LINk Legacy Document – who should you send it to?

Since blogging on the LINk Legacy Document, I’ve been asked where LINks should send their Legacy Documents.

The Department of Health has told me that these documents are ‘primarily to inform local conversations’ – and in short, there is no one nationally who is collecting these. This seems a bit of a shame, as there must be lots of excellent work that is being gathered into these documents.

Anyway, here’s my list of people that I think could be on your Legacy Doc circulation list:

  • Your LINk commissioner
  • Your Local Healthwatch Commissioner
  • Your Healthwatch provider
  • PCT (outgoing!)
  • CCG (incoming!)
  • CQC contacts
  • Foundation Trusts
  • Independent Health Providers
  • Chair of your Health & Wellbeing Board (Maybe the whole Health & Wellbeing Board)
  • Councillor with oversight of Local Healthwatch contract
  • Your LINk mailing list
  • Your ‘LINk friends’ – FT Governors and others who have worked closely with you etc.
  • Local community groups and organisations that have an interest in Healthwatch

Let me know if you think there’s anyone else that I’ve missed!

It would also be worth publishing online in the following locations:

You can also use lots of your Legacy info in your Annual Report, which you should also upload to the Healthwatch England Information Hub in due course.

If you have any other ideas, let me know!

P.S. A great piece of LINk Legacy Work from Luton LINk

Debbie Roberts who has worked with the Luton LINk published this fab piece of work on the LINks Exchange website, which I love. She said: “In Luton one of the [Legacy] conversations was captured using graphic facilitation. Attached is the image of the wall map. Its size was around 3.5m x 1.5m and it had a strong impact on the people in the conversation and was a great tool to share messages with others.”

Luton LINk Legacy picture

Luton LINk Legacy picture – click for larger image

I love an infographic and if I was Luton Healthwatch, I would decorate the Healthwatch office using this as wallpaper. 🙂


Local Healthwatch Funding Allocations and the Francis Challenge

With six weeks to go until Local Healthwatch is launched….

Recommendation 146 of the Francis Report raises a challenge for Local Authorities about the funding of Local Healthwatch:

146. Finance and oversight of Local Healthwatch
Local authorities should be required to pass over the centrally provided funds allocated to its Local Healthwatch, while requiring the latter to account to it for its stewardship of the money. Transparent respect for the independence of Local Healthwatch should not be allowed to inhibit a responsible local authority – or Healthwatch England as appropriate – intervening.

There has been a bit of debate on the blogosphere about what this recommendation means exactly. It isn’t enormously clear, and in today’s difficult financial climate, it seems unlikely and unrealistic that every local authority is going to pass on a somewhat undefined and non-ringfenced budget for their Local Healthwatch programme. But that does appear to be the challenge that Francis is putting forwards.

What is your local authority spending on Local Healthwatch?

In order to work out what your local authority has been allocated for Local Healthwatch, you need two bits of information: your LINks funding plus your Local Healthwatch funding. Here’s how you work it out*:

  1. LINks funding will be carried forward as the baseline for local Healthwatch funding. To find this figure for your area, look at this letter and find your local area for 2010-11.
  2. From April 2013-April 2014, the Department of Health will also make funding available for the ‘additional functions’ of Local Healthwatch.  To find this figure for your area, look at this document and do a search for your Local Authority area.

Now do your sums: add up (1) the LINk allocation plus (2) the Local Healthwatch Allocation and find your answer.  This figure is the indicative funding available for Local Healthwatch in your area.

Then you can do a little sum to work out what percentage of this allocation your local authority has actually allocated to Local Healthwatch (i.e. the value of the Local Healthwatch contract).

Other funding things that might confuse you:

There are additional funding ‘pots’ that some areas may be taking into account, but don’t let these confuse you! Essentially, they are:

  1. the start-up funding for Local Healthwatches (an additional amount of money provided by the Department of Health which is to fund the set up of Local Healthwatch) and;
  2. the ICAS (Independent Complaints Advocacy Service) funding. The ICAS funding and function ceases to be commissioned nationally in April and will be commissioned locally instead.  In some areas, this funding pot has been rolled into the Local Healthwatch specification and funding, but in other areas it has not. Bear this in mind when you are doing your sums.

