Enfield CCG’s Annual Report

on its Legal Duty to involve Patients and

Public in Commissioning for

1 April 2015-31 March 2016

Final Version

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Contents 1.0 Introduction ..................................................................................................................................... 3

2.0 About Enfield CCG ........................................................................................................................ 3

2.1 About Enfield .......................................................................................................................... 4

2.2 Vision for Engagement ................................................................................................ 5

2.3 Structure and Resources ............................................................................................. 6

3.0 Developing the Infrastructure for Engagement and Participation (processes and

networks) Collective Participation ...................................................................................................... 8

3.1 Engagement Processes and Networks in place ........................................................... 8

3.2 PPG network ............................................................................................................. 10

3.3 Structures .................................................................................................................. 10

3.4 Partnerships .............................................................................................................. 11

4.0 Meeting the collective duty for Engagement & Participation Activity ................................... 12

4.1 Integrated NHS 111/OOH Services procurement ....................................................... 12

4.2 Improving Ophthalmology Services ........................................................................... 13

4.3 Safeguarding Conference – July 2015 ....................................................................... 14

4.4 For Third sector engagement in mental health: .......................................................... 14

4.5 Young Minds training ................................................................................................. 14

4.6 Stronger links with the Voluntary and Community Groups: ........................................ 15

4.6.1 Enfield Strategic Partnership’s Voluntary Sector Strategy Group ............................ 15

4.6.2 Enfield CCG Community and Stakeholder Reference Group .................................. 16

4.7 Learning from the yearly 360 Degree Stakeholder survey carried out by Ipsos Mori for

NHS England ................................................................................................................... 16

4.8 Further engagement .................................................................................................. 17

5.0 Meeting the Individual Participation Duty ................................................................................. 17

5.1 Supporting the self-care agenda ................................................................................ 19

5.1.1 Choose well Campaign ........................................................................................... 19

5.1.2 Stay well this winter ................................................................................................ 20

5.1.3 Other information provided to support the self-care agenda .................................... 20

5.2 Developing a new neuro-navigator post ..................................................................... 21

5.3 Patient feedback - Continuing Healthcare and Personal Health Budgets ................... 21

5.4 Care Plans- Integrated Care for Older People ........................................................... 22

5.5 Integrated Learning Disabilities Service ..................................................................... 25

5.6 Working with providers to deliver individual participation ........................................... 26

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5.7 Meeting the collective and individual participation duties: Recruiting an elected Patient

Participation Group Representative to our Governing Body ............................................. 26

5.8 Elected PPG Representative Statement .................................................................... 28

5.9 Meeting the collective and individual participation duty – Consulting on changes to

gluten-free prescribing ..................................................................................................... 29

6.0 Forward Plans for 2016-2017 .................................................................................................... 30

7.0 Healthwatch Statement ............................................................................................................... 31

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1.0 Introduction We are pleased to present our third Annual Patient and Public Engagement Report,

now called Enfield Clinical Commissioning Group’s Annual Report on its legal Duty

to involve Patients and the Public in Commissioning. This report describes how we

discharged our statutory responsibilities for patient and public participation during the

period 1 April 2015-31 March 2016 as described in the Health and Social Care Act

2012.

2.0 About Enfield CCG

NHS Enfield Clinical Commissioning Group (CCG) is a GP-led organisation that is

responsible for purchasing most of the healthcare services for residents of the

London Borough of Enfield. Enfield is a north London borough that is one of the

largest in terms of size (31 square miles) and the fourth largest in terms of population

(324,574 Office of National Statistics mid-year 2014 population estimate) amongst

the thirty-three London boroughs.

Our role is to plan, buy (commission), and monitor the quality of health services for

local people. We are committed to working together with residents and other local

stakeholders to improve the quality of local services and the health and wellbeing of

our community.

We commission services from three main local providers:

Royal Free London NHS Foundation Trust (including Barnet and Chase Farm

Hospitals* Enfield CCG is the lead commissioner for the Chase Farm site).

North Middlesex University Hospital

Barnet, Enfield and Haringey Mental Health Trust (including Enfield

Community services). We are lead commissioner for this Trust.

We also hold NHS contracts with a range of other acute, community and mental

health providers, which enables our local population to have a choice in delivery of

services.

We work closely with the four other CCGs in North Central London that is Barnet,

Camden, Haringey and Islington, to plan and improve services together where there

are benefits across a larger population. This includes delivering stakeholder

engagement together where appropriate such as the integrated 111 and out-of-hours

service.

In January 2016 local health and social care systems across England came together

to form 44 Strategic Transformation Plan (STP) “footprints”. These STP footprints will

plan future services based on the needs of local populations and support changes to

local services to make these more sustainable over the next five years. These plans

will ultimately deliver the Five Year Forward View vision of better health, better

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patient care and improved NHS efficiency. Our STP planning footprint is North

Central London so Enfield CCG has continued to work closely with neighbouring

CCGs as well as joining up with local Councils and NHS providers to develop plans

that we will start to engage on in 2016/17.

2.1 About Enfield

Over recent years the population of Enfield has been steadily growing. During this

year, we commissioned services for a resident population of around 324,574. Over

the next decade the population is predicted to steadily increase reaching 330,000 by

2018 and 340,000 by 2023. Between 2015 and 2023 the predicted population rise is

5% and by 2032 there will be a population rise of 10%. The predicted population

increase is partially due to:

new housing developments

population migration from other London boroughs

international migration

The population and in-migration trends are significantly changing the demographic

profile and diversity of the borough. The 2015 School Census shows the changing

nature of the population as Enfield pupils are from 22 ethnic groups. This census

shows that for pupils resident in Enfield and those attending Enfield maintained

schools, the proportion of white British pupils was 22.75% with other white groups at

25.39%, other ethnic groups were 15.88%, mixed groups at 10.01% and black

groups at 25.7%.

Enfield has a large population of 0-14 year olds and older people in comparison to the rest of London. Enfield’s population is also changing in terms of age. Age groups 55-59 and 85+ are rising the most at an average of 3.79% and 3.73% per annum respectively. 20-24 age-group and 45-49 age-groups are predicted to be shrinking by an average of -0.47% and -0.71% per annum (ONS).The proportion of under 15s (21.2%) is higher than both England (17.7%) and London (19%) averages. Enfield is a borough with a significant level of high deprivation. Enfield has the highest number (23,210) of children living in poverty within London. It is the 14th most deprived borough of the 32 London boroughs and the 64th most deprived local authority district in England out of 326. 25.5% of children under 16 years are in low-income families, which is the eleventh highest of all London boroughs. The three Edmonton wards, in the South East, are all within the most deprived 10% of wards in England, whilst 12 of Enfield’s twenty-one wards are in the most deprived 25% of wards in England. The population is also growing faster in the deprived wards. Overall, the proportion of Enfield’s population who are living within the most deprived 10% of areas throughout the country as a whole has increased from 7.0% to 10.3%. The financial challenge faced by organisations across the NHS is how to spend their budgets in a way that improves the health and wellbeing of the whole population while ensuring that services meet the needs of individuals and deliver value for

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money. Enfield CCG is a financially challenged CCG under legal directions as of August 2015 and the CCG was placed in special measures in 2016/17. Last year we invested £394.9 million buying health services for people living in Enfield. With a growing population, rising demand for services and a financial deficit the CCG, like other NHS organisations, has to evaluate every service it commissions. At the end of the financial year 2015/16 we reported a cumulative deficit of £33.4m. This was planned for and agreed with NHS England at the beginning of the year.

2.2 Vision for Engagement

Enfield CCG’s corporate objectives are determined by the health and wellbeing

needs of our local population. Our corporate vision states: “We are committed to

commissioning services that improve the health and wellbeing of the residents

of Enfield borough through securing of sustainable whole systems care.”

