Quarterly Update Report October 2010

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ITEM 11

Quarterly Update Report October 2010

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NHS Cumbria

Quarterly Update Report for Health and Well-being Overview and Scrutiny Committee: July 2010

Introduction

This quarterly update report is intended to provide brief information for Committee members on relevant activity within NHS Cumbria and on issues affecting delivery of healthcare in the county. It also updates the Committee on ongoing scrutiny issues that are not currently being dealt with in a Task and Finish Group. Further information on all the issues referred to in this update (or other items of interest to the Committee is available from NHS Cumbria. Please contact Peter Clarke (contact details on final sheet)

1. Financial Context

Notwithstanding the government‟s commitment to ensure real terms increases in NHS funding levels, there is, as previously reported, a requirement for the NHS to deliver very substantial efficiency gains in order to meet financial targets. Whilst precise targets have not been identified, for NHS Cumbria this is of the order of 5% per year. A cash releasing savings target has been identified for the PCT for 2010/11. In addition there are continuing cost pressures in year. Plans are therefore in place to achieve a saving of £19.5m in the year. At the same time there is a specific requirement to reduce management costs (on the basis of a national definition of such costs). For NHS Cumbria this amounts to a further £2.7m reduction in the management cost spend in 2011/12, arrangements for which need to be in place for 1st April 2011. NHS Cumbria and North Cumbria University Hospital Trust were not able to conclude the contract negotiations for 2010/11 and the contract became subject to arbitration by the SHA. The outcome of this process has been that there is now a £12m pressure on the health economy. Discussions continue with the SHA about how this sum is to be managed and in the meanwhile the PCT is incorporating the sum in its financial reporting.

2. Quality and Excellence: Liberating the NHS

Members will be aware that the publication of the white paper has set in train a major set of structural and process changes in the NHS. Whilst the full implementation of the white paper is contingent on further policy development and legislation, aspects of the principles reflected in the document are already impacting in Cumbria. Members will be aware that the approval given to NHS Cumbria to be a direct provider of community health services has been revoked and that it must divest itself of its provider function by 31st March 2011. Following an option appraisal, the Board agreed to transfer services to Cumbria Partnership Foundation Trust. This is subject to approval by the SHA which is expected in the week commencing 18th October. Detailed work is now being undertaken by the two organisations to achieve a smooth and safe transfer and to reap the clinical and service benefits of integration. This work is being led by a joint Project Board. There is a need to satisfy the requirements of Monitor and the Cooperation and Competition panel as well as undertake the range of tasks required within the organisations in order to disaggregate and transfer the services and approximately

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2,500 staff. The plans for the transition and how CPFT will manage the integration of the transferred services will be developed in more detail over coming weeks. The project team would welcome an opportunity to brief members of the Committee more fully in due course. It might be appropriate to look to do this in January 2011. The white paper sets out a model of GP Commissioning that reflects many aspects of the approach developed in Cumbria over the last couple of years. In the light of this, the Clinical Senate (comprising the six locality GP lead commissioners) has formally expressed interest in designation as an “early implementer” site, the Secretary of State having invited expressions of interest in order to inform the finalising of the detail ahead of the national implementation date. If this expression of interest is approved, a briefing on its implications and timescale will be shared with members of the Committee. The white paper foresees all NHS hospitals as being part of a Foundation Trust. The Committee will be aware that the University Hospitals of Morecambe Bay Trust was successful in its foundation trust application, with effect from 1st October. A white paper on the future of public health is expected in December. This is a crucial element of the proposed overall changes and its publication is keenly awaited.

3. Mental Health and Wellbeing

At the time of the consultation on mental health inpatient beds, NHS Cumbria committed to the publication of a Mental Health and Wellbeing strategy and to undertaking an associated consultation process. Following the completion of the mental health needs assessment and a process of extensive engagement, there is now an emerging strategy. A stakeholder day was held on 13th October to inform the further refinement of this and the emerging strategy is to be formally considered by the Clinical Senate and the Health and Wellbeing Board. At the same time an outline of its practical implications and the proposed service changes is being developed. It is then intended to launch a formal consultation on the vision and how it should be carried forward in order to deliver its goals for people in Cumbria. This formal consultation is likely to commence in January and run for a three month period.

4. Cockermouth Hospital

A planning application for the new Community Hospital in Cockermouth was approved (subject to conditions) by the Allerdale Borough Council planning committee on 13th September 2010. The hospital will serve the people in town and the surrounding villages. The new facility will become a fully integrated „health campus‟, offering more services than the current hospital, including merging the three GP surgeries, diagnostics and dental services. It will have closer links with community staff, involving fewer occasions when patients will have to travel for hospital treatment. In-patient beds and minor surgeries will be delivered alongside other community services including office accommodation for community nursing staff, home carers, social workers, health visitors, midwives and mental health teams. This will bring big benefits to patients, allowing nursing teams and other professionals to work together to support people more effectively. The outline business case was approved by the Trust Board earlier this month and has been submitted to the North West Strategic Health Authority for a decision later this year. If approved, it is hoped that building work will begin early 2011 and will complete mid 2012.

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The Committee‟s Closer to Home Task Group meeting 25th October will receive a detailed presentation about the radical integrated developments in the Cockermouth community. The Allerdale Locality has been nominated for „Best Integrated Care Model‟ in the National Primary Care Association awards, for the creation of a more joined up health system in Cockermouth.

5. Carlisle Medical Group

Carlisle Medical Group (CMG) continues to work with eLIFT Cumbria in order to review site options for its planned health centre, and to this end it hopes to bring this process to a conclusion very shortly. In doing so it will take out a firm option on a site and begin detailed planning work for the health centre. Should this process conclude that CMG‟s original preferred site of Hilltop Heights is the correct location for the new health centre, detailed plans will be developed which address the Health Impact Assessment recommendations to fully explore transport links to the site and offer an expanded range of services in the Morton area of Carlisle.

6. Stanwix Medical Centre

Stanwix Medical Practice and branch surgeries of St Pauls and Fusehill Street plan to develop a new purpose-built health centre in the north of Carlisle. NHS Cumbria is currently working with the Practices on the service requirements. The former Belah School site has been identified as the preferred location for this development, subject to the production of a full business case and detailed costings. A further update on the services to be provided from the new centre should be available in the near future.

