LONDON REGION TEMPLATE for 2015/16 REPORT€¦ · LONDON REGION TEMPLATE for 2015/16 REPORT Final Participation Template 2015/16 Page 2 Deprivation Tower Hamlets is a borough of contrasts,

LONDON REGION TEMPLATE for 2015/16 REPORT

Final Participation Template 2015/16 Page 1

HSCA 2012 Statutory Obligation (Participation Duties)

The London CCG Engagement Leads Networks have worked collaboratively to

develop a template to support their organisations statutory participation

obligations reporting requirements. (Please return by 31st October 2016)

Name of CCG: Tower Hamlets CCG

Name person completed this report: Jessica Neece- Engagement Manager

Internal sign off obtained from: Ellie Hobart- Deputy Director of Corporate Affairs and Simon Hall-

Acting Chief Officer

Healthwatch statement completed by: Dianne Barham- Chief Executive

Date submitted to regional team: 28 October 2016

Please note the report covers the period- 1st April 2015 to 31st March 2016

SECTION ONE – Context Setting – (demographics, vision, resources) The purpose of this section is to obtain summary background information regarding the population demography of your CCG, including ethnicity, deprivation, age, etc. You may wish to include population information and demographics found in JSNA Population profile or you can add a hyperlink to the relevant documents.

Demographics

Tower Hamlets: Our local area

Tower Hamlets is unique in many ways. Home to 287,000 people, it has a very diverse

population and one of the largest Bangladeshi communities in the country. More than 69%

of people are from a minority ethnic group and more than 90 languages are spoken.

Tower Hamlets also has one of the fastest growing populations in London. With an expected

growth rate of 20% over the next 10 years, the population is projected to exceed 338,000 by

2025. The vibrancy of Tower Hamlets is also apparent in its physical and cultural assets

including the many waterways, Victoria and Mile End parks, a variety of museums and

markets, and the Tower of London (from which it derives its name). All of these elements

contribute to the borough’s unmatched sense of place and identity.

Commercial development, including the site of the London 2012 Olympic and Paralympic

Games, Thames Gateway and Canary Wharf alongside significant residential development,

has resulted in a significant increase in housing over the last few years.



Deprivation

Tower Hamlets is a borough of contrasts, it is both one of the most deprived areas in

England (ranking as the 7th most deprived borough in the country) yet it is also home to one

the country’s main financial centres in Canary Wharf. With 72% of local wards included in

the 20% most deprived areas of the country, this has an adverse impact on the health and

wellbeing of local people and places a huge demand on the CCG’s resources.

A significantly higher percentage of people in Tower Hamlets live in social housing (54%)

compared to the rest of London (37%) and, despite the substantial housing growth, high

levels of overcrowding persist. The borough also has less green space than the national

average, with 1.1 hectares per 1,000 people compared to 2.4 hectares nationally.

Although Tower Hamlets has some of the most deprived wards in the country, it is also

undergoing change which has led to wards around Canary Wharf, Limehouse and St.

Katherine becoming more affluent.

Health headlines

Many people in Tower Hamlets are living with a long-term condition and hospital admission

rates for heart disease and stroke are above the national average. According to the 2011

Census results, 13.5% of people in Tower Hamlets stated they had a long-term health

problem or disability that limited their day to day activities (34,300 people). This is slightly

lower than the regional and national rates (14.1% in London and 17.6% in England).

Other important health figures about our population:

We have the highest child poverty rate in the UK with 39% of children living in

poverty.

Life expectancy in Tower Hamlets remains lower than the rest of the country.

Approximately nine percent of babies born in Tower Hamlets have a low birth

weight.

A quarter (25.3%) of children aged 10- to 11-years are obese.

Premature death rates from circulatory disease, cancer and respiratory disease are

the second highest in the UK.

Healthy life expectancy

The high levels of deprivation in Tower Hamlets has a direct impact on the number of years

that people remain healthy later in their lives. This means that they begin to develop

multiple health problems far earlier in life than elsewhere. The difference in this ‘healthy

life’ expectancy is 10 years lower in Tower Hamlets than in other parts of the country. This

has an effect on both the demand for health services and the complexity of health issues.

The annual GP consultation rate for adults aged 50-64 in the most deprived parts of the



borough is up to twice as high as in wealthier parts of the country. The problems that

people go to their GP for help with are also, on average, more than twice as complex. Given

the significant health inequalities within the borough, the CCG takes a life course approach

to planning and commissioning services, from birth to the last years of life. The Joint

Strategic Needs Assessment (JSNA), produced by the London Borough of Tower Hamlets

Public Health team supports us to better understand the health needs of our population. A

summary of the key health challenges of our population is provided below in the figure

below, sourced from the most recent JSNA.

Vision for Engagement Please include the vision for engagement and participation for your CCG.

Our vision for Patient and Public Involvement (PPI)

“Involving patients and the wider public is central to service planning, development and provision. Not only is it vital for service improvement, it also leads to a more positive patient experience of care. We want to commission services that are based on the needs and



priorities of our community and ensure that our providers deliver patient centred care. To do this, we will work with the community to ensure the patient and public voice can play an active role in shaping, planning and improving our local NHS services.”

NHS Tower Hamlets Clinical Commissioning Group (THCCG) aspires to put the voice of local

people at the heart of everything we do. THCCG has continued to carry out and drive

forward its PPI strategy and in 2015-16 established the Community Commissioning Panel

(CCP) which is made up of local residents who provide the patients’ voice and perspective

on key pieces of work the CCG carries out. The CCP is a formal part of THCCG’s governance

structure and ensures that the voice of the local communities and patients remain central to

the work of the CCG. The CCP holds THCCG to account and helps drive and promote the five

key objectives set out in our PPI strategy.

THCCG | 5 PPI strategic objectives

The PPI strategy has five overarching objectives that help us achieve our vision and put local

people at the heart of everything we do:

1. Develop the CCG’s strategic approach to PPI Create a culture where PPI is embedded and reflected in the work practices of the CCG and the services it commissions. 2. Help people to learn about the CCG and how to get involved Provide local people and members of the public with access to clear information about the CCG and changes to the health and social care system. Engage the local community in understanding the CCG so they can actively choose to be involved. 3. Provide direct opportunities for people to get involved Develop a more comprehensive and creative approach to ensuring that patients and the public are involved in the design, management, delivery and review of the services the CCG commissions and the broader commissioning process. Use varied approaches and best practice to enable local people with protected characteristics to have meaningful influence. 4. Improve our understanding of the services we commission from the patients’ perspective Using intelligence from patient experience is a central way that we assess the quality of services that we commission, working with our service providers to ensure they have strong patient experience standards, deliver patient-centered services and have a workforce that values PPI. 5. Support grass roots capacity and capability for patient and public involvement Support local people and local organisations to be involved in the design, monitoring, delivery and review of CCG programmes. Create real opportunities for organisations and local people to provide feedback and experiences of services commissioned by the CCG in order to enable local influence on strategic priorities and decision-making processes.



The outcomes we seek to achieve through PPI

The table below plots the outcomes that we are seeking to achieve by delivering the

activities and projects encompassed under our five strategic objectives.

Outcomes achieved through the addressing the PPI objectives PPI objectives

1 2 3 4 5

A. Patient involvement is embedded in the CCG organisational culture and is consistently sought.

X X X X

B. Patients and members of the public can easily access reliable and clear information about the CCG and its commissioning role.

X X X

C. Patients and members of the public know how they can get involved in commissioning and choose to do so.

X X X

D. Greater involvement in decision-making, giving patients greater knowledge and ownership of health services and managing their own health.

X X

E. Improved quality and experience of services based on local needs and feedback of users.

X X X

F. Improved capacity for local people and organisations to be involved in commissioning of health care services.

X X X X

The full version of our PPI Strategy can be viewed here.

Meeting the participation duties

We want local people to be involved in identifying problems and designing solutions. We want to listen to their feedback and act on it. Systematic involvement of patients and the public should lead to more joined-up, coordinated and efficient services that are more responsive to local needs. Furthermore, involving people and communities helps people to understand and influence how heath and care services operate, how they can be accessed and used effectively and allows people to take greater ownership of local health services and their own health. Our definition of PPI is “the involvement of patients and members of the public in the design, management, review and delivery of services‟, reflecting our ambition for people to be involved in commissioning at all stages. We define individual participation as patients and carers being involved in and managing their own health, care and treatment by being involved in decisions about their care and having choice and control over the NHS services they use. The CCG is committed to enabling individual participation and addresses these requirements through other core programmes of work which are detailed in section four.

http://www.towerhamletsccg.nhs.uk/THCCG%20Patient%20and%20Public%20Involvement%20Strategy%20Refresh%202015-18%20FINAL.pdf



Structure and Resources Please include details of the current resources for participation and engagement in your CCG, including SLA/specification if this service is provided by a CSU/third party. You may wish to present this in the form of organisational structure charts, with details of non-pay budgets allocated to engagement & participation.

