REPORT OF ENGAGEMENT – STAKEHOLDER EVENT21st MAY 2015

1. Aims

1.1 The aim of the event was to update stakeholders on the progress made to support and deliver the strategic vision (2014-2019). The aim was also to consult on the direction of the 5 Year Strategy and forward plan.

2. The Event:

2.1 The event was held at The Venue, Huyton Civic Suite on 21st May 2015.

2.2 The event was well attended with 60 delegates from a range of stakeholder groups (see Table 1).

Stakeholder Group DelegatesPPG Members (Patients/Patient Reps) 7

Primary Care Clinicians/Clinical Leads 4

Hospices 1Third Sector Reps 9Providers 15Local Authority/Public Health 5Healthwatch 3Neighbouring CCGs 1NHS England 1CCG Staff Support 13Housing Associations 1Total 60

3. Presentations & Discussions

3.1 Welcome (Dr Andy Pryce, CCG Chair)

Dr Pryce introduced the annual event and welcomed all stakeholders. The Chair spoke about the progress made on the key themes from the last event

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being integration, communication and best use of resources and community assets.

3.2 5 Year Strategy (Dianne Johnson, Accountable Officer)

Dianne Johnson, Accountable Officer, introduced the 5 year strategy and revisited the strategic vision. Dianne provided context by explaining that demand for healthcare services, complex need, life expectancy and the expectation for immediate access to services has risen at a point where the NHS is experiencing financial challenges.

3.3 The Accountable Officer informed delegates that earlier in the year; NHS England invited CCGs to come forward with expressions of interest to take on an increased role in the commissioning of primary care services. The intention was to enable CCGs to improve the quality of primary care services locally for the benefit of patients.

3.4 The delegated responsibilities will transfer during a 12 month period of transition from 1st April 2015. The programme will be managed through a robust programme management approach consisting of establishment/transition and further development of Primary Care.

3.5 Stakeholders were reminded of Knowsley’s Neighbourhub approach to service delivery. The four hubs (North/East/South & West Knowsley) made up of the registered patients of its geographical location will provide co-ordinated case management approach with the aim to ensure services are integrated and seamless from the perspective of a patient supporting them to remain well within the community.

3.6 Moving forward this approach will support us to deliver the 2015/16 commissioning plan and explore options set out in the NHS England Five Year Forward view.

3.7 Commissioning Plan 2015/16 (Philip Thomas, Director of Commissioning) Following on from presentation provided by the Accountable Office, Philip provided an update of phased implementation of the neighbourhubs. With phase one underway, phase two consists of:

Roll out of community nursing into each hub Introduction of Co-ordination and navigators

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The procurement of the Alternative Provider Medical Services (APMS) which provides additional GP capacity in-hours to include 7 day working.

3.8 An overview of some of the priorities outlined in the 2015/16 commissioning plan was shared:

3.9 Mental HealthThere are a number of workstreams about to commence to support the delivery of parity of esteem, valuing mental health equally with physical health.

3.10 Primary Care3.11 The CCG will focus upon implementing a delegated commissioning

infrastructure. The recent award of funds from the Prime Minsters Challenge Fund will accelerate the implementation of the neighbourhubs and pilot innovative use of technology.

3.12 PrescribingAn external review is scheduled which should provide the CCG with the insight to support a Medicines Management work plan to continue to progress the element of the Primary Care Quality premium.

3.13 Procurement and Mobilisation of new servicesThere are a number of services due for review, procurement and mobilisation during 2015/16 including Patient Transport Services, Community Diabetes and Respiratory services.

3.14 Other Areas Continuing Healthcare (CHC) - Assessments and reviews will brought in house as a responsibility of the CCG by June 2015.

3.15 There will be a Pan Merseyside review of Maternity services and the National Institute for Health and Care Excellence (NICE) is due to release guidance later in the year in relation to cancer care services.

Workshop – 2 Areas of Work

3.16 Stakeholders were provided with patient stories, half of the room given a scenario with a focus around Mental Health and the other half were asked to have a discussion around diabetes (appendix 4 and 5).

3.14 From the table discussions the group were asked to highlight three areas that had been identified, feedback was noted:

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Table Mental Health

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1Peer Support - Expert by Experience (As used in Warrington)Reducing stigma - Need to educateFocus upon a multi-agency approach (Health/social care)

6Early Intervention - schools etc.Identify the right channels of communicationImprove access to low level services (Community forums/support)

7Reducing stigma - "Break down" the term Mental HealthImprove Primary Care access to early interventionsCommunicate access within the community to support services

8Locality Support - Navigation supportUse of 24/7 innovative technology (Improve access to self-help)Education for both patients and professionals

Table Diabetes2

Improve Access to preventative careImprove education and understandingMulti-disciplinary care/management (GP/Practice Nurse)

3Record of Care - take your medical history with youAccess to local servicesImprove education and understanding

4Early Screening - intervention and preventionLook at the wider network - i.e. lifestyle hubCommunity support - use of community networks/support forums

5Identify opportunity – influence schools local curriculumAccess to information and knowing where and who to askIntegration of systems - your care and management travels with you

3.15 The Five Year Forward View (Andrew Thomas, Governance Director)

3.16 Andrew Thomas provided an overview of aims of the Five Year Forward View (FYFV). Essentially, the NHS five year forward view calls for a collaborative approach to improving patient care.