Enfield CCG recognises that engagement is one of the key enablers to deliver this vision. We will do this by:

Working in partnership with individuals and patient groups to ensure they are central to our work.

Working in an open and transparent way with our public and partners.

The Communications and Engagement Team plays a strategic role in helping to

ensure our organisation delivers high quality communications and to support

engagement being embedded across all our work.

We know that to achieve the very best health for local people, we need to listen, understand and hear what they are saying about their needs and their current experience of local services and reflect that feedback in all that we do to improve services. We also want to ensure that the services we commission are fair, equitable and do not disadvantage particular communities or groups. Our vision for engagement describes the principles of how we will deliver the

statutory collective and individual participation duties in the Health and Social Care

Act 2012.

“We are committed to delivering the highest standards of communications and

engagement and putting the patient voice at the centre of our organisation.

At every stage of our commissioning cycle we will work to ensure that the

services we plan, buy and monitor are all coordinated and tailored to the

individual needs and preferences of patients, their families and carers -

delivering a patient centred NHS.

We are committed to an open and active dialogue with our community. We will

always be honest about the challenges we face and ask patients, partners and

our stakeholders to help us find the best way to improve local health services

and get better value for money.

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We aspire to develop more creative and innovative methods of engagement to

get our whole community involved in the NHS and improving their health and

wellbeing.”

We also use The Consultation’s Institute’s definition of consultation to define the

principles of how we will deliver our statutory requirements to consult under the

Health and Social Care Act 2012.

“Consultation is the dynamic process of dialogue between individuals or

groups, based upon a genuine exchange of views with the objective of

influencing decisions, policies or programmes of action.”

2.3 Structure and Resources

During the year 2015/2016 Enfield CCG directly employed an in-house

Communications and Engagement Team. This Team provides comprehensive in-

house internal and external communications and engagement services for Enfield

CCG as well as strategic and professional advice to the organisation on

communications, engagement, media, reputation management and public affairs.

During the year 2015-16 the Head of Communications and Engagement reported

directly to the Director of Quality and Integrated Governance, whose portfolio also

includes: quality, governance, safeguarding and patient experience. Our team works

to the principles described on pages 10-11 of our Communications and Engagement

Strategy.

Following a review of the Service Level Agreement (SLA) with our North East

London (NEL) Commissioning Support Unit the following service lines were

decommissioned from January 2015: public affairs, media management (including

out of hours), strategic communications, marketing and reputation management.

Operationally, most parts of the standard operating procedures for these services

were already being delivered in-house. The decommissioning released some

savings which were planned to be partially reinvested this financial year in the

Communications and Engagement

Assistant

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creation of a new post – a Communications and Engagement Assistant. The post

was recruited to in September 2015 and reports to the Communications Manager.

The communications and engagement activities that are delivered annually in line

with constitutional requirements are three GP membership and three Patient and

Public Engagement events along with a limited number of other events and activities

(e.g. Patient Participation Group network meetings). These are still funded via a

small non-pay budget managed by the Head of Communications and Engagement.

Bespoke communications and engagement activities that support commissioning

programmes or projects are funded by the commissioner for that area through a

budget line approved in the Project Management Office (PMO).

Enfield CCG continued to commission smaller bespoke support service from NEL

CSU in 2015/16 which delivered the following services:

Management of Freedom of Information requests, which formed part of the

CSU’s new core offer

Web technical support and hosting of the CCG’s website as this offers value

for money and a service that cannot be delivered in-house.

Joint Health Overview and Scrutiny Committee (JHOSC) support in

recognition of the fact that this committee reviews work programmes

undertaken by one or more CCGs and therefore is best delivered at scale.

Additional services purchased from NEL CSU with SLAs

Equality and Diversity service – This was originally commissioned as a

specialist service line from communications and engagement and remains a

separate contract. This service provides specialist knowledge and operational

capacity that is unavailable in-house. This service was therefore

recommissioned in 2015/16

An SLA was set up with NEL CSU to deliver communications and

engagement on proposals to commission an integrated 111 and Out-of-Hours

service when the current contracts come to an end. This programme of work

is led strategically by Enfield CCG as the lead commissioner for the

procurement across North Central London. This need for additional resources

recognises that the communications and engagement function supports large

programmes of strategic change. Increasingly we are undertaking

communications and engagement with other CCGs and partners. It also

demonstrates the importance of consistent communications and engagement

activities across North Central London.

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3.0 Developing the Infrastructure for Engagement and Participation

(processes and networks) Collective Participation

3.1 Engagement Processes and Networks in place

Enfield CCG has an extensive list of stakeholders and takes a proactive approach to

networking to ensure that we keep everyone up-to-date on the CCG’s work and

enable them to get involved.

We run three corporate Patient and Public Engagement (PPE) events around our

commissioning cycle. These events are open to all our stakeholders and members of

the public. We provide BSL translators whenever our deaf community wish to attend

these events. We also accommodate any other needs as requested (e.g. large print

materials). The objective of these events is gathering feedback on our

commissioning plans, service developments and supporting quality improvements.

A report is prepared after every event based on clinician-led group work. The

attendees, who provide their details, become part our stakeholder network, receiving

regular email news and updates. Key outcomes from the PPE events this year have

included: improved patient information leaflets, improving the service specification for

integrated 111 and Out of Hours (OOH) services. Our PPE event reports can be

found on our website under Listening to You.

We work closely with patient groups and networks around service improvements

through a range of activities including workshops and steering groups, for example

patient involvement in the integrated 111/OOH procurement which was carried out

with the four other CCGs in North Central London (Barnet, Camden, Haringey and

Islington). Another example was the engagement and partnership working to deliver

Transforming Care for people with Learning Disabilities and/or Autism.

We also obtain patient experience through surveys which are used to support

service improvements such as the Urgent Care Review which ran from 19 February

– 3 April 2016. It was launched at the Over 50s Forum Winter Fair on Friday 19

February. Following feedback received at that event, the questionnaire was reviewed

and amended and then uploaded on the website and circulated to all stakeholders.

The Communications and Engagement Team supports the bi-monthly Governing

Body meetings which are attended by a number of members of the public. Written

questions can be submitted in advance. The public have an opportunity at both the

beginning and at the end of the meeting to engage with the Governing Body on

issues on the Agenda. The Team supports the delivery of written answers to any

questions asked, as well as hosting a tea and coffee session with the public before

the meeting. The Governing Body meetings are an important way for the public to be

kept up-to-date on the work of the CCG and the organisation welcomes participation

in these meetings.

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We hold an Annual General Meeting (AGM) at which we present our Annual Report

and Accounts. Our Constitution requires that we have attendance from our GP

membership to approve the Annual Report and Accounts. We also advertise the

event to the public and send invitations to our stakeholders. The format for our AGM

is presentation led and reflects the contents of the Annual Report and Accounts. It is

also an opportunity to provide details on future commissioning plans. This year we

held a question and answer session for the public on our challenges and future

plans.

We held patient events during 2015/16 which focused on particular projects or key

work programmes including integrated care and service redesign. These workshop

style meetings enabled patients to hear about proposals at an early stage and to

comment on the emerging plans. They also offered an opportunity for expert patients

to become more involved in long-term projects, taking the plans forward by sitting on

steering groups and by acting in an advisory role.

Patients and Healthwatch Enfield were also involved in commenting on key

publications including: the Equality Information and our summary Annual Report and

Accounts and patient questionnaires for the Community Services improvement

programme.

