nhs southwark clinical commissioning group … · rosemary watts rw head of membership, engagement...

1 Chair: Dr Jonty Heaversedge Chief Officer: Andrew Bland

The best possible health outcomes for Southwark people

NHS Southwark Clinical Commissioning Group Engagement and Patient Experience Committee Minutes of meeting held on 16 May 2015 2-5pm

Room GO2C, 160 Tooley Street SE1 2QH

PRESENT

Diane French DF Lay Member and EPEC Chair

Dr Jacques Mizan JM GP Clinical Lead/ NHS Southwark CCG

Rosemary Watts RW Head of Membership, Engagement and Equalities NHS

Southwark CCG

Dr Obi Ezeji OE GP Clinical Lead/ NHS Southwark CCG

Abimbola

Puddicombe

AP North (Borough and Walworth) Locality Patient Participation

Group

Rhiannon Hughes RH Advising London

Ela Kwasney-

Spechko

EK-S South (Peckham and Camberwell) Patient Locality

Participation Group

Peter Offord PO South (Peckham and Camberwell) Patient Locality

Participation Group

Delia Dunford-

Swirles

DD-S South (Dulwich and Nunhead) Patient Locality Patient

Participation Group

Barry Silverman BS North (Borough and Walworth) Locality Patient Participation Group

John King JK South (Dulwich and Nunhead) Patient Locality Patient Participation Group

Andrew Bland AB Chief Officer – NHS Southwark CCG

Paul Jenkins PJ Interim Director of Integrated Commissioning, NHS Southwark

CCG

Yvonneke Roe YR GP Clinical Lead/ NHS Southwark CCG

Chitra de Caires CD-C Healthwatch Southwark

Malcolm Hines MH Chief Financial Officer – NHS Southwark CCG

IN ATTENDANCE

Nina Martin

(minutes)

NM Locality Programme Support Officer, NHS Southwark CCG

Laura Brannon LB Membership and Engagement Manager – NHS Southwark

CCG

Omar Al-

RamadhanI

OA-R Planning and CCG Assurance Manager – NHS Southwark

CCG

David Smith DS Head of Transformation – Integration – NHS Southwark CCG

APOLOGIES

Rosemarie Barber RB North (Bermondsey and Rotherhithe) Locality Patient

Participation Group

Nadia Crichlow NC North (Bermondsey and Rotherhithe) Locality Patient Participation Group

Andrew Rice AR Forum for Equality and Human Rights in Southwark



1. Introduction and Apologies

The Chair welcomed members and attendees to the meeting and all apologies were noted. The process and the ground rules for the meeting were explained. The declaration of interest register was circulated for members to update as necessary. No conflicts of interests were declared to any of the business on the agenda.

2 Minutes and Matters Arising

Minutes agreed subject to the following amendments: 1. Attendance – Barry Silverman (BS) was present at the meeting of 19

March 2015 Actions from previous meeting: Engaging and communicating with patients about the Extended Primary Care Service Further to discussions at the March meeting, RW tabled the plan for the proposed outreach and engagement for the Extended Primary Care Access Service (EPCS). She noted that the plan is a work in progress and continually being added to. She updated that based on the feedback from the last EPEC, the CCG has organised more outreach session in the Bermondsey and Rotherhithe area. She further reported that the communications and outreach around the service has begun and is progressing well. This action is now closed. Patient’s perspective on urgent care as they might contribute to Southwark’s commissioning of services for unplanned and urgent care – BS updated that that the Urgent Care System Development Group (NHS 111 Service) – NHS England is now the Urgent Care System Evaluation Group and he is a member of this by appointment. Patient Experience deep dive report – RW updated that the London Patient Insight dashboard has not progressed so the item has not been added to this meeting’s agenda. She further added that the CGG has employed a Quality Manager who is leading on this piece of work but at present his focus is on the quality agenda with a view to focussing on patient experience later on. Further to request by Delia Dunford-Swirles (DD-S) to clarify the meaning of the term “dashboard”, RW clarified that it refers to a document which pulls together and collates feedback on a range of different patient experience such as survey results and comments on NHS Choices into one document.