Useful links:

What to do with this data:

  • Do your sums and work out what your Local Authority is spending on Local Healthwatch. What percentage of their funding allocation are they spending? Does your LINk consider this to be adequate? If not, then before it packs up its typewriter, your LINk might want to think about bringing these figures to the attention of your local Scrutiny committee.

* P.S.
I’m not entirely sure that the above sources of funding information are up-to-date – but they are all I could find. The documents seem very slippery and the funding allocations hard to pinpoint – and obviously, they are not ringfenced. But if anyone has any more information, do let us know and I will correct or amend the above info!


LINk Legacy Document – here’s ours

It’s almost time for the LINks to wrap up their good work and pass the parcel on to Local Healthwatch.

Lots of local Healthwatches will be managed by new organisations, new staff and new volunteers – so we need to make sure that the knowledge and learning of the LINks is passed on.  One of the ways is with a Legacy Document – which the LGA recommends is written by each LINk as a parting gift to the incoming Healthwatch.

We’ve just finished writing ours in Somerset, and it’s now out for comment to the wider LINk and general public. So we thought we’d share this with you, in case you are still chewing your pencil and looking for some inspiration.

We couldn’t find any simple templates out there so we put this together with the aim of transferring as much of our knowledge as possible to the new organisation.

>> Download Somerset LINk Draft Legacy document

(It’s quite large – 5MB, so you will need to wait a minute or two for it to load)

Somerset LINk Legacy Document

Somerset LINk Legacy Document

Contents:

We structured the document in two parts: looking back at the LINk, and looking forward to Healthwatch:

Part 1 TELLING THE STORY OF THE SOMERSET LINK

  • What is the LINk Legacy Document?
  • Background
    What is Somerset like?
    Health and Social care in Somerset
  • LINk Lesson 1: Engagement
    How did we engage with the community?
    How did we engage with the third sector?
    How did we engage with stakeholders?
    Who are our stakeholders in health?
  • LINk Lesson 2: Communication
    Who was interested in the LINk?
  • LINk Lesson 3: Working with Volunteers
  • LINk Lesson 4: Our LINk Activity
    Our Projects: Research
    LINk Activity
    Enter & View
  • LINk Lesson 5: Equality & Diversity

PART 2: LOOKING FORWARD TO HEALTHWATCH SOMERSET

  • Ideas for Healthwatch Somerset
    Our Legacy Survey
  • Challenges: Our Risk Register
  • LINk Library
    List of key stakeholders
    Key Dates 2013
  • Thank you
    Appendix 1: Extracts from The Francis Report

Another useful document:

What to do with this data:

Hopefully it will be of some use or inspiration if you are still scribbling away at your Legacy Document.

(If you want this Legacy Document in Word, I’d be happy to send it to you – just email me at lucy.nicholls@helpandcare.org.uk.)


The Francis Report and LINks/Healthwatch

The “Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry chaired by Robert Francis” – aka ‘the Francis Report’ – was published last week.

If you work in health, or patient involvement, then you must at the very least read the Executive Summary. It is very readable and concise and I’d recommend you print off a copy for bedtime reading and scribble on it.

I’m publishing on this blog the particular points that I think that LINks/Healthwatches need to read, digest, ponder and respond to. I think they are really important (and in fact, I’ve copied these paragraphs and put them in our LINk Legacy Document to be passed on to Healthwatch Somerset).

N.B. For the full chapter looking at patient involvement, you need to read Chapter 6 of Volume 1 of the full report.

Extracts from The Executive Summary:

The voice of the local community

  • 1.17 It is a significant part of the Stafford story that patients and relatives felt excluded from effective participation in the patients’ care. The concept of patient and public involvement in health service provision starts and should be at its most effective at the front line.
  • 1.18 Analysis of the patient surveys of the Trust conducted by the HCC and the Picker Institute shows that they contained disturbing indicators that all was not well from long before the intervention of the HCC.
  • 1.19 Community Health Councils (CHCs) were almost invariably compared favourably in the evidence with the structures which succeeded them. It is now quite clear that what replaced them, two attempts at reorganisation in 10 years, failed to produce an improved voice for patients and the public, but achieved the opposite. The relatively representative and professional nature of CHCs was replaced by a system of small, virtually self-selected volunteer groups which were free to represent their own views without having to harvest and communicate the views of others. Neither of the systems which followed was likely to develop the means or the authority to provide an effective channel of communication through which the healthcare system could benefit from the enormous resource of patient and public experience waiting to be exploited.
  • 1.20 Patient and Public Involvement Forums (PPIFs) relied on a variably effective, locally provided infrastructure. The system gave rise to an inherent conflict between the host, which was intended to provide a support service but in practice was required to lead with proposals and initiatives offered to lay members, and members of the forum, who were likely to have no prior relevant experience and to be qualified only by reason of previous contact with the hospital to be scrutinised.
  • 1.21 In the case of the Trust’s PPIF, the evidence shows quite clearly the failure of this form of patient and public involvement to achieve anything but mutual acrimony between members and between members and the host. A preoccupation with constitutional and procedural matters and a degree of diffidence towards the Trust prevented much progress.
  • 1.22 If anything, local Involvement Networks (LINks) were an even greater failure. The, albeit unrealised, potential for consistency represented by the Commission for Patient and Public Involvement in Health (CPPIH) was removed, leaving each local authority to devise its own working arrangements. Not surprisingly, in Stafford the squabbling that had been such a feature of the previous system continued and no constructive work was achieved at all.
  • 1.23 Thus, the public of Stafford were left with no effective voice – other than CURE – throughout the worst crisis any district general hospital in the NHS can ever have known.
  • 1.24 Under the new reforms, local healthwatch is intended to be the local consumer voice with a key role in influencing local commissioning decisions through representation on the local Health and Well-being Board. They will be expected to build on existing LINks functions. The responsibility for establishing Local Healthwatch will rest with the local authorities in the same way as it had for LINks. As is the position with LINks, the DH does not intend to prescribe an operational model, leaving this to local discretion. It does not prejudice local involvement in
  • the development and maintenance of the local healthcare system for there to be consistency throughout the country in the basic structure of the organisation designed to promote and provide the channel for local involvement. Without such a framework, there is a danger of repetition of the arguments which so debilitated Staffordshire LINks.
  • 1.25 The local authority scrutiny committees did not detect or appreciate the significance of any signs suggesting serious deficiencies at the Trust. The evidence before the Inquiry exposed a number of weaknesses in the concept of scrutiny, which may mean that it will be an unreliable detector of concerns, however capable and conscientious committee members may be.
  • 1.26 Local MPs received feedback and concerns about the Trust. However, these were largely just passed on to others without follow up or analysis of their cumulative implications. MPs are accountable to their electorate, but they are not necessarily experts in healthcare and are certainly not regulators. They might wish to consider how to increase their sensitivity with regard to the detection of local problems in healthcare.
  • 1.27 There are a wide range of routes through which patients and the public can feed comments into health services and hold them to account. However, in the case of Stafford, these routes have been largely ineffective and received little support or guidance.
  • 1.28 Local opinion is not most effectively collected, analysed and deployed by untrained members of the public without professional resources available to them, but the means used should always be informed by the needs of the public and patients. Most areas will have many health interest groups with a wealth of experience and expertise available to them, and it is necessary that any body seeking to collect and deploy local opinion should avail itself of, but not be led by, what groups offer.

Extract from the Table of Recommendations:

  • Patient, public and local scrutiny
    145 Structure of Local Healthwatch There should be a consistent basic structure for Local Healthwatch throughout the country, in accordance with the principles set out in Chapter 6: Patient and public local involvement and scrutiny.
  • 146 Finance and oversight of Local Healthwatch
    Local authorities should be required to pass over the centrally provided funds allocated to its Local Healthwatch, while requiring the latter to account to it for its stewardship of the money. Transparent respect for the independence of Local Healthwatch should not be allowed to inhibit a responsible local authority – or Healthwatch England as appropriate – intervening.
  • 147 Coordination of local public scrutiny bodies
    Guidance should be given to promote the coordination and cooperation between Local Healthwatch, Health and Wellbeing Boards, and local government scrutiny committees.
  • 148 Training
    The complexities of the health service are such that proper training must be available to the leadership of Local Healthwatch as well as, when the occasion arises, expert advice.
  • 149 Expert assistance
    Scrutiny committees should be provided with appropriate support to enable them to carry out their scrutiny role, including easily accessible guidance and benchmarks.
  • 150 Inspection powers
    Scrutiny committees should have powers to inspect providers, rather than relying on local patient involvement structures to carry out this role, or should actively work with those structures to trigger and follow up inspections where appropriate, rather than receiving reports without comment or suggestions for action.
  • 151 Complaints to MPs
    MPs are advised to consider adopting some simple system for identifying trends in the complaints and information they received from constituents. They should also consider whether individual complaints imply concerns of wider significance than the impact on one individual patient.

