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Contents Page

Background ................................................................................................................................................... 4

About the Partnership ............................................................................................................................... 4

The NHS Long Term Plan ........................................................................................................................... 4

The Partnership Long-term Plan ................................................................................................................ 5

What we do and what we have heard ......................................................................................................... 6

The Partnership ......................................................................................................................................... 6

Our engagement – report methodology ................................................................................................... 6

What are people saying they are unhappy about? ..................................................................................... 8

Access issues .............................................................................................................................................. 8

Poor communication ............................................................................................................................... 10

Disjointed care ......................................................................................................................................... 10

Not having broader needs met................................................................................................................ 11

What is making their lives better? ............................................................................................................. 12

Caring and compassionate staff .............................................................................................................. 12

Community and family support ............................................................................................................... 12

Responsive and accessible services ......................................................................................................... 13

Effective communication ......................................................................................................................... 14

Choice and control ................................................................................................................................... 14

What do they say would make them happier if it were available or done differently? .......................... 16

Involving people ...................................................................................................................................... 16

More community support ....................................................................................................................... 17

Improved sccess ...................................................................................................................................... 18

Better communication ............................................................................................................................. 18

Using technology better .......................................................................................................................... 19

More joined-up care ................................................................................................................................ 19

Developing the Partnership Long-term Plan .............................................................................................. 21

Clinical priority areas ............................................................................................................................... 22

Strategic resourcing areas ....................................................................................................................... 23

Conclusion ................................................................................................................................................... 25

Appendix 1 – list of submissions by partner organisations ....................................................................... 26

Appendix 2 - full list of reports by theme .................................................................................................. 27

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Background

About the Partnership

The Humber, Coast and Vale Health and Care Partnership is a collaboration of 28 organisations

from the NHS, local councils and other health and care providers, working together to improve

health and care across our area.

The Partnership was established in

early 2016, when organisations

came together to start thinking

about some of the really big

challenges facing the NHS and

wider health and care sector over

the coming years. In October 2016,

we published our outline plan for

the Partnership, which sets out our

key goals and aspirations for our

population.

Since then, we have been working

together within each of our six

local areas, as shown on the map,

and across broader geographies

where it makes sense to do so. We

have been working together to

look for ways to join up health and

care services and to make them

work better for local people.

The NHS Long Term Plan

The NHS Long Term Plan sets the direction of travel for the NHS over the next ten years. It sets out

some of the ways that we want to improve care for people: including making sure everyone gets

the best start in life; reducing stillbirths and mother and child deaths during birth by 50%; taking

further action on childhood obesity; increasing funding for children and young people’s mental

health; bringing down waiting times for autism assessments.

It also includes the importance of delivering world-class care for major health problems;

preventing 100,000 heart attacks, strokes and dementia cases; investing in detecting and treating

lung conditions early to prevent 80,000 stays in hospital; and delivering community-based physical

and mental care for 370,000 people with severe mental illness a year by 2023/24.

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It also sets out how we can address the challenges that the NHS faces, such as staff shortages and

growing demand for services. This means doing things differently and giving people more control

over their own health and care, whilst preventing illness and tackling health inequalities.

The Partnership Long Term Plan

The NHS Long Term Plan also emphasises the important role of local Partnerships, known as

Integrated Care Systems (ICSs), to deliver these new ways of working. The Humber, Coast and Vale

Health and Care Partnership is working on a range of collaborative programmes, which align

closely with the priorities identified within the NHS Long Term Plan. In line with the requirements

set out in the NHS Long Term Plan, the Partnership is now working to produce its own long-term

plan. This will be produced in draft form by the end of September 2019 and a final version will be

published by December 2019.

To support and inform the development of the Partnership Long-term Plan, the Partnership will

engage with a broad range of stakeholders and enable a range of voices and perspectives to

inform the plan and the priorities identified within it. The first step in this engagement exercise is

to bring together the knowledge and intelligence we already hold as a Partnership. Partner

organisations across Humber, Coast and Vale regularly engage with patients, staff, the public and

other stakeholders on issues relating to health and wellbeing in their local area. The purpose of

this engagement audit is to bring together this intelligence in one place in order to shape the

emerging Partnership Long-term Plan and also to form the basis for further involvement work that

will take place in the summer.

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What we do and what we have heard

The Partnership

There are 28 partner organisations within the Humber, Coast and Vale Health and Care

Partnership. This includes NHS Clinical Commissioning Groups, NHS provider organisations, non-

NHS provider organisations, Local Authorities and regional bodies. A full list of partner

organisations is available on our website: www.humbercoastandvale.org.uk/where.

Each of the organisations that belong to the Partnership engages regularly with local residents or

citizens, including those who use local health and care services in a variety of different ways.

NHS organisations have statutory obligations to involve patients and the public, either directly or

through representatives, in:

The planning and provision of services.

The development and consideration of proposals for changes in the way services are

provided.

Decisions to be made by NHS organisations that affect the operation of services.

Partner organisations therefore work to ensure that local people, patients, stakeholders and

partners are informed, involved and have an opportunity to influence changes to health and care

provision. Involvement should be appropriate to the level and scale of change proposed.

As a Partnership, we have signed up to a collective commitment to engagement. In our work we

commit to:

Be open and transparent in our processes and explain why sometimes there is information

we can’t share.

Be honest about the challenges we face and the constraints we must work within.

Be willing to listen.

Encourage patients and the public to work with us to do things differently.

Seek out lesser heard voices and offer support where required to enable people to

participate.

Empower staff to share their ideas and to try out new things.

Admit when we get things wrong and be willing to try a new approach.

Our engagement – report methodology

Over the past 18 months, as a collective, we have engaged with tens of thousands of people across

the Humber, Coast and Vale area in a variety of different ways. This engagement has taken many

forms, including face-to-face conversations, paper, online and telephone surveys, focus groups,

listening events, public meetings and visits to health and care facilities. It has covered a range of

service areas, patient groups and local issues, according to local need and the programmes of

work being undertaken by partner organisations.