Commissioners regularly undertake engagement as part of their work and embed the

feedback into service improvements. The Communications and Engagement Team

works with commissioners and project managers to design bespoke programmes of

communications and engagement using a corporate template. This ensures that a

stakeholder analysis is undertaken at the project initiation phase, key messages

developed, risks assessed and activities mapped to ensure delivery of the work

programme. Part of this specialist advice service involves testing the level of

engagement needed and whether a consultation needs to be planned into the project

timeline. Advice on Communications and Engagement at the beginning stages of the

project is complemented by an equality impact assessment (EIA) and Quality Impact

Assessment (QIA). All three documents are reviewed as the projects progress.

This also ensures that projects utilise the existing engagement structures such as

weekly e-newsletters to GP member practices and staff, our website, Smart Survey

and stakeholder e-bulletins, intranet and Twitter. It also ensures that managers

understand that activities and outcomes must be recorded to provide assurance to

the PPE Committee. We also share updates from our partners such as NHS

England.

The annotated commissioning cycle diagram (Appendix A) underpins our planning for our key corporate events, which happen at specific points during the year. We use “You Said, We Did” feedback to show how we have used the comments given at each PPE event to shape our projects and influence our future strategy.

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Our website, intranet and Twitter are key communications channels. We have over

2,000 followers on Twitter since starting our account on 1 April 2013. Our followers

include key stakeholders such as providers, partners, local MPs, councils and

voluntary sector partners as well as members of the public. We use Twitter to

promote our organisation but we also retweet information from other organisations

when they have news, healthy lifestyle information or campaigns that we feel would

benefit our patients. We regularly review our website and intranet statistics for

trends. We use e-communications channels to have an active dialogue with harder-

to-reach communities such as the young and working adults. For example, the

Patient Experience Tracker project which purchased tablets for practices allows

people to complete a questionnaire giving real-time feedback on patient experience.

We also use Smart Survey to create online surveys and are planning to expand the

use of this as other features are added to this product.

3.2 Patient Participation Group network

We host a network for our GP member practices’ Patient and Participation Groups

(PPGs). During this year PPG members elected a PPG representative to Chair the

network and to sit on the Governing Body. This network had previously been chaired

by two interim PPG representatives. The Network sets their own agendas, agree

their speakers and develop their own work plan. These meetings are organised and

administered by the Communications and Engagement Team. The PPG network

Chair also sits on the PPE Committee and provides reports on issues that arise at

these meetings. PPG members have their own email on the CCG website where

queries and concerns can be raised. Outcomes from this year have included: PPGs

advising the CCG on the election process, practices getting involved in the election

and inviting guest speakers including NHS England. Further information is provided

in sections 5.8 and 5.9.

3.3 Structures

In our first two years as a CCG our priority was to establish and embed the engagement structures that were laid out in our Constitution. Enfield CCG adapted the model CCG Constitution to ensure that it reflected the needs of our local population. The Communications and Engagement team ensure that structures are in place to support engagement work and that activities are planned, monitored and outcomes reported. Examples of this approach include: developing communications and engagement plans for Transformation programmes, recruiting volunteer representatives for service improvements e.g. ophthalmology and keeping the engagement log updated. We have developed a governance process for shared decision making enabling local GPs and their patients to have a voice in our organisation. Our Patient and Public Engagement (PPE) Committee was formally established in April 2013 and is one of five sub-committees of the Governing Body. The PPE

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Committee meets bi-monthly and has a strategic role in developing patient engagement and participation across the CCG as well as monitoring equality and diversity. The terms of reference for the PPE Committee are available on our website. The PPE Committee is chaired by the Governing Body Lay Member for PPE and members this year included two other Governing Body members – the Director of Quality and Integrated Governance and the Governing Body Practice Manager Representative as well as PPG representatives, the Head of Communications and Engagement, PPE Manager along with representatives from Public Health and Healthwatch Enfield. Two interim patient participation group representatives also sat on this committee for the early part of this year. During this year the PPE Committee completed the process of recruiting the elected PPG representative after receiving delegated responsibility from the Governing Body. In September 2015, the elected PPG representative took her seat on the committee. It also discharged other key functions in line with its terms of reference such as: reviewing work programmes against participation duties, the publishing of Equality Information and advising on key partnership work such as engagement for the Better Care Fund.

Schematic Structure of feedback in Enfield CCG

3.4 Partnerships

Locally we have a vibrant and engaged population and we are committed to hearing

people’s views on the NHS and how we can improve it. At Enfield CCG we continue

to build partnerships with our local stakeholders as evidenced by our 360

stakeholder survey results for 2015 commissioned by NHS England. We developed

an action plan based on this year’s feedback to enable us to respond proactively to

the comments in the report. Further information is provided in section 4.7.

One of the key actions we took this year was to set up a Voluntary and Community

Stakeholder Reference Group. This new group, set up in September 2015, is made

up of local umbrella organisations that match the nine equality groups(protected

CCG Governing Body

Patient & Public Engagement Committee Patient

Participation

Groups Network

Equality Delivery System 2

Task and Finish group Groups

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characteristics) as defined by the Equality Act i.e. age, disability, gender

reassignment, marriage and civil partnership, pregnancy and maternity, race, religion

or belief including lack of belief, gender and sexual orientation This has enabled

these key stakeholders to get more involved in the work of the CCG and our

commissioning improvements.

We work closely with key partners including Enfield Council and local NHS providers

to improve local health and social care services and to ensure the long-term

sustainability of our health economy. This year we have continued to work with

Enfield Council on the Better Care Fund; on delivering the Joint Health and

Wellbeing Strategy, Joint Strategic Needs Assessment and developing joint plans for

integrated care.

We have continued to work in close partnership with the other four NCL CCGs

(Barnet, Camden, Haringey and Islington) to develop our strategic plans for

transformation and planning improvements for when there are benefits across a

larger population.

We took on larger joint co-commissioning primary care with the other NCL CCGs in

partnership with NHS England on 1st October 2015. We set up a Joint Primary Care

Commissioning Committee which meets in public. Another example of this

partnership engagement work across NCL is the joint commissioning plans for 111

and out of hours service under which a patient reference group was set up to

contribute to the service specification. Members of this patient reference group also

took part in the procurement process.

4.0 Meeting the collective duty for Engagement & Participation

Activity

Enfield CCG regularly undertakes activities to meet the collective engagement duty.

This duty places a requirement on CCGs to ensure public involvement and

consultation in commissioning processes and decisions. It includes involvement of

the public, patients and carers in:

planning of commissioning arrangements which might include consideration of

allocation of resources needs assessments and service specifications.

proposed changes to services which may impact on patients.

In this section, we will focus on examples that show how we have delivered the

collective duty across a number of key areas.

4.1 Integrated NHS 111/OOH Services procurement

During 2014/15 we began engagement on a major procurement for integrated NHS 111 and Out of Hours Services across North Central London. Enfield CCG works in line with our local Procurement Policy, which requires patient involvement and

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utilises specialist support from the procurement team at North and East London Commissioning Support Unit (NEL CSU). Nationally and locally, NHS procurement exercises can cause anxiety for local stakeholder groups who are concerned about privatisation. When the procurement exercise was announced, Keep Our NHS Public Groups in Camden and Haringey were vocal with their concerns. Both services originally had been commissioned separately – NHS 111 across five boroughs and GP OOH services for Barnet, Enfield and Haringey in isolation from Camden and Islington. Local commissioners had analysed the pattern of usage for both services. GP OOH services are only accessible through NHS 111. Commissioners were able to analyse when and where patients were accessing services and for what conditions. Data showed that patients often accessed services away from home but in the North Central London area. This, along with further analysis showing the types of illness and injuries people contacted NHS 111 about provided information to the commissioners about the improvements that could be made to the quality of services being delivered. By integrating services, the OOH service could work together with NHS 111 ensuring more clinical support and faster access to appointments. Other improvements planned during this procurement exercise included adding more pharmacy support and more support from specialist nursing e.g. contraceptive advice. We invited all the groups who had expressed concerns about the procurement to join a stakeholder reference group. This was an opportunity to discuss their concerns and to get patients and their representatives involved in developing the service specification. The group, which included representatives from all boroughs, positively contributed to the service specification ensuring that quality and patient experience was at the heart of the improvements. The group also nominated representatives onto the procurement panel where they took an active role in reviewing bids and scoring and questioning potential providers. The results of the procurement panel’s decision was announced in April 2016. All the patients involved in the stakeholder reference group were supportive of the decision.