7. COPD Service in Carlisle

A new community COPD Team was launched in Carlisle in September. Its role is to support people with COPD (chronic obstructive pulmonary disease) to stay out of hospital and be treated closer to home. It follows the development of similar teams in the west and in South Lakes. The team will offer: education to patients on how to manage their condition; treatment and checkups at home and in community clinics and specialist support to patients as they are discharged from hospital.

8. Cleator Moor Health Centre

A planning application has been submitted to Copeland Borough Council for a new Health Centre which will serve the people in Cleator Moor and the surrounding area. It is understood that the application has been approved – with some detailed conditions. The new health centre will provide a new modern state of the art facility which will be capable of expansion to ensure future healthcare needs are met. It will provide a range of health services including; GP surgeries, NHS dental provision, emergency dental treatment, a community pharmacy and a range of health clinics. Both existing GP surgeries in Cleator Moor (Wath Brow Surgery and Wyndham Street) will move into the new Health Centre once the building work is compete If the plans are approved it is hoped that building work will begin early in 2011 and will be completed early in 2012.

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Funding for the £4.1 million centre is expected to come through the NHS Local Improvement Finance Trust (LIFT) programme - a scheme which has already delivered £2.3 billion of new primary healthcare buildings across England. The Outline Business Case has been approved by the NHS Cumbria board and submitted to the North West Strategic Health Authority for a decision later this year.

9. Penrith Community Hospital

Building work has now begun on the planned Assessment and Diagnostic Service for patients across Eden at Penrith Community Hospital. It will be situated in the old Carlton Ward. The new facility forms part of the changes in Penrith hospital presented to the committee earlier this year, its start having been delayed. The Assessment and Diagnostic Service will enable patients to be observed for a longer period of time before a diagnosis or referral is made. This will allow the hospital team to see if a patient responds to short-term treatment, such as intravenous antibiotics or rehydration, before a decision is made over whether the patient needs longer term treatment or if they need to be admitted to hospital. The work is expected to be complete early in 2011.

10. South Lakeland Older Peoples Services

A new service approach for health care of residents of nursing and residential homes across in South Lakeland is now being introduced. The intention is for care for each home to be provided by a single GP practice, supported by a team of nurses, therapists and a pharmacist. The locality is also developing a system whereby patients discharged from hospital will receive short term structured follow-up in order to make sure that the proper and effective arrangements are put in place on discharge (social care, nursing care, new treatments) and that they are being provided and are functioning as intended.

11. Award nominations for GPs in South Lakeland

The GP led commissioning group in South Lakeland, has been shortlisted for three national health awards. The first nomination is for „Best Service Redesign - Respiratory‟ for their work with the South Lakes Respiratory Service. The second nomination is for „Best Integrated Care Model‟ for their work to ensure that health and social care services are as joined up as possible across the South Lakes area. The third nomination is in the „Most Advanced Primary Care Clinical Commissioning Group‟ category, which is sponsored by the Department of Health. This category aims to recognise excellence and progress within GP led commissioning.

12 Pharmaceutical Needs Assessment

The recent White Paper Pharmacy in England: “Building on Strengths – delivering the future” identified the need for every Primary Care Trust to develop a Pharmaceutical Needs Assessment (PNA). This became a statutory requirement in May 2010 and has to be produced by February 2011. The pharmaceutical regulations state that all PCTs need to consult with a prescribed list of stakeholders and report on the comments made after the consultation period.

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As a result NHS Cumbria is formally consulting on the PNA for Cumbria for 60 days from the 4th October 2010. The draft of the PNA for Cumbria maps local health needs, current pharmaceutical services and any gaps in provision. The PNA will be used as a commissioning tool to develop pharmaceutical services in the future, with requirements set out to inform control of entry. The OSC is a “stakeholder” whose comments on the draft would be particularly welcome Responses should be returned by the 3rd December 2010.

13. Fluoridation

NHS North West and United Utilities have recently confirmed that there has been a lengthy interruption to the fluoridation of water at the Cornhow water treatment works in West Cumbria. Fluoride is added to some water supplies to help improve dental health. It is used to supplement a good personal dental health routine which should include regular brushing twice a day using fluoride toothpaste. The Cornhow water treatment works, services approximately 45,000 people in Workington Seaton, High Harrington, Great Clifton, Silloth down the coast to Marport and Flimby, and inland to Cockermouth The supply was suspended in April 2006 due to the need to upgrade equipment at the treatment works, and it has been established that fluoride has not been added to the water supply since that time. NHS North West is working with United Utilities, with support from NHS Cumbria, to understand the full facts around this issue and to establish a course of action to remedy the situation as soon as possible. Elswhere in Cubmria, fluoride is added to the water at Ennerdale, which services approximately 81,000 people in Whitehaven, Arlecdon, St Bees, Frizington, Salterbeck, Egremont, Cleator Moor, Beckermet down the coast to Ravenglass and Bootle.

14. Dental Services

At the last meeting of the Committee members requested some additional detail regarding the number of children and adults who visited a dentist in Cumbria between April 1st 2008 and March 31st 2010. The estimated figures are: Children Adults

Allerdale 16,930 39,853

Barrow-in-Furness 11,078 28,560

Carlisle 28,918 62,528

Copeland 6,418 19,208

Eden 7,923 14,545

South Lakeland 18,041 50,114

Total 89,308 214,808

Please note that these figures are based on the area in which patients were treated, not where they reside.

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15. Real Accountability

All Primary Care Trusts (PCTs) now have a legal obligation to report annually on the influence people's views have had on their decisions. NHS Cumbria has recently completed the first report under this duty which covers the period April 2009-March 2010. It provides important evidence of our responsiveness and accountability to Cumbria residents, setting out many examples of the ways the PCT has spoken with and consulted the people in the county during 2009/10. The report is attached for the committee‟s information.

Peter Clarke Deputy Director: Communication and Engagement [email protected]

mailto:[email protected]

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Real Accountability NHS duty to report on consultation April 2009-March 2010

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Introduction

NHS Cumbria exists to improve the health and wellbeing of the half a million residents of Cumbria. As an organisation we are committed to working with local people, finding out what they think and involving them in planning local health services. The duty to involve the public under section 242 of the NHS Act 2006 raised the bar for the way NHS organisations are expected to consult and engage with people and respond to the feedback received. All Primary Care Trusts (PCTs) now have a legal obligation to report annually on the influence people‟s views have had on their decisions. This is the first report under this duty and covers the period April 2009-March 2010. We believe it provides important evidence of our responsiveness and accountability to Cumbria residents.