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The following report highlights some of the key themes emerging from that engagement and some

of the things that people in the Humber, Coast and Vale area have told us about their health and

wellbeing. These themes are drawn from more than 36,000 instances of engagement and

involvement with the public and have been summarised by partners in their submissions for the

report.

To structure the report, we asked all partners to answer the following three questions based upon

recent engagement they had undertaken:

1. What are people saying they are unhappy about? (For example, can’t find NHS dentist,

want to lose weight, not enough buses to get out and about).

2. What do people say is making their lives better? (For example, having some support to do

their shopping, cheaper gym membership, good social life based around local community

centre).

3. What do they say would make them happier if it was available/ done differently?

(For example, information about support for depression/anxiety, someone to help them

use the internet, easier to book appointments with GP).

This report provides a high-level summary of the key themes and views that emerged from the

engagement that took place across the Partnership over the past 18 months; grouped according to

these key questions. Common themes have been collected from a range of sources provided by

partner organisations, based on the engagement work they have undertaken. It is important to

stress that the comments and themes do not apply universally across all services and all localities

within Humber, Coast and Vale. They are presented here to give a high-level overview of the types

of issues local patients and citizens are experiencing in relation to health and care services in our

region, and provide a starting point for understanding where improvements can be made when

developing future plans.

In addition the report provides links to further information on what the public is telling us about

their health and care in Humber, Coast and Vale in relation to the areas covered by the

Partnership’s collaborative programmes.

This report has been produced in order to provide a starting point or a baseline upon which

further public engagement can be built and to inform the early thinking of the Partnership as it

seeks to develop its vision for the future and Long Term Plan.

The aim of the Partnership Long Term Plan is to set out high-level ambitions and outcomes that

the Partnership will work towards delivering over the coming five-year period. Specific service

change elements will still be subject to the same requirement to involve patients and the public,

which remains the duty of the relevant organisation(s) responsible for implementing that

particular change.

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What are people saying they are unhappy about?

The issues and concerns raised by patients and the public in our engagement with them are often

complex and affect different localities in different ways, however some overarching themes have

been raised consistently in engagement work undertaken by partners across the Humber, Coast

and Vale region. The following summarises the key issues that are causing concern or are the

source of negative experiences for people within the region, which include:

These common themes have been grouped from a range of sources, including engagement events,

surveys and complaints data across a range of partner organisations. Therefore, it is important to

stress that they do not apply universally across all services and across all localities within Humber,

Coast and Vale. They are presented here to give a high-level overview of the types of issues local

patients and citizens are experiencing in relation to health and care services in our region and

provide a starting point for understanding where improvements can be made.

Access issues

Many of the most commonly raised concerns amongst patients and the public in the Humber,

Coast and Vale region relate to difficulties that arise in accessing health and care services across a

broad spectrum of service areas. This can be for a variety of reasons, such as the physical location

of services; restrictions that have been placed on eligibility criteria; services that were previously

available but have been withdrawn, changed or moved to a different location; people are having

to wait to access the service because demand is high or staffing levels are stretched. Some of the

specific areas of concerns raised include:

Waiting times

The length of time it can take to get an appointment with a GP.

Waiting times for some mental health services, in particular services for children and young

people (CAMHS).

Autism waiting times (including for diagnosis).

Long waits getting through to community musculoskeletal (MSK) services.

Waiting times for follow-up appointments in some hospital-based services (e.g.

ophthalmology).

Changes to/withdrawal of local services

Change of eligibility criteria for some services (e.g. podiatry).

Access issues

Poor communication

Disjointed care

Not having broader needs met

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Withdrawal of or changes to prescribing and types of medications/treatments that are

available on prescription (e.g. gluten-free products).

Services being moved and/or centralised in other locations.

Introduction of new clinical thresholds for routine or planned surgery (e.g. potential for

surgery to be delayed while a patient tries to lose weight or stop smoking). This has led to

concern amongst some communities about surgery being rationed.

Closure of minor injuries units in Hornsea, Withernsea and Driffield.

Travel and transport issues

Rural isolation and restricted transport/changes to public transport making it difficult for

people to access health and care services.

Lack of coordination between patient transport and other services, which can result in

long wait times and missed appointments.

Not being able to access patient transport (usually due to not meeting the eligibility

criteria).

Difficulty accessing out of hours GPs and other urgent care services in rural areas where

there is no public transport available.

Hospital parking – missing appointments due to not being able to find a parking space;

high cost to regular patients/visitors.

Appointment times at specialist hospitals (e.g. Castle Hill) are too early for people

travelling long distances from other parts of the region.

Restrictions to access

Difficulty accessing GP appointments:

o often cannot book appointments in advance;

o opening hours not convenient;

o concern that GP receptionists act as ‘gate keepers’ and potentially restrict access;

o frustration with GP appointment systems that require patients to call at 8:00am for

a same day/urgent appointment.

Difficulties accessing adult mental health crisis services due to lack of capacity, particularly

when needed in a crisis situation.

Stigma around mental health issues (particularly for working-age men and children or

young people) prevented some people from seeking help.

Services are only available in some areas and not others – for example, the lung health

check pilot was introduced in Hull but not in other areas (this was raised as a concern by

some residents in Scunthorpe).

IVF treatment is limited.

Difficulties accessing NHS dentistry were highlighted by residents in some areas.

Services can be more difficult to access for some communities and individuals for a variety

of reasons. This includes transgender people, or those who are deaf or hard of hearing. For

example, a lack of understanding within NHS services of gender identity and provision of

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suitable spaces for accessing healthcare (e.g. waiting rooms that are male or female) was

identified.

Poor communication

Another issue that is frequently raised as an area of concern for local patients and members of the

public is ineffective communication and/or a lack of available information. This can be because

different health and care organisations are not communicating with one another to coordinate an

individual’s care or because they are not communicating effectively with the person using their

services and failing to give the level of information, advice or support that is required.

