final_aqp_engagement_report_9-11-11

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Extending Patient Choice

of Provider (AQP)

Engagement report

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Table of contents Introduction.................................................................................................... 3

Engagement process and methods............................................................... 3

Feedback from survey................................................................................... 5

Engagement of main local providers, Shadow Health and Wellbeing

Boards and local Clinical Commissioning Groups....................................... 13

Next steps.................................................................................................... 16

Appendices

Appendix A - Engagement and communications plan.................................. 17

Appendix B - Analysis of existing data.......................................................... 27

Appendix C - Analysis of survey results........................................................ 37

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1. Introduction In August 2011, the Department of Health (DH) published Operational Guidance to the NHS: Extending Patient Choice of Provider (DH, 2011) in which it outlined the Government’s commitment to extending the patient choice of Any Qualified Provider for appropriate services with the intention “to empower patients and carers, improve their outcomes and experience, enable service innovation and free up clinicians to drive change and improve practice” (DH 2011, p. 6). The Department of Health conducted a national engagement with clinicians, providers, commissioners, patient groups and voluntary organisations to identify services for priority setting. These are as follows:

Musculo-skeletal services for back and neck pain

Adult hearing aid services in the community

Continence services (adults and children)

Diagnostic tests closer to home such as some types of imaging, cardiac and respiratory investigations to support primary assessment of presenting symptoms

Wheelchair services (children)

Podiatry services

Venous leg ulcer and wound healing

Primary care psychological therapies (adults) In preparation for 2012/13, commissioners are required to have engaged with patients, patient representatives, healthcare professionals and providers on local priorities for extending choice of provider by 30 September 2011 and by 31 October 2011 have used the feedback to identify three or more community or mental health services for implementation.

2. The engagement process and methods To meet the above requirement, the Calderdale, Kirklees and Wakefield Cluster Partnership, with the support of Clinical Commissioning Groups, embarked on engagement with local patients, patient groups and stakeholders from 15 September 2011 to 9 October 2011. An engagement and communications plan supporting this work was developed, which can be seen in Appendix A.

2.1 Review of existing data

Existing data held by the three respective PCTs were collated and analysed to form part of the engagement process.

The information to be considered as part of this exercise was any patient feedback received in relation to the proposed services within the last two years via the Patient Advice and Liaison Services, complaints/customer services teams, patient experience surveys, FOI requests, and previous engagement and consultation activities. Analysis of this data can be found in Appendix B.

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2.2 Survey

A web based survey was developed to encompass the direction of the Cluster in relation to AQP. The communication channels identified in Appendix A were used to disseminate this to all stakeholder groups. Furthermore, this was supported by attendance at local events and meetings. The following stakeholders were engaged as part of the process:

Patients, carers and relatives, general public

Voluntary and Community Groups

GPs, practice staff and patient reference groups

Local Involvement Networks

Staff

Health and Wellbeing Boards

Providers

Clinical Commissioning Groups

Town & Valley Committees / Ward Forums

Elected members / Councillors

Overview and Scrutiny Offices

Local Medical Committees, Local Pharmaceutical Committees, Local Dental Committees and Local Ophthalmic Committee

Media

The Communications Team lead on press releases, social media, intranet and internet sites for each PCT. In addition, GP Links were utilised where available. Current communication channels, both internal as well as those of existing networks, were utilised to reach these stakeholders, distributing information and supporting the engagement process. More information can be found in Appendix A.

To ensure that this survey was accessible to those without access to the internet, hard copies were provided upon request and disseminated during public events (a list of these can also be found in Appendix A). To ensure as high response rate as possible, freepost address was used for such replies. In addition, contact details of local Engagement Teams were publicised for callers to have the option to complete the survey over the phone.

Following a review of internal intelligence and discussions with clinical commissioning groups and Health and Wellbeing Boards, the list of services used as part of the process was as follows:

The eight services identified in operational guidance; however to reflect the local need, musculo-skeletal services were considered in general rather than specifically for neck and back pain.

Dermatology

WY Sexual Assault Referral Centre

Phlebotomy

Community Ultrasound

Cataracts

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3. Feedback from survey Across the Cluster area, 356 surveys were received in a combination of postal and online submissions. The numbers for the respective Clinical Commissioning Groups are as follows:

Table 1 – response rates by CCG Frequency Percent

Not answered 15 4.2

Calderdale Commissioning Consortia 65 18.3

Greater Huddersfield Commissioning Consortia Group

72 20.2

North Kirklees Health Alliance 44 12.4

Wakefield Alliance 150 42.1

Out of area 10 2.8

Total 356 100.0

In the first question, respondents were asked to select three services from the list of options and to indicate their ranking of choice in terms of what service was the highest priority, mid priority and lowest priority to them. It should be noted here, that not all respondents selected only three options and, as such, the findings include all selections made by respondents. Furthermore, discussions and further comments received indicated that some respondents found it difficult to comment on selection of services they have not themselves received. An overview of the results for this question is summarised in Table 2. This is followed with an analysis of the benefits respondents felt would be gained from being able to access a wider selection of qualified providers for their treatment. Further information to this can be found in Appendix C.

High

Low

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Table 2 – Service priorities (Cluster area) Highest priority Mid priority Lowest priority Total

N % N % N % N %

Services Adult Hearing Services in the community 40 2.73% 43 2.94% 27 1.84% 110 7.51%

Continence services (adults and children) 30 2.05% 29 1.98% 18 1.23% 77 5.26%

Musculo-skeletal services (MSK) 60 4.10% 45 3.07% 31 2.12% 136 9.29%

Venous leg ulcer and wound healing 43 2.94% 28 1.91% 19 1.30% 90 6.15%

Diagnostic tests and scans closer to home 159 10.86% 55 3.76% 22 1.50% 236 16.12%

Children's Wheelchair services 43 2.94% 27 1.84% 14 0.96% 84 5.74%

Podiatry services 43 2.94% 47 3.21% 30 2.05% 120 8.20%

Adult Psychological Therapies 69 4.71% 39 2.66% 33 2.25% 141 9.63%

Dermatology 30 2.05% 33 2.25% 23 1.57% 86 5.87%

West Yorkshire Sexual Assault Referral Centre 38 2.60% 26 1.78% 21 1.43% 85 5.81%

Phlebotomy 45 3.07% 35 2.39% 20 1.37% 100 6.83%

Community Ultrasound 44 3.01% 30 2.05% 29 1.98% 103 7.04%

Cataract services 38 2.60% 36 2.46% 22 1.50% 96 6.56%

Total 682 46.58% 473 32.31% 309 21.11% 1464 100.00%

Table 3 – Benefits (Cluster area) N Percent of Cases

Benefits Better quality of treatment 145 40.7%

More convenient locations 236 66.3%

Shorter waiting times 229 64.3%

More convenient appointment times 196 55.1%

Nicer environment 56 15.7%

Easier to get an appointment 200 56.2%

Friendly and helpful staff 93 26.1%

Feeling of empowerment 97 27.2%

More control over own care 200 56.2%

Easier to access 188 52.8%

No benefit 42 11.8%

Total 1682 472.5%

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When considering the service priorities and perceived benefits per clinical commissioning group area, the following tables illustrate the results:

Calderdale Commissioning Consortium

Highest priority Mid priority Lowest priority Total

N % N % N % N %









Dermatology 9 3.10% 6 2.07% 6 2.07% 21 7.24%


Phlebotomy 10 3.45% 7 2.41% 4 1.38% 21 7.24%



Total 149 51.38% 80 27.59% 61 21.03% 290 100.00%

Calderdale Commissioning Consortium

N Percent of cases











No benefit 15 23.1%

Total 278 427.7%

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Greater Huddersfield Commissioning Consortium


N % N % N % N %









Dermatology 4 1.59% 3 1.19% 4 1.59% 11 4.37%


Phlebotomy 7 2.78% 8 3.17% 3 1.19% 18 7.14%



Total 108 42.86% 83 32.94% 61 24.21% 252 100.00%


N Percent of cases











No benefit 7 9.7%

Total 305 423.6%

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North Kirklees Health Alliance


N % N % N % N %









Dermatology 3 2.03% 6 4.05% 1 0.68% 10 6.76%


Phlebotomy 5 3.38% 1 0.68% 3 2.03% 9 6.08%



Total 70 47.30% 40 27.03% 38 25.68% 148 100.00%

North Kirklees Health Alliance N Percent of cases











No benefit 8 18.2%

Total 210 477.3%

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Wakefield Alliance


N % N % N % N %









Dermatology 14 2.08% 15 2.23% 9 1.34% 38 5.64%


Phlebotomy 22 3.26% 16 2.37% 10 1.48% 48 7.12%



Total 311 46.14% 230 34.12% 133 19.73% 674 100.00%

Wakefield Alliance N Percent of cases











No benefit 7 4.7%

Total 801 534.0%

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Respondents were given an opportunity to state what other benefits there were in increasing a choice of provider. The following was submitted:

Table 4 - Other benefits

More suitable for some vulnerable groups where there are barriers to access because of stigma, co-morbidity, poverty

The possibility of working with the professionals rather than being done to; possibly even more time to be treated like an intelligent human being

Cured more quickly Just greater convenience

Competition to present providers More secure feeling

There could be less restrictions in other areas

The staff may already know your problems

Are there benefits? NHS are capable of podiatry service, given the initiative, skills and good not wasteful management

Treatment not at present available via NHS Good neighbour scheme

More time to be listened to and supported Possible easier parking

Naive question - choice is a nonsensical mirage

More satisfaction - the choice is ours

What I want, where I want it, and when I want it

Hopefully to feedback to NHS which providers offer best service

OAPs are my main priority Better parking

Problem is that excess capacity costs £££ but does reduce waiting times and can shake out weaker providers

Sticking as near as possible to appointment times

Possibility of alternative treatments A new MYHT board

Not sure patients have enough information to make a considered choice

Choice is an illusion and waste of money, we will end up with more monitoring boards than front line workers

Choice

Respondents were also asked to note other services which they felt would benefit from more choice of provider. The responses to this question are noted below. As can be seen from the data, most responses related to mental health services both for adults and children, with counselling being specifically noted by some. The second most noted service was physiotherapy.

Other services

Cancer treatment Primary Care

Fracture clinics Neonatal services

Stop smoking services and mental health support for children

At Home' assistance, both medical and home help

Diabetes - equality across all practices Mental health, stroke

Home care Mental health

All mental health services - a range of different therapies, not just medical interventions.

Neurology Services

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I, like thousands of others, am simply not in a position to give an opinion on these questions: I do not have access to any of the relevant statistics about the incidence of these diseases nor about their effects on those affected.

Wants one good provider, choice is wasteful and will lead to lower standards as providers aim for profit. If they don't they will go bankrupt.

People should be able to choose from as wide range of providers as possible for all services.

Apologies but I'm not really familiar with the majority of the services given on the previous page and so am unable to prioritise.

Would like to see better choice of INR testing, with possibly self testing offered to some patients.

More help for OAPs

Physio Limb loss and amputee services

Speech and Language Diagnostic tests e.g. BP, cardiovascular, Chlamydia

Family interventions services, Depot clinics, CBT for psychosis

Elderly services

Neurological Sexual transmission disease

Children's outpatient appointments Orthopaedic services

Knee and Hip replacements All services should be subject to AQP

Breathing problems i.e. COPD Children’s psychological therapies, alternative therapies

Mental health in particular CBT IPT and counselling

Wider range of services for chronic disease management - a more accessible system for seeing the professionals and a decent advocacy service

Rheumatology Oncology

Counselling services within the community

Choice of dentist for adults with learning difficulties, wheelchair services for adults, physiotherapy for adults with learning difficulties

Local services for local people are what matters.

Physiotherapy

Sexual health for young people Nursing

Counselling Dietetics, weight loss programmes

Minor injuries Aids and Adaptations, Community outreach learning disability, Hydrotherapy

Hip and knee replacements Community matrons

Physiotherapy, Radiology Better choice re 'CHOICE' once diagnosed

Domiciliary Neurological Conditions Service Physio

CBT Therapies I have significant concerns about increasing choice of provider as it destabilises current services

Child psychological services of CAMHS Street wardens for elderly/housebound etc

Occupational Health Physiotherapy /particularly in care homes

Adult care providers Dietetics services

First aid that could be dealt with locally and centrally

Out of hours doctors

Orthopaedics Mental health services, adults

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Orthopaedics District Nursing and Heath Visitors

General clinics attached to GPs that offers top to toe checks in a walk in clinic. This would be helpful for young and adult carers.

Minor Accidents, Physiotherapy, Radiology, Dietetics

Easier referral for alcohol problems Scans, physiotherapy, x-rays

Mental health help for carers Any requiring invasive surgery

To increase trained Health Visitors More services at Pontefract Hospital

Diabetes and pain management treatment

4. Engagement of main local providers, Shadow Health and Wellbeing Boards and local Clinical Commissioning Groups.

The Contracting Teams within each PCT area lead on the engagement of the above stakeholders and the below notes the steps taken:

Shadow Health and Wellbeing Boards

The Shadow Health and Wellbeing Board meeting

was attended where a briefing document on AQP

was discussed. The Contracting Lead was able to

gain feedback from the Board to incorporate into the

process.

7 September

25 October

Kirklees

Calderdale


The Clinical Commissioning Executive meetings in

Kirklees were attended where a briefing document

was presented for discussion which described AQP

and the current requirement. CCGs were asked for

feedback on the priority services.

Information was distributed to Calderdale CCG

Teleconference held with Wakefield Health Alliance

31 August and

26 October

24 August and

26 October

16 September

22 September

28 September

North Kirklees Health

Alliance

Greater Huddersfield

Commissioning

Consortium

Email information

sent to the Shadow

Board in Calderdale

Calderdale

Commissioning

Group Clinicians

meeting

Clinical Commissioning Executive – North Kirklees Health

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26 October

Alliance and Greater Huddersfield CC

Wakefield Health Alliance

Providers

At each of the meetings below, a paper was

presented for discussion which described AQP and

the current requirement. Providers were asked for

any intelligence on the priority services included in

the process. Each provider was asked to proved

feedback. No feedback has been received to date.