4.2 Improving Ophthalmology Services

We continued to work closely with Enfield Vision and other local experts to improve

ophthalmology services for patients. Local commissioners took part in a group set up

by the Thomas Pocklington Trust along with Enfield Vision, Healthwatch, Enfield

Council, Enfield Homes and other key stakeholders to discuss improvements we

could make to local services. We also held two workshop groups, facilitated by the

Head of Communications and Engagement which discussed improving the services

that the CCG commissions. A patient representative was recruited to take part in

these workshops. Outcomes included; clinical guidance has been improved, which

has led to better quality services being delivered by each provider and improved

patient outcomes.

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4.3 Safeguarding Conference – July 2015

We organised a Safeguarding Conference that was attended by 146 delegates. The

conference was chaired by NHS England and our safeguarding team invited experts

to present on a variety of topics that affect both adults and children. Topics covered

included the national Prevent strategy, child exploitation and female genital

mutilation (FGM). Delegates included local GPs, nurses, social services and

voluntary sector groups that are all directly involved in delivering care to patients.

While this conference was delivered to professionals, the objective was to ensure

that staff and community representatives can care better for our community. The

conference received overwhelmingly positive feedback. See Appendix B for more

details.

4.4 Voluntary organisations engagement in mental health:

We are members of the Enfield Voluntary Partnership Board chaired by London

Borough of Enfield, which includes all mental health organisations and healthwatch.

The Board meets to share and explore where voluntary organisations can make a

difference and to give details of what each other are doing.

We commission Nafsiyat, a voluntary organisation for additional Improving Access to

Psychologist Therapy (IAPT) treatments for difficult to reach ethnic groups as they

are multi-lingual, for example Turkish, Somali and Eritrean.

Enfield Mental Health Users (EMU), in collaboration with Enfield CCG and the

London Borough of Enfield, organised some mental health service user and carer

conferences/workshops in 2015/2016. The first EMU Service User Engagement

Conference was held on 4 September 2015 when 120 people attended. There was

also a Mental Service User Conference on 10 October 2015 about Mental Health

First Aid- Tips and Strategies to protect your mental and physical well-being. See

Appendix C & C1 for the EMU Service User Engagement Conference Report and the

agenda for Mental Health First Aid workshop. The second mental health service

user and carer conference was about suicide prevention and was held in April 2016.

EMU and Enfield MIND are standing members of our IAPT service improvement

committee. They represent the voice of service users and service users via EMU

were involved in the re-designing of the IAPT leaflet.

See Appendix D for details of the voluntary and community contracts monitoring list.

4.5 Young Minds training

Enfield CCG is the lead commissioner for Barnet, Enfield and Haringey Mental

Health Trust. We are aware of the impact that mental health problems have on our

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community. This is a particular concern of local people who regularly feedback that

they wish to see mental health high on the CCG’s agenda. This year we

commissioned Young Minds to provide training for our community focused Child and

Adolescent Mental Health Services (CAMHS). The training was free and aimed at

improving the skills of people who regularly interact with young people e.g. faith

groups and other community groups. This training also supported the delivery of the

Joint CAMHS strategy, which was developed with patient and community group

feedback. More detail is provided as an Appendix E.

4.6 Stronger links with Voluntary and Community Groups:

4.6.1 Enfield Strategic Partnership’s Voluntary Sector Strategy Group We are a member of multi-agency Enfield Strategic Partnership’s Voluntary Sector Strategy Group (VSSG), which provides the mechanism for strategic consultation and partnership working between the Enfield Strategic Partnership (ESP) and the Enfield Voluntary and Community Sector (VCS). VSSG members commit to the principles of the Enfield Compact, which is a local agreement that sets out the principles for positive partnership working across the statutory, voluntary and community sectors within a spirit of mutual respect and partnership. The aim of the Enfield Compact is to help create new ways of working together for the benefit of those who live, work, study and do business in Enfield. The terms of reference and membership list for Enfield Strategic Partnership’s VSSG are attached at Appendices G and H. Through the role of the VSSG, Enfield CCG and the Council have been working with the voluntary sector on re-shaping the role of the sector in helping deliver care and support in Enfield in light of the requirements of the Care Act, and plan to accelerate 2016/2017 progress. An invite for one of the collaborative events is attached- Appendix I (NB: Although this refers to the “role of Enfield Council”, the CCG was equally involved as the topics show). A key area for improvement recognised by all parties was to develop better relationships between health professionals on the ground, including GP practices, and the voluntary sector. Part of the re-shaping the CCG and Council want to promote, relates to development of VCS community navigators operating in GP localities to provide information, advice and support to individuals working closely with multi-disciplinary, multi-agency professionals. As part of this collaboration, the CCG (and its social and health care partners) worked with a voluntary sector partnership including Age UK Enfield, Enfield Community Transport, Enfield Asian Welfare Association, Greek & Greek Cypriot Community and Over 50s Forum to develop Phase 1 of a longer-term voluntary sector hub which will operate in health facilities, including GP surgeries. Phase I is currently being mobilised. It is a pilot looking at how the voluntary sector could become part of integrated multi-disciplinary teams working to support

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individuals. This is looking at two specific areas, which were identified as being areas of particular improvement by partners, including the voluntary sector representatives in their role in the Integrated Care Programme:

Post-diagnostic support for people with dementia;

Falls Prevention.

Phase II (2016/17) will extend the role of the voluntary sector in other areas of

primary and secondary prevention through a similar navigation model, but for a wider

number of issues than Phase I – priorities to be decided in dialogue with the sector

4.6.2 Enfield CCG Community and Stakeholder Reference Group

Enfield CCG set-up the Community and Stakeholder Reference Group in September 2015 to respond to the comments made in the 360 degree stakeholder survey 2015 concerning involving patient representatives on a regular basis with commissioning.

The CCG, following discussions with Enfield Council colleagues, agreed to select the members of the group to represent the nine protected characteristics under the Equality and Diversity Act. We wrote to the umbrella organisations that represent these groups to invite them to join. The group currently meets four times a year.

The group’s purpose is to provide the patient, service user and public perspective, as articulated by voluntary and community sector representatives on the development, planning, implementation and evaluation (success and challenges) of health services commissioned by Enfield CCG. The Terms of Reference for the Enfield CCG’s Voluntary and Community Stakeholder Reference Group is Appendix J.

The group has received updates on key pieces of work that the CCG is undertaking

including the development of the commissioning intentions and primary care

developments. The group is chaired by the Head of Communications and

Engagement and the agenda is set in agreement with all members, who often

request updates on key areas of interest. Outcomes during this year included

improving the way we collectively involve patients in our commissioning plans

through the involvement of umbrella organisations who brief their networks.

The Head of Communications and Engagement was the guest speaker at Enfield

Voluntary Action’s (EVA) AGM- Presentation, which is Appendix K. This was to

ensure that the wider voluntary and community groups were aware of this new

stakeholder group and to give them an opportunity to comment

4.7 Learning from the yearly 360 Degree Stakeholder survey carried

out by Ipsos Mori for NHS England

Following the receipt of the 2015 360 degree survey, we reviewed and developed a

targeted action plan, details of which are provided in Appendix L.