Content

The PCT is required to report on any consultation carried out by any person that influences the commissioning decisions and other relevant decisions it makes. There is no one definition of consultation, but in essence it means the act of asking a person for their views on a proposal or issue before a decision is taken. In this first report, the PCT has taken a broad view of what should be included. This has been informed by the NHS “Engagement Cycle”1 which graphically illustrates (see below) how people‟s views should be taken into account at every point of the commissioning cycle.

1 The Engagement Cycle: A new way of thinking about Patient and Public Engagement (PPE) in World Class

Commissioning NHS with InHealth Associates April 2009

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This has enabled us to identify over 30 projects in year. These range from large-scale health needs assessments, which have contributed to the Cumbria Joint Needs Assessment, to very local issues around GP practice premises. Each project is described using a standard template devised by NHS NW. For further information about individual projects, either follow the link where provided or email the contact name given at the end of each description. For further information about NHS Cumbria‟s public engagement activity, please contact the Public Engagement Unit on 01539 797878 or email [email protected]

If you would like this information in an alternative format (large print, tape or Braille) or a different language please ring 01539 797878.

Calls from TypeTalk users are welcome.


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Project

E-cycle

Who has

been consulted?

What specific issues were stakeholders asked about?

What information was provided to stakeholders?

What was the

feedback from the engagement

activity?

What decision has

been taken & how the feedback influenced

any decision?

Status

What key stakeholder or local groups have been involved i.e. Local Authority, Patient

groups, LINks

Brief description on what the objective of

the activity is and what are the key questions being

asked?

Including links to any formal documents, leaflets etc

Include range of views from different groups.

Also links to any documents already published regarding

feedback

Explain how the views of people who have taken part in the

activity have been taken into account. Also include any other issues considered (which it was

not possible to act on & why)

completed / ongoing /

future

Rural proofing strategic priorities

Strategic planning

Action with Communities in Cumbria Rural residents and community activists; community planning groups

Stakeholders were asked to examine NHS Cumbria strategic priorities and see if they appeared correct for their local area. They were asked to give their experiences of accessing healthcare in rural Cumbria.

In advance of the workshop sessions, participants were given a short briefing paper so they were aware of the questions being posed as a part of the study to help draw out a rural perspective on the issues under discussion. The structure of the briefing paper encouraged participants to break their discussions into four principle elements:

Joint Strategic Needs Assessment

NHS Cumbria‟s Strategic Plan

Established Arrangements for

Service Delivery

Future Services (Closer to Home)

Participants highlighted areas of concern such as the accessibility of services, the reliance on social networks, the number of isolated groups that have no contact at all with health services, the time taken for emergency services to reach their community. A full report was produced.

The report provided valuable insight into the impact of commissioning decisions on isolated rural communities. The report is being filtered through decision makers at Board and Locality level.

Completed

Further information: [email protected]


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Project

E-cycle

Who has

been consulted?


What

information was provided

to stakeholders?

What was the feedback from

the engagement

activity?

What decision has been taken & how

the feedback influenced any

decision?

Status


groups, LINks

Brief description on what the objective of the

activity is and what are the key questions being

asked?

Including links to any formal

documents, leaflets etc

Include range of views from different

groups. Also links to any documents

already published regarding feedback

Explain how the views of people who have taken part

in the activity have been taken into account. Also include any other issues considered (which it was not possible to act on &

why)


future

Redesigning sexual health services

Strategic planning

Young people across Cumbria in schools and other youth provisions

Series of activities eg. Cumbria health related behaviour questionnaire, Cumbria Youth Alliance sexual health survey, events held by Connexions to inform:

current experience

what the service should look like in future

what settings should services be delivered in

Discussion notes and presentations

Behaviours - increased awareness of availability of condoms amongst teenage boys, low knowledge of certain STDs Cumbria Youth Alliance & Connexions work found young people wanted more advertising of/education on current services, increased confidentiality, increased opening times, more welcoming staff

Sexual Health

Services Review

Views gathered have:

shaped the commissioning model

informed priorities (phase 1 focus on high quality, accessible community contraceptive and sexual health services)

contributed to the development of detailed specifications

Ongoing Gallery walk planned Oct 10



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Project

E-cycle

Who has

been consulted?

What specific issues were stakeholders

asked about?

What

information was

provided to

stakeholders?

What was the


activity?

What decision has


any decision?

Status


groups, LINks

Brief description on what the objective of the activity is and

what are the key questions being asked?




feedback

Explain how the views of people who have taken part in the activity have been taken

into account. Also include any other issues considered (which it was not possible to act on &

why)

completed / ongoing / future

Gypsy /Traveller health needs assessment

Strategic planning

Gypsy Traveller population in Cumbria (nomadic, semi-nomadic and settled) Health Professionals Non-health professionals working with local Gypsy Travellers

To engage more fully with the Gypsy Traveller population in Cumbria. Public Health commissioned a team of local Travellers to conduct face-to-face interviews with other local Travellers across the county to determine appropriate interventions that will have a positive impact on health outcomes and reduce the inequalities experienced by the largest minority ethnic group in Cumbria. Key questions related to:

personal ill-health experiences

experiences of using health services

health beliefs

Interviewers were equipped with immunisation & vaccination leaflets that had been developed previously in consultation with local travellers.

103 interviews were conducted with Travellers and questionnaires were received from a range of health and non-health professionals. A Report (Health Needs Assessment: Cumbria Gypsy Travellers, Nov 2009) has been compiled summarising the views, experiences and beliefs of Gypsy/Travellers in Cumbria in relation to health and health services. It also includes a wide range of responses from health and non-health professionals. The report is available on request.

A series of draft recommendations were made in response to the Health Needs Assessment (HNA) and a launch event was then held for the Report. Gypsy Travellers, health and non-health professionals who took part in the HNA attended and the draft recommendations were discussed and amended accordingly. There is a Cumbria Traveller Strategic Health Group that meets quarterly and includes Traveller representation. The recommendations from the HNA inform the Group‟s action plan. The Report is now being disseminated as widely as possible across Cumbria and the North-West.

HNA complete but actions from the recommendations are ongoing.



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Project

E-cycle

Who has

been consulted?


asked about?



the engagement activity?

What decision

has been taken & how the feedback

influenced any decision?

