Closing the door on the LINk….

We are one week into the world of Local Healthwatch, so it seems like a good time to pause and reflect …

Last month I was invited to talk at a Westminster Briefing in London about the lessons that I had learned working for a rural LINk. It was a fab way to spend what was officially my last day working for the LINk – and it gave me the chance to give my views to a delightful and interested audience while knowing that the chance of getting myself fired was very slim indeed. (You can read a summary of my talk which has been published today on the Westminster Briefing website.)

I came up with seven lessons that we’d learnt as a rural LINk:

  1. The scale of the work is enormous:
    Over £1 billion of public money is spent on health and social care every year in Somerset.
  2. Demands placed on volunteers are huge:
    Are we really expecting volunteers to thoroughly and effectively monitor and scrutinise over £1 billion in services every year?
  3. Lay people need lay language:
    Believe me, patients have no interest in your authorisation pipeline.
  4. There is not a ready-made PPI army out there:
    There are a few amazing people who are able and willing to commit their time and talents to involvement and scrutiny work. But there are not armies of them. Yes, the hedgehog sanctuary has lots of volunteers – but health scrutiny is not cute and fun. We need more honesty about this.
  5. Third sector organisations lack resources to get involved:
    Third sector organisations have knowledge, grass roots awareness and an understanding of what is happening on the ground. But it is not easy for them to just ‘brain dump’ onto LINks or Local Healthwatch. This requires resources – and charities are struggling just to stay afloat with their own core business. They don’t have the time or staff to do anyone else’s work for free.
  6. The public want a professional service:
    There are very few volunteers will are willing to project manage, collect data, analyse complex information, manage volunteers and have an oversight of health and social care – and all for free. This all needs proper resourcing.
  7. Funding mustn’t be a dark art:
    Funding for LINks – and for Healthwatch – is not ring-fenced. Funding of around 50% of the allocation was not uncommon for LINks, and similar levels of funding have already been seen to be happening to some Local Healthwatch bodies as well. However, the organisations that understand the funding allocations are often those who are the recipients of the contracts – and are therefore in a jolly tricky position when it comes to challenging funding decisions. But while local authorities are being squeezed to the point where they may be unable to provide the services that Healthwatch bodies are supposed to scrutinise, this funding issue is going to be enormously difficult to resolve.

Another article was published today about Local Healthwatch that I also enjoyed reading: Patient Voice? by Martin Rathfield of the Socialiast Health Association. Of Local Healthwatch, Martin concludes:

Each successive iteration of the PPI structure ends up more timid than the one before it, and this appears to be the going down the same road.

His article is well worth a read, particularly for his observations about Foundation Trust scrutiny and the role of Governors.

So, today’s bedtime reading:

All comments welcome!


The NHS Reforms on One Side of A4 … including Public Health England

And then I made a version with Public Health England on it…

“Where is Public Health England?” pointed out a keen Twitterer, who was perusing my very pretty “NHS Reforms on one side of A4“, so I had to go back and glue in some more pieces.

Hmmm… I do worry that the trouble with sharing this version with members of the public is that it might be tipping the diagram into Thanks-But-Now-I-Really-Am-Glazing-Over territory (the ‘PCT Clustering’ effect), but I will include it for accuracy:

NHS Reforms with Public Health England

 What to do with this data:


The NHS Reforms on one side of A4

What you can download here:

>> The NHS Reforms on one side of A4
>> The NHS Reforms in Somerset on one side of A4
>> The NHS Reforms document in PowerPoint, so you can make your own local version!

After explaining the NHS Reforms for the millionth time to a member of the public (in biro on the back of an NHS Catering serviette) I set myself the challenge of trying to produce a one-page diagram showing the very basics of the reforms.

Here is my final effort:

The NHS Reforms - on one side of A4

The NHS Reforms - on one side of A4

I decided to make it very simple and stick to the BIG MESSAGES, rather than attempting to capture the detail e.g. of clustering, which seems to make the most enthusiastic member of the public glaze over and start looking for their PPI sandwich rations, but so far this diagram seems to do the job. I think it gets the balance between boring people senseless and over-simplifying, but I’m very open to any suggested amendments.

And then I made a local version…

Well I liked this so much that I made a local version for Somerset, showing exactly what budgets were going where, and what the GP localities looked like in the county. So here is the local picture for Somerset:

The NHS Reforms in Somerset

The NHS Reforms: Somerset version

What to do with this data:

Enjoy!


Health and Wellbeing Boards: a digested read…

I keep being asked about Health and Wellbeing Boards, and what they are for exactly, so I’ve written a one-page Health and Wellbeing Board Briefing Paper summarising the basics.