THCCG committed £121,000 towards Patient and Public Involvement (PPI) in 2015/16 in the

form of an engagement and participation budget. The PPI budget is in addition to the Corporate

Affairs Team budget where engagement sits. The Corporate Affairs team is made up of a

Deputy Director of Corporate Affairs, Organisational Development Manager, Engagement

Manager (PPI), Engagement Manager (Membership and Stakeholders) and Administrative

support. Additional support for Engagement and Communications is also brought in as when

required from our Commissioning Support Unit with whom we have an SLA that outlines the

flexible support they will provide each year.

THCCG Corporate Affairs Team Structure (March 2016)

In addition to this, THCCG embeds Patient and Public Involvement as a significant governance

theme. Lay Member, Julia Slay, is the Patient and Public Involvement Governing Body lead. Her

role is fundamental in providing strategic leadership and support to the structure described

above and to ensuring the THCCG governing body is held to account for embedding PPI within

all of the CCG work areas. The PPI Lay Member also acts as the Chair of the Community

Commissioning Panel (CCP) to ensure that the CCP has influence within key work areas of the

CCG.

Internal Governance – Monitoring and Review

THCCG’s PPI activities are monitored via the CCG Transformation Board, which the Community

Commissioning Panel (CCP, see case study 5 for more details) feeds into. The CCP is chaired by

Deputy Director of

Corporate Affairs

Engagement Manager

(PPI)

Organisational

Development Manager

Engagement Manager

(Membership and

Stakeholders)

Administrator

(until Sept/Oct)

Administrator

Business Manger

(until Sept/Oct)



the PPI Lay Member, who feeds back suggestions made by the CCP to the Transformation Board

and the Governing Body. This ensures that the CCP has appropriate influence and the

recommendations made by the CCP can be implemented and supported from the top down.

The CCP also sits above the working groups, who are all required to have detailed PPI plans that

the CCP can support and approve. The diagram below provides a visual representation of the

governance arrangements detailed above.

PPI items are taken to the THCCG Governing Body, Executive or Senior Management Teams for

discussion and approval, as required or requested. All public governing body meetings start

with the presentation of a patient story (see case study 3 for more information). The patient

stories coincide with the theme of the governing body meeting and further ensure that patients

remain at the heart of the THCCG decision making process.

Additionally, through the work of the CCP and further development of the Patient Leadership

programme in 2015/16 (see case study 4 for more information), the CCG has been working on

how patients and the public are involved directly in THCCG’s work to assure patient and public

involvement is embedded at all levels of the organisation.



SECTION TWO – Developing the Infrastructure for Engagement and Participation (processors and networks) The purpose of this section is to gain an understanding of how engagement has been established within your CCG. There are four main areas that we would like you to cover: Processes – what processes for engagement are in place, please give examples of how you have included the local population in your work. This could be through focus groups, participation and engagement events, and any other engagement mechanisms.

Setting the definition of PPI for THCCG

Involvement covers a broad spectrum of activities and can mean different things to different

people. Terms such as “engagement”, “consultation” “co- production” and “participation” are

often used interchangeably with “involvement” as the meaning of all these terms overlap.

However, each term has a slightly different emphasis: “engagement” has an emphasis on having

someone’s understanding and interest in an issue or process, ‘consultation’ is often used to refer

to a formal process where people are asked their views on a proposed decision, “co-production”

has an emphasis on working in partnership from the very beginning of a project, and

“participation” has an emphasis on behaviour and action.

THCCG uses the term “involvement” to cover all these terms, and has defined PPI “the involvement of patients and members of the public in the design, management, review and delivery of services”. We have used a wide range of processes to involve patients and the public in our work. THCCG has approached PPI on two key principles: (1) We involve the right people for the purpose; (2) We provide clearly defined purposes to people, who are involved as appropriate to the purpose. The most appropriate process or processes are selected based on the principles stated. When planning and developing PPI activities THCCG will first define:

WHAT | What is our commissioning purpose?

For example, to provide information, for needs assessment, services review, to decide

priorities, services to design/re-design or to manage, monitor and evaluate performance.

WHY | Why do people need to be involved?

For example, do we want to give people information, get information from them, provide

opportunities to work in partnership and influence decisions or to influence patient or

public behaviours.

WHO | Who needs to be involved?

For example, the public - broadly or specific groups, patients – broadly, specific service

users and specific groups of people, carers – themselves and those they care for.



Once defined, we will then decide the most effective process or processes to achieve meaningful

PPI. Patients and the public are often consulted for their preferred methods of involvement.

Processes are developed based on this steer. THCCG’s overall approach to PPI demonstrates the

ability to be tailored and bespoke based on the need, purpose of involvement and the needs of

people involved.

Two key examples of processes we used to involve patients and the public in 2015/16 include our

Annual General Meeting (AGM) and Community Intelligence Bursary. Our AGM is open to

members of the public, providers and stakeholders and is an opportunity to learn about our past

achievements and plans for the future. At the 2015 AGM we set up stalls where members of the

public could learn about Commissioning Intentions, key work programs like TST and could ask

commissioners and CCG staff questions and provide input into key work areas. 2015/16 also saw

the launch of our Community Intelligence Bursary (CIB) where local voluntary and community

sector organisations were invited to bid for funding to conduct innovative research projects

which aimed to improve services, address health inequalities and develop new ways of engaging

and involving patients and communities to improve healthcare in Tower Hamlets. Over 1,200

local people from a range of backgrounds were engaged with as a result of the Community

Intelligence Bursary. We were able to capture the views of seldom heard groups and individuals

who do not normally provide insight or feedback about local health services.

Section three presents a range of case studies that detail the processes used to involve patients

and the public in our work and the impact of this involvement. The table below presents a

number of key examples of processes we used to involve patients and the public in 2015/16.

Processes we have used to involve patients and the public in 2015/16

Communicating and providing

information

We have used a variety of different routes to communicate with people, to tell them about the CCG, how they can be involved and pass on key messages. Routes include the CCG and partner websites, press, advertising and community media (including radio and TV), print publications (such as our ‘introduction to Tower Hamlets CCG’ guide), utilising local networks, projects and events (including with partners such as Healthwatch and the voluntary and community sector), promotion via local community and health venues and video story-telling.

Gathering information from people

We have used a large range of different processes to gather information from people and these processes vary in their depth and whether they also link or lead to further involvement activities or opportunities. Examples include gathering and analysing information from patient feedback, complaints and alerts processes, sharing and receiving gathered information with partners, one-to-one interviews, questionnaires and surveys, focus groups and workshops, video interviewing and large public engagement and community events.

Working in partnership

Various processes have been used to allow us work in partnership with patients and the public, giving them the opportunity to be involved in commissioning in more depth and be able to have an influence or lead in decision making. Examples include permanent user groups that involve a large number of people who nominate representatives to join committees or steering groups, focus groups, interviews and design events where participants steer the decision making, design projects where people are involved in the design of a project or activity from start to finish and processes that support people to become patient leaders and work in partnership across the organisation.



Networks – details of any formal networks that you are responsible for including information about the constituency, purpose and outputs from the network.

We have a number of involvement networks and structures in place that involve people regularly

in commissioning. These involvement networks enable THCCG to engage with both specific

community groups as well as wider stakeholders. These networks also help us develop specific

commissioning streams and wider, more general programmes and strategies that involve

multiple partners and stakeholders.

Maternity Services Liaison Committee (MSLC): 75 local women meet on a monthly basis in

the community to share their experiences of maternity care through a local liaison

committee run by Social Action for Health (SAFH). The MSLC has been supported to develop

since it became operational in 2008 in order to support commissioners, clinicians and

management leads to establish a user-led approach to informing their commissioning

priorities. SAFH invite women to talk about the positive and negative aspects of care.

Members meet regularly to share their experiences and feedback is formally given to THCCG

and providers at quarterly meetings. This feedback is used to inform service improvements

and to improve local services. As part of this network, SAFH is able to operate a ‘live

feedback’ approach and is required to ensure recruitment and representation according to

the demographics and local needs highlighted by women in Tower Hamlets.

Tower Hamlets Together (THT) User and Stakeholder Forum: Tower Hamlets has long been

challenged by poverty, ill health and variable standards of care. In recent years, health and

social care clinicians and professionals have collaborated to strengthen delivery within the

borough. This transformation has acted as a catalyst for health and social care integration in

its broadest sense and the formation of Tower Hamlets Together (THT). THT is an evolving

provider partnership, established in 2013, that includes Barts Health NHS Trust providing

acute and community services, East London Foundation Trust providing mental health

services, London Borough of Tower Hamlets providing social care, public health and

children’s services, and Tower Hamlets GP Care Group delivering primary care.