3.17 Seven national care delivery options have been set and care models have been suggested.

3.18 In January the NHS invited applications for ‘vanguard’ test sites for the New Care Models programme. There were more than 260 applications and in March, the first wave of 29 sites were chosen to begin the programme. Each

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test site will take a lead on the development of new care models. Andrew shared a number of case studies to demonstrate the potential of some of the models.

3.19 Workshop and Voting ExerciseThe seven delivery options were outlined and stakeholders were asked to discuss which of the models would work for Knowsley. After the detailed discussions took place each stakeholder was asked to vote using an electronic keypad.

3.20 The results were noted:

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Andrew thanked all stakeholders for their input.

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4. Questions, Answers and Comments (Andy Pryce, CCG Chair)

4.1 All feedback was noted:

A stakeholder representing Public Health raised the need to reinforce relationships and the importance of integration. Recent promotion of a public health service (Healthy Homes) could have been improved by more of a joined up approach.

A stakeholder requested for papers and presentation slides to be available prior to the event to allow the information provided to be digested and understood.

A stakeholder requested that the CCG consider using less jargon and acronyms when presenting.

A member of the public described the event as “exhausting” due to the amount of information shared within the presentations.

A plea was noted from a stakeholder to encourage GPs to not only work in borough but to also live in the area. This will reinforce decisions being made by local people.

Concerns were noted in relation to medication waste and stock piling within the borough.

5. Close

5.1 Dr Pryce thanked everyone for coming and for their input into the event and closed the session.

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Appendix 1 – Attendees

Name Organisation

Alan Shaw Patient Representative

Alison Van Dessel Knowsley CCG

Andrew Pryce Knowsley CCG

Andrew Thomas Knowsley CCG

Angela Cornwall Knowsley Engagement Forum

Angela Whittaker Aintree University Hospitals

Angie Smithson Aintree University Hospitals

Anne Tattersall Knowsley CCG

Anthony Wilmore CRI (Drugs and Alcohol commissioned by Public Health)

Beth Weston Aintree University Hospitals

Christine Warburton Knowsley CCG

Clair Jones Royal Liverpool and Broadgreen Hospital

Clare Barrow Knowsley CCG

Dawn Boyer Knowsley CCG

Debra Lawson Knowsley CCG

Dianne Johnson Knowsley CCG

Dr Paul Conway Knowsley CCG

Dr Pervez Sadiq Knowsley CCG

Dr Ronnie Thong Knowsley CCG

Gail Briers 5 Boroughs Partnership NHS Foundation Trust

Graham Barker KPAC

Helen Meredith Knowsley CCG

Ian McConville Riverside Housing

Ian Stewardson St Helens & Knowsley Teaching Hospitals NHS Trust

Jacqui Johnson Knowsley CCG

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Name Organisation

Jan Box Knowsley Carers Centre

Janet Tildsley Healthwatch/Patient Representative

Jayne Tattan Patient Representative

Jeff Johnston Liverpool Women's Hospital

Jim Jameson User Led Organisation

Jo Herndlhofer Sefton CCG's

Julie Moss Knowsley MBC

Kate Charles Stroke Association

Kath McEvoy Knowsley CCG

Lucy Tomlinson Public Health

Mary Spreadbury Healthwatch

Mr Turrie Patient Representative

Mrs Turrie Patient Representative

Neil Wright Willowbrook Hospice

Nicky Barnett Bradbury Fields

Norah Flood 5 Boroughs Partnership NHS Foundation Trust

Pat Blair Patient Representative

Pat McCarthy KPAIS

Paul Mavers Healthwatch

Paul Williams St Helens & Knowsley Teaching Hospitals NHS Trust

Paula Lamas Knowsley Disability Concern

Pauline Burrows Patient Representative

Phil Newton Patient Representative

Philip Thomas Knowsley CCG

Rachel Hurst Merseycare

Sarah McNulty Knowsley MBC

Sharon Alcock Royal Liverpool and Broadgreen Hospital

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Name Organisation

Steve Gowland Healthy Homes

Susan Slater-Jones 5 Boroughs Partnership NHS Foundation Trust

Thelma Smith Lyndale Cancer Support

Therese Patten Alder Hey Children’s NHS Foundation Trust

Tom Fairclough Knowsley CCG

Tony Leo NHS England

Tony Wilding Liverpool Heart & Chest Hospital NHS Foundation Trust

Tracey Harrington UC24

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Appendix 2 – Programme Agenda