Lots of people seem to think that Health and Wellbeing Boards are high-powered people (ok, that bit is about right…) sitting around a big bag of cash and pondering whether it should be spent on local charities, pot-holes or a nice yachting holiday. The reality is not quite as exciting, what with the bags of cash being somewhat depleted with the current economic situation etc etc…

Anyway, I thought this briefing paper might be useful for other people to hand out too, so here it is:

Health and Wellbeing Board Briefing Paper

Health and Wellbeing Board Briefing Paper

All about… Health and Wellbeing Boards

Health and Wellbeing Boards are a new idea, to bring together local commissioners to work together to jointly plan more efficient and effective services for local people.

Health and Wellbeing Boards bring together commissioners – who plan and buy local health, social care and children’s services – from the NHS, Public Health and Social Care, as well as local councillors and a patient representative (from LINk/Local Healthwatch).

What will Health & Wellbeing Boards do?

  • Challenges: The big pressures on public services include rising demand, rising health treatment costs – and the state of public finances.
  • Planning services: With increasing pressures on public finances, it will be the job of the board to work together to plan services that meet the needs of local people, while achieving best value for money.
  • Joint Strategic Needs Assessments: They will look at the evidence of what works best to help target plans and resources. They will be responsible for making sure that the local Joint Strategy Needs Assessment is written and that plans for services are based on this (the JSNA is a piece of research that every local authority has to undertake, which ‘tells the story’ of local people’s needs).
  • Joint Health & Wellbeing Strategy: They will be responsible for developing a local ‘Joint Health and Wellbeing Strategy’, based on their JSNA. The Board will need to make sure that local services are in line with this Strategy.
  • Look at the big picture: The Board will look at people’s health and social care needs together, as well as taking into account the bigger picture – things like transport, housing, jobs and leisure – so that services help people stay healthy and independent.

A bit of background:

  • The idea for Health and Wellbeing Boards came from the Health and Social Care Bill, which is currently going through parliament. The Bill is part of the Government’s plans to change health and social care services and the way they are commissioned.
  • Some of the Bill’s key plans include giving clinicians, such as GPs, responsibility for commissioning health services, and strengthening ‘local accountability’ – for which Health and Wellbeing Boards will have a crucial role and responsibility.
  • All local authorities will have ‘shadow’ Health & Wellbeing Boards up and running by April 2012 and permanent boards will be in place by April 2013.

>> Download the Health and Wellbeing Board Briefing Paper in Word
>> Download the Health and Wellbeing Board Briefing paper in pdf

What to do with this information?

  • Carry this briefing paper around with you to helpfully hand out to members of the public who want to know all about Health and Wellbeing Boards. Or to third sector people who are convinced that the Board is sitting around a big pot of cash…

A Clinical Commissioning Group Patient Engagement Strategy

I posted back in November about the rather fun work we were doing here in Somerset putting together a Patient Engagement Strategy for the new interim Clinical Commissioning Group (CCG).

The Somerset CCG had been chosen by the Department of Health to do some work on developing Patient Engagement.  They’ve had two Patient Enagement Managers – Tony and Sue – who have worked with the Head of Patient Experience at the PCT (Margaret Grizzell) and an officer from the local LINk (that’s me). We’ve looked at current engagement structures, had feedback from patients and people within the county (including running a ‘PPI Conference’) and produced a Strategy and an Action Plan for the CCG to carry forwards.

>> Somerset Patient and Public Engagement Strategy and Action Plan 2012 (the Action Plan is at the back of the document by the way)

Somerset CCG Patient Engagement Strategy & Action Plan

It's more substance than style, I must admit...

We’ve also started to produce a draft structure for representating the ‘patient voice’ in Somerset.

Draft structure for representating the 'patient voice' in Somerset

Draft structure for representating the 'patient voice' in Somerset

We already have Health Forums (Fora innit?) emerging in the 9 Somerset Federations, so the plan is to base a formal structure around these fora so that messages and views and general engagement-type communciation can escalate from the top to the bottom and vice-versa.

It’s all quite draft-y at the moment and we’re asking people for their views and suggestions for what might be efficient and effective – and inclusive of as many voices as possible.

I’ve really enjoyed helping with this project and I hope that it will lead to a good foundation for patient engagement in the new world of clinical commissioning!