There are various workstreams within THT and there is one dedicated to user

involvement. The main aims of the group include:

Increase THT’s understanding of patient, carer and community experience,

engagement and involvement, while coordinating and sharing resources for

collaborative engagement across Tower Hamlets.

Increase the use of and involvement in co-production activities to ensure

patients and carers are able to take more control of their health and care and

influence and design services.

Increase understanding of service and care need (particularly ‘seldom heard’

communities).



Older People’s Reference Group (OPRG): The OPRG is a group jointly funded by THCCG and

the London Borough of Tower Hamlets for local older people to share their views on health

and care issues that are important to them. The OPRG provides a consultative forum,

operating at a strategic level and giving direction for services to improve the quality of life

for older people.

Some of the key pieces of work the OPRG have been involved in have been developing a

Dignity Code to be used by all statutory agencies in the borough when planning and

delivering services for older people. Several service providers and commissioners of services

in Tower Hamlets have signed up to and/or endorsed the Dignity Code so it is important

that older people know of the codes existence and how they can refer to it when accessing

services. The OPRG has also provided key input into the falls recommendation and care

planning methodology.

Joint Mental Health Commissioning Programme: This programme is shared between

THCCG and London Borough of Tower Hamlets. The Mental Health Partnership group

operates as an inter-agency, bi-monthly forum which brings together statutory partners, the

voluntary sector, and representatives of service user and carer organisations. Together, they

contribute to the implementation of the joint mental health strategy, which is reviewed

annually in an open summit sponsored by the partnership.

Utilising our GP network: Service alerts allow primary care staff to share patient feedback

about local health services with THCCG. The online service alert system enables GPs, practice

nurses and practice mangers to directly feedback patient experience, gathered from their

patients which THCCG uses to hold providers to account. The GP network structure we have put

in place also enables our members to share significant feedback and themes through patient

participation groups and practice-based feedback.

Health and Wellbeing Forum: The Health and Wellbeing Forum (HWBF) is a collaborative

partnership of third sector organisations in Tower Hamlets that aims to improve health and

wellbeing and reduce health inequalities for residents in the borough. The HWBF is supported

by Tower Hamlets Council for Voluntary Services (THCVS) and aims both to empower

communities to engage effectively in debate with health services and to enable statutory

services and health professionals to hear, understand and respond adequately to the health

needs of local communities. The HWBF meets quarterly and a member of the THCCG

Engagement Team attends each meeting to ensure clear links between the forum and THCCG.

THCCG commissioning programme leads also attend the forum to take items for discussion,

consultation and partnership working.

Healthwatch Tower Hamlets (HWTH) Advisory Group: The HWTH’s Advisory Group consists of

twelve Healthwatch members who represent the voice of local residents and have

responsibility for developing the strategic direction and priorities of HWTH. The Advisory

Group meets every other month. THCCG have a place on the Advisory Group and brings



agenda items for information, discussion and input when relevant. As with the HWBF, leads for

CCG programmes of work attend or request a slot at the Healthwatch Advisory Group meetings

to involve Healthwatch and garner their expert opinion on patient experience. The HWTH

Advisory Group provides advice to the Healthwatch Board on the strategic direction and

priorities for HWTH.

Structures – details of engagement structures that are in place

Community Commissioning Panel

During 2015/16, the CCG investigated new ways to work with the community, including

setting up a Shadow People’s Panel whose role was to develop the vision, purpose and

responsibilities for a corporate patient involvement structure. The recommendations of the

Shadow People’s Panel led to the establishment of a Community Commissioning Panel (CCP)

whose aim is to bring a local voice to the CCG and help shape healthcare in Tower Hamlets.

Members of the CCP have been recruited and trained over the past few months and the

panel is now ‘live’ and providing input to key pieces of CCG work. Thirteen individuals from

diverse backgrounds who live in Tower Hamlets make up the CCP. The CCP provides the

patients’ voice and perspective on appropriate committees, focus groups and patient panels

that feed into the THCCG decision making process. This enables THCCG to improve and

enhance services and identify areas for improvement. The CCP also provides challenge

where appropriate to ensure the needs of service users, patients and carers remain central

to the way THCCG works. The CCP also provides support to THCCG to maximise involvement

of key community groups and individuals. The CCP is chaired by the PPI Lay Member, who is

able to champion the work and purpose of the panel to the Governing Body and other key

stakeholders.

The current PPI Lay Member was recently recruited, and there was a seven month gap

where there was not a PPI Lay Member in post, as the previous PPI Lay Member stepped

down in January 2016. At the same time, there was also not a dedicated PPI Engagement

Manager in post until April 2016 as a result of maternity leave and recruitment issues. As a

result of the staffing issues described above there was a lack of dedicated focus on PPI for

short period. We are now fully staffed and have developed ambitious plans to drive forward

PPI and make it a key priority for THCCG in the coming year.



Partnerships – details of partnership work with other organisations.

The successes of our PPI ambitions rely heavily on working closely with our local partners, to

coordinate activities and share best practice. We also recognise partners, such as the

voluntary and community sector as leaders best-placed to undertake PPI on our behalf.

Working in partnership underpins all of our PPI strategic objectives. Some of the partners

we work closely with include:

Healthwatch Tower Hamlets

Tower Hamlets Council for Voluntary Service (THCVS)

Tower Hamlets Health and Well-Being Forum (collective of voluntary and community sector organisations with a focus on health)

London Borough of Tower Hamlets (Local Authority)

Our local providers of services, i.e. Barts Health NHS Trust

Other CCGs, for example Newham and Waltham Forest

NHS England

Public and patients

THCCG also embeds partnership working across its formal networks, which are often

delivered or strongly involve the voluntary and community sector. Where possible, networks

are developed in conjunction with other partners to support wider programmes including

the Transforming Services Together (TST), which operates as a CCG Collaboration to include

Waltham Forest and Newham CCGs. We have been working closely with our CCG partners to

develop TST and have recently collaborated on a joint engagement strategy that aims to

involve local people in the re-design and improvement of key services across the TST patch.

It is important when delivering large-scale change in partnership, that any networks or

structures are underpinned by local intelligence. Therefore, local voluntary and community

sector groups and Healthwatch are often consulted where possible to ensure that delivery of

the change programme is seamless and does not duplicate other local networks. We will also

be working with our key partners in the near future to develop an engagement strategy

across our local STP footprint. Partners like THCVS and Healthwatch will be vital in ensuring

patients are involved and can provide input into the process as well as communicating key

messages and updates to local residents.



SECTION THREE- (Meeting the collective duty) Engagement & Participation Activity (what has been the outcome/impact?) The purpose of this section is to provide evidence of the engagement activities (programmes/projects/initiatives) that have been undertaken directly by the CCG, through commissioned providers and in partnership with others, and the impact and outcome they have had on their original objectives. For each engagement activity please specify:

Objective – what was the purpose of the engagement activity?

Activity - what was done?

Who – who was involved in the engagement? How – how were the participants recruited and what were their roles and responsibilities

Outputs, Impact & Outcome – what was learned? What changes were made as a result of the engagement? Was this information shared with CCG partners? What were the key messages for other organisations?

Please include details of the way in which the CCG is ensuring that it is listening to and responding to voices of individuals and groups who have often been considered hard-to-reach. In each case please indicate which of the following has been impacted by the activity:

Procurement

Contract and service monitoring

Service planning and design

Commissioning intentions

Strategy development Quality of service

CASE STUDY 1 | Community Health Services Procurement Engagement

OBJECTIVE/PURPOSE: Involve local residents in procuring community health services

WHO: Seven local residents who use or care for people who use community health services

HOW: Recruitment in conjunction with Healthwatch, training on procurement processes,

on-going support to ensure their voice was heard during meetings and evaluations.

PROJECT DETAILS: THCCG was in the middle of re-procuring community health services – a project due to run over the course of two years. In April 2015, we worked with the Chair of Healthwatch (who was also a member of the public and patient involvement group that had been formed to help shape engagement throughout the procurement), to recruit local residents to become part of the procurement panel and help to choose the new service provider. After advertising in the local newspaper and online, the CCG received dozens of applications. We ran assessment centres and interviewed 25 applicants. The assessment involved asking a small group of residents to work together as a team to ‘interview a local healthcare provider about its patient engagement processes, and then make recommendations to the CCG about what should change’. We assessed the individuals’ ability to work as an effective team, such as their listening and negotiation skills, as well as their understanding of health services. From this, seven local residents – a mix of men and women, patients and carers from different ethnic groups and age ranges – were selected to



sit on the procurement panel. The group underwent training to learn about community health services and procurement, including how to evaluate a bid submission. They were encouraged to actively participate in meetings, and to always question providers, commissioners and clinicians if they did not agree or understand their approach. The group was then supported to actively work alongside commissioners and independent clinicians throughout the extensive procurement process. This included attending all of the dialogue days with potential providers, where they discussed engagement plans and the service model, and made recommendations and gave feedback. They also carried out evaluations of the written submissions, and attended moderation meetings to agree overall scores. IMPACT: As a result of the patient involvement, the final community health services

specification has an extremely robust patient involvement section, which they directly

influenced. At the point the services commence, the new provider will be held to account

for delivering against the service specification, it will require them to work hand in glove

with the community, and continuously involve local people in improving services.