3. Issues from member groups and organisations.

3.1 North Southwark Locality PPG

The Committee was advised that there has been no north locality since the March

EPEC. The next north locality meeting will be on the 24 June and an update of

this will be given at the July EPEC.



3.2 South Southwark locality

John King (JK) and Ela Kwasney-Spechko (EK-S) updated on the key discussions

from the meeting held on 5 May 2015. Though the meeting was well attended,

the Committee was asked to note that number of practices represented was low.

There were 14 patients but only nine practices represented. RW encouraged

clinical leads to encourage patient participation at PPG as well as at the locality

PPGs.

The key discussion items at the meeting were as follows:

Extended Primary Care Access Service.

There was a presentation on Local Care Networks.

There was a discussion on the King’s discharge audit

DD-S added that the PPG at Forest Hill Group Practice had not met for a while.

She commented that the delay in recruiting a new practice manager has

contributed to the delay in meeting. RW confirmed that a new practice manager,

Sonia Stykova has been recruited and this may add impetus to these meetings.

RW took this opportunity to advise that an evening engagement event is planned

for 1 June 2015 from 6-8pm as part of National Patient Participation Awareness

week (1-6 June). The event will be at the Blackfriars Settlement. She added that

practice staff working with PPGs are encouraged to attend and support this event

3.5 Healthwatch Southwark (HW-S)

Chitra De-Caires updated on the work of HW-S as follows:

1. HW-S held a public forum on 19 March. A copy of the Public Forum report

is available on the HW-S website. Key issues that came out at the forum

were:

Sexual Health - Young people need to be able to access services

away from home. C-Card can only be accessed in limited pharmacies

based on distance to home and therefore puts young people off from

accessing services. The service is shared with GSTT as they have

community sexual health clinics

Social Care - Social care assessment or support should not just be

given when a person is in hospital and more GPs should be able to

signpost patients to access care and support. The information will be

used to build on HW-S priority work in this area

Health and Wellbeing - Healthy eating, sense of community, access to

information and support, and appropriate signposting from GPs is

crucial for health and wellbeing.

2. Enter and View: HW-S found that the Snowsfield service is working to a

http://healthwatchsouthwark.co.uk/wp-content/uploads/2015/02/HW-Public-Forum-Report.pdf



high standard and was largely rated excellent by users of the service. HW-

S recommendations included having more activities during evening and

weekends, review risk assessment policy for leave to smoke and training

for staff. The report will be finalised in the next few weeks. The aim is to do

more work with child and adolescent mental health services, both

community and inpatient to assess the care for young people.

The overall impressions were that the unit was looking after more

specialist cases when they are resourced to be a generalist ward. This

impacts on existing resources

3. Quality Accounts: HW-S organised three workshops to get feedback from

patients to feed into the statements they are making as part of the three

provider trusts quality account submissions. . Accounts from South

London and Maudsley (SLAM) and King’s College Hospital (KCH) have

been submitted. They will be submitting responses to Guy’s and St

Thomas (GSTT) the following week. These workshops were done in

collaboration with Healthwatch Lambeth, Bromley and Lewisham.

4. Ballot Boxes have been placed at four surgeries in different localities to

gather patient feedback and experiences. These will be rotated.

5. Upcoming events:

On-going engagement work with Vietnamese community – including

pop up at Vietnamese Supermarket and visits to Vietnamese Older

Peoples Group and the Mental Health group.

Focus group with travellers on community on 19 May

Possible pop up with CCG to promote Public Forum

The next Public Forum will be on 10 June. The focus will be on joined

up care and what this will look like from the patient perspective.

The Chair queried where in the structure is there opportunity to share the work

being done by HW-S. It was confirmed that HW-S has representation on the

governing body, the committees and programme boards of the CCG.

The Engagement team also recently met with the Healthwatch Manager to get

feedback on their work and activities. There are also plans to jointly hold a

building intelligence workshop.