Status

What key stakeholder or local groups have been

involved i.e. Local Authority, Patient groups,

LINks






feedback

Explain how the views of people who have taken part in the activity have

been taken into account. Also include any other

issues considered (which it was not possible to act

on & why)


future

Suicide prevention strategy

Strategic planning

Third sector Local authority Police LINk Advocacy workers

Suicide rates in Cumbria are significantly higher than the average for England. Following the preparation of a draft strategy for Cumbria, a multi-agency suicide prevention reference group was established to agree an action plan to reduce suicides in Cumbria.

Epidemiological review documents, good practice examples elsewhere.

Key recommendations included:

mental health promotion

social marketing campaign focusing on young men

increased staff training

early identification of those “at risk”

shared intelligence

Recommendations included in final strategy. Group to be reconvened at regular intervals to monitor action plan together with an annual “standing stakeholder conference”.

Ongoing



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been consulted?

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were stakeholders asked about?


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Status



LINks






feedback




on & why)


future

Mental health and wellbeing strategy

Strategic planning

3rd sector Service users and carers Cumbria Mental Health Group (commissioned by NHS Cumbria) Equality & diversity groups Housing providers Foundation Trust members

Initially an asset mapping exercise. One-to-one meetings with existing groups. Series of locality meetings facilitated by the Cumbria Mental Health Group focusing on mental health and wellbeing. Targeted questionnaire.

Epidemiology reviews. Information about community asset mapping.

Wide range of issues raised by different groups, common themes included:

examples of social prescribing

gaps in support services

need for early intervention

examples of community-led support

engagement of “seldom heard” individuals and groups.

The feedback will be included in the draft strategy.

Ongoing Draft strategy expected completion Autumn 2010 Further engagement will follow.



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asked about?




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LINks






feedback




on & why)


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Dementia strategy

Strategic planning

3rd sector Cumbria Mental Health Group (commissioned by NHS Cumbria) Carers Housing providers

To develop a new care pathway for dementia based on outcomes around six stages from prevention and early signs through to end of life and bereavement. Service users and carers specified the outcomes for each stage; what was important to them and what they would expect a service to deliver

Linked into work previously undertaken by countywide work-streams and details of work undertaken in Lancashire in development of an outcomes framework. Copies of draft model and service elements. Invited to stakeholder workshops for further discussion & input. Feedback forms. Updates via email.

Process was very well supported and outcomes welcomed. All comments helped to shape and finalise dementia pathways and service elements.

The outcomes have been agreed and set firmly into the framework.

Now being approved by Ongoing Conditions and Mental Health Care Stream Boards. Expected completion Autumn 2010



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Project

E-cycle

Who has

been consulted?


asked about?

What information was

provided to stakeholders?

What was the

feedback from the

engagement activity?

What decision



Status



LINks




Include range of views from

different groups. Also links to any

documents already published

regarding feedback




on & why)


future

Conversations for life

Strategic planning

Recently bereaved families General public

Although most adults would prefer to die in their own homes, only 22% of people in Cumbria currently do. Publicly advertised workshops were run over Cumbria for professionals and the general public:

To raise awareness of end of life issues and advanced care directives

Enable people to practice how to have end of life conversations

Explore which factors about end of life where most important to individuals.

Participants watched a short film commissioned by NHS Cumbria featuring local people talking about their experience of somebody close to them dying. An experienced facilitator talked to the groups about end of life issues and the national end of life strategy. Specially designed flashcards were used to help participants identify feelings and themes that were important to them. An end of life website was also developed – this has had over 3,000 visitors. www.cumbriaconversationsforlife.nhs.uk

100 members of the general public attended the workshops which were very well received. Feedback very positive and highlighted need for further public debate about death and dying. Strong desire for families to be supported in caring for a dying relative at home.

NHS Cumbria commissioning strategy now has a goal around end of life care: By 2013 to increase the percentage of deaths at home from 21.7% to 26%

Ongoing


http://www.cumbriaconversationsforlife.nhs.uk/


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been consulted?


What


to stakeholders?

What was the


activity?

What decision has


any decision?

Status


groups, LINks

Brief description on what the objective of the activity

is and what are the key questions being asked?



Include range of views from different groups. Also links to any documents already

published regarding feedback





future

Future for primary and community health services in Barrow-in-Furness

Strategic planning

Local residents (including “hard to reach” groups) Local 3rd sector organisations LINk

Identify how the community health and social care system can be developed to realise and harness the potential of individuals and communities in order to achieve improved health outcomes.

Provide insights for those working within local NHS.

Enable local people to be involved in the development of new ideas for services – and shape the „what, how and where‟ of their delivery.

Series of deliberative workshops whereby 30 participants were successively given information about health inequalities, current pattern of primary and community services, future challenges to inform and stimulate discussions.

Local residents developed:

a new vision statement for healthcare in Barrow

a set of “success” criteria against which future proposals for primary and community services will be evaluated

a number of scenarios illustrating from the public‟s perspective what is should feel like to use those services

TccBarrow final

report

The results of the workshops featured in the local press and NHS Cumbria‟s website to “test” them with the wider public in Barrow. Workshop participants joined health & social care professionals on a two-day study trip to Manchester and Liverpool to look at alternative service models. The work continues to inform the development of local services including the final estates solution.

Ongoing



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decision?

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groups, LINks



asked?








why)


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“Harraby Together We Can” multi-agency project

Strategic planning

Local residents Developing a model for engaging and empowering local communities particularly in promoting wellbeing and community cohesion using an asset based approach.

Participatory budget training

Residents highlighted:

Lack of facilities for young people

Traffic issues.

Multi-agency action in partnership with residents resulting in:

Pedestrian refuges

Upgraded parks and play areas

Introduction of summer gala.

Ongoing



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future

Children & young people Project 1 Choice of lead provider

Specifying outcomes & procuring services

10 young people from all over Cumbria were invited to an initial event at Brathay Hall Trust, to look at health services:

existing

future hey were aged 11 to 18, and were from varying demographics and social backgrounds. .

All were asked to give examples of their current and past experiences of navigating through children‟s health services within Cumbria, they were asked to share their experiences, which lead to discussion headings. Group work was also carried out around

emergency admissions

IT

closer to home services

how they would like to be treated by staff

Information was given to all participants around what the intentions of the project were, and what we would do with the information that they shared.