Having the patients in the room during discussions with providers also heavily influenced

the tone of the conversation, and ensured that patients were put at the heart of the new

service model.

RESEARCH DATE: 1 April 2015 – 31 March 2016

CASE STUDY 2 | Integrated Personal Commissioning (IPC) – Establishment of Realising Change Group

OBJECTIVE/PURPOSE: To establish a coproduction group to help with the delivery of IPC in Tower Hamlets

WHO: By working closely with voluntary sector partners involved in the IPC programme - Real and Bromley by Bow Centre, the vision was to develop a co-production group consisting of people who have lived experience of accessing health and social care services, to support the roll out of IPC in Tower Hamlets.

HOW: An engagement event was held in the autumn of last year to formally establish a

coproduction group, which is formally known as the Realising Change group.

PROJECT DETAILS: From 1st April 2015 THCCG has been operating as a demonstrator site for IPC. THCCG is 1 of 9 sites in the country selected by NHSE to be included as part of the IPC programme. IPC looks at blending funding from health and social care, providing people with holistic person-centred care and support planning and the offer of a Personal Health Budget (PHB) where applicable. This is a new approach in health and social care and by working with voluntary sector partners who are also involved in the programme, the idea was to set up a co-production group that would have involvement in helping to deliver IPC in Tower Hamlets and also act as a peer support network for those individuals who wish to take part in IPC programme.



IMPACT: Since the formation of the Realising Change group they have been involved in

strategic meetings with NHS England to provide insight into the role of the group and how

they have been supporting the delivery of the IPC programme. The group have been invited

to operational meetings and have been involved in developing patient literature for the IPC

programme. The group have also acted in an advisory capacity for any communications

materials put together by the CCG in relation to IPC. This year the group are undertaking a

development programme to equip themselves with the skills and knowledge to promote IPC

to the wider community and act as a champion for the programme.

RESEARCH DATE: October 2015

CASE STUDY 3 | Corporate PPI Programme- Patient Stories

OBJECTIVE/PURPOSE: A Patient Stories Programme, capturing experiences of people who use local health services to present to the THCCG Governing Body, to embed the importance of listening to the voice of the local population.

WHO: 10 local people who use services commissioned by THCCG.

HOW: Delivery of one-to-one interviews which are recorded and presented. Interviews

explore a patient’s experience (positive or negative) of using a local health service and

patients give a first-hand account of their experience. This engagement programme was led

by THCCG Engagement Team. Participants were recruited in various ways; via GPs and

clinicians, the voluntary and community sector, Healthwatch, other PPI activities, general

word of mouth.

PROJECT DETAILS: One of the ways that we seek involvement and capture feedback from patients and members of the public is via our Patient Stories Programme. A Patient Story is an account of one event or episode of care or the experiences of a group of people, typically given to a member of the CCG staff, who interview and film them. Their story is edited and presented to the CCG Governing Body at the bi-monthly public meetings. Patients can also be supported to attend and give their story in person if they feel comfortable with this.

Patient Stories help to forge and maintain a connection between the CCG Governing Body and their primary purpose of commissioning high quality, safe health and care services. By listening to the Patient Story the CCG Governing Body have the opportunity to understand patients’ experiences, see what worked for them and what didn’t, what barriers they faced and how they think services should be developed or improved.

In 2015/16, the following Patient Stories were presented to the THCGG Governing Body:

• Last years of life – one patients’ experience of navigating services at this difficult time. • Maternity Services- Patients detail their experiences of using maternity services in Tower

Hamlets and provide feedback about changes and improvement.



• Patient Leadership Programme- An account of the participant’s experiences and the impact that the Patient leaders hope to have on local health services.

• Positive Surgery Experience at Barts Health- A patient was able to have two operations at once, which helped to reduce patient stress, improve experience and save the NHS time and money.

All videos can be seen on the Tower Hamlets CCG You Tube page. IMPACT: By listening to real and recent experiences of people who use services THCCG commissions, the Governing Body is given the opportunity to see the experiences of services through the eyes of patients and be able to maintain a focus on the continual improvement of patient care and safety from the patients’ perspective. Each patient story is introduced either by the Governing Body lead for PPI or lead for the programme in focus. The Governing Body have time after the story to discuss what was heard, comment and commit to actions based on the feedback. These discussions and commitments are recorded in the minutes of the meeting and then sent to the people who participated in the programme in a correspondence that thanks them for the involvement, highlights the Governing Body’s response to their stories and shows them what will happen next with their feedback and suggestions. The stories are also shared with partners so that they can learn from what patients are telling us and the feedback is used to inform commissioning alongside other feedback gathered via the various PPI activities the CCG has in place.

In 2016/17 THCCG will be looking back across the Patient Stories Programme to analyse the

feedback thematically and look for consistent issues, as well as following up on the

commitments made by the Governing Body after the stories had been told.

Research Date: April 2015 -March 2016

CASE STUDY 4 | Patient Leadership Programme

OBJECTIVE: Recruit, develop and support a group of local people to become Patient Leaders, who take part in commissioning, quality review and service design at a strategic level across the CCG’s programmes.

WHO: 14 local people were recruited by Social Action for Health who were commissioned to deliver and manage the Patient Leadership programme for a second year.

ACTIVITY: The Patient Leaders project was launched in April 2014. The aim was to provide a

programme of training and development support to a small group of Tower Hamlets

residents to enable them to take on leadership roles within the local health and social care

environment.

The Patient Leaders were given learning and development opportunities, to develop the

knowledge, skills and experience to get involved in and influence commissioning. The

model offers a dynamic system for learning, allowing participation at all levels:

https://www.youtube.com/channel/UC0h4KJZzYWdo2B665DJ-Jfg



OUTPUTS, IMPACT AND OUTCOME:

The Patient Leadership programme is coming into its third year and a new cohort of Patient

Leaders were recruited this year. The first two cohorts of Patient Leaders continue to

develop solutions to difficult issues in health and social care, work in partnership to redesign

services, and offer support and guidance to the new cohort of Patient Leaders.

This year, Patient Leaders were given a virtual tour of the NHS which allowed them to

directly access and better understand the part of the health care system in which they were

interested in leading change. Additionally, Patient Leaders attended workshops and

trainings to learn about the variety of services the NHS offers and to meet CCG

commissioners and other stakeholders who could support them with their learning and

development.

Patient Leaders participation in these workshops and events has equipped them with the

skills to represent Tower Hamlets residents and discuss issues like community involvement,

language barriers, and lack of confidence that may prevent others in the community from

providing feedback or getting involved with the NHS or other health services. One Patient

Leader commented, “The knowledge that I have gained about the NHS has enabled me to

advise members of the public, with confidence; directing to appropriate services and

signposting, or simply listening. Another Patient Leader stated, “I have learnt the techniques

behind tackling changes, whether in my personal life or in healthcare.”

Patient Leaders are also conversing with stakeholders in the health care system at

engagement activities. This enables Patient Leaders to gain a better understanding of the

context in which health services operate which in turn allows Patient Leaders to influence

and lead change in a meaningful way. These connections also help them gain more

information about an area of interest as well as opportunities to contribute to or influence

services.

“When I had weekly training sessions to go to I felt I could actually have an impact on our

community, I was meeting local residents and stakeholders and was communicating with the

other patient leaders, it felt like you were creating new networks.”



“Now when I am invited to an event, I have a voice to be able to speak on behalf of others.

Some things you are invited to, you didn’t know if you could make a difference.

Commissioners and Healthwatch value us and the appreciation is there’”

Patient Leaders were involved in excess of 500 hours of activity relating to Health and Social

Care engagement during the course of the year. The scope of these activities ranged

considerably from attendance at partnership group meetings, sitting on consultation panels,

attending briefing and training sessions, peer mentoring activities, one-to-one meetings

with commissioners, health professionals, community members, experts and decisions

makers.