Jacques Mizan (JM) requested that HW-S share some of the tools and

methodologies they employed during their engagement and suggested the

organising of a shared learning meeting.



3.6 Forum for Equalities and Human Rights in Southwark (FEHRS)

Apologies received from Andrew Rice. RW drew the Committee’s attention to

March 2015 newsletter from the FEHRS which was circulated electronically. All

were asked to note the various news items and upcoming local events

3.7 Advising London (AL)

Rhiannon Hughes (RH), Client Support Co-Ordinator updated as follows and

confirmed that the organisation’s name has changed from Blackfriars Advice

Centre to Advising London:

Clients that are not registered with GP surgeries – A fifth of the Latin Americans in the area are not registered with a GP. Advising London would like to work together with the CCG to encourage clients to register. RH added that she presently encourages clients to build a relationship with their doctor if they have a mental health condition.

Most of their clients with mental health conditions are not linked in with doctors and are very nervous about attending appointments. Advising London is working with Together UK and their wellbeing service to try and ensure that their clients’ mental health needs are identified.

They see a number of clients who have been given unfit for work notes from their doctors. This terminates their Job Seekers Allowance, (which then terminates their Housing Benefit). This means people are falling through the net and being left unsupported. She advised that she is currently trying to build up referral routes with doctors so they can make direct referrals for clients to her. RH is able to assess all of the client’s needs, advise on which support groups may be suitable and whether their housing is suitable. If not, she can assist them in obtaining more suitable housing. She can also help ensure they are receiving the correct benefit.

Advising London has started a new project involving 'hubs' around Southwark where they arrange an appointment for the client to come to the organisation. They are also trying to have a doctor or a priest available for those clients who may find this useful.

RH stated that a digital platform was the way forward in interacting with clients. And they will be working with organisations who are leading on getting the community to access information and services digitally.

Yvonneke Roe (YR) suggested re-introducing a benefits advisor in practice. RW added that she understood that the CCG is in conversation with Southwark Council to explore co-locating welfare rights advice in GP practices.

http://www.southwarkadvice.org.uk/sites/default/files/downloads/March_2015.pdf

http://www.southwarkadvice.org.uk/sites/default/files/downloads/March_2015.pdf



4 Engagement in developing Local Care Networks (LCN)

David Smith (DS) – Head of Transformation –Integration at the CCG, presented

and led discussion and advised that he would like to take away from the meeting,

ideas on how LCNs can most effectively engage with patients and service users.

He drew the committee’s attention to the diagram depicting Southwark’s population and its needs to emphasise why the LCNs are being developed. The higher up the diagram, the more the health needs the higher the financial health investment. He also asked if enough is being invested in prevention. He informed that Southwark’s strategy for dealing with this includes the creation of GP federations who are able to work at scale. These have already been set up with one each in the north and south of the borough. These federations will be able to deliver more services by working together. The next step is the development of LCNs. These are a body of health and social care providers including the voluntary sector. He stated that presently the health economy is such that the communication between providers is not as it should be and this impacts on the patient’s experience. The aim is to look at patients holistically and work towards linking GP services with other health, social and community services. Consideration is also being given to what services can be delivered in the community and to bear in mind that when people access health services their issues may stem from social issues. The plan is to have two LCNs in the south and north of the borough and the first priority will be prevention. Comments and ideas on engagement were then invited from the Committee.

BS commended the quality of the paper and the work of the CCG and commented that the 50% of “people experiencing inequalities or putting their health at risk”, sounds disapproving.

DD-S asked for clarity on the practicalities and asked for clarity around the physical location of the LCNs. DS advised that as time progresses the CCG will be looking at facilities but presently the focus is on looking at how services are delivered more efficiently and effectively and in a more joined up way. Andrew Bland (AB) advised that as the model evolves the focus will be on less physical things, e.g. such as workforce development.

BS referred to the Direction of Travel and suggested that a map of transport routes be considered when engaging to assess if there are any barriers. He also commented on the need to clarify how social care will be involved.



DF asked whether the CCG is envisioning the setting up of steering groups. AB advised that meetings may take the form of a network that meets within relevant geographical areas.