CHFT Contract Committee

SWYPFT Quality Board MYHT Contract Management Group KCHS/Locala Contract Management Group CHFT Contract Management Board

8 September 12 September 14 September 15 September 20 September

Calderdale/Kirklees Cluster Kirklees/Wakefield Kirklees Calderdale/Kirklees

Clinical Commissioning Groups and Shadow Health and Wellbeing Boards were also asked to consider the priority services using the first question of the survey. The list bellow illustrates the feedback received. Kirklees Shadow Health and Wellbeing Board

Highest priority – MSK and Diagnostic tests

Mid priority – Podiatry and Adult hearing services

Children’s wheelchair services were also noted, however this would not be considered as the best selection given current local developments in this service


Highest priority – Dermatology and Diagnostic tests

Mid priority – Adult hearing services, MSK and Adult Psychological Therapies

Low priority – not given North Kirklees Health Alliance

Highest priority – Adult hearing services, Diagnostic tests and Adult Psychological Therapies

Mid priority – not given

Low priority – not given

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Locala (KCHS) In their response, Locala stated the following:

Our Senior Management Team have now had chance to discuss the AQP options in some detail. We have the following feedback. We have decided that of the twelve services that have been identified as possibilities for commissioning through AQP, the following are preferences for Locala Community Partnerships CIC:

Diagnostic tests and scans closer to home

Musculo-skeletal services (MSK)

Podiatry services

Continence services (adults and children) – if this is the full service and not just the specialist element

Locala would be positive if other services were selected for the AQP model. However we would want to you to know that it is our view that “Venous leg ulcers and wound healing” would not be the best selection at this time due to the probable fragmentation of services that would occur and the potential for a negative impact on seamless integrated services for adults. We also can confirm that there are no other services that Locala would prefer to see commissioned as Any Qualified Provider in 2012-13.

Calderdale and Huddersfield NHS Foundation Trust In their response, CHFT noted the following:

Thank you for sharing your paper on the PCT’s approach towards the implementation of Any Qualified Provider (AQP). As discussed at the Contract Management Board on Tuesday 18th October 2011, the Trust would like to share the following comments and concerns. It is our understanding that 2012/13 will be considered a transitional year with the introduction of a limited set of community and mental health services and this will be by PCT Cluster and not each individual PCT in line with DH guidance.

We believe that the DH will establish a national qualification process to reduce bureaucracy and transitional cost for both providers and commissioners, and that this guidance is expected in the autumn. We would be grateful if the PCT would share this information for clarification purposes across the health community once this guidance is available.

Currently all Trust services are listed on the Directory of Services for secondary care with some community services available on the primary care system. The guidance suggests that a register of AQP services will be established for referrers. Could you please clarify the approach to this and how the register will work alongside the established directories to ensure a fair process that does not disadvantage the existing provider.

As the Trust is unsure of the PCT’s intentions with regard to the services that will be subject to AQP, we are unable to comment on the appropriateness or impact of the selection. However, we would ask that the PCT focuses its approach to services where capacity issues are apparent, as this may provide a whole systems solution across the cluster.

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The Trust would like to express concern regarding some of the services that maybe chosen by the cluster, and would ask that the PCT considers the impact upon the current providers, as this may lead to the disestablishment of existing services should patients choose an alternative provider introduced by the PCT. In such circumstances, the Trust is clear that the contractual position enables the application of TUPE.

As formally noted at the Contract Management Board, the Trust would like to reinforce the position that TUPE would apply to services where a significant reduction in demand occurs as a direct result of the implementation of AQP. We have clarified this position with our legal advisors.

Finally, we would welcome clarification on the contractual process for supporting contracts which are currently held by the SHA, for example, repairs to wheelchairs. This process is unclear in your paper and will have contractual implications for the Trust and the Standard Contract.

Calderdale Calderdale CCG

1. Adult Psychological Therapies 2. Podiatry 3. Wheelchair services for children and Physiotherapy

Wakefield Wakefield Health Alliance

Wakefield Health Alliance was consulted in relation to the service priorities and the CCG identified Adult hearing services as a priority for inclusion on the AQP shortlist.

5. Next steps The findings captured within this report will be presented to the Contracting Leads within the Calderdale, Kirklees and Wakefield District Cluster to inform the selection of local priorities for consideration. Once a decision has been made and ratified, a formal submission will be made to the SHA. Stakeholders involved in the engagement process will be informed of the outcome.

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Appendix A – Engagement and communications plan

Extending Patient Choice of Provider

Engagement and Communications Plan

September 2011

Produced on behalf of Calderdale, Kirklees and Wakefield Cluster Partnership

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1. Introduction

In August 2011, the Department of Health (DH) published Operational Guidance to the NHS: Extending Patient Choice of Provider (DH, 2011) in which it outlined the Government’s commitment to extending the patient choice of Any Qualified Provider for appropriate services with the intention “to empower patients and carers, improve their outcomes and experience, enable service innovation and free up clinicians to drive change and improve practice” (DH 2011, p. 6).

The Department of Health conducted a national engagement with clinicians, providers,

commissioners, patient groups and voluntary organisations to identify services for priority setting.

These are as follows:

Musculo-skeletal services for back and neck pain

Adult hearing aid services in the community

Continence services (adults and children)

Diagnostic tests closer to home such as some types of imaging, cardiac and respiratory investigations to support primary assessment of presenting symptoms

Wheelchair services (children)

Podiatry services

Venous leg ulcer and wound healing

Primary care psychological therapies (adults)

In preparation for 2012/13, commissioners are required to have engaged with patients, patient representatives, healthcare professionals and providers on local priorities for extending choice of provider by 30 September 2011 and by 31 October 2011 have used the feedback to identify three or more community or mental health services for implementation. To meet this requirement, the Calderdale, Kirklees and Wakefield Cluster Partnership, with the support of Clinical Commissioning Groups, will embark on engagement with local patients, patient groups and stakeholders. The Cluster is committed to ensuring that local people are informed, involved and have an opportunity to influence any changes.

2. Stakeholders The national guidance sets out the key groups that the Cluster is required to engage with - patients, patient representatives, healthcare professionals and providers. This plan takes this into account and builds on it with the following groups being considered stakeholders as part of this process:

Patients

Carers and relatives

General Public

Voluntary and Community Sector groups

Patient support groups

General Practitioners, practice staff and patient reference groups

Local Involvement Networks (LINks)

Health and Wellbeing Boards


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Providers

Staff

Media

The engagement process will be supported by the Communications Team who will lead on press

releases, social media, and intranet and internet sites for each PCT. In addition, GP Links will be

utilised where available.