We hope to continue to build upon the success of the Patient Leaders Programme through

continuous evaluation and reflection of all of those involved. An evaluation of the Patient

Leadership Programme identified four key areas of impact:

•Influencing provision of local services

•Influencing and shaping commissioning priorities

•Redefining and influencing Patient & Public Involvement locally

•Impression and recognition of Patient Leaders by stakeholders

We hope to further build up on these areas of impact in the future and will continue to

explore how we can maximise impact going forward. Patient Leaders will continue to be

involved in the work of THCGG and other health partners and have contributed to the

following pieces of work: People on the Patient Leadership Programme have been involved

in a variety of CCG work areas. For example, Patient Leaders have supported the Integrated

Personal Commissioning programme through setting up a co-production group that looks at

how patients and professionals can work together to increase the uptake of personal health

budgets and improve the experience of people who have personal health budgets. Patient

Leaders have also helped to influence local health services such as maternity services, the

nutrition and food service at Bart’s Health and the way GP’s engage with their patients.

Research Date: February 2016

CASE STUDY 5 | Community Commissioning Panel

OBJECTIVE/PURPOSE: Establish a patient panel that is a formal part of the CCG’s governance structure that provides the patient’s voice on key pieces of CCG work.

WHO: Thirteen local residents with various backgrounds and interests

HOW: Recruitment in conjunction with local partners including Healthwatch and Social

Action for Health. Panel members were then trained on procurement processes, influencing,



understanding the local health landscape and are provided on-going support to ensure their

voice was is during meetings and other forums.

PROJECT DETAILS: During 2015/16, the CCG investigated new ways to work with the community, including setting up a Shadow People’s Panel whose role was to develop the vision, purpose and responsibilities for a corporate patient involvement structure. The recommendations of the Shadow People’s Panel led to the establishment of a Community Commissioning Panel (CCP) whose aim is to bring a local voice to the CCG and help shape healthcare in Tower Hamlets. Members of the CCP have been recruited and trained over the past few months and the panel is now ‘live’ and providing input to key pieces of CCG work. Thirteen individuals from diverse backgrounds who live in Tower Hamlets make up the CCP. The CCP provides the patients’ voice and perspective on appropriate committees, focus groups and patient panels that feed into the THCCG decision making process. This enables THCCG to improve and enhance services and identify areas for improvement. The CCP also provides challenge where appropriate to ensure the needs of service users, patients and carers remain central to the way THCCG works while providing support to THCCG to maximise involvement of key community groups and individuals. In order for the panel to influence commissioning in a meaningful way, it is integrated into the CCG’s formal governance structure. Although the panel will have a considerable influence, it will remain independent to enable choice and freedom. The panel will feed into the Transformation Board and will review and suggest improvements to engagement plans and business cases from the perspective of the patient. The CCP is chaired by the PPI lay member, who is able to champion the work and purpose of the panel to the governing body and other key stakeholders. IMPACT: The Community Commissioning Panel helps THCCG to ensure the patients

perspective is included in the work we do. The CCP helps THCCG to incorporate the patient’s

perspective in a practical way and supports staff members to seek out and utilise patient

feedback within their work areas. The CCP also helps THCCG to plan and deliver effective

engagement across our diverse population as the panel have insight and suggestions about

the best strategies for engagement, involvement and communication. More specifically, the

CCP has provided feedback and helped to shape commissioning intentions, tender

specifications for primary and urgent care engagement and have reviewed questionnaires

and surveys designed to gather feedback from the community.

RESEARCH DATE: March 2016



CASE STUDY 6 |’Mark your Mind’ Young Peoples Mental Health Campaign

OBJECTIVE/PURPOSE: To raise awareness and increase support for young people’s mental health in Tower Hamlets.

WHO: 20 local young people were recruited through local organisations to support the campaign by designing the key messages and activities.

HOW: We worked in partnership with Healthwatch, LBTH, ELFT and the VCS to develop and

deliver the campaign as well as recruit local young people to be involved in the planning an

delivery. An initial planning meeting was held where initial campaign messages, the

methods for communication and the engagement strategies were developed by young

people. The young people involved felt that a video, an interactive website and an outreach

and support programme aimed at Bangladeshi families would be the most effective way to

raise awareness and help to improve the mental health of young people in Tower Hamlets.

The young people’s panel that is run by Healthwatch also supported the campaign by

offering specific support for the video element and peer evaluation for all of the campaign

activities.

PROJECT DETAILS: A video about reducing the stigma around mental health was produced by local young people and is being circulated as one element of the campaign. An interactive website was also developed by the organisation Young Minds, where visitors to the site can get advice, share stories, learn about support available locally and link up with other young people to discuss mental health and receive peer support. A local organisation was commissioned to deliver extra support sessions and provide outreach services to Bangladeshi families, as young people identified that typically Bangladeshi young people will rely heavily on their families for support and guidance about mental health. A family event that focused on mental health awareness and support attracted over 50 local families and received positive feedback from attendees. IMPACT: The campaign is still active and continues to reach a large number of young people

in Tower Hamlets. A final evaluation of the campaign is planned for early next year. So far

some of the key achievements have been:

•Increased awareness of mental health services available for young people

•Increased number of young people talking about and engaging with mental health services

•Increased awareness of mental health and local support available among Bangladeshi

families

•Impression Increased participation in commissioning and priority setting by local young

people

By involving local young people in the Mark Your Mind Campaign, we were able to create

campaign objectives that are meaningful to young people that make a difference to their

mental health. Young people were also able to share with us some key intelligence about

communication preferences and what support is needed within specific communities in



relation to mental health. This in turn helped us to develop a campaign that has been

initially successful and has empowered local young people to get involved and help shape

local mental health initiatives and service objectives. The success of the Mark Your Mind

campaign and engagement strategy has a set a good practice precedent for the future and

will help us to carry out meaningful engagement with young people on future pieces of

work.

RESEARCH DATE: January 2016

CASE STUDY 7| Primary Care Reference Group

OBJECTIVE/PURPOSE: To set up a reference group made up of patients and professionals to provide insight into how we can make primary care sustainable into the future.

WHO: A group of 16 stakeholders including GPs, public health professionals and local patient representatives.

HOW: A wide range of people were asked if they were interested in becoming a member of the group. We wanted to ensure patients from diverse backgrounds were able to join the group and worked with Healthwatch, the Patient Leaders (see case study 4) and local community groups to recruit residents who were representative of the local population. Final membership was decided based on past experience, personal perspectives and/or their links to with the local community. The role of members of the group was to provide input into new ideas for models of care, sense check future plans and ensure that the voice of local residents was represented on all reference group agenda items.

PROJECT DETAILS: The CCG has set as one of its priorities to support practices to better meet an ever-increasing workload through a new model of care. A ‘Primary Care Reference Group’ was set up to engage with stakeholders and develop outputs towards identifying and implementing sustainable longer-term solutions for Primary Care. Eight half day workshops took place over a period of six months where new models of care were discussed and developed with the group members. A range of issues, data and scenarios were presented to the group to discuss and work through at each workshop. Members were asked to feed in information and provide feedback based on their past experiences and thoughts about how primary care could be improved in the future. IMPACT: Based on the input and discussions that took place within the Primary Care

reference group, THCCG has developed an outline model of care that is now undergoing

wider engagement and scrutiny from the public and other stakeholders. This has been

presented to GP Provider Boards and the CCG Governing Body and the model holds

particular weight as it has had significant input from patients from its earliest stages.

In 17/18 there will be further initiatives implemented that came from the Reference Group;

specifically the introduction of a ‘Tower Hamlets Health and Wellbeing Club’ where all new

patients will receive an induction to their GP practice as well as an introduction to all of the

health services that are available in Tower Hamlets. This plan has also been outlined in the

CCG Commissioning Intentions letter to Primary Care providers. The input from patients has



been key in developing the new model for primary care and we feel that as a result of

involving patients in the early planning stages we will be able to improve patients

experience of primary care and create a sustainable model that will deliver outcomes that

local patients want.

RESEARCH DATE: December 2015

CASE STUDY 8 | The Bridge Virtual Ward Project- Supporting Children and Young People with Complex Needs

OBJECTIVE/PURPOSE: A research study to understand the views, opinions and experiences of children, young people and their parents and carers who have received the new services from the Bridge, which offers multidisciplinary support for children and young people with complex needs. The study will listen to and report their stories and experiences and will also make recommendations for service improvements. At the end of the project period, discussions will take place with the health, education and social care teams providing care to hear and understand their views in order to make wider improvements to the service based on comprehensive patient and staff feedback. The research is still currently in progress and will finish in March 2017; this is an update on out findings so far.

WHO: Approximately 50 children and young people had been selected to take part in the project. It was decided that 10 children and their families/carers would be interviewed during Phase 1 and interviewed again in Phase 2.

HOW: Healthwatch Tower Hamlets was commissioned by THCCG and Barts Health to carry

out in depth interviews with young people and families who use the Bridge. Where possible,

young people were interviewed directly but in some cases due to the complex health needs

of the young person, their parent or carer was interviewed. Interpreters were made

available to support interviews with participants who required language support. The

interviews lasted between one and one and a half hours and were digitally recorded in

order to ensure that all feedback and information was accurately gathered and could be

used to inform service improvements.