There was considerable feedback around the discussion headings. This was captured by the young people, and they then presented an ideal care pathway to the rest of the group. They were invited to the consortium selection day, where the an NHS trust gave a presentation on their ideas for health services in Cumbria, The feedback gathered by the group was used as a direct challenge to the provider, focussing on:

staff attitudes to young people

transition from child to teen in health

equipment

travelling to other areas for care

All of the information gathered was used to develop 7 new care pathways in C&YP health care. Serious consideration was given to the views, aspirations and experiences of young people. The original group members have been given regular updates as to the progress of the project, and from their direct involvement in the selection process, a new lead provider has been selected. One of the original group members now sits of the consortium‟s management team, now named „health builders‟.

Completed



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future

Children & young people Project 2 Development of care pathways


Children Young People, Parents Carers Community groups 3rd sector

Invited to comment on the care pathways that were developed following the initial engagement work. Asked to comment if they agreed to the improvements made to the way we deliver health care to children and young people.

The 7 care pathways were disseminated to all parties, by translating the documents into a „user friendly‟ version, this took into consideration, the target audience, clear and simple language and text.

children looked after

early years

emotional well being

long term conditions

school age

urgent care

young people health and well being

A wide range of feedback was collected but the main themes were

more services available in Cumbria to reduce travelling

a website where information was available solely for young people

more information available in more health settings (not just info for adults)

The pathways are not due to be completed until September 2010 however in their final version, all the feedback will be used to shape how the pathways will look and ultimately delivered. The pathways will be available to all young people in a child friendly form in Autumn 2010, incorporating all of the contribution of children, young people and their families.

Ongoing



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future

Locality panels


One hundred local residents (600 in total) have been recruited on to one of six locality panels. These panels match the six GP led commissioning boards in Cumbria.

Each panel will have an opportunity to support local primary and community health services and influence the way in which these services are developed by working with the commissioning board responsible for their area.

A welcome pack giving general information on NHS Cumbria and specific information on locality plans. Plans to use the panels 4 to 6 times a year using a range of methods – including survey questionnaires, telephone interviews and focus groups.

Initial recruitment and refreshing of the panels was done by an external agency. The make up of the panels reflects the demographic profile of the area they cover. The initial response was very positive they found people very willing to get involved. The first piece of work with the panels has been a telephone survey to gather basic insights, opinions and values applied to a range of health subjects.

The aim of the panels is to give local residents an opportunity to input into locality developments, express concerns, ideas and views on services and contribute their experience of services. Public engagement leads will work with the locality boards on how to make best use of their locality panel; support and monitor specific pieces of work and summarise each piece of work for central monitoring. A set of guidelines have been developed on the use of the locality panels

Ongoing Locality panels will be consulted on the Pharmaceutical Needs Assessment



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Who has

been consulted?


What


to stakeholders?

What was the


activity?

What decision has


any decision?

Status


groups, LINks











future

Health impact assessments: Brampton Millom


Elected representatives Local residents Local chamber of trade & community associations Patients 50+ Forum 3rd sector

To consider the impact of a new facility combining community hospital and care home functions in one new location. Questions included:

Co-location of services

Choice of sites

How to minimise negative impacts and maximise positive ones.

Public health profile information for the area, including inequalities and challenges. Role of and structure of a health impact assessment. Project plans for combined facility.

Stakeholders produced a wide range of recommendations around:-

Maintaining benefit to the community as a whole

Protecting local businesses and 3rd sector groups

Promoting true cohesive working among different agencies involved in the facility

Reducing disruption during construction

Protecting existing leisure sites.

The health impact assessment is part of a package of shaping the development of the project. Financial considerations have since postponed the project. When and if it re-emerges, the health impact assessment recommendations will be taken into account.

Completed

Further information: [email protected] or [email protected]



24

Project

E-cycle

Who has

been consulted?


What


to stakeholders?

What was the


activity?

What decision has


any decision?

Status


groups, LINks











future

Health impact assessment West Cumberland Hospital


Elected representatives Local residents 3rd sector LINk

To assess the potential impacts of the proposed redevelopment of West Cumberland Hospital on population health and existing health inequalities in West Cumbria. To make recommendations on actions which could limit identified negative health impacts of the development and enhance predicted positive health impacts. To look at possible impacts during the demolition and building works both on hospital services and the surrounding local community.

Public health profile information for the area, including inequalities and challenges. Role of and structure of an HIA. Project plans for the redevelopment of West Cumberland Hospital.

Impacts and recommendations identified included:

access to services

influencing people‟s healthy behaviour through environment, education and employment.

The process related to two phases – during construction and longer term redevelopment.

From the evidence collated and presented it is clear that the development has the support of the local population to deliver high quality services in a modern facility which is fit for current and future purpose. A number of further potential benefits were also identified as well as a number of potentially negative impacts – strategies have been identified to maximise the merits and mitigate the drawbacks.

Completed



25

Project

E-cycle

Who has

been consulted?




What was the


activity?

What decision



Status

What key stakeholder or

local groups have been involved i.e. Local Authority, Patient groups,

LINks


the activity is and what are the key questions

being asked?




feedback




on & why)


future

Redevelopment of West Cumberland Hospital led by North Cumbria University Hospitals NHS Trust


LINk Neighbourhood Forums Patient support group Patients and carers

To ensure that patients and the public‟s views are taken into account in the detailed design of the redeveloped hospital.

Newsletters www.buildingyourhospital.ncuh.nhs.uk

Concerns expressed by patients, public and other stakeholders include:

parking

decanting & transitional arrangements

Parent and child parking More disabled parking spaces

Ongoing

Further information: [email protected] or [email protected]

http://www.buildingyourhospital.ncuh.nhs.uk/



26

Project

E-cycle

Who has

been consulted?



What was the


activity?

What decision has


any decision?

Status


groups, LINks






feedback





future

Diabetes service user group


Patients Carers

To ensure the following are informed by service user views:

Service model

Service elements and care pathways

Ongoing provider performance management

Service model

Service specification

Service elements and pathways

Background information on prevalence and incidence etc.

Ongoing feedback through representatives of the service user group attending the Cumbria Diabetes Reference Board.

Some practical examples:

Acknowledgement of need to develop some service elements, such as exercise

Helped identify immediate priorities, including retinal screening and podiatry

Need to provide an independent voice on what service users can expect, leaflet under production

Ongoing



27

Project

E-cycle

Who has been

consulted?


What


to stakeholders?


the engagement

activity?



decision?