DS advised that the present focus is on establishing the remit of the proposed model before working on other arrangements. The Chair asked each attendee to suggest specific ideas for engagement. Ideas proposed included the following:

Engagement should be both general and specific (identify population groups who need to be targeted)

Go to where people are

Explore various methodologies and service redesign tools and look at tools apart from focus groups.

Focus on where gaps in the service affect people.

Churches and faith groups

Refine and clarify the message so that it is not abstract. Get the message right before proceeding with engagement.

Do a film depicting people falling between the “cracks”…. A patient journey.

Operational level – engage with service providers/co-production with voluntary sector

Utilise digital platform as this is the future of prevention.

Council one-stop shops

Involve patients in any decision-making

Give thought to what problems LCNs are meant to solve

Engage with service providers

Co-production with the voluntary sector.

DS thanked the meeting for their suggestions

5. Draft Terms of Reference (ToR)

RW introduced the item by stating that drawing on the conversations at the

previous EPEC meeting she had amended the terms of reference to reflect these

discussions. Specific areas of change included the remit around patient

experience and expanding the membership.

RW drew the Committee’s attention to section two on Committee Membership

and asked for comments on the proposed membership of the Committee.

Comments as follows:

JK referred to item “h” and advised that this should be read as four patient

representatives from each of the two Locality Patient Participation Groups.

RW clarified that EPEC still needs to ensure representation from each of

the two geographical areas within each locality PPG.

BS added that EPEC has confidence in its maturity and should now seek to



explore having an open space for the public, not unlike our governing body

meetings. RW drew the Committee’s attention to the paper’s cover sheet

and the recommendation to allow observers to the meetings at the Chair’s

discretion and by prior agreement.

MH added that we can maintain a core membership but still allow for

observers to attend.

Paul Jenkins (PJ) added that a core membership of 22 may make the

meeting unwieldy and it may be worth looking at engaging differently rather

than expanding membership.

If meetings become a public forum there is a need to ensure that the

purpose of the meeting is adequately understood by participants. It must

not be perceived as a forum to raise grievances

BS suggested doing a review of the membership by November 2015.

JK added that we can comfortably increase patient representatives by up

to four based on interest at the locality patient participation meeting.

BS commented that the ToR makes no reference to EPEC’s relationship

with other bodies in London. RW advised that EPEC members attending

meetings of other groups are not attending in the capacity of EPEC

representatives.

JM referred to section 43 – Planning, and asked for clarification on whether

the Committee’s role is that of a sounding board for a developed strategy

or is the committee expected to help draft the strategy, as the latter

appears to be very resource intensive.

RW advised that the Communications strategy needs refreshing. The last strategy

had contributions from a working group from EPEC before final approval by EPEC

and GB. RW clarified that the annual work plan is brought annually to EPEC for

agreement. The strategy is a three year document and is due for a refresh.

When the strategy was originally developed three years ago, a sub group of

EPEC was set up to advise RW.

Action: Rephrase the planning section: 4.1, 5.1 and 2.1 (h) (RW)

Action: It was agreed that a draft of the refreshed strategy will be brought to

the July meeting (RW)

OE proposed the need for a broader pool of engaged patients. He proposed

asking patients if they knew of other people who would like to be involved.



All to feedback any further comments grammatical or otherwise on the ToR by the

following week.

It was agreed that the draft ToR will be recommended to the Governing Body for

approval once they have been agreed by EPEC.

6. CCG’s Draft Business Plan

Omar Al-Ramadhani, the CCG’s Planning and Assurance Manager led discussion on the CCG’s draft business plan. The document plan details the actions that the CCG will undertake in 2015/16 to deliver its corporate objectives and the objectives outlined in the CCG Operating Plan. The Business Plan will also be used to identify objectives for all CCG staff so that individual work plans link back to achieving the CCGs objectives. It will also be used to develop the Board Assurance Framework and will be linked to the risk register. He further updated that the draft plan has been reviewed by the CCG’s Senior Management Team and Integrated Governance and Performance Committee.