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4.8 Further engagement

This year, some of the examples of how we have met our collective participation duty

include:

Delivering the cycle of corporate events described in our Constitution that is: 6 Governing Body meetings in public and three patient and public engagement (PPE) events.

Members of the public are invited to submit written questions to the Governing Body before each meeting. Responses to these questions are provided before the meeting. The public are able to confirm if they wish to discuss the responses received further.

We plan three PPE events to ensure early engagement opportunities on any of the commissioning services changes being considered. We issue a feedback form at every event and we encourage the public to suggest future agenda items. This year mental health and primary care developments were the most popular requests. Following public feedback these events are clinician led with short presentations and round table discussions.

We visit hard to reach groups to talk to them about the CCG, work being undertaken and to find out more about their needs. This year one of the groups we visited was the Deaf Forum, when the CCG gained a better understanding of barriers to access for deaf patients. We have used this feedback to work with NHS England and member practices to improve access to translation services.

We provide speakers on request for partner or voluntary sector events. This year our GPs and Governing Body members visited events such as Enfield Racial Equality Council’s Annual General Meeting and the Over 50s Forum.

Planning and delivering joint events with Enfield Council and NHS England including a Safeguarding conference.

There are many more examples in Appendix M, which is our corporate engagement

log.

5.0 Meeting the Individual Participation Duty

This duty requires CCGs to:

ensure they commission services which promote the involvement of patients

across the full spectrum of services.

Ensure collaboration between patients, carers and professionals, recognising

the expertise and contribution made by all.

We are committed to redesigning and commissioning services that enable patients to

take control of their health through individual participation in their care planning. We

want patients to be in control of their health and support them to achieve outcomes

that improve their wellbeing. This section provides some examples of how we met

the individual participation duty this year.

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The CCG has clear responsibilities in relation to commissioning for quality, informed

by the NHS Constitution (2011):

To ensure that services we commission are safe, effective, provide good patient experience and continuously improve

To secure health services that are provided in an integrated way, working in partnership with the Local Authority

To actively seek patient feedback on health services and engage with all sections of the population with the intention of improving services

As a membership organisation, working with NHS England, to support primary medical and pharmacy services to deliver high quality primary care

Appendix N describes how we monitor quality and the individual participation duty

delivered through providers during the commissioning cycle.

The key ways we monitor our contracts and services locally across the three quality

domains are:

• Our early warnings system – designed for reporting concerns from our GP members based on feedback from their patients. This system has been adopted by other CCGs.

• Providers send us patient experience reports that are discussed at the Clinical Quality Review Groups (CQRQ).

• Equality Impact Assessments of any planned change to services are reviewed to check that no community is being unfairly disadvantaged.

• Our patient enquiries service and our communications inbox and telephone numbers, often receive comments, complaints and concerns which we investigate, respond to and record.

• Feedback from Healthwatch Enfield • Monitoring Twitter. We have a standard response for complaints and feedback

received. • Collecting feedback directly from patient groups • Monitoring feedback on national websites such as NHS Choices, Patient

Opinion and other public comments • Viewing feedback from patient forums such as the Maternity Services Liaison

Committee (MSLC), the North Middlesex University Hospital Focus Group, Parent and Young People Participation Group.

• Evaluation of services we have commissioned such as the GP urgent access pilot.

Key outcomes included: • The early warning quality alerts received that were a result of patient feedback

to the GP. Themes and trends are reported to the CCG Clinical Reference Group and escalated to the Governing Body as necessary through the Quality and Safety Report.

• The views of patients have led to improvements such as: improving patient information leaflets and expanding service specifications.

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• Improved quality of care from individual providers. For example, the Care Home Assessment Team (CHAT) has continued with a number of care homes to improve the standard and quality of nursing care.

• Barnet, Enfield and Haringey Mental Health Trust (BEH MHT) Care Homes Assessment Team works closely with LBE’s and Enfield CCG’s Safeguarding Teams and Enfield’s safeguarding procedures (which include CQC involvement) to identify and address any provider concerns

• Quality issues identified or raised during via the quality alerts process go to the quality meeting for the contracts the CCG manages.

• More partnership working with Trust Development Authority, Care Quality Commission, and NHS England on quality issues.

5.1 Supporting the self-care agenda

5.1.1 Choose well Campaign

From April 2015 – October 2015, Barnet, Enfield and Haringey CCGs continued to

run the Choose Well campaign which started in December 2013. The Choose Well

North London app was part of a wider campaign by Barnet, Enfield and Haringey

aimed at relieving pressure on hospitals’ Accident and Emergency (A&E)

departments and highlighting the range of other local NHS services that are

available. Widely publicised information was available on CCGs’ websites and

leaflets.

The App was developed and promoted to help people decide what service they need

and where to go to get it. The names, locations and opening hours of every

pharmacy, GP surgery, walk-in and urgent care centre and hospital A&E in Barnet,

Enfield and Haringey was included on the App along with a locator map showing

where the nearest service was. The App was free and available to Apple and

Android users. It was also available in four languages – English, Turkish, Polish and

Somali – the App also included a game users could play to familiarise themselves

with NHS services.

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5.1.2 Stay well this winter

We supported the National Stay well this winter campaign which ran from November 2015 – March 2016. This campaign particularly targeted those people aged over 65 or older and people with long term conditions. It provided information about the flu jab, keeping warm; getting advice from pharmacists; what medications were needed in people’s medicine cabinets at home; taking medication as prescribed and looking out for others. The information was held on our website and was communicated via stakeholder lists and social media. Leaflets were provided at all events organised by CCG staff, including the PPG Network meetings as well events that CCG staff attended; leaflets were also sent to all GP practices for patients to be able to pick up.

5.1.3 Other information provided to support the self-care agenda

The Communications and Engagement Team provided information on a variety of issues from a variety of sources at all of the events or meetings attended e.g.

Choosing the right treatment- Choose well or stay well this winter leaflets

NHS call 111 leaflet

Improving Access to Psychological Therapies- Let’s Talk leaflets and cards co-produced by Barnet, Enfield and Haringey Mental Health Trust and Whittington Health

NHS Enfield CCG – Repeat Prescription? What you need to know Only order what you need

Age UK – Staying steady Keep active and reduce your risk of falling

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Minor Ailment Scheme

Get up and go - a guide to staying steady co- produced by Saga, in association with the Chartered Society of Physiotherapy and Public health England

Bowel Cancer Testing

Advanced Decision (Living Wills)

Preferred Priorities for Care Patient Information Leaflet A brief guide for patients

NHS England easy read Making health and social care information accessible Update July 2015- accessible information standard approved

NHS Complaints Advocacy

Promoting joining their own Patient Participation Group

5.2 Developing a new neuro-navigator post

During this year, we took a proactive approach to improving services for people who

have had a severe stroke or brain injury. Previously patients had received long-term

tertiary care but the transition to neuro-rehabilitation care in the community had been

more complex. Patients could access care and support from the neuro-rehab nurse

at the Royal Free Hospital, but we wanted to create a post based in Enfield to

improve local support to them.

The neuro-navigator coordinated a conference where patients and local stakeholders

including social services, nurses and patient groups come together and discuss the

current pathway and ways to improve it. Patients were represented by their carers

who had been through the pathway.

The feedback from the conference was used to:

to redesign the patient pathway

develop the job description for the neuro-navigator.

The outcome of this conference was that we were able to translate patient

experience into improving the pathway and the successful recruitment of a new

nurse who is based at the CCG and can directly assess and support patients and

carers.