Current communication channels, both internal as well as those of existing networks, will be

utilised to reach these stakeholders, distributing information and supporting the engagement

process. This is outlined below:

Target audience Method of communication

Calderdale Kirklees Wakefield

Patients, carers and relatives,

general public

Calderdale Engage

NHS Calderdale

website, Facebook

and Twitter

Calderdale Carers

Project website

Parent Carers website

17 Area Forums –

weekly E newsletter

Press release to be

shared with Local

Authority Press

Officer to share with

staff

Press release to be

shared with Acute

Trust Press Officer to

share with staff

NHS Kirklees

website,

Facebook and

Twitter

KPOS email

distribution

VAK weekly e-

bulletin

LINk events

LINk Steering

Group

LINk distribution

list

INVOLVE

database

Get Involved

database

participants

(individuals;

208)

Discussion

Forum on

Kirklees

Council’s

website

NHS Wakefield

website and

Twitter

People Bank

participants

Press release to

be shared with

Local Authority

Press Officer to

share with staff

Press release to

be shared with

Acute Trust

Press Officer to

share with staff

Service specific

groups

Community

Development

Team

LINk

VAWD

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Readers Panel

LINk community

events

Expert Patient

Programme

Support Groups

Press release to

be shared with

Local Authority

Press Officer to

share with staff

Press release to

be shared with

Acute Trust

Press Officer to

share with staff

Service specific

groups

Voluntary and Community

Groups

Voluntary and

community sector

website

Bi-monthly Voluntary

Action Calderdale

newsletter

Calderdale

Community Forum

BAME website

VAK weekly e-

bulletin – 1,200

contacts

KPOS email

distribution –

100+

LINk community

events

VAK monthly

health bulletin

Get involved,

share your

views database

– VCS

organisations

contacts; 103

VAWD

LINk

GPs, practice staff and patient

reference groups

Link Bulletin

GP Link

Email to

Practice

Managers for

their information

as well as

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distribution to

GPs and PRGs

where these are

in place.

PRG network

meeting

LINKs LINk website

LINk steering group

meeting

Attendance at

Steering Group

meeting

Attendance at 2

LINk events

Wakefield

District LINk

Council Meeting

Staff Buzz newsletter

Intranet

Blog – verbal briefing

Staff email

Senior Managers’

Team Meeting

Weekly Talk

Intranet

Newsbytes

Intranet

Health and Wellbeing Boards Information to be

circulated

electronically –

explanatory email with

a link to web survey to

all members of HWBB

Presentation at Shadow Board meeting

Email

information to

the Chair of

Shadow Board

Providers Calderdale and Huddersfield Foundation Trust, Mid Yorkshire Hospitals Trust, South West Yorkshire Partnership Foundation Trust, Kirklees Community Health Services/Locala

Clinical Commissioning Groups Information to be

circulated

electronically –

Presentation at meetings

Email to CCG

Chairs and lead

commissioning

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explanatory email with

a link to web survey to

CCG

Information to

be circulated

electronically –

explanatory

email with a link

to web survey to

CCG PPI leads

(Chairs and PMs

with PPI

portfolio lead)

and Lead

commissioning

staff

manager

Town & Valley Committees /

Ward Forums

Calderdale 17 Area

Forums – weekly

e-newsletter

Kirklees Area

Committees –

information to be

circulated

electronically

Community

Development

Team

Elected members / Councillors Information to be

circulated

electronically via

Local Authority

Communications

Lead

Information to

be circulated

electronically via

Local Authority

Communications

Lead

Information to

be circulated

electronically via

Local Authority

Communications

Lead

Overview and Scrutiny Offices Information to be

circulated

electronically

Information to

be circulated

electronically

Information to

be circulated

electronically

LMC, LPC, LDC

and LOC

Information to be

circulated

electronically

Information to

be circulated

electronically

Information to

be circulated

electronically

Media Press release Press release Press release

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In addition to dissemination of messages, the following events will be attended during the

engagement process:

Target Audience

Date PCT area

Patients, carers and relatives, general public

EPP Course 20 September for 6 weeks

Wakefield

PRG Network Meeting 21 September Wakefield

Warrengate PRG meeting 22 September Wakefield

Eastmoor PRG meeting 22 September Wakefield

Batley, Birstall and Birkenshaw Area Committee 28 September Kirklees

Making it Better event 29 September Kirklees

Making it Better event 1 October Kirklees

GASPED 5 October Wakefield

Voluntary and Community Sector groups

Children & Young people’s Involvement meeting 10 September Calderdale

Children and Young people Wakefield

LINk Steering Group meeting 13 September Kirklees

Calderdale Carers Project meeting 14 September Calderdale

Disability Partnership Calderdale 20 September Calderdale

Calderdale Healthwatch event 22 September Calderdale

Calderdale Interfaith Council AGM 22 September Calderdale

Batley BLIND Society AGM 22 September Kirklees

LINk ‘Making it Better’ events 29 September

and 1 October

Kirklees

NHS Calderdale AGM 29 September Calderdale

Calderdale Older Peoples Forum meeting 3 October Calderdale

LINk council meeting 4 October Wakefield

LINk public meeting 5 October Calderdale

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Target Audience

Date PCT area

Patient support groups/condition specific

groups

Basement project (substance misuse) 3 October Calderdale

Wakefield Deaf Society Wakefield

Carers Group Wakefield

Stakeholders

NHS Kirklees AGM 28 September Kirklees

Kirklees Partnership Outreach Service event 28 September Kirklees

Shadow Health and Wellbeing Boards 7 September

25 October

Kirklees

Calderdale


31 August

24 August

16 September

22 September

28 September

North Kirklees

Health Alliance

Greater

Huddersfield

Commissioning

Consortium

Email information

sent to the Shadow

Board in Calderdale

Calderdale

Commissioning

Group Clinicians

Meeting

Clinical

Commissioning

Executive – North

Kirklees Health

Alliance and

Greater

Huddersfield CC

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Target Audience

Date PCT area

Providers:

CHFT Contract Committee SWYPFT Quality Board MYHT Contract Management Group KCHS/Locala Contract Management Group CHFT Contract Management Board

8 September 12 September 14 September 15 September 20 September

Calderdale/Kirklees Cluster Kirklees/Wakefield Kirklees Calderdale/Kirklees

3. Engagement process and methods

3.1 Review of existing data

Existing data held by the three respective PCTs will be collated and analysed and form part of the

engagement process.

The information to be considered as part of this exercise is any patient feedback received in

relation to the proposed services within the last two years via the Patient Advice and Liaison

Services, complaints/customer services teams, patient experience surveys, FOI requests, and

previous engagement and consultation activities.

3.2 Web based survey

A web based survey will be developed to encompass the direction of the Cluster in relation to

AQP. The communication channels identified in section 2 will be used to disseminate this to all

stakeholder groups identified. Furthermore, this will be supported by attendance at local events

and meetings.

To ensure that this survey is accessible to those without access to the internet, hard copies will be

provided upon request and disseminated during public events. To ensure as high response rate

as possible, freepost address will be used for such replies. In addition, contact details of local

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Engagement Teams will be publicised for callers to have the option to complete the survey over

the phone.

The survey will commence on 16th September 2011 and end on 7th October 2011. The design of

the survey will take into account the Department of Health operational guidance as well as local

priorities.

Based on engagement with Health and Wellbeing Boards, local Clinical Commissioning Groups

and internal intelligence, the list of services forming part of the engagement will be as follows:

The eight services identified in operational guidance; however to reflect the local need, musculo-skeletal services will be considered in general rather than specifically for neck and back pain.