Communication with patients, particularly those being treated by hospital doctors, more

often than not is via letter or face-to-face outpatient appointments, which can cause some

problems or concerns.

o Letters go missing or don’t arrive.

o Letters are not always sent to GPs in a timely manner, which means they do not

have the most up to date information about a patient.

o Those we engaged with said that waiting for information, such as appointment

letters, test results or details of treatment or diagnosis, was a significant cause of

added stress and anxiety.

Some individuals raised concerns about not knowing why they have been referred to

hospital by their GP. For example, this was raised by people being treated for cancer who

did not know they had been referred urgently because of suspected cancer but instead

found this out when they arrived for their hospital appointment and were greeted by a

Macmillan nurse.

People are unsure about when to use NHS 111 service, when to call a GP or when to go to

A&E. There are a lot of mixed or competing messages about the best route to treatment;

this is particularly difficult when services change.

People are telling us that they are not aware of the different treatment options and

services that are available to them. People would like to know:

o Where to find out more information about their condition.

o What support is available to them (both in the NHS and the voluntary and

community sector).

o Which information source they should trust.

o There is also a need to improve information for clinicians and other practitioners to

support signposting.

Changes to services and how to access them are not always communicated very effectively.

Disjointed care

The difficulties of having to navigate a complex and at times fragmented health and care system

are felt by many patients and citizens in our region. Difficulties with communication, as highlighted

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earlier, can exacerbate the problems associated with fragmented delivery of care. Some of the key

issues raised by local residents include:

Information is not being shared between departments and so people have to repeat basic

facts and information to numerous professionals. The onus is on patients to remember

which medications they are taking and any changes to their condition or treatment plan,

which adds stress and anxiety and can lead to errors or delays.

Concerns that seeing a different health professional doesn’t work if they do not have

access to your records and/or know your medical history.

Levels of change within services are also a cause for concern (e.g. where there is high

turnover of staff or where services are adapting to new ways of working). This was a

particular concern for people accessing mental health services and/or social care (e.g.

domiciliary care) or people with long-term conditions. It can cause anxiety for service-users

if they do not know who will be providing their care from one week to the next and can

lead to frustration if they feel they have to repeat their story again and again.

Not having broader needs met

Often people accessing health and care services have other needs beyond the clinical

interventions required to treat their specific illness. Where these needs are not recognised or met,

this can be a source of concern for local people.

Patients do not always feel supported after their cancer treatment is completed.

Some people have identified that they are not receiving a holistic needs assessment or

cancer care review.

There is not enough post-diagnostic support available (this was raised for a number of

groups/conditions including people with dementia, those with mental health conditions,

children diagnosed with autism).

Another area of concern is delays in being discharged from hospital due to waiting for

social care packages and/or additional support.

A lack of peer support was identified by some groups.

Recognition and support for people who are carers is not always robust and systematic.

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What is making their lives better?

Throughout our engagement activities and regular conversations with the public, we hear many

positive stories about the people and the services that are having a positive impact on their health

and wellbeing. The stories behind this data are rich and diverse; nevertheless, there are a number

of key themes that are consistently highlighted as important to local people. The things that are

making their lives better include:

Caring and compassionate staff

Being cared for by happy, kind and compassionate staff is having a significant positive impact in

the lives of local people. Many individual compliments that our organisations receive identify

instances of staff going the extra mile to ensure their patients are well cared for. Specific areas

highlighted include:

Having a person-centred approach to care, where staff separate the person from the

illness, supports recovery.

The diversification of roles, within GP surgeries in particular, is having a positive impact

according to local people. For example, having access to a pharmacist to review medication

or being able to go straight to a physiotherapist (rather than via a GP) for muscle problems

were highlighted as positive by local patients.

Feeling listened to and cared for by non-judgemental, professional staff at all levels.

“To all staff in the NHS – you are fab”.

A theme emerging from the engagement being undertaken is a growing recognition amongst

those using services of the pressure staff are under to provide good quality care. There is concern

amongst a growing number of patients that the NHS (and broader health and social care sector)

will not have enough staff in the future to deliver good care.

Community and family support

Where NHS services work alongside families, carers and the voluntary and community sector to

develop a support offer together, this is having a positive impact on peoples’ health and wider

wellbeing. Some specific examples of this have been highlighted through our engagement.

Caring and compassionate staff

Community and family support

Responsive and accessible services

Effective communication

Choice and control

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Support from voluntary and community sector organisations and/or projects in the local

area is really important to people.

Involving families and carers and considering their needs as well as the needs of those

they care for is really important to local people.

Social prescribing has been highlighted as having a positive impact on peoples’ health and

wellbeing, and is connecting them to their communities and the many activities they can

get involved in to improve their health and wellbeing.

The introduction of alternatives to A&E for those in mental health crisis across the region

is enabling people to access support from the right people, at the right time, and in a more

appropriate environment. These projects have been successful due to good joint working

with the voluntary and community sector alongside NHS providers and commissioners.

Peer support was identified as important by many people we engaged with. Being able to

meet people in similar situations and learning from one another is having a positive impact

for many different groups of patients and citizens.

A range of condition-specific support groups were also highlighted in our engagement as

having a positive impact on peoples’ lives and helping to support them to manage their

condition and live fulfilling lives (e.g. Macmillan, MS Society, Alzheimer’s Society).

Responsive and accessible services

When health and care services are easy to access at the point of need, this is having a positive

impact on peoples’ lives. We have heard from patients that services are best when they provide

good quality care in an appropriate venue that is accessible at a time that is convenient. The

services that are having a positive impact on peoples’ lives are those that are responsive to the

changing needs of an individual and/or their condition(s), and are flexible enough to fit around and

support them in the other aspects of their lives that are important (e.g. supporting a family,

accessing employment etc). There are a number of key themes that were highlighted as having a

positive impact, including:

Care closer to home

Availability of specialist support so that people can recover at home rather than in a

hospital bed.