STAKEHOLDER EVENT

Thursday 21st May 2015 at 1.15pm in the Signature Suite, the Venue, Civic Way, Poplar Bank, Huyton, L36 9GD

Lunch from 12.30pmAGENDA

1.15 Welcome and overview including feedback from the 2014 Stakeholder Event

Dr Andrew PryceChair

1.30 The CCG’s 5 Year Strategy – Progress Report 2014/15

Dianne JohnsonAccountable Officer

1.50 Commissioning Plan 2015/16 Philip ThomasCommissioning

Director

2.10 Commissioning Plan 2015/16Workshop – 2 Key Areas of Work

Philip ThomasCommissioning

Director2.45 BREAK

3.00 The Five Year Forward View Andrew ThomasGovernance Director

3.15 The Five Year Forward ViewWorkshop – “What might work for Knowsley?”

Andrew ThomasGovernance Director

3.50 Summary & Close Dr Andrew PryceChair

4.00 CLOSE

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Appendix 3 - Patient Story Diabetes

Introduction - A Patient Story

Diabetes is a life-long, multi-system disease which affects blood glucose control

Complications of poor blood glucose control include Cardiovascular Disease, Peripheral Vascular Disease (which can, in turn, lead to amputations), Kidney Disease, serious eye conditions and neuropathy.

Insulin deficit diabetes (Type 1) is genetic (although can be contracted environmentally e.g. infection) and relatively unpreventable.

Insulin resistant diabetes (Type 2) accounts for approx. 90% of all diabetes cases and is strongly linked to obesity, metabolic syndrome, family history & age.

Nationally approx. 5% of the population are affected by diabetes with numbers predicted to increase 5% each year. In Knowsley 6.9% of adults are diagnosed with diabetes and it is estimated that a further 0.7% of adults will have diabetes without being formally diagnosed.

It is recognised that people who develop Type 2 diabetes almost always haveImpaired Glucose Regulation (IGR) first and that without an appropriate intervention the majority of patients with IGR will go on to develop Type 2 diabetes within 5-10years. In Knowsley there are over 1100 patients who we know have IGR.

Evidence suggests that with the right intervention the onset of Type 2 diabetes can be significantly delayed and in some cases prevented.

Once diabetes has been diagnosed a holistic approach care is essential to supporting good outcomes for patients, nationally the standard of diabetic care is monitored based on 9 care processes.

Whilst Knowsley performs in the top 25% in the national diabetes audit which monitors achievement for these 9 care processes there remains significant scope for improvement with only 24.8 % of Knowsley patients receiving all 9 care processes, only 2.6% patients with diabetes & BMI >30 offered weight and 19.8% having had depression screening.

The CCG commissioned a Consultant led community diabetes service in 2013 to provide treatment and education for patients diagnosed with diabetes. The contract for this service is due to expire in March 2016. This offers an opportunity for us to look at developing a diabetes model for the borough which will ensure a comprehensive approach to supporting patients at risk of developing diabetes as well as optimising management of risk of complications and patients ability to self- manage their condition.

The CCG has plans in place for a Clinical stakeholder event to be held on 25 th June – all key providers and primary care stakeholders will be invited to attend in order to

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look at developing the clinical model (a save the date email should already have been issued). This will be followed by extensive patient and public engagement over the summer months to make sure that any commissioned service meets the needs of our patients, their families and carers.

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Appendix 4 - Mental Health Workshop

Introduction

We know that mental health services need investment and development if we are to achieve ‘Parity of Esteem’ with physical health services. Our work to date has told us that response to crisis is a priority area for development.

We all have a basic understanding of what is available and what to do if someone is experiencing a physical health crisis. For example:

Seek medical help Ring 111 Attend walk in centre Attend A&E Ring an ambulance Do we have the same understanding of what to do in the event of a mental health crisis?

A reasonable proportion of us have even undergone basic first aid training that will help us keep people safe and aid their recovery.

How many on the table have undertaken some form of first aid training? Have you undertaken anything similar regarding ‘first aid’ for mental health?

We need to improve our response to mental health crisis and we can work to mirror the best of what we have in place for physical health, but if we are to achieve true ‘Parity of Esteem’ we need to invest in prevention in the same way that is done for physical health. There are many examples of prevention activities that aim to stop or delay people becoming physically unwell. These include:

National TV campaigns and Awareness Raisingo Change for Life adverts o Basic first aid responses e.g. FAST (stroke)o 5 a day campaign

Smoking cessation programmes Guideline daily food intake Activity for life Screening programmes Investigations and blood tests Health checks Wellbeing checks Assistive technology Tele-health and Self-Care

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