Dermatology

WY Sexual Assault Referral Centre

Phlebotomy

Community Ultrasound

Cataracts

The document will take the full option list as the basis for the engagement, asking participants to

select their three priorities and ranking these as high, mid and low priority. Furthermore, it will

provide an opportunity for participants to share their suggestions on any other services which

could be considered as part of extending the choice of provider.

In order to be able to fully analyse the data and offer an opportunity of more localised intelligence,

participants will be asked for part of their postcode.

3.3 Analysis of data and presentation of findings

The data gathered via the review of existing intelligence as well as the proposed engagement

initiatives will be analysed by the Cluster Engagement Team. A report of findings will be produced

and presented to the contracting teams to inform the selection of local priorities for consideration.

Cluster decision on the priorities selected will be communicated to stakeholders. In terms of the

public, patients and VCS organisations, existing networks and communication channels will be

used to disseminate the information.

4. Document distribution

This engagement plan will be shared with the Calderdale, Kirklees and Wakefield Cluster

Partnership as well as individual CCGs.

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Appendix B – Analysis of existing data The documents and sources included in the review of information held across the Cluster are as follows:

Calderdale Local Involvement Network with Calderdale Parent and Carer’s Council, Continence Services Task Group

Comments Campervan – NHS Kirklees

COPD discussion groups – NHS Kirklees

Data from Complaints and PALS – across the cluster

Patient Opinion - Kirklees

Eye Care in Calderdale, Results of Consultation Activity May – August 2009

Future of the NHS Event – NHS Kirklees

Hip replacement focus groups – NHS Kirklees

Holme Valley Memorial Hospital redesign – NHS Kirklees

Initial requirements for the wheelchair service specification - NHS Calderdale

Mid Yorkshire service strategy consultation

MSK service patient survey – NHS Calderdale

National Patient Survey reports – across the cluster

NHS Constitution consultation

Pain discussion group – NHS Kirklees

Patient experience reports – NHS Wakefield

Pharmaceutical Needs Assessment consultation – NHS Kirklees

Public and Patient Involvement Report on ‘Transforming Community Services’ in Calderdale.

Quality reports- NHS Wakefield and District

Report findings from Patient Engagement of Primary Care Psychological Therapies & General Practices response to self-help provision – NHS Calderdale

Single Equality Scheme consultation – NHS Kirklees

Stroke discussion group – NHS Kirklees

Transforming Community Services Event – NHS Kirklees

Yorkshire and Humber Specialised Commissioning Group, Vascular Services Review Consultation Report - March 2011

1. Venous leg ulcer and wound healing No specific comments

2. Podiatry services Lack of appointments at Cleckheaton HC

No contact from Cleckheaton HC

Waiting times at Mirfield HC (over 18 weeks)

No appointment available at Dewsbury HC

No annual appointment given

Appointment issues

No appointments available and concern over manner of reception staff at Batley HC

Would prefer more regular appointments

Manner of Podiatrist at Fartown HC

Unable to contact

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Podiatry Services (NHS Wakefield) 500 questionnaires were distributed to five clinical locations. Out of the 463 questionnaires actually handed out to patients, 365 were returned giving a response rate of 73%. Question 1 - Were you treated with dignity and respect? Of the service users who responded to this question, 97% felt that they had been treated with dignity and respect. No one felt that they had not been treated with dignity and respect, 2% felt that they had to some extent and 1 person did not respond to this question at all. Question 2 - Did the health professional ask your permission before treating you? Of the service users who responded to this question, 85% said that permission had been sought prior to treatment, 5% said no, that they had not been asked, 7% could not remember and 1% did not respond to the question. Question 4 - Did the member of staff listen carefully to you? There are high levels of agreement amongst respondents that they feel listened to during their time with the service. Of the service users who responded to this question, 96% felt that the member of staff treating them listened carefully and 2% did to some extent. Question 6 - How would you rate the care you received? There appears to be high satisfaction within users of the service of the service. 96% of respondents rated the service as excellent or very good. No respondents felt that the care received was poor. Question 7 - Have you found your Podiatry treatment beneficial? E.g. has it improved your mobility/ reduced your pain/discomfort? Some of the positive comments received are as follows: ‘’With having nail removal it has allowed me to continue with running, which had been painful before’’. ‘’Pain in back has gone, they discovered one leg shorter than the other’’. ‘’It improved my mobility a lot. I have less pain for a while which means there is less discomfort’’. ‘’Better than the alternative – which at one point, was surgery! Couldn’t function effectively prior to treatment’’ Question 9 - Is there anything you feel could be improved? 69% of the patients who responded to this question were happy with or felt that there was nothing else that could be improved with the service (a full copy of the responses can be found in the full podiatry report). Some of the suggestions put forward by patients to improve the service were as follows:

Improve parking at Pontefract Health centre, especially for disabled users.

Increased frequency of visits.

More regular appointments available.

Shorten length of appointments.

Time between appointments could be reduced.

Seen more – 3 months too long.

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My nails grow quicker than 3 months need to be seen in 6 weeks and to make appointment when leaving.

No – would prefer 2 monthly appointments, not 3, it’s too long. All patients referred to the service are assessed and the frequency of visits determined according to their presenting clinical/medical need, this may not always mirror what the patient would like. If patients are not happy about the frequency of their visits, this is usually discussed with the patient at the time and recorded within the patients Podiatry record. If patients are still unhappy with the decision of visit frequency to the service, they can access a second opinion by an alternative clinical member of staff. At each visit, patients are reviewed and the frequency of treatments maybe increased or decreased dependant on clinical/medical need.

3. Adult hearing services in the community Where to get hearing aid repaired?

4. Children’s wheelchair services A mum complained about lack of suitable wheelchair for her disabled son.

Wheelchair not received within 20 weeks. GP had not ordered. Wheelchair services prioritised. Initial requirements for the wheelchair service specification (NHS Calderdale)

Box to tick on referral form to say that the referrer has had a discussion with the person being referred.

One assessment to cover everything rather than a few covering different things.

Person-centred assessment, based on person’s lifestyle choices, made into a statement of need signed by both parties.

The right to have a discussion if you do not agree with the assessment.

The right to have something that may seem contrary to the assessment but suits you e.g. a ‘tighter fit’ wheelchair that can fit through your doors at home (with a disclaimer to sign if necessary).

Provider required to be clear about what can and cannot be provided within the budget.

Recognition that the needs of people with progressive conditions can change very quickly, and a system flexible enough to respond to this.

Transparency about waiting times, with information about the manufacturing cycle for specific types of chair.

Requirement for the provider to keep a minimum stock of a range of different types of chairs that can be used as a stopgap for people waiting for a chair.

A target from receipt of referral to completion of assessment, then specific targets for different types of chair.

Clear information about how the voucher scheme operates.

A voucher scheme for powered chairs as well as manual chairs.

Requirement for staff to undertake disability awareness training, equality & diversity training and support planning training.

Requirement for provider to set out what is covered under repairs/ maintenance and what has to be paid for.