Care home liaison teams are having a positive impact by helping people to stay in their

own home and avoid going into hospital unnecessarily.

Easy access to services (including online)

Whilst online solutions do not suit everyone (as identified through our engagement), being

able to access services online at a time and place that suits the individual was highlighted

by many people as a significant positive development. This includes:

o Online ordering of prescriptions.

o Online appointment booking systems.

o Online/virtual consultations with a GP or other health professional.

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North East Lincolnshire’s Single Point of Access (for health and care services) was

identified as a positive innovation – making it easier and simpler for people to get the care

and support they need.

Extended opening hours and reduced waiting times

Introduction of extended hours/additional clinics at different times (shaped by what

people have asked for) is having a positive impact.

Reduced waiting times for some mental health services – ability to self-refer into some

talking therapies (IAPT services) is meaning that more people are able to go straight to the

mental health support they need.

Fast referral for cancer diagnosis/treatment.

Pleasant environments

The importance of the physical environment where care is provided being appropriate and

pleasant has an impact on peoples’ experience of the services they access. In particular,

where improvements have been made to physical environments in response to patient

feedback, this has been highlighted by patients as a positive development.

o Community mental health teams based in modern, non-medical premises.

o Having a choice of food to meet different needs and improved quality of food.

o The introduction of dementia-friendly wards has improved care.

Effective communication

Having good communication, that is accessible and timely, significantly improves an individual’s

experience of care. Keeping people up to date, informed and feeding back to them when changes

have been made is very important to those who use our local services. Some of the examples

where good communication is improving experiences of care that were highlighted by people that

we engaged with include:

The introduction of a welcome pack for mental health inpatient units has had a positive

impact.

An outpatients’ video for people with learning difficulties to explain the service and what

to expect in an understandable way has been well-received.

One provider has recruited a group of patient volunteers to carry out a review of patient

leaflets. The new leaflets have improved layouts and clear, ‘patient-friendly’ language.

Choice and control

Not having control over the situation they find themselves in and not knowing what is going to

happen next is often a cause of concern amongst people who use health and care services. This

can exacerbate what are already difficult situations when people are experiencing ill-health.

Where people are given sufficient information and opportunities to have choice and control over

their treatment and their conditions, it is having a positive impact on their quality of life.

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Person-centred care in end of life services really matters – thinking of the patient and their

family and providing care around the needs of the patient.

Being able to choose who visits postnatal wards is improving peoples’ experiences of care.

Where people have long-term conditions, understanding their condition and being

confident enough to manage it improves their overall health and wellbeing.

Being able to self-refer into services without having to go through a GP has been identified

as a positive change to current services (e.g. to see a physiotherapist for muscle problems,

or go directly to talking therapies for depression and other mental health problems).

Including families and carers in a person’s treatment, offering extended visiting times to

give people more opportunities to choose who supports them, is important.

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What do they say would make them happier if it were available or done

differently?

Through the engagement activities undertaken by partners, many patients, service-users, carers

and citizens have made suggestions about what could be done to make their lives happier and

healthier. Many of these suggestions or ideas involve simple changes, others are more complex

and require multiple partners to work together to deliver the change. The ideas and comments

have been summarised into the following themes:

Involving people

When undertaking the engagement that informed this report, a key theme that was often

repeated was a desire from those who use health and care services to be more involved in

managing their own health, making decisions about their health and care, and having a say on

changes to services that they use now or might use in the future.

More co-production and working together with health professionals to develop

personalised care plans.

o Being listened to and involved in decisions about my care (or the person I care for)

is important.

o Focus on people, not targets.

More information:

o People need easy access to accurate information and support in order for them to

engage in lifestyle change. They would like more information about how to lead a

healthy lifestyle.

o Increase information about prevention, screening and early signs and symptoms so

that people can access treatment early.

o Information leaflets could be provided to patients about how to effectively manage

their condition.

Better advocacy and support for people going through the continuing healthcare

assessment process and improving knowledge and understanding of staff so that they can

provide better support to those who need to access this type of support.

Listening to patient feedback on an ongoing basis and using this to improve services

provided in the future.

Involving me, my carer and my wider community

Improved access

Better communication

Using technology better

More joined-up care

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Supporting carers

The vital role played by carers was highlighted by many of the people that partners engaged with.

Greater awareness of carers and their needs would improve the experiences of carers and those

they care for when accessing health and care services. Some of the areas for improvement

suggested include:

Raise awareness of carers amongst the general public. Support the identification of carers

and improve sign-posting to ensure they are aware of the support that is available.

Support carers in all aspects of their life, not just health. Carer-friendly education and

employment is vital.

More information and training for carers:

o Provide general information about the role of caring and support that is available.

o Enable carers to access higher-level training about the conditions of those they are

caring for so they can learn how to support them more effectively.

o Develop resilience training for carers to help them to cope with difficult situations.

o More information is required on the outcome of carers assessments and the

pathways to support carers.

Ensure that appointments are as joined-up as possible (e.g. appointments grouped into the

same day/place) so as not to the waste time of the carer and the person they care for.

More community support

Access to community and peer support and links to the wider voluntary and community sector are

having a positive impact on many people’s lives and therefore people would like more of it and for

this type of support to be available to everyone in all communities.

To expand the range of community groups and activities on offer, particularly in more

remote communities.

Improving the community offer to provide for peoples’ broader needs, such as:

o Volunteering opportunities for people with dementia and other long-term

conditions.

o Improving the number and range of accessible toilet facilities in public places.

o Improving physical environments for people with dementia (e.g. fixing wobbly

pavements).

Improve the local social prescribing offer and links to GPs – ensuring that GPs are fully

committed to social prescribing and have the information to effectively link people to the

right support.

Creation of peer support networks (e.g. for people who self-harm).