5.3 Patient feedback - Continuing Healthcare and Personal Health

Budgets

This year we received very positive feedback in relation to our Continuing Healthcare

Service (CHC). Not all CCG’s have an in-house CHC team, but with Enfield’s ageing

local population, we place a high value on directly assessing and caring for our most

vulnerable residents.

This year we sent out 225 surveys asking patients and their carers who had been

through the CHC service what their experience was. The feedback was overall

positive and there were comments about the professionalism of staff that had

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conducted the reviews. The feedback from this survey was used to improve the CHC

services.

From 2 November 2015, the Continuing Healthcare Survey (CHC) went out both as

an online link and a hard copy with all continuing care decision letters. Responses

were collated and are included within the CCG’s performance reporting on a

quarterly basis.

The surveys are hosted by Quiq Solutions Ltd as part of the online NHS England

Continuing Healthcare Assurance Tool (CHAT). Enfield CCG is part of the pilot

project for this tool. The CHC patient survey template and the results to date are

given in Appendix O.

There were 35 individuals receiving all or part of their care through a personal health

budget in 2015/16; of these 24 were Continuing Healthcare funded, two were shared

funding with Enfield Council and the remainder were Mental Health funded.

The quarter one (April 2015-June 2015) Continuing Healthcare Funded Care Spend

and Activity benchmarking report (Somerset return) for Enfield showed that there

were 18 CHC Personal Health Budgets. This was the third highest number in London

region with only Greenwich & Kingston CCGs having more.

Personal health budgets are run either through the local authority direct payments

team or through our own brokers ‘My Support Broker’ and their payment

management arm ‘My Support Money’.

5.4 Care Plans- Integrated Care for Older People

The aim of the Integrated Care for Older People Programme is to provide better coordinated, holistic health and social care services for older people with frailty, emphasising the need for a greater focus on prevention, early identification and coordination of assessment, care planning & case management. Its objectives are to:

Identify people as early as possible;

Assess, care plan and provide interventions with patients to enable patients to be stabilised;

Ensure that the patient is at the heart of care planning & delivery;

Make system components act as a single system and include carers, as well as the voluntary sector;

Deliver care in the most appropriate setting;

Avoid unnecessary activity and costs incurred in the system to achieve long-term sustainability

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Interrelated component parts of the programme aim to work together to provide seamless, person centred and holistic services for Enfield’s older people who are frail or pre-frail. One of the pivotal components of the overall Programme is the delivery of Primary Care Management function in the integrated care network. GPs, as Lead Accountable Professionals, are at the heart of care planning and care delivery supported through 4 multi–disciplinary Integrated Locality Teams (ILTs) consisting of social care, community health and geriatricians. GPs and these teams develop and update joint care plan summaries as part of the requirements of NHS England’s Enhanced Service for People at High Risk of Unplanned Admissions (“Top 2%”). Our providers of our risk stratification intelligence provide information about the number of such plans agreed and an extract (for end Jul-15) is shown in the table below on page 22 (NB: Practices have been anonymised; all but two practices have signed up to the service). For the period 1st April 2015 – 31 March 2016, we provided the following care packages for:

562 Continuing HealthCare

492 funded nursing care

29 for other funded individuals

267 mental health individuals

This means that we funded a total of 1,350 care packages.

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Health and social care partners were also set to launch an updated Care Plan Summary as part of the further development of the ILTs for April 2016. The proposed Care Plan Summary template is Appendix P. This will be available to all health and social care partners in Enfield via the development of a Shared Record System scheduled for quarter one of 2016/17 (Partners include: GP practices, Barnet, Enfield and Haringey Mental Health Trust (which run Enfield Community Services), Enfield Council, North Middlesex University Hospital and Royal Free London Hospitals). This Shared Record System will have a professional and patient portal to be delivered in 2016/2017.

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5.5 Integrated Learning Disabilities Service

The Government and leading organisations across the health and care system are

committed to transforming care for people with learning disabilities and/or autism

who have a mental illness or whose behaviour challenges services.

The national plan, Building the Right Support that has been developed jointly by

NHS England, the Local Government Association and Association of Directors of

Adult Social Services is the next key milestone in the cross-system Transforming

Care Programme to reshape local community services to focus on personalisation,

health and wellbeing and prevent crisis. This is supported by a new Service Model

for commissioners across health and care that defines what good services should

look like. The plan builds on other transforming care work to strengthen individuals’

rights; through the roll out care and treatment reviews across England, to reduce

unnecessary hospital admissions and lengthy hospital stays; and test a new

competency framework for staff, to ensure we have the right skills in the right place.

NHS England, the London Borough of Enfield (Enfield Council) and the CCG are

committed to transforming care for people with a learning disability and/or autism

enabling people to live successfully in the community and move out of long term

hospital care. We are working together with North Central London to develop a high

level plan to transform care for children, young people and adults with a learning

disability and/or autism in line with Building the Right Support. A first draft of this

plan was submitted to NHS England in February; a final draft of our NCL plan was

submitted at the end of March 2016.

We are also committed to involving people with learning disabilities and / or autism,

families and carers in the development of services in response to delivering the New

Service Model. We are currently considering how we engage with people and their

carers to help us co-design our plans and services, with a range of stakeholders. As

we develop our plans, we will make them available on our website.

In Enfield we have established a community intervention service that focusses on

supporting people falling into crisis to remain healthy and well in the community. We

have seen a significant reduction in the number of community admissions to

hospitals.

In February 2016 there were a total of 6 people in Enfield with learning disability

and/or autism in hospitals or secure settings. There were 3 people receiving short

term assessment and treatment services funded directly by us. The 3 people were in

secure settings funded directly by NHS England. The excellent care being delivered

by the integration of these services to deliver was recognised by Jane Cummings,

Chief Nursing Officer, NHSE- Appendix Q.

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5.6 Working with providers to deliver individual participation

We work with providers using the levers provided by the standard NHS Contract and

other local quality indicators to continuously improve patient experience.

We undertake a wide range of activities both through contract management and

through governance as well as quality and safety measures to regularly monitor

provider data. We have a positive dialogue with providers about continuously

improving quality but we also vigorously challenge when we believe services could

be improved. Both Patient Experience Reports and Healthwatch’s Enter and View

reports are discussed at our Quality and Safety Committee meetings as well as the

relevant provider’s Clinical Quality Review Group (CQRG). Progress on the

recommendations made is monitored by the respective CQRGs. Our Quality and

Safety Committee also require assurance on the implementation of commissioner

recommendations for the provider trusts. Healthwatch Enfield is a member of our

Quality and Risk sub group which reports to the Quality and Safety Committee.

An example of improving the quality of care from individual providers is the local

Care Home Assessment Team (CHAT) team, which has worked directly with a

number of care homes to improve the standard and quality of nursing care in Enfield.

5.7 Meeting the collective and individual participation duties:

Recruiting an elected Patient Participation Group Representative to

our Governing Body

When our GPs designed our Constitution they embedded the values of patient and

public engagement in the governance of our organisation by having a co-opted

elected representative from member Patient Participation Groups as a non-voting

member of the Governing Body.

By June 2014 all our member practices had PPGs. Practice Managers were

supported by our Governing Body Practice Manager lead. They were given a toolkit

to help setup and manage the group. During 2013/14 we recruited two interim PPG

representatives through an advert and interview process. The successful candidates

signed a one year voluntary contract and sat on the CCG’s Governing Body and

PPE Committee as well as helping us to start up our PPG network during 2015/2016.

Our PPG network met quarterly during 2014/15. PPG Chairs, PPG members,

practice managers and staff that support PPGs all attended this meeting. The

network was supported by NHS England engagement funding. Money was spent on

training for PPGs including: developing mission, vision, aims and objectives,

governing documents as well as sponsored membership of the National Association

of Patient Participation.