More flexible opening hours, particularly for people who work – for example, opening on a Saturday morning and/or having a late evening.

Clear details of how referrals will be prioritised (using input from the wheelchair service user group).

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More welcoming environment, for example, having at least one person facing the window in reception, being greeted on arrival etc.

Signage from road and for getting into the building.

5. Community ultrasound No specific comments

6. West Yorkshire Sexual Assault Referral Centre

No specific comments

7. Dermatology PALS (NHS Kirklees)

Unhappy at diagnosis and lack of further tests for daughter.

8 week long referral to HRI. Contacted appointments and was told that clinics were fully booked and didn’t know when they could arrange appointment.

Concern over relocation of Dermatology from HRI to CRH. Patient Opinion (NHS Kirklees)

Quick appointment. Happy to stay on specialists’ books, as new referral not needed if problem reoccurs.

Great service, excellent care and friendly approachable staff at Moorfield.

Excellent treatment received at Moorfield.

8. Musculo-skeletal services (MSK) MSK service patient survey (NHS Calderdale) The audit had a 47% return rate

75% reported excellent service, 24% good and 1% average.

All service users would recommend the service to others.

99% stated they were given enough time to discuss treatment and progress

92% felt involved in the planning of future treatment and management.

90% stated the clinicians used language that they understood.

Comments received

1st class service. Appointment on time. Treatment very well explained.

I felt this was a very professional assessment of my condition and was a well presented diagnosis and proposal follow up treatment.

More than happy with the consultation. I was treated with respect & consideration throughout.

We found it much better & easier to attend the doctor’s surgery rather than have to attend the hospital for this appointment. The member of staff was very helpful & understanding.

Very helpful. Very nice people. Great help.

It is far less stressful having services provided closer to home - Todmorden Health Centre is a great new resource for the town. Very satisfied with efficiency & convenience. Staff at HRI MRI very welcoming & made me feel at ease.

I was disappointed with the waiting time of the service (10 weeks).

My appointments were changed twice; when I rang to re-book I discovered the appointments given couldn’t take place as the consultant didn’t work in the centre on the given days.

It would be helpful to know why appointments are cancelled without notice.

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The Service Overall for MSK (NHS Wakefield) Patients were asked to rate the overall care they had received at the Musculo-skeletal Service. 101 (74%) patients rated the service as ‘Excellent.’ 30 (22%) of patients rated the service as ‘Good’, and 3 (2%) rated it as ‘Satisfactory’. No patients rated the service as ‘Poor’ and 2 (1%) failed to answer the question. Therefore, over 98% of patients seen within the service in this period rated it as ‘excellent’ or ‘good.’

The initial contact process could be improved. Letter sent to patient asking them to contact MS clinic for example. This would mean first contact would not be a negative e.g. Letter saying patient hadn’t contacted MS clinic.

Car parking not good enough.

John was excellent. Noticed my problem straight away. Given follow up appointment today. Better than I was with my back which John sorted, but leg pain now?

The car parking is an issue. But the convenience of using Hightown is a much better alternative than Ponte, Pinders, Clayton etc. So let’s have more services at Hightown Hospital.

I think my treatment was excellent and the Doctor was really good with me.

Was given open appointment, just in case other treatment was no help. (Physio);

Very convenient to be able to attend in ‘after work’ hours.

Parking is a real problem. Signs warning clamping in progress but nowhere to park. Big issue!!!

Very limited car parking space but otherwise excellent.

I am satisfied with the treatment I got and the service was very good. Thank you once again, highly satisfied.

We arrived early and asked about restaurant or café for a drink. We were treated very courteously and given clear directions by a member of staff. We were well impressed on our first visit.

9. Phlebotomy Waiting times at Fartown HC

Waiting times at HRI & community venues

Would prefer a community venue

Waiting time at CHFT (2 hours)

Needle phobia patient unhappy at methods used to take blood

Struggle to get appointment for child

Struggle to get phlebotomy appoint at GP

No local phlebotomy venue in Denby Dale

Unhappy at GPs arrangement for phlebotomy at Shepley HC

10. Continence services (adults and children) Cost of continence pads and how assessments are carried out

Non-provision of pull up continence pants in the Calderdale area

Mother concerned about the number of continence pads allocated to her disabled son.

Availability of pads

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Calderdale Local Involvement Network with Calderdale Parent and Carer’s Council, Continence Services Task Group (April 2010) What people said they feel is wrong Age: Age to qualify for continence aids changed in July 2009 from age 4 to 5, seems purely a cost based decision which parents want reversing. Quantity: Not enough continence pads issued to anyone, just a ration of 4 which is insufficient for the lowest level of need if a pad is worn 24 hours a day. (Also some get 5 some 6??) People are forced to top up privately (see Price). Pads must be sent with people into schools, hospitals etc and often get used quicker than they can be replaced from the allowance leading to a need for “policing” of your pads. Quality: No choice of pad, those provided often leak, both faeces and urine, causing massive stress in terms of increased changing of clothes and bedding as well as pads. They don’t fit many users, there is a gap in the size range that often children fall through, they seem to make people uncomfortable and frequently tear before they are even in place. Choice: No gender choice, no choice at all. No pull ups provided by the Continence Service, parents feel this to be random and discriminatory when they are an essential aid to increasing independence that most children benefit from at some point and that many people with special needs use for longer than other children. Price: Special needs pads, once children outgrow ordinary sizes or if those offered aren’t suitable and no alternative is offered, are massively expensive, also very bulky and are hard to store. Parents spending up to £35 per week. Parents cannot tag their own order onto the regular Calderdale order even if the pads offered are suitable, so parents must coordinate 2 deliveries. Delivery is expensive so bulk storage a further problem. Delivery: Every 8 to 12 weeks is too long creating storage problems for many families. Disposal: No consistent system for disposal. Some families get yellow bags but with fortnightly collections they lie around outside the property too long, they are causing friction with neighbours in some cases. No secure bin is provided to store the waste which can get very bulky and conspicuous. Some families get no collection facilities at all. Inequality: Everyone gets a different service without carer’s being aware of any real assessment or difference in need. Some get gloves and/or gels and wipes, others don’t. Information: Lack of information as to how the service works and how to access it or make a complaint, it feels hit and miss who gets what and seems apparently dependant on who the professionals are involved and how well they know the system. Need for a point of contact for continence services more generally, currently accessed through a range of professionals depending on the age of the person, therefore no continuity or consistency across families. Continence Service needs a point of contact for an individual account, accessible, advertised and available on the paperwork that comes with the pads. Continence Service doesn’t provide support, information and advice on incontinence issues to parents, just pads, the one sort and that’s that.

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Consultation: Lack of consultation of parents as to how the tender is working, no way for them to feedback their experiences and influence change, the PCT chooses the tender but the users have no say in the choice. Historically there have been different systems and contractors that users preferred. They were not consulted about the changes leading to the present system. What people said they want Age: Qualifying age reducing back to 4 Quantity: More pads, not unlimited but a realistic number to cope with a basic need while maintaining dignity and without increasing stress on parents. Quality: Better quality pads that fit and don’t tear or leak. Choice: Choice of pads/aids if the standard ones aren’t ok. A range of products to reflect a range of needs. Price: Not to have to spend so much on a basic product that may be needed for years. Delivery: More frequent delivery if wanted. Disposal: More frequent disposal with suitable, secure storage available to all. Inequality: More openness and fairness in the supply of pads and other products. Information: More information, support and advice. Consultation: Some consultation of views please and more weight given to user views on how the service works.