Status



LINks



asked?








why)


future

Elective care stream gallery walks


Patients and carers using the following services:

Musculo-skeletal

Dermatology

Gynaecology

Sleep apnoea

Inputting current patient experience to the development of new service specifications.

Initial drafts of specifications were circulated. Patients and carers were then invited to workshop events with clinicians and other stakeholders run on “Gallery Walk” principles in which they were invited to “walk through” various elements of the draft specifications.

Issues differed according to the specifications discussed. The format of the events was popular with both clinicians and patients/carers.

Issues which were discussed and action agreed or not through the “live” process. The feedback from each session was then collated and utilised in the production of the final specifications.

Completed



28

Project

E-cycle

Who has

been consulted?




What was the


activity?

What decision has been taken

& how the feedback


Status



LINks



asked?




Explain how the views of people who have

taken part in the activity have been taken into account. Also include

any other issues considered (which it

was not possible to act on & why)


future

Be a star breastfeeding campaign


The consultation was carried out by The Hub Social Marketing Agency on behalf of NHS Cumbria Health Professionals, young mothers-to-be and young mothers, their partners, parents and friends - all in Barrow

To ascertain knowledge and attitudes towards breastfeeding, prior to a Be A Star campaign focusing on understanding barriers to breastfeeding and appropriateness of existing support

The pre-testing involved Be A Star campaign images from other areas being shown to new mothers and mothers-to-be. An example of campaign material can be found at the following link: http://www.beastar.org.uk/wp-content/uploads/2009/11/vicky_poster_copyright.jpg

Many mothers-to be intend to breastfeed, but change their minds shortly after the birth

Grandparents and partners are influential in infant feeding decisions

Social pressure is seen as the most significant barrier to breastfeeding

Low awareness of national breastfeeding campaigns

Need to ensure that all women in the target audience are able to understand the campaign‟s messages

The Be A Star campaign was launched in Barrow but was adapted, following the research, particularly the pre-testing, to make clear that the Stars whose images were used in the campaign were local, breastfeeding mothers

Consultation complete

Campaign ongoing


http://www.beastar.org.uk/wp-content/uploads/2009/11/vicky_poster_copyright.jpg




29

Project

E-cycle

Who has

been consulted?


What


to stakeholders?


the engagement

activity?



decision?

Status


groups, LINks



asked?








why)


future

Chlamydia screening Project 1 Young people


Group of young people (16-25)

To obtain informal anecdotal feedback on proposed new branding for the screening service and views about sexual health, particularly chlamydia

Existing chlamydia screening materials and proposed new branding: Existing : www.c4urself.nhs.uk Proposed: www.best2know.co.uk

The majority felt that the new branding was an improvement on materials currently used. Many felt that the existing creative was „offensive‟ and not conducive to encouraging regular screening

This informed the decision to adopt and proceed with the new branding and link into the regional website. Materials were produced/phased in and the text request service was extended.

Initial phase complete, service promotion ongoing


http://www.c4urself.nhs.uk/

http://www.best2know.co.uk/


30

Project

E-cycle

Who has

been consulted?


What


to stakeholders?


the engagement

activity?



decision?

Status


groups, LINks



asked?








why)


future

Chlamydia screening Project 2 Stakeholder engagement & materials distribution


GPs, Pharmacies, Connexions, Schools, Further Education, Lancashire Public Health Network - supported by media releases

Stakeholders were ask for support in raising awareness of the chlamydia screening programme and to ensure that free testing kits are made readily available to young people.

Leaflets, posters, window stickers and business cards along with accompanying correspondence giving more information about the national chlamydia screening programme.

A4 Poster.pdf

Generally positive feedback. GPs and pharmacies displayed posters. Connexions checked to ensure pack availability at local venues. First overt blanket screening event held at one secondary school- seen as a positive exercise. Events also held at all FE venues across the county. All screening events seen as positive in offering screens and raising awareness of STIs

Will continue to encourage GPs and Pharmacies to display materials and offer screens where possible. Will continue to work with Connexions to reach young people. Plan to arrange twice yearly screening events at further education venues. Plan to encourage secondary schools to host further routine screening days of young people.

Ongoing



31

Project

E-cycle

Who has

been consulted?


What


to stakeholders?


the engagement

activity?



decision?

Status


groups, LINks



asked?








why)


future

Chlamydia screening Project 3 Kendal calling


Other NHS Trusts, Police, DAAT, CRI, St John Ambulance, Festival Organisers – supported by media releases

Look at how best to promote and offer chlamydia screening and health and safety advice at large music festival.

Face to face and telephone conversations with various stakeholders were held to share information. Links to NHS Choices website provided for inclusion in social media and press releases. Learnings from similar events attended by other NHS organisations (Glastonbury and V Festival) to optimise and plan for event in Cumbria

Collaborative – in particular:

obtaining advice following similar initiatives

working jointly with police in relation to media releases and

festival organisers in relation to event delivery.

Subject to funding, plan to run similar initiatives at future events. Have already arranged to attend the Big Shout event in September.

Event complete. Formal evaluation awaited



32

Project

E-cycle

Who has

been consulted?





the engagement

activity?



decision?

Status


groups, LINks



asked?







why)


future

Stop smoking service


Other Cumbria NHS Trusts, Police, Northwest Ambulance Service, Cumbria County Council, Six District Councils, GPs Pharmacies Dentists, Level Two Trained Intermediates Veterinary Surgeries, large routine and manual employers

How best to reach public and private sector employees who either smoke or come into contact with people who do – and encourage them to seek free confidential advice and support to stop smoking with NHS Cumbria Stop Smoking Service

Background information on the prevalence of smoking, the impact it has on the health of people in Cumbria and the cost of treating people with smoking related illnesses. Incentive offered to all NHS Staff across Cumbria who successfully managed to stop smoking. Conversations with partner organisations on how best to encourage their staff who smoke to seek help from stop smoking service. Also encourage health and social care professionals who come into contact with smokers to refer to the stop smoking service. Bespoke posters, postcards and business cards distributed to help with awareness raising. Example materials:

NHS_SSS_A4PharmaPoster.pdf

NHS_SSS_A4VetPoster.pdf

Ongoing feedback including regular meetings of Cumbria‟s Tobacco Alliance group.

Ongoing feedback has helped to identify opportunities for reaching people who smoke and areas for improvement. E.g. meeting with Cumbria Constabulary Occupations Health team highlighted that referral forms were out of date with incorrect information – this has now been rectified.

