Involving local people
Our Healthier South East London – summary of engagement activity
The models of care developed through Our Healthier South East London are the result of several years of partnership working between clinicians, commissioners, council social care leads and local hospitals and have been informed by extensive engagement at south east London level and through CGGs with local communities, patients and the public.
Patient and Public Advisory Group (PPAG)
We have patient and public voices (PPVs) on each of our clinical workstreams influencing all our key programmes of work and feeding into our PPAG. The PPAG is made up of 14 PPVs, each of whom covers one or more specific workstreams. PPAG meets on a bi-monthly basis.
Elective Orthopaedic Clinical Network
During 2017/18 Guy’s & St Thomas’ NHS Foundation Trust, King’s College Hospital NHS Foundation Trust and Lewisham & Greenwich NHS Trust delivered over 2,600 hip, or knee joint replacement operations for patients. Our elective orthopaedic clinical network has prioritised working with patients and their carers who have experienced our care pathways. We have recruited one Patient & Public Voice who has experienced two hip replacement procedures. She communicates with network members on a regular basis and contributes to our discussions and decision-making during monthly network meetings. If you have experienced, or cared for a patient receiving planned hip or knee surgery in South East London and would like to contribute to improving care delivery, please contact firstname.lastname@example.org to express your interest.
To ensure all orthopaedic patients receive appropriate support and understand how their care will be delivered, clinicians from our three NHS hospital trusts, supported by our patient representative, have reviewed and updated patient pre-operative education called “joint school”. All hip and knee joint replacement patients are strongly encouraged to attend a ‘joint school’ prior to attending surgery. The changes made will support more patients to have a positive experience of care and achieve best outcomes from their surgery.
This year the network agreed an ideal pathway for delivering hip and knee replacements. It aims to adopt this across all our hospitals to ensure patients have access to excellent service where ever they are treated.
For patients and carers who don’t have time to regularly engage with us, we have carried out focus groups so that we can learn what it felt like to receive care; what support was helpful and what could have been done to improve their experience of receiving treatment. Focus groups have been held at Orpington Hospital (For King’s College Hospital NHS Foundation Trust patients), AgeUK Lewisham (for Lewisham & Greenwich NHS Trust Patients) and at Guy’s Hospital (for Guy’s and St Thomas’ NHS Foundation Trust patients).
Patients said: Patients described the anxiety they experienced in not having a booked surgery date and having to wait longer than 18 weeks for treatment.
We are doing: Every month the clinical network observes our progress in treating patients within 18 weeks of referral. We are also recording the volumes of patients waiting more than 35 weeks, and more than 52 weeks. Our target is that at least 92% of patients receive treatment within 18 weeks and no patients wait longer than 35 weeks for treatment. We currently have high numbers of patients who are waiting too long for surgery and the network is working on how we can solve this problem together.
Patients said: Some patients were invited to pre-operative education ‘joint school’ group classes and some were not.
We are doing: Since January 2019 all SE London planned hip and knee replacement patients are strongly encouraged to attend a pre-operative education class to learn about how to prepare mind and body for surgery and how to make the best recovery and rehabilitation after surgery.
Patients said: Some patients find reading information and following guidance really challenging and others have a huge appetite to research how they can prepare for this type of treatment.
We are doing: We are in the process of writing updated patient information and communication templates throughout planned hip and knee replacement care pathways which provide the bare necessities for patients, but also provide links to further information and resources.
Patients said: The occupational therapy and physiotherapy staff were really supportive and helpful in helping us get moving again following surgery.
We did: Early mobilisation of patients on their day of surgery helps them to recover better. Nurses in the wards have been trained by physiotherapists so that they too can support patients to stand up, use a walking frame and transfer to a toilet.
A Maternity Voices Partnership (MVP) is a group made up of women and their families, commissioners and healthcare professionals working together to review and contribute to the development of local maternity care. There are MVPs across all of the six boroughs of south east London and each MVP has a local action plan. In addition there is MVP representation on both the south east London maternity public health workstream and the south east London Better Births Plan workstream. The role of the MVP member within these workstreams is to be the voice of the women who will use the maternity services, providing guidance around the needs of this group of women and fully contributing to all discussions around the workstream objectives.
Stakeholder and Equalities Reference Group meetings
We continued to hold these meetings in 2018/19 to ensure our plans are assured around patient and public engagement and equalities issues. The Stakeholder Reference Group submitted feedback as part of NHS England’s initial engagement on developing the NHS Long Term Plan.
Mental health support for young people
On 4 February 2019 Kooth was launched across the whole of south east London for an initial period of 14 months. Kooth is an online counselling service which gives 11-19-year olds access to free, anonymous mental health and emotional well-being support. A communications and engagement plan, included an ongoing social media campaign and presenting at school assemblies, is being developed to ensure that young people are aware of the service.