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Improved access

Access, and the need to improve access to services, was a consistent theme across the

engagement carried out by partners. Some of the specific areas identified as having the potential

for positive change include:

Improving access to primary care (GP) services:

o Provide access to GP services outside of working hours.

o Make it easier to get through to the GP surgery for advice and/or book

appointments (more receptionists/better phone system).

o Enable me to see another medical professional if my GP is not available or if

someone else can deal with my case.

o Ensure access to GP services for people who are homeless.

o Provide more consistency of access to GP appointments.

o Improved access to NHS dentistry services, in particular, considering the needs of

York’s student population.

More services closer to home:

o People would like more services to be delivered in the community and at GP

practices to reduce the need for hospital visits.

o More services to be available at local hospitals (e.g. Scarborough).

o Community drop-ins for mental health services were also mentioned.

Improved transport and access:

o Improved transport links to existing services (e.g. railway link to York Hospital, park

and ride bus services for local hospitals, improving the road network).

o Improved parking at local hospitals.

o Better transport system in place for accessing appointments at regional hospitals

when travelling for specialist treatment.

o Increasing access to services in remote areas – finding other ways to deliver

services (e.g. mobile bus in rural areas where people can get advice or support).

Addressing shortages or gaps in capacity:

o Increase availability of high-demand services where there are long waits.

o Improve speed and access to diagnostics and treatment.

Equity of access is also very important to people – residents want to be able to access the

same treatment and support regardless of where they live.

Better communication

Improvements in the way services communicate with one another as well as with those who use

them would make a huge difference to peoples’ lives.

More information is needed about how to get support out of hours as many people still do

not know or are unsure what to do. People tell us they would like to know more about how

to use the NHS responsibly (i.e. which service to use when).

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People using local services would like to have more information about their care ‘pathway’.

In particular, they would like to know where they are “in the system” and what to expect

next.

o Written treatment plans that can be referred back to.

o Call/text reminders for appointments.

o Tracking system – when you order a parcel online, you can track where it is and see

exactly where you are in the queue, people would like the same in relation to their

health and care services, this would significantly improve people’s experience of

waiting irrespective of the length of the wait itself.

Good communication is particularly important for people with learning disabilities –

information should be provided in the most suitable way (e.g. easy read) by staff who have

appropriate training.

Training or awareness-raising for all staff to improve services for LGBTQ+ people and

increase understanding within health services of the needs of these communities.

Using technology better

Some of the suggestions put forward by patients and people who use local services about how to

improve them include making better use of technology that is already available to improve access

to and experience of health and care services.

Using technology to access GP services, for example, instant messaging or video calling as

ways of seeking advice from a GP.

Alternative methods for booking appointments within GP practices and hospital service

should be explored, with a particular focus on online methods.

End meaningless follow-up appointments in secondary care or find ways to use technology

in place of appointments (e.g. virtual appointments/remote access via video link or

telephone; remote monitoring of conditions using wearable devices).

Develop an app for symptom-checking so that people are more confident making health-

related decisions.

Use technology to enable patients to know where they are in the queue.

Faster scans and pathology reporting.

Digital records to improve information sharing to enable better care.

More joined-up care

One of the key areas for improvement identified in engagement with patients and the public is the

opportunities offered by improving integration between organisations and services across the

health and care sector. Some specific areas highlighted include:

Organisations and departments sharing information with each other about my care when

and where appropriate would significantly improve my experience.

Integration of health and social care provision for dementia so that support is seamless.

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Coordination of tests and consultations so that each appointment is no longer than it

needs to be and unnecessary return visits can be avoided.

o Patients who took part in focus groups were often willing to travel to a specialist

diagnostic centre provided they were able to have all their diagnostic tests

completed in one visit and if car parking was available and affordable.

More preventative services (particularly in mental health) to prevent people from reaching

crisis situations.

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Developing the Partnership Long-term Plan

Our Partnership Long-term Plan will set out how we will implement the aims and ambitions of the

NHS Long Term Plan in our region. It will also identify the aspirations of our Partnership to improve

the health and wellbeing of local people across Humber, Coast and Vale. The plan will focus on the

areas where we are working together already, building on the success of our existing collaborative

programmes. These collaborative programmes cover six key clinical priority areas, three strategic

resourcing areas and work that is being undertaken in each of our local areas (known as “places”)

or across more than one area.

The diagram below sets out the ways in which we work together as a Partnership, at a local level

and at scale, to improve the health and wellbeing of the 1.4 million people who live within

Humber, Coast and Vale. Our Partnership Long-term Plan will set out what we hope will be

different in five years’ time in each of our priority areas.

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Clinical priority areas

The Partnership is working collectively to support transformation in six clinical priority areas.

These are:

• Cancer

• Elective care

• Maternity

• Mental health

• Primary care

• Urgent and emergency care

Across the Partnership, a range of consultation, engagement and involvement activities have been

undertaken in relation to services in many of these priority areas. Appendix 2 provides links to the

published reports relating to each of these clinical priority areas. These reports provide further

background reading to support the development and refinement of plans in each of these clinical

priority areas.

Some of our clinical priority programmes have a significant amount of engagement activity from

which to draw upon (e.g. primary care and mental health), whereas others have less existing data

and intelligence in the form of written reports (e.g. cancer and maternity). In all cases, further

engagement and involvement on an ongoing basis will form a key part of the development of

these programmes of work.

Across a number of our clinical priority programmes, the Partnership has been actively putting in

place additional engagement mechanisms to ensure the people who use local services are able to

help shape those services for the future.

For example, our Local Maternity System has developed a network of five Maternity Voices

Partnerships (MVPs), four of which are led by lay chairs. MVPs create opportunities for local

service-users to shape the way in which their maternity services are delivered, by sharing their

experiences and feedback about their care and co-producing new and developing services. The

Humber, Coast and Vale MVP network conducted a recent survey of over 500 expectant and new

parents. The responses to this survey will help determine how information about choices to be

made in pregnancy is shared in the future as the Local Maternity System develops personalised

care plans and the digital offer.