11. Diagnostic tests and scans closer to home Waiting for MRI scan at CHFT for some weeks

Patient wants bone scan at another hospital, GP insisting has to go to Bradford

Confusion over MRI scan referral. GP cannot refer directly, has to be through physio. Patient delayed.

12. Cataract services Unhappy with GP as believes he had a delay in diagnosis of Cataracts.

Received letter day before Cataract operation at CRH. Patient attended, but Doctor refused to do operation. Doctor from HRI, but clinic at CRH.

13. Adult psychological therapies Patient opinion post re: Wife ended life following Post Natal Depression. Feels NICE guidance

around Home care wasn’t followed.

Referral to Neurological Psychologist at CHFT was returned with no alternative providers given.

Delay in treatment following psychological assessment.

Lost referral for CBT. Been waiting 2 years.

Lack of communication with family of patient.

Specialist Community Eating Disorder service waiting time of 12-18 months unacceptable. General Public Survey on Counselling and Psychological Services (NHS Calderdale) Key messages to come out of the discussions and survey

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One of the most important messages to come from the survey was the problem people experienced accessing the service due to long waiting times, with one service showing a 60 weeks waiting time. However a high number of people (72%) also said they completed all sessions offered once received. People were also asked to rate the services they received, ranking them between Excellent – Poor, with the following outcome:

Service Average Response Score Description

GP 1.9 Fair-Good

Voluntary Organisation 2.1 Good-Excellent

Mental Health Trust 1.7 Fair-Good

CAMHS 2.3 Good-Excellent

Private Organisations 2.5 Good-Excellent

Below are some of the other key message relayed from the discussions and survey.

A number of people said they would welcome: shorter waiting times availability of more one to one sessions continuity of staff greater flexibility in accessing these services greater flexibility on opening times, including weekends and evenings choice of therapist from different backgrounds more information about the service and waiting times availability of group sessions

97% of people questioned felt different types of support would be beneficial and said they would be willing to consider ‘other’ types of interventions, besides counselling. The top six areas were: physical activity buddying/befriending scheme written information self-help groups self-help material e.g. computer based packages, books telephone helpline

General comments / feedback Public and Patient Involvement Report on ‘Transforming Community Services’ (NHS Calderdale) When we are looking at commissioning local services at what level would you like to be involved? The key findings are:

The majority of people want information on how we commission services.

The aspect most people want to actively take part in is how we spend money.

Some members of the public want to be actively involved in what services we should buy and the contract process.

Not everyone wants to be involved in all aspects of commissioning services but we still need to provide opportunities for involvement to those who do.

Considering contracts provided the most collective responses of not interested or no reply. This could be a lack of awareness of how public can influence the process.

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What do you think are the main considerations we should take into account when providing local services? From these findings we can see that the top five priorities for the public are:

Free Parking 48%

Near good public transport networks 47.5%

Friendly and Polite Staff 42.7%

Being able to choose appointment times and visits to suit me 38.9%

A clean and comfortable environment 34.3% The top five priorities mirror the findings from other recent consultations with the public such as ‘Practice Plus’ (2,500 responses) and the developments to build a new health centre in Brighouse (3,000 responses). The priority of friendly and polite staff comes through in other surveys including GP Practice surveys and Patient Experience Survey, with most people being satisfied with professional staff and less satisfied with reception staff. In addition staff attitude is one of the largest reasons to complain (see PALS and Complaints data). Other high scoring areas are access and value for money:

Services at weekends 29.5%

Value for money 28.9%

Services based in the community 26.7%

Clinical safety 26.5%

Services out of hours 26.5%

Good disabled access 25.8% It is also worth noting that some of the aspects that support equality were scored fairly low, this is due to it being a very specific requirement for only some members of the public. In conclusion all the priority areas listed, which were based on previous feedback from a variety of involvement activity and consultations, were deemed as a priority with only one additional theme added by one individual (a train station in Elland). This should help assure the transforming community service groups that we do know what is important to the public when buying services. Q4. What else is important to you when we are looking at commissioning services? The question asked for qualitative comments. All comments have been listed below and are in common themes. The main themes for comment were on: 1. Access and waiting times – in particular the length of time to get an appointment, the amount

of time kept waiting and the response time. Telephone access is also an issue for some and relates to automated and non local numbers being used, these are not popular with the public and this can also be mirrored through issues raised through PALS, GP Practice surveys and more recently through LINKs.

2. Staff and Staff Attitude - there were comments about staff being well trained and skilled to do

the job they do and also given enough time to perform duties well.

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3. Equality and Diversity – There were a number of mixed comments in this category and the key themes were about language used and spoken, disability access and more care for the elderly. There were also a few comments on facilities such as separate toilets and wards for men and women and baby changing.

4. Better Coordination of services – For most responding this related to the continuity of staff

and keeping people in their home for longer through joint working. Sharing information was also in the comments and concerns that services based out of the local area may not meet local needs.

5. Value for Money – most comments wanted value for money but not at the expense of poor

services. Cost and quality needed to be balanced. In addition there were a few comments about buying local services.

6. Involving People – people do want to become involved and help make decisions about the

services we buy. Better information and communication on changes is needed so people can make informed decisions.

7. Transport and Parking – transport and parking is one of the top priorities for the public, the

comments are people’s experiences of the cost of parking when using services and limited spaces.

8. Quality – There were a number of comments that support the public view of a quality service.

These range from clean buildings to well monitored services and welcoming staff.

References Calderdale Local Involvement Network with Calderdale Parent and Carer’s Council, Continence Services Task Group (April 2010) Information from NHS Calderdale PALS, Complaints and Compliments (received during 2010-2011) Information from NHS Kirklees PALS, Complaints and Compliments (received during 1/4/10 – 31/8/11) NHS Calderdale, Initial requirements for the wheelchair service specification NHS Calderdale MSK service patient survey. Clinical Governance / Audit report (January 2010) NHS Wakefield District, WDCHS Quality Board Monday 28 March 2011. Patient Experience feedback received since September 2010 NHS Wakefield District, WDCHS Quality Board 16 November 2010. Patient Experience Report Public and Patient Involvement Report on ‘Transforming Community Services’ in Calderdale. Results and Analysis of Engagement Activity, May 2009 – August 2009 Report findings from Patient Engagement of Primary Care Psychological Therapies & General Practices response to self-help provision (2007) Patient Opinion postings

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Appendix C – Analysis of survey results Question 1 – Please choose and rank THREE services where you feel a wider choice of providers should be available (please select three services only, with one priority for each).