Other useful links:

What to do with this data:

  • Read it and digest it.
  • Circulate it to your LINk volunteers and colleagues.
  • Consider how you will respond to the recommendations and lessons learned.
  • Ask your local CCG and providers how they are responding to the recommendations.

All the new Commissioning Groups in the South West

I was asked by a local charity whether I had details of all of the new Clinical Commissioning Groups (CCGs) in the south west and which LINk and PCT related to which CCG. The CCGs are the groups that are taking over responsibility for health commissioning as part of the ‘NHS Reforms’. (See my post here for a nice simple explanation of the reforms.)

Well I rummaged through the piles of paper on my desk but I couldn’t find all the information in one place, so I’ve put it together in a spreadsheet for you:

LINks and CCGs in the south west

LINks and CCGs in the south west

It’s worth remembering that the LINk that covers any area will also be the same as the Local Authority (council) that covers the area. That’s useful because of course, the Local Authorities host the Health & Wellbeing Boards, which are another part of the new landscape.

CCGs (and PCTs) in the south west all mapped nicely:

This is a useful picture which is handy for the wall in the office. It shows all the PCT “Clusters” (i.e. the ‘merged’ PCTs which cover larger areas, which are merging to save on resources i.e. staff as everything is handed over the new CCGs) and how they relate (in terms of areas that they cover) to the new CCGs. It is Quite Interesting and if you work in this area, you should jolly well know all about it (click for a larger image):

CCGs and 'Cluster' PCTs in the south west

CCGs and ‘Cluster’ PCTs in the south west

The Devon Picture:

The situation in some areas is nice and simple. For example, in Somerset, we have one PCT (which has ‘clustered with itself’ – don’t ask), one local authority (i.e. council), one Clinical Commissioning Group and one LINk.  See how smug and sensible we are?

However, in other areas, such as Devon, you have a bit of a spaghetti of clustered PCTs and CCGs and LINks drunkenly sprawled all over each other with no apparent coherence or co-terminosity whatsoever.  Caroline at the Devon LINk sent me this handy PDF which explains the Devon situation in five maps, so if you are a Devon person, you might like to study these maps so that you can attempt to give yourself a migraine memorising the whole thing:

The new health landscape in Devon

The new health landscape in Devon

What to do with this data:

  • Print it out and stick it on the wall: It’s colourful and USEFUL. Hoorah.
  • Read it: This is all useful background information, to give you a flavour of how the new NHS landscape is shaping up in the south west.
  • Use the contact details: If you need to plan any work across the south west, these contact details should come in handy.
  • Tell me if I’m wrong or send me more information:Let me know if you have any useful maps of your area, or indeed if Devon is actually really simple and I’m just a bit dim.

P.S. Thanks to Mark Woodcock at the Strategic Health Authority for helping me find some of this data!


Patient Engagement and Clinical Commissioning Groups: Where to start…

Here’s a good paper for CCGs…

This handy NHS Confederation discussion paper has been doing the rounds recently. I think it’s a nice paper summarising engagement suggestions for Clinical Commissioning Groups (CCGs). CCGs need to get their heads around this stuff because, as this paper reminds us:

CCGs will be expected to have put an approach to enagement in place in order to achieve authorisation by the NHS Commissioning Board.

If your LINk is working with your local CCG, this would be a good paper to hand around. This paper is nice and concise – even I can manage to read 7 pages without getting distracted…

It's good. Read it.

Useful info for CCGs

It doesn’t do exactly what it says on the tin, as it really focuses on Clinical Commissioning Groups, and doesn’t focus on the new commissioning system in its entirity (i.e. it doesn’t mention Health and Wellbeing Boards). But it’s a good discussion paper and gives an honest view about some of the problems and difficulties of engagement.