DD-S read excerpt of a letter published in a newspaper regarding NHS

remuneration and the appointment of directors. The Chair advised that the CCG

will be increasing the number of directors and this has become necessary to

manage complexity. She advised that this will be within the CCG’s current

financial remit.

P3 – third paragraph, second line should read: “On 1 July 2015, the CCG will

“replace” four new clinical leads……..”.

DD-S commented on P11 2.1.2c relating to ‘overseeing market and provider

development … enabling a greater range of health and social care services to be

delivered in the community’ and wanted to know whether these organisations are

properly scrutinised.

The Chair added assured her that there are very robust procurement processes in

place including robust contract monitoring processes but, whilst these questions

are valid, they are beyond the remit of EPEC.

PJ clarified that the” market of services” refers to the services the CCG

commission and added that the CCG secures the widest range and value for

money in the services it commissions.

He further advised that all providers have a scrutiny and governance process

which provides assurance.

AB added that the Quality Programme Board plans to undertake a series of



quality related deep dives to ensure provision of high quality and safe services.

BS referred to P5 and commented that EPECs receives good clinical lead

representation and contribution and suggested considering how this can be

further enhanced.

Action:

Bring revised communications and engagement work plan

showing clear links to the business plan to July EPEC.

7. 7.1 Engagement Board update JM updated that at present the biggest priority of the board is obesity services and focus is on two key areas:

Developing a virtual engagement platform. He advised that presently there is scoping around what digital methods are available and sourcing best practice in this area.

Smoking cessation – The Prevention Board has tasked the Engagement Board to take forward a design challenge for smoking cessation in Southwark. There was a co-design meeting this morning to draft a bid to take this work forward. Regular updates on this piece of work will be brought to EPEC.

In response to question, JM clarified that the term design challenge refers to the process of presenting a task to people and asking them to come up with answers to a question. 7.2 Engagement in shaping obesity services Laura Brannon (LB), the CCG’s Membership and Engagement Manager updated the Committee on the engagement work undertaken to help shape the new tier 2/3 obesity service. She updated that there was engagement throughout January to February using surveys as well as speaking to groups of seldom heard voices. She advised that over 75 people responded to the survey. Following this, two workshops were organised in April. A total of 26 people attended the workshops. Information fedback from the survey was used to develop personas. Workshop participants were asked to put themselves in the shoes of the relevant persona. She added that it was worth noting that some of those attending were people the CCG had not engaged with before. Their demographics were collected - 36% were Black British/ African/ Caribbean and 20% were from other BME backgrounds A meeting will be arranged in the summer to inform people of the CCG’s decision regarding developing the service as this will help to support engagement once people can see the impact of their contributions. The Committee commended the paper and the work carried out and was asked to



comment on the engagement activity and to give their support to the next steps for engagement. BS suggested that account be taken of the motivating language in the system as he feels there is a large amount of demotivating language in circulation. Discussion ensued around lobbying politicians around the food industry. The Chair raised the issue of the breadth of the demographics and stated that it needs to be broad enough to capture a wide range of views as a wider range of views will lead to a more effectively designed service. Further comments:

View patients as individuals

The point was also raised that the service needs to be culturally

responsive.

All were asked to bear in mind that this is a pilot, so will evolve as implemented

and lessons are learned.

JM added that once the pilot is implemented, it will be useful to link in with the

digital engagement work.

OE asked if research and borough wide evidence were taken into account and

queried the validity of the data given the small number of respondents. LB added

that national evidence was taken into account before undertaking engagement.

JM reminded that given the timelines within which we had to work, the

engagement had to be a quick process. PJ added that engagement was only one

part of the process in shaping the service and that the CCG has utilised national

and borough specific evidence.

The Chair commended the work and encouraged the continued testing and

engagement with different demographics.

8. Any other Business

8.1 Our Healthier South East London (OHSEL)

8.1.1 Issues Paper – RW updated that patient stories have been fed into

the programme to inform the development of the Issues Paper. By way of

context, MH added that the OHSEL is about delivering sustainable,

accessible, affordable service and care. He further added that the May

election delayed the publicising of the Issues Paper.