Similarly, the Humber, Coast and Vale Cancer Alliance has received funding from Macmillan Cancer

Support to establish a community and patient involvement network across the area. The network

will provide opportunities for anyone affected by cancer to be involved in the work of the Cancer

Alliance though a variety of mechanisms. The network will support a range of engagement

opportunities, including: face-to-face and 1:1 discussion; attendance at network meetings; email

communication; and discussion through social media platforms, which will enable us to engage

with people on a level and frequency that they would like to be involved.

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A patient and public engagement officer came into post in April 2019 and is currently setting up

the network, which is due to launch in summer 2019.

Strategic resourcing areas

In addition to our collaborative work on clinical priorities, the Partnership has established three

boards to coordinate activity across the Partnership in relation to three areas that are critically

important to enabling change to happen. These are:

• Workforce

• Digital

• Capital and estates

Whilst most of the engagement activities that have generated intelligence and feedback for this

report have not focused explicitly on these three areas, they have often been referenced in the

course of engagement on other topics.

In addition to the themes captured elsewhere in this report, the following table provides a

summary of the comments, suggestions and ideas for further development arising from the

engagement work undertaken by partners.

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High-level feedback – Strategic Resourcing Areas

Workforce Digital Estates

Compliments NHS staff are amazing. When it works, digital is great. Buildings matter.

Kindness and compassion shown by

health and care professionals is at the

heart of good quality services.

Online services are making it easier for

some people to access care and look

after themselves.

Good quality, appropriate buildings

can improve peoples’ experiences of

care.

Concerns Continuity is important – many people

told us that they would like, where

possible, to see the same professional

for ongoing care needs.

“Digital first” is not for everyone – we

need to ensure alternatives are in place.

Many people in our communities are

passionate about and committed to

their local facilities (and often the

buildings in which they are provided).

Some people have concerns that staffing

levels are not high enough.

Some people have concerns about data

security.

Parking and transport issues are a

major problem at many local facilities.

Suggestions We need to do a better job at “selling”

our local area – it has so much to offer.

Make shared care records available to all

those involved in a patients’ care

(including the individual) as standard.

Make it easier to park and/or drop

loved ones off at appointments – this

will take the stress out of travelling.

Support carers, family and friends – see

them as part of the extended workforce.

Invest in wearables and other

technology to make services more

responsive to need.

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Conclusion

Humber, Coast and Vale is a diverse region with many different and sometimes overlapping

communities and neighbourhoods. Our ambition, as a Partnership, is for everyone in our area to

“start well, live well and age well”. We want all of the 1.4 million people who live in Humber,

Coast and Vale to have the best start in life, to have opportunities to live healthy lives and be

able to access care and support when they need it.

To achieve this we are working hard to make the necessary changes to our local health and care

system so that it can become better at helping people to stay well for longer and provide good

quality treatment and care to those who need it both now and in the future.

We recognise, however, that change can often be a source of anxiety or concern amongst the

public and, in particular, those who use services and those who staff them. Whilst many people

tell us they would like to receive care at or closer to home, there is also a strong perception

amongst many within our communities that the hospital is the best place for treatment and care

as is evidenced in the engagement that has informed this report. Evidence tells us that many

types of care that were once provided in hospital settings can now be provided in community

locations or in peoples’ own homes.

As we develop new ways of delivering health and care and responding in potentially different

ways to the needs of our local communities, it is more important than ever to be able to explain

clearly why these changes are being made. It is also important that we continue to involve local

people in the design and delivery of these changes on an ongoing basis. The ideas, suggestions

and themes set out in this document provide a baseline from which further engagement can

take place.

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Appendix 1 – list of submissions by partner organisations

The following partners submitted a response contributing intelligence to this report:

Care Plus Group

City Health Care Partnership CIC (CHCP)

Healthwatch East Riding of Yorkshire

Healthwatch Kingston upon Hull

Healthwatch North Lincolnshire

Healthwatch North Yorkshire

Healthwatch York

Hull University Teaching Hospitals NHS Trust (HUTH)

Humber, Coast and Vale Cancer Alliance

Humber Teaching NHS Foundation Trust

Navigo

Northern Lincolnshire and Goole NHS Foundation Trust (NLaG)

Northern Lincolnshire Maternity Voices Partnership

NHS East Riding Clinical Commissioning Group

NHS Hull Clinical Commissioning Group

NHS North East Lincolnshire Clinical Commissioning Group

NHS North Lincolnshire Clinical Commissioning Group

NHS Scarborough and Ryedale Clinical Commissioning Group

NHS Vale of York Clinical Commissioning Group

Tees, Esk and Wear Valley NHS Foundation Trust (TEWV)

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Appendix 2 - full list of reports by theme

Programme Theme Report Author Link

Clinical Priority Areas

Cancer Prostate Cancer Focus Group

HCV Cancer Alliance

https://humbercoastandvale.org.uk/2019/04/09/patient-reflections-on-their-prostate-cancer-journey/

NHS Long Term Plan HCV Cancer Alliance

https://humbercoastandvale.org.uk/wp-content/uploads/2017/08/NHS-Long-Term-Plan.pdf

Elective Care Community MSK Services East Riding CCG http://www.eastridingofyorkshireccg.nhs.uk/data/uploads/get-involved/workshop-feedback-report-final-version.pdf

Outpatients Healthwatch North Lincolnshire

https://www.healthwatchnorthlincolnshire.co.uk/sites/default/files/outpatients_report_hwnl_-_final_version.pdf

A Clearer View – Ophthalmology

North Lincolnshire CCG

https://northlincolnshireccg.nhs.uk/wp-content/uploads/2019/02/a-clearer-view-engagement-report-final-2.pdf

Ophthalmology Report North East Lincolnshire CCG

http://www.northeastlincolnshireccg.nhs.uk/data/uploads/consultation/ophthalmology/a-clearer-view-engagement-report-final-2.pdf

Health Optimisation East Riding of Yorkshire CCG

http://www.eastridingofyorkshireccg.nhs.uk/data/uploads/get-involved/health-optimisation-feedback-report-v3-final-draft.pdf