Table 2 – Service priorities Highest priority Mid priority Lowest priority Total

N % N % N % N %









Dermatology 30 2.05% 33 2.25% 23 1.57% 86 5.87%


Phlebotomy 45 3.07% 35 2.39% 20 1.37% 100 6.83%



Total 682 46.58% 473 32.31% 309 21.11% 1464 100.00%

High

Low

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Question 2 - If there are any other services which you would like to see more choices of provider offered, please tell us below.

Other services

Cancer treatment Primary Care

Fracture clinics Neonatal services

Stop smoking services and mental health support for children

At Home' assistance, both medical and home help

Diabetes - equality across all practices Mental health, stroke

Home care Mental health

All mental health services - a range of different therapies, not just medical interventions.

Neurology Services

I, like thousands of others, am simply not in a position to give an opinion on these questions: I do not have access to any of the relevant statistics about the incidence of these diseases nor about their effects on those affected.

Wants one good provider, choice is wasteful and will lead to lower standards as providers aim for profit. If they don't they will go bankrupt.

People should be able to chose from as wide range of providers as possible for all services.

Apologies but I'm not really familiar with the majority of the services given on the previous page and so am unable to prioritise.

Would like to see better choice of INR testing, with possibly self testing offered to some patients.

More help for OAPs

Physio Limb loss and amputee services

Speech and Language Diagnostic tests e.g. BP, cardiovascular, Chlamydia

Family interventions services, Depot clinics, CBT for psychosis

Elderly services

Neurological Sexual transmission disease

Children's outpatient appointments Orthopaedic services

Knee and Hip replacements All services should be subject to AQP

Breathing problems i.e.: COPD Children’s psychological therapies, alternative therapies

Mental health in particular CBT IPT and counselling

Wider range of services for chronic disease management - a more accessible system for seeing the professionals and a decent advocacy service

Rheumatology Oncology

Counselling services within the community

Choice of dentist for adults with learning difficulties, wheelchair services for adults, physiotherapy for adults with learning difficulties

Local services for local people are what matters.

Physiotherapy

Sexual health for young people Nursing

Counselling Dietetics, weight loss programmes

Minor injuries Aids and Adaptations, Community outreach learning disability, Hydrotherapy

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Hip and knee replacements Community matrons

Physiotherapy, Radiology Better choice re 'CHOICE' once diagnosed

Domiciliary Neurological Conditions Service Physio

CBT Therapies I have significant concerns about increasing choice of provider as it destabilises current services

Child psychological services of CAMHS Street wardens for elderly/housebound etc

Occupational Health Physiotherapy /particularly in care homes

Adult care providers Dietetics services

First aid that could be dealt with locally and centrally

Out of hours doctors

Orthopaedics Mental health services, adults

Orthopaedics District Nursing and Heath Visitors

General clinics attached to GPs that offers top to toe checks in a walk in clinic. This would be helpful for young and adult carers.

Minor Accidents, Physiotherapy, Radiology, Dietetics

Easier referral for alcohol problems Scans, physiotherapy, x-rays

Mental health help for carers Any requiring invasive surgery

To increase trained Health Visitors More services at Pontefract Hospital

Diabetes and pain management treatment

Question 3 – What benefits do you feel patients could get from being able to choose from a wider selection of qualified providers for their treatment?

N Percent of Cases











No benefit 42 11.8%

Total 1682 472.5%

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If other, please specify:

Other benefits

More suitable for some vulnerable groups where there are barriers to access because of stigma, co-morbidity, poverty

The possibility of working with the professionals rather than being done to; possibly even more time to be treated like an intelligent human being

Cured more quickly Just greater convenience

Competition to present providers More secure feeling

There could be less restrictions in other areas The staff may already know your problems

Are there benefits? NHS are capable of podiatry service, given the initiative, skills and good not wasteful management

Treatment not at present available via NHS Good neighbour scheme

More time to be listened to and supported Possible easier parking

Naive question - choice is a nonsensical mirage

More satisfaction - the choice is ours

What I want, where I want it, and when I want it Hopefully to feedback to NHS which providers offer best service

OAPs are my main priority Better parking

Problem is that excess capacity costs £££ but does reduce waiting times and can shake out weaker providers

Sticking as near as possible to appointment times

Possibility of alternative treatments A new MYHT board

Not sure patients have enough information to make a considered choice

Choice is an illusion and waste of money, we will end up with more monitoring boards than front line workers

Choice

Background information: Respondents were asked to note their postcode in order for the service priorities to be viewed across the cluster as well as for individual CCG areas. They were also asked to answer questions about their personal status. The information below illustrates the responses received.

Frequency Percent

Age Not answered 6 1.7

Under 16 1 .3

16-25 6 1.7

26-35 22 6.2

36-45 53 14.9

46-55 94 26.4

56-65 90 25.3

66-75 52 14.6

76-85 22 6.2

86+ 4 1.1

Prefer not to say 6 1.7

Total 356 100.0

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Frequency Percent

Carer Not answered 12 3.4

Yes 135 37.9

No 199 55.9


Total 356 100.0

Frequency Percent

CCG Not answered 15 4.2

Calderdale Commissioning Consortia 65 18.3

Greater Huddersfield Commissioning Consortia Group

72 20.2

North Kirklees Health Alliance 44 12.4

Wakefield Alliance 150 42.1

Out of area 10 2.8

Total 356 100.0

Frequency Percent

Disability Not answered 11 3.1

Yes 97 27.2

No 240 67.4


Total 356 100.0

N Percent of Cases

Type of disability

Learning Disability 3 3.1%

Long Term Condition 48 49.5%

Mental Health Condition 14 14.4%

Physical or Mobility 63 64.9%

Hearing 21 21.6%

Visual 16 16.5%

Prefer not to say 1 1.0%

Total 166 171.1%

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Frequency Percent

Ethnicity Not answered 12 3.4

Asian Bangladeshi 1 .3

Asian Indian 13 3.7

Asian Pakistani 7 2.0

Black Caribbean 4 1.1

Mixed White and Asian 1 .3

Mixed White and Black African 1 .3

Mixed White and Black Caribbean 1 .3

Mixed other 1 .3

White British 289 81.2

White European 6 1.7

White Irish 3 .8

White other 1 .3


Other 4 1.1

Total 356 100.0

Frequency Percent

Gender Not answered 9 2.5

Male 111 31.2

Female 231 64.9


Total 356 100.0

Frequency Percent

Maternity Not answered 18 5.1

No 224 62.9

Prefer not to say 3 .8

Not applicable 111 31.2

Total 356 100.0

Frequency Percent

Religion Not answered 26 7.3

Buddhism 2 .6

Christianity 180 50.6

Hinduism 32 9.0

Islam 16 4.5

Judaism 2 .6

Sikhism 1 .3

No religion 69 19.4


Total 356 100.0

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Frequency Percent

Sexual Orientation

Not answered 27 7.6

Bisexual 3 .8

Gay man 4 1.1

Heterosexual 291 81.7

Lesbian 2 .6


Total 356 100.0

Frequency Percent

Transgender Not answered 27 7.6

Yes 8 2.2

No 308 86.5


Total 356 100.0

final_aqp_engagement_report_9-11-11

Documents

patient groups

engagement process

liaison services

appropriate services

proposed services

patient feedback

mental health services

national engagement