It includes a handy one-page summary of “Common techniques used in engagement work” which lists engagement techniques, their advantages and disadvantages, and when they might be used.

LINks – are you working with your local Clinical Commissioning Group?

You really should be working with your local CCG as they develop their engagement work, because, again to quote from this paper:

CCGs will achieve most benefit by undertaking a thorough evaluation of existing PPE mechanisms before embarking on new approaches.

And obviously, being a keen LINk person you already have drawers stuffed full of this sort of information and mapping that you’ve been playing with for the last three years at least… So now’s the time to get it out and share.

What we’re doing in Somerset (as you asked)

In Somerset, we are lucky because the PCT is a cluster of one and we just have one Clinical Commissioning Group. (My sympathies to those LINks who have four…) The Somerset CCG was selected by the Department of Health to do some pilot work on patient engagement, so the Clinical Commissioning Group has two Patient Engagement Managers, Tony Hampson and Susan Harris. Tony and Susan have been working with the PCT’s Head of Patient Engagement, Margaret Grizzell, to pull together an Engagement Strategy for the CCG. Along with this, a 12-month Action Plan has been put together for developing and embedding patient engagement in the CCG’s processes. This is in its final stages, and once this has been finished, the documents will be made public (in the next couple of weeks) and then put out for feedback from the public and from Patient Participation Groups, patient groups etc.

I’ve been helping along the way with suggestions and facilitation and sharing any info that I have that might feed into this work. A conference is planned for December when a selection of groups and individuals will have the chance to look at the plan in more detail and feed back more ideas and suggestions. All in all, it seems to be developing well and is proving a great opportunity to draw together what we know about engagement locally and come up with new ideas for the future. I’ll keep you informed…

What to do with this data:

  • Email it to all your chums in CCGs who are working on Engagement with you.
  • Give it to Patient Reps who are keen on This Sort Of Thing as it gives a good basic overview of Engagement techniques.
  • Read it yourself!

Indices of Deprivation: finding out about your neighbourhood

The Office for National Statistics is the place to go for useful information about the area where you live. It’s super-handy for report writing, if you want to throw in some charming maps and bar-charts to illustrate the demographics of your area, with lots of lovely footnotes showing that you have done your research properly, see?

Find out some basic info about your neighbourhood

How Taunton compares

I recommend starting by looking at the statistics that are available for your neighbourhood, which you can find at neighbourhood.statistics.gov.uk.  For a nice easy-to-read summary, enter your postcode in the right-hand section (‘Neighbourhood Summary’) and press SEARCH.

This will give you lots of useful figures  – numbers of people living in your area, number of houses – and lots of other information from the Indices of Deprivation.  It shows in a very simple graphical format how your neighbourhood compares with the national picture.

You can browse for more data covering all sorts of areas by clicking on the tabs at the top of the website, which will tell you information about people, health, business, work, education, housing – and all in nice simple diagrams! What’s not to like about that?

What are the Indices fo Deprivation?

Since the 1970s the government has calculated local measures of deprivation in England. This information is used to target resources (it’s v. useful for supporting funding applications). The following comes from the introduction to the report The English Indices of Deprivation 2010:

Deprivation covers a broad range of issues and refers to unmet needs caused by a lack of resources of all kinds, not just financial. The English Indices of Deprivation attempt to measure a broader concept of multiple deprivation, made up of several distinct dimensions, or domains, of deprivation.

The seven ‘domains’ are:

  1. Income deprivation
  2. Employment deprivation
  3. Health deprivation and disability
  4. Education, skills and training deprivation
  5. Barriers to housing and services
  6. Crime
  7. The living environment deprivation

Find out more:

If you want to find out more about the Indices of Deprivation you can view the full reports and excel spreadsheets via:
http://www.communities.gov.uk/publications/corporate/statistics/indices2010

What to do with this data:

  • Put it in your reports of course! This data is perfect for producing lots of lovely nuggets of information for providing background information for reports.  Very useful for the ‘local background’ section of your LINk Annual Report, too.
  • Print out boundary maps: There is a very useful tool for printing out boundary maps on the ONS site here. If you have a bit of a fiddle you can print off all sorts of useful maps – ward boundaries, PCT boundaries, Local Authority boundaries – all of which is useful for many reasons, not least so you can work out whether you are actually turning up at the right LINk…