Ongoing



33

Project

E-cycle

Who has

been consulted?


What


to stakeholders?

What was the


activity?

What decision has


any decision?

Status


groups, LINks











future

Carlisle medical group – building design


Patients of the practices affected by merger plans. Existing Patient Forum members, plus those who had expressed an interest as a result of an earlier 30,000 patient consultation.

Aim to get patient perspective of initial (internal) design of a new building, to help make the layout and services most relevant to those using them.

Facilitated session using plans of the building and of intended services, introduced by a GP.

Patient priorities were:-

Privacy at reception

Booked in by receptionist (not self-serve unit)

Rooms accessible to wheelchairs and buggies (even motorised wheelchairs and twin buggies!)

Rooms easy to find with good signage.

Consulting room is „relaxed design‟ rather than „clinical design‟.

Centre includes a pharmacy.

While site and design of the new building has changed since the event, the priorities from the workshop will input to the interior layout and organisation of the new building.

Activity completed; results still being used.



34

Project

E-cycle

Who has

been consulted?


What


to stakeholders?

What was the


activity?

What decision has


any decision?

Status


groups, LINks











future

Cleator Moor health centre


Patients Local residents Local regeneration company Local authority

The aim of the survey was to give patients an opportunity to influence the layout and design of a proposed new health centre as well as an opportunity to get involved in a range of health related issues in the future which include a patient panel - Talking Food Taking Action. The survey was the start of a series of engagement opportunities in the area linked to the Government Intensive Local Engagement Project

The development of the new health centre has been under discussion for over 5 years. Various presentations have been delivered to a wide range of stakeholders. Plans will go on public display once planning permission has been received.

Key issues:

Conversations at reception can‟t be overheard

Located near to a pharmacy

Entrance is safe and inviting

Good access by public transport

Plenty of parking. It appears there is a degree of scepticism in the community as to the health centre becoming a reality. Willingness from those who did return the questionnaire to get involved in the future.

Response to the questionnaire was disappointing but the results gave a flavour of what people think is important. The project‟s Steering Group are required to respond to the public input when plans go on display. Recruitment for the patient panel has now begun.

Survey completed Project ongoing.



35

Project

E-cycle

Who has

been consulted?


What


to stakeholders?

What was the


activity?

What decision has


any decision?

Status


groups, LINks











future

EMIS web - sharing patient records


Patients Patient Voice Group

A series of focus groups were held to identify:

any concerns around confidentiality

preferences for an opt in or opt out system

required safeguards

patients‟ information needs

Presentations on the nature of the new system and the proposed levels of data sharing.

General support for the principle. Practical suggestions to mitigate patient concerns.

The Patient Voice Group have been instrumental in producing user friendly patient information which has been distributed through all GP practices in South Lakes.

Complete



36

Project

E-cycle

Who has

been consulted?


What

information was

provided to

stakeholders?



What decision has been

taken & how the feedback influenced any decision?

Status


groups, LINks






feedback


been taken into account. Also include any other issues considered (which it

was not possible to act on & why)


future

Services for vulnerable older people in South Lakes

Managing demand & performance

3rd sector Patients Carers

The project has been developed to track the impact of new service models in primary and community care being piloted in the Kendal area. Information has been sought on:

Current patient experience (1:1 interviews, district nursing questionnaire survey)

Current staff experience (workshop including 3rd sector)

Current carers‟ experience (focus group).

Patient and staff “stories”

The workshop highlighted the difficulties around defining “housebound” people – the initial focus of the project. The District Nursing survey identified what was really important to patients (continuity of care and compassion rather than choice of appointment times).

District Nursing

Report

The focus of the project was extended to encompass a wider group of vulnerable older people. This is an ongoing process over the next 12+ months. Patient and staff experiences will be reassessed in 6 months time to show the impact of different ways of working. 3rd sector have identified potential for local “health agents” – volunteers attached to GP practices able to signpost vulnerable older people to a range of services (statutory and non-statutory). NHS has identified several priority areas including:

Reorganisation of district nursing services

A transitional care programme

Structured care and treatment reviews.

Ongoing



37

Project

E-cycle

Who has

been consulted?


What


to stakeholders?

What was the


activity?

What decision has


any decision?

Status


groups, LINks











future

Cystic fibrosis services


Patients Families

Specialist fibrosis services had been consolidated in Carlisle supported by consultants working out of Newcastle. Patients and families were asked about:

the impact of the change

the quality of the service being delivered

using questionnaire and patient story methods.

Both patients and parents expressed a need for a regular clinic supported by the Newcastle consultants in West Cumbria.

A new service level agreement will be developed in line with NHS Cumbria‟s strategic aim of providing services “closer to home”.

Complete



38

Project

E-cycle

Who has

been consulted?


What


to stakeholders?

What was the


activity?

What decision has


any decision?

Status


groups, LINks











future

Reiver forum


Current and past patients with their families and carers

Invited to join the Reiver Forum, a staff and patient group dedicated to capturing experiences to help improve services at the SUSD unit.

What is good/bad about Reiver House?

What information is needed?

How can we improve communication to patients and families?

How can we improve arrival, access and parking, discharge.

Past patient information, verbal accounts of current ways of working and patient experiences. Facilitated session based on Experience Based Design approach

Information available is poor, and movement from Acute hospital to Reiver House not understood by patients (or sometimes staff).

It‟s difficult to park.

The atmosphere is welcoming and tranquil and staff are friendly and kind.

Individual rooms are good for privacy and comfort, but can be lonely.

We should keep involving patients and staff in gathering experiences and improving services.

The Forum has been involved in:-

Developing a new patient leaflet and information pack.

Getting new information displayed in Reiver House.

Maintaining the Forum as an ongoing group.

Inputting into a real-time-feedback service experience pilot.

Staff have also:-

Developed admissions criteria

Visited acute hospital wards to spread the word about Reiver House.

Made more information available on NHS websites.

Access and car parking remain issues that are hard to resolve – the car park is owned by a private company and is outside NHS control.

Ongoing



39

Project

E-cycle

Who has

been consulted?





the engagement

activity?



decision?

Status



LINks



asked?








on & why)


future

Food & fitness – Change4Life community messaging project


County Sport Partnership, County Council, six district councils, Carlisle Leisure, Local Radio Station, Department of Health, local businesses

Obtain DH Funding for C4L MarComms activity in Cumbria. Encourage local sign up to Change4Life. Obtain match funding and support/Sponsorship from relevant partner organisations in Cumbria We also engaged with selected local business regarding sponsorship of the project.

