 2. What do you associate with healthy living? 3. And what do you understand by the term ‘unhealthy living’? 4. What is likely to have the ‘worst’ impact on someone’s health? They were asked: Questions about their own lifestyles and that of their friends and family, what they would like to change and what they felt the barriers were, and What Public Health should do to improve public health in the Medway area, where efforts should be concentrated and what services they were aware of. What you said People said their priority areas were stopping smoking, drinking less, taking more exercise and leading more active lifestyles, eating more healthily and reducing stress. These issues also resonate with stakeholders, although drug misuse and screening are key issues that this audience believes need addressing too, however these were not seen as major issues by the public. Common barriers to achieving change were perceived lack of time, preference for doing other things, lack of motivation and support, cost, perceived lack of access to services and products and limited knowledge of how to change in some areas (particularly healthy living). A range of common incentives emerged: o Community working towards a common goal / supporting each other o Lifestyle benefits o Achieving lifestyle balance / the importance of balance / developing a new routine o Increased range of social activities / new social activities o Cost savings (smoking / alcohol) NHS Medway Engagement Annual Report 2009/2010
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Health benefits were not mentioned explicitly by many and there was little mention of financial incentives/ rewards. People said a future campaign should include a shock element; clear, direct messages; communicate the range of available services and encourage the community What we did Informed by engagement, we developed and launched A Better Medway campaign to encourage people to make small changes to their lifestyles to become healthier.
Campaign focuses on 5 areas highlighted by the research (Eating healthily; getting active; stopping smoking; drinking sensibly and managing stress) Logo strap lines challenge healthy lifestyle barriers (time, cost, access) e.g. ‘Easier ways to be healthy’. Focuses on no/low cost activities that are easy (and fun) so aiming to address cost, motivation and interest barriers. Use of local people who have already made a positive lifestyle change showing that the campaign is for the Medway community and everyone is making the change together and supporting each other. Logo uses ‘Medway’ to demonstrate there is support locally and the campaign is for the Medway community. Campaign materials e.g. website and print signpost relevant local services and support. Campaign materials offer education in relevant areas in friendly hint format. Healthy pledge concept reinforces message of supporting each other, as well as encouraging a small step towards a healthier life (which could lead to a better balance). Campaign uses friendly, clear and direct tone of voice.
The campaign is supported by a fund (A Better Medway Community Chest) offering grants of £500 to £5,000 to voluntary or community organisations supporting people in Medway with eating healthily, getting active, preventing and stopping smoking, drinking sensibly and managing stress. What has changed? Since the campaign launch, provisional data indicates that: Over 800 health pledges have been made. The website has provided information, tips, tools and local resources to more than 3,000 people. A Better Medway Community Chest funding has been awarded to 13 local groups supporting the community with eating healthily, getting active, preventing and stopping smoking, drinking sensibly and managing stress. Full final data is due in January 2011.
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Speech and Language Therapy Children’s Speech and Language Therapy Review
Status: Completed
Introduction As a result of a complaint from Medway LINk which had been contacted by a number of service users concerned about access to services and length of waiting times, NHS Medway conducted a review. Who was involved and how? NHS Medway and Medway LINk worked together to review the service and co-ordinate engagement with service users. A workshop was attended by NHS Medway, Medway LINk, service users and service providers on 12 October 2009 to review the service and gather the experiences of service users. What you said The two workshops identified several areas which needed to be addressed including: An analysis of demand and capacity Referral criteria and processes Triage and Assessment Introduction of therapy plans A review of administration to free up therapists time to see more patients Discharge procedure In addition service users said that information about the service was inconsistent and needed to be communicated better. They said an audit of what exists should be undertaken and tested to ensure information is relevant, easy to understand and effective. Commenting on the project, Graham Hills, Operational Director of Medway LINk, said: “This is an excellent example of a well structured approach to commissioning and community engagement. It is particularly heartening that this project relates to groups of users who are seldom heard.” What we did Medway Community Healthcare has brought in extra short term capacity to reduce the existing waiting list and is reviewing clients on the waiting list to ensure they are still resident in Medway and meet the referral criteria. They have also introduced a centrally managed waiting list to ensure that clinical priority determines speed of response and not where a person lives. A full service review will look at how much money is being spent across the health and social care economy and what it delivers; establish the level of need and forecast expected change; benchmark performance; ensure existing capacity is being used effectively and make changes where performance needs to improve. What has changed? Pre-consultation waiting time for assessment was up to 14 months with a further wait of up to 12 months for therapy. The waiting time is now 16 weeks with no wait for therapy after assessment. NHS Medway Engagement Annual Report 2009/2010
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Wheelchair Service Wheelchair service review
Status: Completed
Introduction NHS Medway has been working with the Kent and Medway NHS and Social Care Partnership Trust to review operational performance of wheelchair services and to agree changes to deliver improvements. The work started following a number of complaints about long waiting times. Who was involved and how? Initial visits were carried out by the commissioning lead for NHS Medway that identified that staff were undertaking assessments to a good standard but there were a number of problems that resulted in wasted capacity. There was inconsistency in the service and the collection of data and information about clients was insufficient. Interviews, workshops and focus groups were held with service providers and users to understand the existing service and where improvements could be made. Observations of clinical assessments were carried out along with interviews with individual service users about their experiences. Nearly £500k was invested to clear the historic waiting list. What you said Patients had very different experiences and the service they received was not consistent. What we did Case notes and mapping was reviewed, reducing referral to triage from 6 weeks to 1 day. Roles and responsibilities of staff have been defined and each member of staff has an area of speciality which they are responsible for. The ordering process has been improved to make sure parts are available. Administrative processes have been streamlined, improving the efficiency of the appointments system and improved patient experience. Introduced a new IT software system. The service has developed local guidelines for clinicians to be able to understand eligibility criteria. This is intended to support clinicians to follow agreed pathways and avoid confusion for patients New database developed to ensure better performance monitoring What has changed? We have written into our contract with our wheelchair providers that the longest time anyone will wait for a wheelchair is 13 weeks. This is for highly specialised, bespoke wheelchairs, built for individual patients, to maximise their comfort and independence. Standard wheelchairs are ready within three weeks and can be made available within two days, when needed urgently. We aim to get wheelchairs for all our patients as quickly as possible. An additional £100k has been invested in 2009/10 to ensure a further waiting list does not build. Waiting times for triage have been reduced to one day and referral to assessment is now down to 15 days.
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What you can do next
Make your experiences count Find us
Get involved
NHS Medway Fifty Pembroke Court North Road Chatham Maritime Chatham Kent ME4 4EL
Share your opinion and help us make services better for you. email: itsyournhsmedway@nhs.net phone: 01634 335173
01634 335020
Patient Advice and Liaison Service (PALS) PALS is here to help when you need health advice, have concerns or don’t know where to turn. email: pals@medwaypct.nhs.uk freephone: 0800 014 1634
Customer Care Listening and acting on your comments, compliments or complaints. email: nhsmedwaycomplaints@nhs.net freephone: 0800 014 1634
Medway Local Involvement Network (LINk) This guide has been produced by NHS Medway. Information in it can be made available in other formats and languages on request to itsyournhsmedway@nhs.net or by ringing 01634 335173
The Medway LINk is your local independent network of local people and community groups working together to influence and improve Medway’s health and social care services. The LINk provides a forum for concerns about service provision and quality, and works with those who plan and run services to bring about real change. Why not join the LINk and help shape local services? email: info@kmn-ltd.co.uk phone: 01303 297050 website: www.themedwaylink.co.uk
2 www.medwaypct.nhs.uk