Gluten-Free Prescribing Scarborough and Ryedale CCG

https://www.scarboroughryedaleccg.nhs.uk/decommissioning-of-gluten-free-prescriptions-for-adult-patients-in-scarborough-and-ryedale/

Maternity Services

Birth Preparation and Parent Education

Hull CCG https://www.hullccg.nhs.uk/have-your-say/past-consultations/birth-preparation-and-parent-education-service-consultation-may-2016-june-2016/

Antenatal and postnatal services in York

Healthwatch York https://www.healthwatchyork.co.uk/wp-content/uploads/2014/06/HWY-Antenatal-Report-FINAL.pdf

Mental Health (including learning disabilities and autism)

Anxiety and Depression Hull CCG https://www.hullccg.nhs.uk/wp-content/uploads/2019/03/lets-talk-engagement-summary-20181112.docx

Eating Disorders Hull CCG https://www.hullccg.nhs.uk/wp-content/uploads/2019/03/201809-eating-disorders-engagement-report-vs.-1.2-track-changes-off.pdf

Mental Health – working age males

Healthwatch East Riding of Yorkshire

http://www.healthwatcheastridingofyorkshire.co.uk/sites/default/files/silent_partners_-_working_age_males_report_october_2017_0.pdf

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Children and young peoples’ mental health

Healthwatch North Lincolnshire

https://www.healthwatchnorthlincolnshire.co.uk/sites/default/files/20171027review_of_children_mh.pdf

Children and young peoples’ mental health

Healthwatch York https://www.healthwatchyork.co.uk/wp-content/uploads/2014/06/Healthwatch-York-CAMHS-Review-2017-Report-1.pdf

Adults with ADHD and/or Autism

Scarborough and Ryedale CCG

https://www.scarboroughryedaleccg.nhs.uk/home/get-involved/closed-consultations/

Support services for adults with ADHD

Healthwatch York https://www.healthwatchyork.co.uk/wp-content/uploads/2014/06/Support-for-Adults-with-ADHD-A-HWY-Report.pdf

Adults with Autism East Riding of Yorkshire CCG

http://www.eastridingofyorkshireccg.nhs.uk/data/uploads/get-involved/adults-with-autism-strategy-feedback-report_v3.pdf

Our work with patients with a learning disability

Vale of York CCG https://www.valeofyorkccg.nhs.uk/get-involved/our-work-with-patients-with-a-learning-disability/

Making York work for people with dementia

Healthwatch York https://www.healthwatchyork.co.uk/wp-content/uploads/2014/06/Making-York-work-for-people-with-dementia-A-HWY-Report.pdf

Primary Care GP Extended Access North East Lincolnshire CCG

https://nelccg-accord.co.uk/data/uploads/documents/reports/final-report-keeping-the-door-open-survey-v4-final.pdf

GP Extended Access update

North East Lincolnshire CCG

http://www.northeastlincolnshireccg.nhs.uk/data/uploads/publications/engagement-reports/keeping-the-door-open-you-said-we-did-feedback-updated-feb-2019.docx

GP Extended Access North Lincolnshire CCG

https://northlincolnshireccg.nhs.uk/wp-content/uploads/2019/02/making-time-for-everyone-consultation-report-v3.pdf

GP Extended Access Vale of York CCG https://www.valeofyorkccg.nhs.uk/our-work/improving-access-to-gp-services/

GP Extended Access Scarborough and Ryedale CCG

https://www.scarboroughryedaleccg.nhs.uk/home/get-involved/closed-consultations/

GP Extended Access East Riding of Yorkshire CCG

http://www.eastridingofyorkshireccg.nhs.uk/data/uploads/get-involved/gp-extended-access-feedback-report-final.pdf

GP Extended Access Hull CCG https://www.hullccg.nhs.uk/wp-content/uploads/2019/03/201805-exacs-engagement-report-vs.-1.1-1.pdf

Changing the future of GP services

East Riding of Yorkshire CCG

http://www.eastridingofyorkshireccg.nhs.uk/data/uploads/get-involved/changing-the-future-of-gp-services-evaluation.pdf

GP services in Withernsea

East Riding of Yorkshire CCG

http://www.eastridingofyorkshireccg.nhs.uk/data/uploads/get-involved/feedback-from-holderness-gp-locality-plan-development-event-final.pdf

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Access to GPs Healthwatch East Riding of Yorkshire

http://www.healthwatcheastridingofyorkshire.co.uk/sites/default/files/fair_system_-_access_to_primary_care__0.pdf

Unity Health appointment system

Healthwatch York https://www.healthwatchyork.co.uk/wp-content/uploads/2014/06/Unity-Health-Appointment-Changes-a-Healthwatch-York-report-1.pdf

GP services Healthwatch North Lincolnshire

https://www.healthwatchnorthlincolnshire.co.uk/gp-surgeries-0

NHS Dentistry in York Healthwatch York https://www.healthwatchyork.co.uk/wp-content/uploads/2014/06/Healthwatch-York-Access-to-NHS-Dentistry-Report-2018.pdf

Urgent and Emergency Care

Urgent Care Services East Riding of Yorkshire CCG

http://www.eastridingofyorkshireccg.nhs.uk/get-involved/urgentcare/

Right Care First Time Scarborough and Ryedale CCG

https://www.scarboroughryedaleccg.nhs.uk/home/get-involved/closed-consultations/

Urgent Care Hull CCG https://www.hullccg.nhs.uk/have-your-say/past-consultations/urgent-care-in-hull-consultation-2016/

Strategic Resourcing Areas

Workforce

Digital Joined Up Yorkshire and Humber

Yorkshire & Humber Care Record

https://humbercoastandvale.org.uk/wp-content/uploads/2019/02/Joined-Up-Yorkshire-and-Humber-2018-v2-1.pdf

Capital and Estates

Acute Services Reviews

Humber Public Engagement Feedback Report

HCV Partnership http://humbercoastandvale.org.uk/wp-content/uploads/2018/11/Issues-Paper-Feedback-Report_web.pdf