PROJECT DETAILS: The purpose of this research was to better understand if the Bridge Virtual Ward service aims actually reflect the needs of service users and their families and to identify aspects of the service that could be improved. The Bridge Virtual Ward Project aims to offer children and young people with complex care needs and high rates of admissions and/or length of stay in secondary care a programme of co-ordinated and integrated support across health, education and social care. Through multi-disciplinary working including offering regular Multidisciplinary Team (MDT) meetings, the service has been designed to deliver a reduction in referrals to secondary care admissions, inappropriate use of Accident and Emergency (A&E) and length of stay. Most importantly, the Bridge aims to prevent the development of longer-term conditions for children, young people and their families.



IMPACT: As this research project is on-going, the Phase 1 evaluation has demonstrated

certain issues and themes that appeared to run through the lives of almost all those

interviewed. Some common themes to emerge were that staff attitudes could be improved

to be more empathic and supportive, families were under a great deal of stress and had

little access to respite and there were common challenges with juggling family life alongside

caring for a child with complex needs. There was strong evidence that these themes

affected how service users perceived and experienced provision. Underpinning these

themes there seemed to be a tenuous balance between the needs - including the changing

needs - of service users, expectations of provision, budgetary realities and issues inherent in

living with complex needs.

This information will help us to know how well the services are performing from a patient’s

perspective and whether patients are getting the services they need. So far, based on the

initial feedback from patients we have been able to begin drafting service improvement

plans and have developed action plans to help address some key issues like addressing the

attitudes of staff through training and feedback sessions. The patient feedback has also

been used to inform future commissioning intentions and has informed the re-procurement

of the Community Health Services Contract in 2015.

RESEARCH DATE: September 2015

CASE STUDY 9 | Engagement for Wheelchair Services Reprocurement

OBJECTIVE/PURPOSE: Work with service users to develop the service specification for the new Wheelchair Service in Tower Hamlets.

WHO: 50 service users who use wheelchair services provided by Barts Health, and their sub-contractor, Whizz-Kids.

HOW: A group of service users were recruited to help develop the new service specification

while staff carried out wider engagement activities with existing wheelchair service users.

The service manager briefed staff on how to effectively carry out the engagement activities

and took advice from the service user panel about how to best engage current service users

in the re-procurement exercise. The service user panel and the service manager determined

that face to face interviews and questionnaires would be the best method of engagement

and the panel also helped to determine the questions and interview strategy so the

information gathered could be fed back into the new service specification. A briefing

detailing the purpose of the engagement was developed and distributed to service users

attending the site and staff undertaking home visits. Copies of the questionnaires were held

in the wheelchair service centre and staff distributed them on home visits. Stamp addressed

envelopes were provided to people completing questionnaires off-site in order to make it

easy for people to return completed questionnaires. The consultation was held over a one

month period and applied the following approaches:



• Face to face semi-structured interviews with patients

• Face to face semi structured interview with carers

• Reviewed comments on the Whizz Mobility website

• Questionnaires completed on site

• Questionnaires returned in the post

PROJECT DETAILS: The Wheelchair service was originally provided as part of the Community Health Services (CHS) contract. A decision by THCCG to re-procure CHS required a review of services included in the CHS contract. The outcome of the review resulted in the exclusion of wheelchair services initiating a separate procurement process. To support the design and scope of the service, the specification was developed following consultation with service users, their carers and/or family members. During the engagement process, we spoke to people who use these services to understand their experiences, what they would like to change and what would improve the quality of care they received from the service. IMPACT: The feedback provided by service users and their carers or family was incorporated

into the specification prepared for the tender process. The key points emerging from the

engagement focused on satisfaction of the service, accessibility and flexibility and access to

a wheelchair quickly and easily, ideally within one day of submitting a request for a

wheelchair. Engaging service users and their carers or families in this way, provided a forum

for users to surface concerns about the quality of care an individual feels they should

receive. Of the 50 patients participating, one person raised concerns about response times,

but this was efficiently managed. The new specification includes a CQUIN for the provider to

increase access rates and access to a chair within one day of receiving a request for a

wheelchair. The CQUIN was developed as a direct result of service user involvement and will

contribute to meeting the outcomes that the service user panel stated were most important

to them. This activity is being monitored as part of the reporting requirements, and we have

received some initial positive feedback from users who have reported high satisfaction

levels with the Wheelchair Service in Tower Hamlets.

RESEARCH DATE: September 2015

CASE STUDY 10 | THCCG Programme: COIN (Community Options user Involvement Network)

OBJECTIVE/PURPOSE: Community Options Involvement Network (COIN) is a mental health service user led group who use their experiences to: 1. Improve mental health services in Tower Hamlets 2. Empower themselves and others to improve their mental health 3. Break down stigma and promote understanding of mental health in the local community

WHO: COIN is led by mental health service users and was facilitated by Community Options, a local mental health service provider.



HOW: The COIN programme delivered a variety of engagement activities including

supporting the work of the Tower Hamlets Mental Health Partnership Board, impacting on

commissioning and procurement activities and delivering local projects such as the co-

production of the online mental health service directory ‘In the Know’. The main focus of

the work of COIN has been on the creation and delivery of regular ‘Your Say Your Day’

events (YSYD) where service users determine the topics that will be discussed and organise

an event where service users and professionals come together to discuss solutions to

current problems within the mental health system.

PROJECT DETAILS: Five Your Say Your Day events were held last year. These events are part of the regular calendar for all stakeholders within Mental Health and are very well attended by patients and professionals. The events take place every two months and are planned in advance by the service users involved in COIN. The themes of YSYD are identified by members of the service user community which often reflect topics of concern or interest identified through wider engagement work done through COIN. The workshop themes this year were; parity of esteem, medication, spirituality, loneliness and relationships. Once the topics have been agreed, the COIN members identify clinicians, community providers and experts by experience to help facilitate the day. The event is interactive and involves different ways of learning and engaging on topics in order to make it inclusive an appealing to a wide range of people. For example, the focus of a recent YSYD event was Personality Disorder, which was attended by our locally commissioned Personality Disorder Service ‘Deans Cross’ who gave an interactive presentation that was delivered by people with Personality Disorder and professionals who support them. The presentation was followed by an open Q&A session that generated useful conversations and solutions to common problems in the system. The event also included a session where impact statements from people with lived experience were shared with those at the event. There was also a workshop on Personality Disorder where people had a chance to discuss key issues and make recommendations for improvement. As a result of the event and its interactive elements, a report with key recommendations was written and sent out to key stakeholders with the view to influence decision makers. IMPACT:

The YSYD events are rated highly among service users and professionals and are consistently

well attended and regarded among the local mental health sector in Tower Hamlets.

Feedback from the events has been very positive with attendees stating that the events

were consistently relevant, positive, informative and inclusive. This is reflected in the high

satisfaction levels with the events; as the average rating from attendees of YSYD events is

8/10.

The overall impact of the YSYD events that took place last year are as follows:

•Increased understanding between those who receive and those who plan/deliver services

•Reduction in barriers and an increase in trust between service users and providers

•Reduction in stigma and self-stigma



•Increase in accountability among service providers

•Service users feel that their experiences are valued and listened to

•Attendees feel better connected and part of the community

•Reduction in feelings of isolation and people feel informed and safe to ask questions

•Creation of a safe space to ask questions and receive information on ‘shameful’ topics

The impact of each event will depend on its topic. A common theme is an improvement in

the delivery and commissioning of relevant services. For example, the personality disorder

themed event had a positive impact on the quality of Deans Cross Personality Disorder

service. Recommendations were made at the event, which were then followed up by the

Healthwatch Enter and View programme. Deans Cross stated, “We had a good specialist

personality disorder service which has now improved its user involvement with feedback

options, improved sign posting and follow up thanks to their willingness and involvement in

YSYD and being open to COIN’s suggestions. This co-produced review of the service

definitely ensured positive outcomes for all involved and future patients of this service.”

RESEARCH DATE: April 2015

CASE STUDY 11 | Service user led grants

OBJECTIVE/PURPOSE: London Borough of Tower Hamlets in partnership with THCCG allocated £109,500 for a small grants programme to support user-led groups for people with mental health issues.

WHO: 29 local community groups were granted funding for social and therapeutic activities that promoted social inclusion, well-being, and independence for adults with mental health issues in Tower Hamlets.

HOW: To qualify for a grant, groups have to be led by a person or people with a mental

health issue. When a group of service users have ideas on how their social care needs could

be better or more creatively met, through the user-led grant process, they therefore have

the opportunity to apply for funding to realise their ideas in practice. Groups are offered

support with the administrative and organisational aspects of running a group, along with

help solving problems as they arise, through a separately commissioned Support User

Network (SUN Network) coordinated by Community Options, a local third sector

organisation specialising in mental health.