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During the year the PPG network shared good practice and strengthened their

working relationships with each other and their practices. Guest speakers presented

to the networks on topics of interest such as: primary care estates and Care.data. An

update on PPG network development was a standing item at both the Governing

Body and PPE Committees throughout the year.

During 2014/15 the PPE Committee planned for the recruitment of the elected PPG

Body representative. The Committee reviewed and updated the process used for

advertisement and selection of the interim PPG representatives. This included

revising the role description and voluntary agreement based on the learning of the

interim representatives as well as updating the recruitment pack. It was agreed that

the recruitment process would be an application form and interview before the

candidate was put forward for election. The PPE Committee also discussed a

proposed voting process for the PPGs.

The PPE Committee received delegated responsibility from the Governing Body in

November 2014 to proceed with the election. It was agreed by the PPE Committee

that the Electoral Reform Services would manage the process independently from

Enfield CCG, in line with other elected Governing Body posts. The election

recruitment pack, role descriptions and voluntary descriptions were all discussed

with the PPG network who were able to amend the documents and comment on the

process. The PPG network agreed that each PPG should get one vote and that

groups would meet to agree which candidate to vote for. The election process was

an online, first past the post system. Provision was made for postal votes if the

person asked to vote on behalf of their PPG did not have an email address.

Two candidates came forward for election from two different localities. Having

successfully completed the application process, each candidate was invited for

interview. The CCG invited two PPG representatives from other London boroughs to

sit on interview panel. The patient representatives gave an independent view to

Enfield CCG about the role. Following the interviews, both candidates were put

forward for election.

The majority of PPGs in Enfield took part in the election process and Electoral

Reform Services confirmed the appointment of Litsa Worrall. She took up her new

role as elected PPG representative in May 2015. The role is a three year

appointment in line with other elected Governing Body positions.

During this year, Litsa Worrall took over chairing the PPG network meeting. The

network still sets its own agenda and has developed its own work plan. The quarterly

network meetings are supported by the CCG Communications and Engagement

Team. Key areas that PPGs have focused on this year include:

reducing the number of do not attends at GP appointments

promoting health and wellbeing

promoting PPGs membership

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providing information about

- Electronic Prescribing

- On line booking

The number of patients attending the network has been steady, with a consistent

number and geographical spread of groups involved. This year, we have also

attracted new groups to the network.

The elected PPG representative attends the PPE Committee and the Governing

Body and gives direct patient feedback to both on issues raised at the PPG Network

meetings.

The network also appointed four patient champions representing each membership

locality. The champions will work within their localities to encourage groups to

develop. Not all membership practices are represented at the network meetings, so

the champions will be contacting each practice to encourage attendance. PPG

members have agreed that some of the work that happens at the network meetings

such as sharing best practice can also be delivered on a one-to-one basis with a

buddying approach. The locality champions’ role will continue to develop in 2016/20.

5.8 Elected PPG Representative Statement

This year we have asked the CCG’s elected representative to contribute to this

report. We would like to congratulate Litsa Worrall on her election as the CCG’s first

elected PPG representative and invite her to comment on her experience and plans

for the future.

‘I was very pleased to be elected by the Patient Participation Group in Enfield in May 2015 to be the PPG members’ voice on the Enfield CCG Governing Body as well as the Patient and Public Engagement Committee. I am proud to support the development of PPGs in Enfield by chairing the PPG quarterly network meetings. Our priorities in our first year have been:

Encouraging the PPGs attending the Network meetings

Developing an agreed workplan for 2015/2016 with the local PPGs groups

Encouraging the agreement of PPG Network to the recruiting of 4 Locality Champions

Communications between PPGs and Enfield CCG

Learning from good practice across PPGs In Enfield

Gaining the views of PPGs – use of Smart Survey

Development of a PPG logo

Implications for the Accessible Information Standards – how PPGs can help

Requesting speakers to attend to provide information and updates to PPG members e.g. Chief Officers of CCG, NHS England and Healthwatch

The PPG is looking forward in 2016/17 to working on:

further developing support for the PPGs Network

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reviewing and agreeing the workplan for 2016/2017

Developing a PPG leaflet

Agreeing and finalising Aims, Objectives for PPGs that could be used by all PPGs in Enfield

Requesting that NHS England attends to explain what are their expectations of PPGs and gain updates from CCG colleagues on ongoing developments

Continuing to share good practice

Developing the role of the Locality Champions’. Litsa Worrall Elected PPG Representative 8 October 2016

5.9 Meeting the collective and individual participation duty –

Consulting on changes to gluten-free prescribing

Enfield CCG is committed to consulting patients when we propose to make changes

to services. This year the CCG undertook its first consultation on changes to gluten-

free prescribing. The CCG wrote the local Health Scrutiny Workstream describing its

proposals and plans to consult local patients and stakeholders. The CCG took a

planned approach to proactively contacting stakeholders and affected patients. The

CCG received over 130 responses to the consultation, receiving responses from

approximately a quarter of the affected patient group. The CCG produced a report to

all the responses received. These were carefully analysed and the feedback was

reviewed by the Clinical Reference Group along with the Quality and Equality Impact

Assessments. The CCG agreed to recommend to GPs to stop gluten-free

prescribing. This decision enables the CCG to reinvest this money in funding

treatments for the benefit of more Enfield residents.

Lessons learnt from the first consultation included:

ensuring that the pre- engagement for any future consultations is as widely

publicised as possible

consider having an on-line survey for those people who were not in a position

to attend any public meetings

ensure that the time period of the consultation period is appropriate to the

changes in services being proposed following consultation with the local

Health Scrutiny Workstream

ensure that the consultation period is well advertised and consider using local

stakeholder networks more in publicising the consultation

consider whether a local voluntary or community organisation could run and

engagement events to help reach a wider audience

review and agree the areas to be covered in the final consultation report

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6.0 Forward Plans for 2016-2017

Although we are proud of what we have achieved in 2015/16, we know that we have

a lot more work to do to embed participation throughout the organisation. We also

need to continually review our methods of engagement to improve how we reach all

sections of our population.

Here are some of our forward action plans for improving and increasing participation

in 2016- 2017.

• Supporting the Enfield PPGs Network - We will support the PPGs network

to develop further now that the elected representative is in post. We will

continue to fund and facilitate four network meetings a year as well as provide

administrative support where possible.

Recruitment of more volunteers to support more involvement in the

Commissioning cycle- We will review the way we recruit and support our

volunteers. The Head of Communications and Engagement and the Patient

and Public Engagement Manager have attended specialist courses run by

Enfield Voluntary Action. Currently the Head of Communications and

Engagement meets regularly with the Elected PPG representative to discuss

what is needed by the PPGs and how the CCG can provide support. Those

volunteers who become involved with the service redesign projects are given

a role description and are supported by the commissioner.

Continuing the development of Voluntary and Community Stakeholder

group- In 2016/17, we will work with the members of the Voluntary and

Community Stakeholder Reference Group to agree what areas, they would

like to provide their feedback on to support the development of strategic

change programmes.

Promoting the Sustainability and Transformation Plan for North Central

London – This plan is currently in its early stage of development. During

2016/2017 we will work with the Programme Management Office

Communications and Engagement lead as well as our colleagues in Barnet,

Camden, Haringey and Islington CCGs to promote and inform patients, public

and our stakeholders about this plan

Working with other groups to support engagement on a variety of

issues- We know that it is difficult for us to reach to all the population of

Enfield, so we will look to asking our voluntary and community organisations

to deliver some engagement activity on our behalf as well as encouraging

groups to contact us for speakers at their events or meetings. This will help to

ensure that we gain views from some hard to reach groups.

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Supporting the self care agenda- working in collaboration with Haringey, we

will develop an information leaflet that provides details of local services

available while also supporting the national campaign Stay Well this Winter.