In summer 2018 we held two workshops to support 2018/19 winter planning, bringing together commissioners, patient representatives, providers and local authorities. The first workshop looked back at the previous winter to determine what challenges we had faced, and to identify where there had been examples of best practice that we wanted to continue for the next winter. The lessons that we learnt from that workshop were then used to inform the next round of winter planning. The second workshop was held later in the summer, and was used to ‘stress test’ draft winter plans. Mock scenarios were used to assess the strength of our plans.
South east London NHS 111 service
In February 2019, the new integrated south east London NHS 111 service was launched.
Provided by the London Ambulance Service, the new service will improve access for those who dial 111. Available 24 hours a day, the service will provide a new Clinical Assessment Service comprised of GPs, pharmacists and nurses who will provide clinical consultations to residents across South East London. The service can provide patient information, issue prescriptions to a pharmacy of choice, book a GP appointment, and, if necessary, refer people to emergency services. Even when a GP practice is closed, residents will be able to access this service and will be directed to NHS 111 and 111 online.
Patients across south east London have informed and influenced this new service. Two patient engagement events were held in 2015/2016 and a survey was sent out to local people across south east (SEL) London. Feedback was used to inform the development of the specification for the service which was approved by the south east London CCGs.
After March 2016, an information pack detailing the response to the patient feedback received – in the form of ‘you said, we did’ – and the more recent developments to the IUC design, was produced and shared with local people. Additionally, patient groups were identified for further targeted engagement. These groups were identified on the basis of those who had access issues (deaf or hard of hearing; patients for whom English is not their first language; patients with learning disabilities) and groups that the equality impact analysis had highlighted as not having been engaged with so far such as people from the LGBT community.
Each CCG was asked to choose one of the patient groups and facilitate engagement with that group. Where possible, this was through the programme team attending an existing patient engagement meeting or convening a meeting for this express purpose. Where this was not possible, information was sent to relevant organisations that liaised with their service users and responded on their behalf. The following activity was undertaken:
- Information sent to Bromley Deaf Access group; the response received included the importance of providing advice relating to staff training, promotion of the service, and the use of deaf friendly language.
- Engagement session held with a Vietnamese group in Lewisham – 9 out of the 10 attendees had never heard of 111 before. Discussions explored the differences between 111 and 999, the translation service available through 111, the redesign of 111 and the best ways to promote the service to the Vietnamese community. The current service and the new design were both very well received.
- Information sent to a KeyRing who supported Speaking Up – Southwark (a group for people with learning disabilities) to get their views on the new design for 111. The response indicated that current members of Speaking Up had not used the 111 service because they hadn’t needed to but they were aware of it and would use it if they needed to.
- Information sent to Metro (a SEL wide LGBT group); the response received included the importance of providing advice relating to staff training, promotion of the service, monitoring LGBT usage and links to voluntary sector services.
- Engagement session with Our Healthier South east London Patient and Public Advisory Group – there were three people who attended who were knowledgeable about 111. There was a very detailed discussion about the current service and the proposed changes. The group approved of the proposed changes. Two members were recruited to the SEL 111 Programme Board and IUC Procurement Evaluation Panel.
All of the feedback received was incorporated into the revised service specification.
Two patients are now permanent members of our programme board. They sat on the SEL IUC Procurement Evaluation Panel and contributed to the scoring of the written bids and the scoring of the bidders at the Objective Structure Clinical Examination (OSCE) day. They also took part in workshops to finalise the questions used in the procurement process. Training was provided to enable them to fully contribute to the procurement process.
During the mobilisation of the new service, the patients have sat on the SEL IUC Mobilisation Programme Board, the Alliance Leadership Team (responsible for building relationships between 111, the GP out of hours services and GP federations), the Clinical Advisory Group (responsible for agreeing patient pathways, standard operating procedures and clinical profiling of services on the Directory of Services) and the Communications and Engagement Group (responsible for informing stakeholders about the changing service).
The patient representatives will remain on our programme board as we move into the benefits realisation stage of the project. One of the patient representatives is also a permanent member of the SEL IUC Clinical Governance Group.
The patient representatives, Paul Brown and Moh Okrekson, said: “We have served as public and patient voices on the 111 Programme Board (since re-designated the Integrated Urgent Care Programme Board) in our capacity as members of the Our Healthier South East London Public and Patient Advisory Committee.
"We were fully involved in the development of the new enhanced NHS 111 integrated urgent care service (IUC) for SE London and in the procurement which awarded the contract to the London Ambulance Service. Since then, we have continued to be involved in the mobilisation of the new service. We have been impressed with the transparency of the process and the willingness of clinicians and managers involved to answer our questions and take our views into account. We have felt part of the team.
"We hope and believe that the IUC service now launched will see many more patients given health advice by clinicians or booked directly into an appropriate NHS service. It will serve patients better and ensure that people get the right care at the right place for their needs and therefore make better use of resources.”