PROJECT DETAILS: Mental health service users helped to identify the need for the service user led grants, as it was identified that there was often lack of funding for activities and support that they felt would help them toward recovery and independence. Service users also helped to set the application criteria and guidelines and helped professionals ensure that this process was led by service users in order to achieve the best outcomes. An application evaluation panel consisting of a member of the Council and Tower Hamlets CCG Mental Health and Joint Commissioning Team, the Community Options SUIP (service



user involvement project) development worker and a service user representative from Newham (to manage potential conflict of interest) was convened to carry out interviews and agree recommendations on which groups would be successful at the end of the application evaluation process. Service users played a key role in both the application process and also in determining which applications would be successful. The fact that the activities that were to be funded were proposed by people with mental health needs, ensured that the grants were meeting local need, focused on activities that users identified as important and often filled a gap in current service provision, as many of the grant funded activities took place out of hours and at times where people with mental health issues felt that they wanted and needed activities and support to take place. A wide range of projects and activities were successful in their service user led grant application. Some of the projects include: •Promotion of wellbeing and confidence through sharing and learning self-care skills •Support for self-harmers through talking therapies •Keep fit and self-defence classes •Support for the Arab community through peer support, social integration, cooking baking and sewing •Support service users with experience of the criminal justice system through mental health support and social activities •Support to help BME women with mental health issues to alleviate isolation, degradation and to become a self-help group IMPACT: A high proportion of the funded user-led groups have been established with the

clear purpose that they actively encourage and promote healthy lifestyles, focus on health

promotion and endorse a positive outlook on the lives of service users through physical

exercise and alternative therapies.

Initial reports and feedback from the projects funded through the service user led grant

scheme has been overwhelmingly positive. Many service users stated that as a result of

being involved in the design and initiation of the activities, the activities truly meet their

needs and interests. The service user led grant scheme also sets a clear precedent and

model of good practice for the future as to how THCCG designs grant funded activities. By

involving service users at each stage of the process, we were able to design a scheme that

met the needs of local residents and also created provision that was for and by local people.

This has resulted in a high uptake and retention rate within each project and has filled in

some of the key gaps in mental health service provision. We have also had some of the most

positive feedback from users about this provision because it was designed and led by people

with lived experience who were best placed to develop projects that resulted in improved

outcomes for all involved.

RESEARCH DATE: June 2015



SECTION FOUR- (Meeting the Individual Participation Duty) Please provide information on the arrangements in place for promoting the individual duty to support patients being in control through commissioning activities and what results can be demonstrated for patients in terms of:

Self-management

Shared decision-making

Personalised care planning and personal health budgets

Tower Hamlets CCG is committed to ensuring that there are opportunities for patients to be

an active participant within their care and to have choice and control over the NHS services

they receive. THCCG believes that people’s lives can be improved when they are given the

tools and confidence to make health and care decisions that are most important and

valuable to them. Please see below for examples of how THCCG is promoting and meeting

the individual participation duty.

Self-management

The CCG is working with GP Practices across Tower Hamlets to encourage them to

pilot the Patient Activation Measure (PAM). The expectation is that this will support

them to tailor their advice/interventions according to individual need. The

evaluation of the pilot (available in quarter 1 of 2017/18) will help to inform plans for

PAM in primary care going forward. PAM is also being piloted by a number of our

local provider partners including Barts Health NHS Trust, East London Foundation

Trust, London Borough of Tower Hamlets and in the voluntary sector.

The CCG has commissioned a suite of services to provide self-management support

for people with a range of conditions including diabetes, CKD, CVD and

hypertension. The expectation is that these services will enable people to better

manage their own condition, thereby improving their overall quality of life and

wellbeing. A health psychology service is also available for people with more

complex needs.

The CCG will, in April 2017, begin an 18 month pilot project to provide increased

psychological support for people with long term conditions.

Patient Leadership Programme – Social Action for Health (SAfH), a voluntary sector

organisation working closely with Healthwatch Tower Hamlets have designed a

training programme, looking to develop patient leaders. This multi-layered training

programme provides a 6-8 week training programme to help local people to

understand the wider systems in health and care. These are supported by ‘Bigger

picture’ events where there is active participation from THCCG teams, Healthwatch

Tower Hamlets, Local Authority and voluntary and community sector to support



people to feel confident to articulate their experiences and views and to take on

patient representation, co-design and supporting roles in a way that is credible and

meaningful. This programme also offers one-to-one support and ‘learning and

reflection network’ opportunities.

Shared Decision Making

Social prescribing- The CCG has commissioned an 18 month pilot of social

prescribing across Tower Hamlets, due to conclude in March 2018. This will be

delivered through GP Practices in partnership with the community and voluntary

sector. The expectation is that it will identify people that could benefit from non-

medical support and link them up to local services that may help to meet their

needs. The evaluation of the pilot (available in quarter 1 of 2018/19) will help to

inform plans for social prescribing going forward.

Enabling patients to access electronic health records- We have recruited a

dedicated member of staff to encourage GP practices to switch on the sharing of the

detailed record and improve uptake and analysis about practice performance. We

have also put in an ETTF (Estates and Technology Transformation Fund) bid for

money to have additional resource to work on delivering the behavioural change (in

practices and for patients) to drive up usage and promotion of online medical

records by patients. We are also currently working with Emis to see if they will add

the eLPR (east London Patient Record) view to the patient app so patients can see

their full care record and not just primary care information. We hope that this will

not only increase the amount of information that patients can access online but also

encourages joint decision making based on improved access to data and personal

health information on the part of patients.

Personalised Care Planning

Integrated Personalised Commissioning (IPC) - THCCG is a national demonstrator

site for IPC. The core components of the programme are to introduce person

centred planning across Tower Hamlets and be in a position to be able to offer

people integrated health and social care budgets, should they wish to take these

up. The focus of the programme is currently on adults with learning disabilities and

children and young people with special educational needs and disabilities.

Care Navigators- THCCG commissions Care Navigators through the Integrated Care

Programme (ICP). Care Navigators act as ‘PA’ to people on the ICP and support

people to book appointments, follow up on test results and liaise between the



multiple providers that a patient sees as a result of their multiple, long term

conditions. Care Navigators ensure that patients play an active role in their care, and

support people to access the treatment that they feel is best for them. Care

Navigators also have regular meetings with the patient and the multiagency staff

that support them to ensure that the patients’ needs are being met and that choice

and control is maintained by the patient throughout the process.

How information technology, including social media, is being used to improve engagement activity.

THCCG Website

We use our website to let the public know about what we are currently working on and

provide opportunities for feedback via our information email address, service specific

questionnaires and surveys and links to information about how to get involved with the CCG

or other health partners. Our website is a first entry point for the public to learn about what

we do as well as how they can get involved and have their say about health services in

Tower Hamlets.

Twitter

We use Twitter to promote engagement opportunities that are run directly by us or by our

partners. We use it as a platform to communicate and engage the public about current

involvement activities that can be joined. We also use Twitter as a way to celebrate and

promote interesting events and pieces of work that they public might be interested to hear

about. This provides us with a tool to engage members of the public who might not engage

via other channels and to raise awareness about the various ways people can get involved

and engage with the work THCCG does. We recently launched a series of engagement

opportunities for members of the public to give their views on primary and urgent care and

promoted these opportunities successfully via Twitter. We provided direct links to surveys

and event information via Twitter and this resulted in a higher completion and attendance

rate of engagement materials and events.

Electronic Kiosks for Friends and Family Test

Each GP practice has a kiosk in the waiting area where patients can easily access and

complete the Friends and Family Test electronically. The kiosks also display other

information about health services and events that are taking place in Tower Hamlets.



How the CCG is holding providers to account for patient and public engagement

GP Intranet- Service Alerts

The Tower Hamlets GP Intranet has a service where GP’s can raise issues with patient care

that are not at the level of serious issues or complaints. It is an online form in a secure

environment that means GP’s can alert commissioners of these issues which then can be

followed up with providers to see if it is a system wide issue that needs to be fixed or

improved, or if it is a one off issue that can be addressed for that particular patient and

resolved.

Community Health Services Contract

Patients were involved throughout the entire process of our recent community health

services procurement. Patients helped to set the service specification, helped with initial

scoping and final interviews where they were able to ask each potential provider how they

planned to involve patients and act on patient feedback. Patients also helped to establish

the monitoring and evaluation framework for the contract and built in robust patient

experience, involvement and satisfaction measures that ensure the new provider is held to

account and has a clear focus on gathering and responding to patient feedback in various

forms. Patients also helped to establish guidelines for how the provider was to engage with

patients ensuring that all patient involvement activities were meaningful and drove positive

outcomes for both patients and the provider. By involving patients at each stage of the

procurement process, we were able to build in patient led involvement measures in the

contract and ultimately award the contract to a provider who patients felt would be able to

effectively engage and involve patients in the service. Additionally, this approach also

ensured that the provider kept patients central to their service delivery and allows the CCG

to hold them to account for the patient involvement measures that they have committed to

deliver.