Development of the CCG’s strategy and commissioning plans- We will

continue use the three corporate Patient and Public Engagement events a

year to inform and support engagement on the development of the CCG’s

strategy and commissioning plans. We will also look at more ways that we

can increase engagement on these plans.

Engagement and Consultation- We continue to carry out targeted

engagement and consultation, where necessary. At the same time we will

review the processes currently in place to improve the delivery of both, so that

we can increase stakeholder involvement

Feedback development- We will continue to work on improving the feedback

we provide to our stakeholders by further developing more You said, We did

outcomes from engagement; improving the information on our website;

increasing the use of social media such as Twitter.

Learning from the yearly 360 Degree Stakeholder survey 2016 carried

out by Ipsos Mori for NHS England - How to take forward the results of the

360 degree stakeholder survey 2016 will be discussed and agreed by the

directors.

Making our Patient and Public Events more effective- Following the

request form the public that all events are GP-led, we will endeavour to

ensure that we have a GP lead, where possible, at events or meeting we are

asked to attend. We have also listened to views concerning venues for these

events and will ensure that we do not book those venues which our public do

not like.

Developing skills and competencies of CCG staff- We will continue to

invest in corporate membership of the Consultation Institute, along with

buying specialist training courses for the Communications and Engagement

Team and other senior leaders in the organisation.

Embedding Participation across the CCG- We will continue to encourage

colleagues to report engagement activities that they undertake by recording

these in our engagement log that is regularly viewed by the PPE Committee.

7.0 Healthwatch Statement

Over the year we have worked with our local healthwatch, although we have not

commissioned them to undertake any engagement work for us. We meet regularly to

discuss issues as well as share reports and information sent to us with our staff and

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our stakeholders. Healthwatch Enfield colleagues also members of the Governing

Body, Patient and Public Engagement Committee, Quality and Risk sub group and

the Equality Delivery System 2 Task and Finish Group.

7.1 Healthwatch Enfield Statement:

Healthwatch Enfield welcomes the effort that Enfield CCG (ECCG) puts in to

trying to engage with patients and the public, but continues to have

concerns over the lack of a coherent strategic approach across the

organisation as a whole.

During 2015-16, ECCG has maintained a strong working relationship with

Healthwatch Enfield. We have felt able to pass on important public feedback

on local service quality in the knowledge that it would be taken seriously by

ECCG. ECCG staff have joined us in contributing to the local Quality

Surveillance Group, where sensitive matters, including information gathered

from the public, can be shared confidentially among a number of different

players in the health and social care system.

Some key staff and Governing Body members in ECCG value the critical

importance of patient and public views in gaining an understanding of the

quality of local services. They also understand how such feedback can

occasionally act as an early warning of potentially wider quality problems

with a service or provider.

During 2015-16, ECCG has continued to work hard on its patient and public

engagement work, to which it shows commitment. It continues to support

the GP-based Patient Participation Groups in their development, while at the

same time allowing them great autonomy to develop their own agendas and

work plans. It also continues, unusually among CCGs, to have a PPG

representative as an Observer Member of its Governing Body.

Healthwatch Enfield welcomes the fact that ECCG has continued to improve

its set-piece engagement events in response to feedback, securing better

attendances at some events, and more meaningful engagement. ECCG tends

to commit very good clinical and staff involvement to these events, and the

public welcomes this type of interaction and discussion with ECCG Governing

Body members and senior staff when they are aware of the event and what is

to be discussed. However, attendance at engagement events remains

extremely variable, with members of the public sometimes out-numbered by

staff. Although some events will always be better attended than others,

Healthwatch Enfield remains of the view that much better advance notice of

each event, its focus and purpose could help to improve public attendance at

some of these events.

Healthwatch Enfield is pleased to recognise good work done by ECCG, for

example, around the re-commissioning of the 111 and Out of Hours services

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across North Central London (NCL), for which ECCG was lead commissioner.

The creation of a Reference Group involving patients and the public was

welcome, although its members were few and drawn from a small pool.

Nevertheless, this group and other engagement work successfully influenced

the service specification, and the NCL clinical leads for the recommissioning,

supported by ECCG staff, were extremely open to receiving this input and

incorporating it where they could. ECCG also benefited from considerable

outreach engagement work done with a range of community groups by

another CCG in NCL. We hope that this engagement work will enhance

111/OOH as the service now gets up and running and starts to develop. We

also hope that ECCG will recognise this as a positive experience that it can

learn from and build on in order to further develop its public and patient

engagement work going forward.

Over the past couple of years, Healthwatch Enfield has given ECCG a

considerable amount of feedback and advice on how it might become more

strategic in its approach to engagement work. We have seen some steps

forward; for example, all ECCG staff are now ‘encouraged’ to inform the

Communications and Engagement Team when they undertake any

engagement work. We do not, however, see this sort of basic exchange of

information as a substitute for a coherent strategic approach.

Healthwatch Enfield still believes that a strategic approach to public

engagement across the whole organisation would arguably entail people from

across all teams coordinating together to ensure that public involvement and

engagement are planned early, systematically, and implemented at the right

time and with the right target communities so as to be able to influence

specific commissioning intentions in a timely fashion. Healthwatch Enfield

would argue that “Right Engagement at the Right Time”, is necessary in

order to make “Right Care, Right Time, Right Place” a reality.

For example, despite ECCG having the best of intentions, its consultation on

discontinuing prescriptions for gluten-free food created friction locally.

Healthwatch Enfield received a number of concerns from members of the

public who were not happy about the way the consultation was being

conducted, and very quickly alerted ECCG to these concerns. People felt

dissatisfied both that they had not been directly informed of the

consultation, despite assurances by ECCG, and then also with the final

decision made by the CCG. In particular, they did not feel that the

objections they had raised had been fully answered, with some specific

suggestions not being mentioned or responded to in ECCG’s response

document. There was also a strong suspicion among those affected that the

consultation had not taken place early enough and was not “genuine” with

ECCG having already made up its mind beforehand. We welcome the

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learning points that ECCG has identified from this exercise. We hope that

they will apply this learning and undertake public engagement and

consultation much earlier and more effectively in any future similar process,

particularly as there are many more “difficult decisions” to be made in the

near future, in terms of allocating scarce resources as effectively as possible.

Also during 2015-16, ECCG involved one patient with diabetes on its Diabetes

Stakeholder Group. It is always good to have patients involved, even if it is

only one person. But a more truly strategic approach, which we urge ECCG

to develop over time, might also have seen ECCG representatives visiting

community groups of people likely to have or to be at risk of developing

diabetes in the future, such as South Asian groups or groups of older carers,

earlier in the commissioning process. Hearing from such groups at an early

stage about their awareness of diabetes, about what they would expect a

diabetes pathway to look like, and what additional information or support

they would need to prevent or to manage diabetes could have been

potentially very helpful to ECCG’s wider work on diabetes. Some such work

could perhaps be conducted with Public Health colleagues for a more

integrated approach to prevention and treatment. Healthwatch Enfield

continues to be very willing to work with ECCG on developing initiatives such

as this.

Healthwatch Enfield recognises that NHS resources are limited. But that

makes early public involvement in changes and developments even more

important. We see a willingness in ECCG to develop fuller public engagement

and, in line with our previous input, we hope that a more strategic approach

to engagement will see ECCG adopt an integrated, coherent approach across

all its major work strands. Healthwatch Enfield will continue to advise and

support ECCG in the development of its engagement work, and we hope that

a more strategic approach can increasingly be adopted by ECCG as it

develops its future commissioning intentions in partnership with the other

CCGs, providers and local authorities of North Central London as part of the

local Sustainability and Transformation Plan.