Focus Group Feedback Report

HCV Partnership https://humbercoastandvale.org.uk/wp-content/uploads/2019/04/Focus-Groups-Feedback-Report_final.pdf

Scarborough/ York

Engagement Report – Stage 1 Scarborough Acute Services Review

HCV Partnership http://humbercoastandvale.org.uk/wp-content/uploads/2018/11/Scarborough-Acute-Services-Review_Engagement-Events_Feedback_final.pdf

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Breast Care One Stop Service at York Hospital

Scarborough and Ryedale CCG

https://www.scarboroughryedaleccg.nhs.uk/home/get-involved/closed-consultations/

Urology One Stop Service at Malton Community Hospital

Scarborough and Ryedale CCG

https://www.scarboroughryedaleccg.nhs.uk/home/get-involved/closed-consultations/

Place

East Riding of Yorkshire

Priorities Report Healthwatch East Riding of Yorkshire

http://www.healthwatcheastridingofyorkshire.co.uk/sites/default/files/priorities_report_0.pdf

Care Homes Report East Riding of Yorkshire CCG

http://www.eastridingofyorkshireccg.nhs.uk/care-homes-1/

North East Lincolnshire

Our Place Our Future survey

North East Lincolnshire CCG

http://www.northeastlincolnshireccg.nhs.uk/data/uploads/feedback/our-place-our-future-2018-feedback.pdf

Way Forward Meeting 2017

North East Lincolnshire CCG

http://www.northeastlincolnshireccg.nhs.uk/data/uploads/consultation/the-way-forward-2017-feedback-and-progress.pdf

Accord Annual Meeting 2017

North East Lincolnshire CCG

http://www.northeastlincolnshireccg.nhs.uk/data/uploads/feedback/accord-annual-meeting-2017-update-and-feedback-for-participants.pdf

Way Forward Meeting 2018

North East Lincolnshire CCG

http://www.northeastlincolnshireccg.nhs.uk/data/uploads/publications/engagement-reports/way-forward-2018-feedback-report.pdf

Accord Annual Meeting 2018

North East Lincolnshire CCG

http://www.northeastlincolnshireccg.nhs.uk/data/uploads/presentations/amm-presentations/getting-better-together-feedback-report-8-nov-18.pdf

North Lincolnshire

Health Matters 4 North Lincolnshire CCG

Health Matters 4 - full hyperlinks-Update on progress and outcomesjg.docx

Health Matters 5 North Lincolnshire CCG

Health Matters 5 - Update on progress and outcomesV4.docx

Scarborough and Ryedale

Keeping our local NHS sustainable

Scarborough and Ryedale CCG

https://www.scarboroughryedaleccg.nhs.uk/home/get-involved/previous-events/

Commissioning Maze Scarborough and Ryedale CCG

https://www.scarboroughryedaleccg.nhs.uk/home/get-involved/the-commissioning-maze-health-spending-in-your-hands/

Out of Hospital Care (Community Services)

Scarborough and Ryedale CCG

https://www.scarboroughryedaleccg.nhs.uk/home/get-involved/closed-consultations/

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York Our NHS in York Vale of York CCG https://www.valeofyorkccg.nhs.uk/data/uploads/get-involved/nhs70/nhs-70-report-for-website-2018.pdf https://www.valeofyorkccg.nhs.uk/you-said-we-did-our-conversations-with-the-local-community/our-nhs-70-celebrations-and-pledges-1/

The Big Conversation Vale of York CCG https://www.valeofyorkccg.nhs.uk/data/uploads/get-involved/engagement-reports/7-9-17-governing-body-engagement-update-final.pdf https://www.valeofyorkccg.nhs.uk/data/uploads/our-work/commissioning-intentions-two-page-summary.pdf

Homecare Healthwatch York https://www.healthwatchyork.co.uk/wp-content/uploads/2014/06/Healthwatch-York-Home-Care-Report-October-2017-1.pdf

Cross-cutting Themes/Specific Groups or Issues

End of Life Care End of Life Care Vale of York CCG https://www.valeofyorkccg.nhs.uk/consultations-and-engagement/developing-and-end-of-life-care-strategy-with-our-local-population/

Children and young people

Healthwatch East Riding of Yorkshire

http://www.healthwatcheastridingofyorkshire.co.uk/sites/default/files/childrens_report_low_res_0.pdf

People who are deaf or hard of hearing

Sounding Out Services Healthwatch North Lincolnshire

https://www.healthwatchnorthlincolnshire.co.uk/sites/default/files/hearing_loss_report_-_final_version.pdf

LGBTQ+ LGBT experiences of health and social care services

Healthwatch York https://www.healthwatchyork.co.uk/wp-content/uploads/2014/06/Healthwatch-York-report-LGBT-experiences-of-Health-and-Social-Care-Services-in-York-September-2018.pdf

Homelessness Homeless Discharge Hull CCG https://www.hullccg.nhs.uk/wp-content/uploads/2019/03/homeless-discharge-engagement-report.pdf

Children with SEND

Short Breaks Hull CCG https://www.hullccg.nhs.uk/wp-content/uploads/2019/02/201804-sb-engagement-report-vs.-1.1.pdf

People with Downs Syndrome

Downs Syndrome Pathway

Hull CCG https://www.hullccg.nhs.uk/wp-content/uploads/2019/02/downs-syndrome-care-pathway-launch-and-engagement-2.pdf

Continuing Healthcare

Continuing Healthcare Healthwatch York https://www.healthwatchyork.co.uk/wp-content/uploads/2014/06/Continuing-Healthcare-A-HWY-Report.pdf

Vulnerable Adults Safeguarding adults report

Healthwatch North Yorkshire

https://healthwatchnorthyorkshire.co.uk/wp-content/uploads/2019/07/Feb-2018-Healthwatch-North-Yorkshire-Safeguarding-Adults-Survey-Report.pdf

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