Mental health contracts

All mental health contracts in Tower Hamlets require providers to engage with patients

about their experiences of using the service and respond to patient feedback. This is a

standard part of the contracting process and further reinforces THCCG’s ambition to ensure

that patients and their views remain central to the services we commission.



SECTION FIVE- Forward Plans for 2016-17 In this section we would like to hear about what your plans are for further developing your organisations capacity and capabilities to meet the participation duties, please include how you will ensure your organisations will have effective mechanisms to ensure groups identified in the Equality Act as having protected characteristics, have opportunities to be involved in the full range of your organisations commissioning activity and your commissioning activities actively supports patients to self-care and be in control.

PPI Training for Internal CCG Staff and Governing Body

We want to ensure that PPI remains at the heart of all we do at THCCG and in order to

ensure that all staff members help to take PPI forward in a meaningful way, we plan to offer

training for staff about how to embed PPI within their work areas. We will be working with

our PPI Lay Member to develop this training and the focus will be on practical tips, best

practice, the benefits of PPI and where staff can receive support with carrying out

meaningful PPI activities. We will also be holding a Learning and Development session for

our governing body about PPI in the coming months in order to promote and embed PPI

from the top of the organisation down.

Health Conversation Event

Building on the success of two past Health Conversation Events, we plan to carry out

another event in 2016/17 where members of the public can meet commissioners, raise

concerns and ask questions about local health services. The purpose of the Health

Conversation event is for commissioners to gain feedback about programme areas, enable

the public to gain a better understanding of the local health landscape, help the public to

learn about how they can get involved with the CCG and other health providers and have

their say about the NHS in Tower Hamlets. The Health Conversation Event is a key way that

we can engage with local residents, especially those who might not normally engage

through more formal channels.

Evaluation of PPI Activities

As evidenced in this report and previous reports, THCCG undertakes a great deal of

innovative and meaningful engagement activities. We are committed to ensuring that

patients have the opportunity to influence and provide feedback across all CCG work areas

and we ensure that we provide feedback to patients who have engaged on certain topics

about the outcomes, changes and impact of their engagement. As part of our efforts to

continually improve our engagement efforts and to better understand its value we plan to

commission an external evaluation of all of our PPI activities to better understand what we

do well and where we could make improvements. This will help us to better focus our



resources and efforts and will also help us to further quantify and highlight the impact that

PPI has on improving health services and outcomes in Tower Hamlets.

Young Health Commissioners

Recognising that the population in Tower Hamlets has a significant proportion of children

and young people, this model will be developed in Tower Hamlets in 2016/17. Children

Commissioners were initially introduced at Newham CCG in 2014/15 as part of the

Transforming Services Together CCG-Collaborative programme. There is also a council run

youth forum that is looking to expand its members expertise into health. We will be working

closely with both the council and neighbouring CCG’s to develop a collaborative programme

to get young people involved in commissioning and driving improvement in services that will

support young people to live healthy lives both now and into adulthood.

We want children and young people to inform the future of services, identify service use

and behaviour patterns earlier in order to embed smart commissioning decisions for our

local population earlier. It is important for the model to be locally co-designed and co-

delivered. Therefore, in 2016/17 we will conduct a research and mapping exercise of local

involvement activity where there is current involvement from children and young people. It

is equally important that our stakeholders feel ownership of the young health

commissioners project and therefore, THCCG will seek the support of Healthwatch, the

voluntary and community sector and local authority to ensure the concept is locally owned

and connected to related involvement activity and networks. We hope to share the learning

from Tower Hamlets across the Transforming Services Together (TST) footprint to inform

commissioning across East London.

Joined up PPI activities and forums through THT: toward an accountable care approach

Tower Hamlets CCG is a partner in Tower Hamlets Together (THT) which brings together the

key healthcare providers across Tower Hamlets. THCCG is actively involved in the user and

stakeholder forum that focuses on patient experience and involvement. There have been

on-going discussions about how to better coordinate our engagement and involvement

efforts to make them more inclusive, comprehensive and better able to meet the diverse

needs of the local population. We will be exploring how a more joined up and coordinated

approach to PPI will work in practice and hope to further improve upon all of the PPI work

that is undertaken by each partner individually. We want to ensure that THCCG is fully

involved and provides key input into the shift to an accountable care approach. We are

excited to see how collaboration with key partners can improve our PPI efforts and

ultimately improve patient satisfaction and outcomes across Tower Hamlets.

Support for the Community Researchers programme

The local authority currently runs a community researchers programme where they train

local residents in participatory research methods and support them to conduct research on



relevant topics with local residents. The programme is entering its second year, and the

local authority is looking to expand the programme, recruit more researchers and provide

further training on additional research methods. The CCG will be looking to support this

programme by providing research topics, relevant training and funding specific pieces of

work. Some potential areas of future research will be around self-care, raising awareness of

community based health services and working with key population groups to better

understand their health needs and access issues.

Further development of the Community Commissioning Panel

We will continue to develop the Community Commissioning Panel (CCP) over the next year.

As the CCP is a new part of THCCG’s governance structure, we will continue to promote its

function internally and will be supporting staff members to take pieces of work and ideas to

the panel for input and sign off. We will continue to support the panel members in their

roles by offering training, providing them with individual support through the Engagement

Manager and PPI Lay Member and will continue to develop how the panel is most effective

in practice. Our aim is to raise the profile of the CCP, maximise its influence and

effectiveness and ensure that the panel are able to champion the patient’s voice and

represent the health needs of the community within all of the work the CCG undertakes.

SECTION SIX - Healthwatch Statement

Our experience of Tower Hamlets CCG is that they are working hard to make their vision for

engagement a reality, as demonstrated by the wide range of activities outlined in this PPE

assurance report. The CCG have worked in partnership with Healthwatch Tower Hamlets

and the voluntary sector to involve the public and patients in priority setting, design,

redesign, procurement and monitoring of the services that they commission. They have

welcomed and valued their contribution and strived to treat them as equal partners and are

genuinely committed to patient and public involvement. We can now confidently say that

patients and the public are having an impact on CCG commissioning and in many cases this

can be reported back to those involved and the wider community.

Real patient and public engagement however takes years to develop and even longer to

bear results, it is therefore difficult to measure its impact over short time frames. This year

has seen a consolidation of engagement initiatives such as the Community Commissioning

Panel and the Patient Leadership Programme. Building the skills and confidence of patients

to participate as equal partners is a gradual process but we are now starting to see them

influence commissioning and procurement processes across the CCG programme. We hope

to see the breadth and depth of their involvement increase in the coming year alongside

more training support for staff in how to best utilise their skills to improve health outcomes.



Healthwatch and the CCG jointly developed a Tower Hamlets Community Intelligence

Bursary programme, working with 17 voluntary and community organisations that trained

33 peer researchers and reached over a thousand local residents, to ensure that the needs

and views of the local community directly influenced how services were designed,

commissioned and delivered. The reports produced covered such diverse groups as Asian

women who had been the victims of domestic violence, Somali men with mental health

problems, drug and alcohol misusers and Bangladeshi people on end of life care. The next

step is to work together to support local groups to come up with their own solutions to

meet the needs identified and allow the community to lead change as their own service

designers and deliverers.

The CCG have developed a wide range of approaches to engaging patients and the public

and understand the need to utilise different tools at different stages of the commissioning

cycle such as: large open events with users and the wider community to understand the

needs of mental health users; smaller workshop events with participants recruited to reflect

the makeup of the local community when trying to better understand the use of primary

care; and in-depth interviews to understand the experience of children and families on the

integrated care programme.

It is really positive to see the CCG working in partnership with the voluntary sector and users

to pilot co-production principles in relation to the Integrated Personal Commissioning and

we hope that this model can be adapted across other areas of their work programme. The

mental health service commissioners continue to strive to work under co-production

principles with users and the community and we have found their involvement with the

Mental Health Task Group and the Healthwatch Youth Panel to be extremely valuable and

effective.

The CCG has continued to build the number of local people involved in their work and to

build a trust that their involvement will have an impact leading to local health

improvements. With the development of the Tower Hamlets Together partnership we

believe there is an even greater opportunity to pull the threads of engagement across

partners and to establish a critical mass of community citizens who can build a healthier and

more resilient Tower Hamlets.

Documents

LONDON REGION TEMPLATE for 2015/16 REPORT€¦ · LONDON REGION TEMPLATE for 2015/16 REPORT Final Participation Template 2015/16 Page 2 Deprivation Tower Hamlets is a borough of contrasts,