Change4Life materials and links http://www.nhs.uk/change4life/Pages/partners-supporters.aspx

Lack of available time and funds meant that many partner organisations were unable to get involved albeit they were supportive of the project.

Additional funding and support was obtained from County Sport Partnership and local MEND provider. Sponsorship gained from four local businesses. As this support was mainly from the north of the county it was decided that the project take place in the north with a second phase in the south subject to obtaining subsequent funding. The first phase of the project is now complete and has evaluated well. NHS Cumbria is now in the process of applying for additional DH funding to run similar activity in the south of the county.

First phase complete. Phase two ongoing.


http://www.nhs.uk/change4life/Pages/partners-supporters.aspx

http://www.nhs.uk/change4life/Pages/partners-supporters.aspx


40

Project

E-cycle

Who has

been consulted?


What

information was provided to

stakeholders?

What was the feedback from the engagement

activity?

What decision has


any decision?

Status


groups, LINks



asked?

Including links to any formal documents,

leaflets etc

Include range of views from different groups. Also links to

any documents already published regarding feedback





future

Penrith community hospital


Sessions and communications tailored to three levels of stakeholder:- 1. Staff 2. Elected

representatives and key stakeholders, eg LINk/Patients‟ Voice Group/League of Friends/OSC.

3. General Public

As a part of Closer to Home (subject to a previous full public consultation) changes were planned for the Community Hospital that had the potential to spread anxiety. Stakeholders were fully informed, and were asked what unaddressed concerns they had. They were also asked how effective they thought the communication, and what else we could do. At the evening event, participants were given example case studies of patient stories to examine and see how they could be improved.

Stakeholders were given (according to group from column 1) 1. Letter explaining

changes, FAQs, one-to-one and group briefing sessions, union briefings.

2. Letter, FAQs, presentations and discussion at a special meeting.

3. FAQs, press articles, afternoon drop-in and evening event (latter two with Cumbria County Council), posters explaining individual components of new service such as STINT, example case study patient stories.

Concerns were expressed over whether there would be enough beds, and enough community support in lieu of them.

Staff concerned that plans weren‟t realistic or that teams weren‟t integrated enough.

Participants expressed relief at being reassured by good information. “I came because my wife goes [to Penrith Hospital] and I was worried they would stop that. I‟m really relieved that‟s not happening.”

Parish councillors were pleased they had been invited direct, and were involved in the information distribution – they‟re often ignored.

CCC staff (who helped run the event) were impressed by how effective case studies were.

3rd Sector organisations presented a need for closer working.

Decided to hold a similar drop-in event in Alston. (see Alston Neighbourhood Forum Event below)

Decided to hold a workshop with 3rd Sector groups focussing on improving discharge. (see 3rd Sector Liaison Group below)

Feedback helped refine future information.

Team Leader Action Group set up to involve staff more effectively in improvements.

FAQs made available more widely.

Completed (review/update planned)



41

Project

E-cycle

Who has

been consulted?


What

information was provided to

stakeholders?

What was the feedback from the engagement

activity?

What decision has


any decision?

Status


groups, LINks



asked?


leaflets etc







future

Patient stories in team leader training


Patients and carers 3rd Sector groups.

3rd Sector groups were asked to assist in recruiting patients or carers to tell their story to video. This resource would then be used in a programme of development aimed at increasing understand of the impact of services on patients, identifying shared values and improving services.

3rd sector groups were given a verbal account of the purpose and nature of the project. Participants were sent an information and consent sheet in advance, and then supported to go through that piece of information before sharing their story. Afterwards, consent was reviewed, and participants were thanked in person, and in writing. Staff were presented the stories in the context of a session on shared values, reflecting on what it is they aim to achieve in their role, and its impact on patients, carers and families.

Participants (both those sharing and listening to the stories) found the session very useful in examining the effect of (sometimes minor) interventions on patients and carers.

Staff reflected on some of the unexpected impacts on carers (eg loneliness and break of routine).

Staff reflected on the impact of their work on more than the patient‟s current health and wellbeing.

Staff engaged to work more closely with carers and explore what else was needed (link to 3rd Sector Liaison Group – see below)

Patients were informed of how their story was used, and given some feedback of the reaction to it.

The project is now being extended to ensure patient stories feature in Cumbria-wide management training.

Ongoing



42

Project

E-cycle

Who has

been consulted?


What


to stakeholders?

What was the

feedback from the engagement activity?

What decision has been taken

& how the feedback influenced any decision?

Status



LINks

Brief description on what the objective

of the activity is and what are the

key questions being asked?


leaflets etc



Explain how the views of people who have taken part in the activity have been taken

into account. Also include any other issues considered (which it was not

possible to act on & why)


future

Eden C2H 3rd sector liaison group


3rd Sector organisations providing direct services to patients, carers and families plus staff and commissioners.

Originally set up as a one-off workshop to action plan improvements to discharge processes. Participants were asked to identify ways of working together, and specific actions to improve services.

Each participant (3rd Sector and staff Team Leaders) contributed a patient story showing aspects of discharge, good and bad.

Wide range of feedback, from all involved, including:-

Some groups felt they had a good level of involvement in discharge.

Felt meeting in this format was very useful, and wished membership to expand.

Telehealth alarms frequently go missing. Impact on service and client not understood.

Communication disjointed and poor.

More GDC needed.

Patients/clients don‟t know who‟s who and why.

Staff don‟t know of services 3rd Sector offer, and vice versa.

3rd Sector groups get good info when STINT are going in, but not always when they are withdrawing.

The Group has agreed to continue meeting.

Membership has expanded to include Adult Social Care, acute hospital discharge planners, LINk and League of Friends (watching brief).

Team Leaders have taken lead role in the group from commissioners.

Better patient information is being produced, with input from all.

A question about telehealth alarms has been included on admissions sheet.

Additional GDC contracted, with training for generic tasks jointly with ASC.

A „key worker‟ approach is being developed.

A working group of NHS and 3rd sector staff has put together a programme of quarterly sessions for staff.

Working on developing job shadowing both ways across NHS and 3rd Sector staff.

Ongoing.



43

Contact details: Name:Peter Clarke Address: NHS Cumbria Tel: 01539 797878 Email [email protected]

Documents

Quarterly Update Report October 2010