The six south east CCGs will agree the strategy document at the governing



body meetings in July. Comments on the Issues Paper will help with the

development of this strategy. This will be followed by deliberative

engagement events in each borough..

8.1.2 Proposed Governance structure – The draft structure was tabled for discussion and comment. MH added that we need to consider the governance structure for the programme to decide how multi-borough decisions are made. He highlighted the Committee in Common for Strategic Decision Making and updated that this is a six borough committee with representation from each of the six CCG’s governing bodies. The aim is to start using this governance mechanism by September/October 2015. BS asked for clarification on the Stakeholder Reference Group – RW responded that this group comprises the Healthwatch members from the six CCGs, CCG Engagement leads, Overview and Scrutiny Committees , the Chair of the Patient and Public Advisory Group, Peter Gluckman, Dr Amr Zeineldine (as chair of the programme’s Clinical Commissioning Board and the South East London Clinical Strategy Committee) and lay members.

9 Date of Next Meeting::

Thursday 16 July, 5 – 8pm in room G02C

10 Post It Note Comments:

Due to time constraints the following items were captured on post it notes by BS for inclusion in the minutes and action as necessary:

BS asked that it be noted that GSTT hospital and community sites including buildings and grounds will be 100% smoke free from 19 June and asked that this be supported.

Terms of Reference (ToR) Enc C:

P5, 7.2 and 8.1 – Is there still a SCCC as 7.1 says Southwark CCG or are they the same – will the pre-2013 language be corrected This should read CCG and is corrected in terms of reference being presented to July 2015 meeting

Paragraph 11.1 – Why is FEHRS given precedence over other voluntary organisations? FEHRS is the umbrella body in Southwark representing equality and human rights issues

What is the paper relating to Integrated care and neighbourhood working included in the EPEC paper for this meeting. This provides for patient representation which includes separate representation from SLIC and patient voice. Has the committee and how is the patient voice representation being (or has been) appointed? This is an action form an earlier EPEC meeting - to distribute the vision for integrated care and neighbourhood working. There is representation on the programme board from a member of the SLIC Citizen’s Board



Actions from May 2015 meeting

Agenda item Action Point Update Date to be completed

Lead Status

Terms of Reference Rephrase the planning section: 4.1, 6.1 and 2.1 (h)

ToR updated and circulated with papers for meeting

July 2015 RW Complete

Terms of Reference Bring a refreshed communications and engagement strategy to EPEC

Strategy to be developed over the summer with a small EPEC working group

July 2015 RW Action in progress

Draft Business plan

Bring revised communications

and engagement workplan

showing clear links to the

business plan to July EPEC

Workplan agenda item at EPEC meeting

July 2015 RW Complete



Outstanding actions from 19 March 2015 meeting


Lead Status

Draft communications plan – extended access service

Evaluate patients’ experience of

travel to Bermondsey Spa and

bring back to EPEC.

CCG working with Quay health Solutions to include travel experience question as part of patient experience survey and to work with practices for wider views of patients

July 2015 HS Action in progress

Ways of working and role of EPEC

Approach the Governing Body

for their vision on the future role

of EPEC

May 2015 EPEC Chair

Action in progress

Any other business

Liaise with NHS England, commissioners of the mobile breast screening unit about re-instating the mobile unit service in SE16.

PJ in liaison with NHSE and waiting for information to provide a brief to EPEC

Once feedback

received from NHSE

PJ Action in progress



Outstanding actions from 2014 meetings


Lead Status

Patient experience deep dive report

A review and report on actions

taken to be brought to the

committee in 6 months

London Patient insight

dashboard to be added to the

agenda of the March EPEC.

London Patient Insight dashboard will now be added to the agenda of the May EPEC. 7 London CCGs have signed up to the dashboard. This work is now being led by the Quality team. EPEC has agreed to have an annual patient experience report.

May 2015 MM Action in Progress

nhs southwark clinical commissioning group … · rosemary watts rw head of membership, engagement...

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