What to do with this information:

  • Be inspired, of course! Lots of people will be working on this sort of thing at the moment, so this info is really here to give you some ideas of what’s been going on in Somerset in terms of early CCG engagement plans.
  • Get involved with your local CCG’s plans: This is obviously ideal work for LINks to get involved in. In order to be authorised (i.e. allowed to take over commissioning properly – a good summary of authorisation here from NHS Hampshire) CCGs will have to demonstrate that they are engaging patients and the public in commissioning decisions. So get involved locally now – whether at the planning stage, bouncing ideas about, or distributing info to your local groups and enthusiastic PPI people.
  • Tell me what you’ve been up to: Let me know if you’re working on similar stuff – I’d love to see how things are working (or not working) in other places!

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!

NHS Organograms – the old vs. the new

The poor Datagoat has been rather neglected of late, but I have a nice juicy organogram to cheer us all up.  I am working on some other bits and pieces too, but this was too delicious not to share.

The Westminster Blog has published these fabbie organograms showing how the structure of the NHS is changing.  Click on the smaller images in the blog and they will take you to larger, clearer images.

The Westminster Blog

A yummy organogram

What to do with this data

The diagrams speak for themselves which is why I love them so much.  They are very useful for conveying to people some of the enormous complexity of how things are changing.

I have printed them out and stuck them on the wall of the datagoat’s pen so I can admire them during the day, and I recommend that you do the same.*

*They have actually missed out Local HealthWatches, so you will need to draw those on with a crayon.


NHS Frontline cuts

There’s been a fair bit of news coverage about cuts to staff in NHS organisations.  There is a lot of attention about this because the conservative party pledged not to cut frontline NHS staff during the election campaign. So the first thing to bear in mind is that these figures are hot potatoes that are being tossed about by all sides in the argument. There are hundreds of commentators discussing these figures, for example, this article from media agency ‘eGov monitor’.

NHS savings and cuts
The NHS has to save £20 billion by 2014.  This is to enable the NHS to balance the books, as there is an aging population which requires more health services, and a higher drugs bill because of scientific advances in medicines and treatments. This £20 billion was set out by the Labour government in 2009 and reaffirmed as the plan of action by the coalition government in their spending review.

The programme to drive this savings plan is called ‘QIPP’ – Quality, Innovation, Productivity and Prevention.  Each trust has its own QIPP plans, which detail how it will save money over the next few years.

What are frontline staff? Definitions of ‘clinical’ and ‘non-clinical
When looking at job loss figures, roles are usually divided into clinical and non-clinical staff. Clinical staff may be doctors, nurses, midwives, Health Care Assistants (HCAs), consultants, dentists, pharmacists, and other staff members who are involved in the direct care of patients. These may also be referred to as ‘frontline staff’.

Non-clinical staff includes staff who are receptionists, catering staff, cleaners and janitors, administrators and staff working in a non-clinical job such as Human Resources or various management and administrative roles.  (Not all managers are non-clinical though, of course – many managers, such as Matrons, are clinical staff.)

Frontline First website:
The Royal College of Nursing has been running a Frontline First campaign. The idea of the campaign is to speak out about frontline cuts and propose alternative ideas for saving money while protecting patient safety:

Frontline First will empower nursing staff to speak out against the NHS cuts that are harming patient care, expose where they see waste in the system and champion nurse-led innovations and ideas that are saving money whilst keeping patients safe.

To find out what information they have in your area, click on the interactive map over your area, and then click on ‘read more’.

False Economy website:
Another interesting resource is the ‘False Economy’ website at www.falseeconomy.org.uk. This ‘anti-cuts’ website is backed by the TUC.

You can click on your area and view the information that they have about your local services.

The False Economy campaign has recently undertaken a piece of research into cuts in health services. This research looked at responses to Freedom of Information requests put to health service trusts and shows over 50,000 job losses. Here’s an article that they’ve put together about their research.

The False Economy NHS data is also published by my favourite source of facts-n-figures, the Guardian Datablog:

This data has also been turned into an interactive map by thedatastudio (and you know how I love interactive maps):

  • Interactive Map of NHS job cuts
    You can click on your area of this map and see what data has been released under the FOI requests. (Bear in mind that if trusts show no job losses, this may be because they have not responded to the FOI requests, not necessarily because they are not losing any positions.)

What you can do with this data:
Have a good look through the websites above and make sure you know what information has been released by your local trusts about job losses.

Frontline, back-end or jiggling about in the middle – whatever the political arguments, a good healthcare organisation will be working with their LINk where changes are occuring that affect services to patients.  So keep your ear to the ground and make sure that where services are reduced or changed, you are confident that proper plans are in place to ensure that patient safety isn’t compromised.


Joint Strategic Needs Assessments (JSNAs)

Today I attended a conference about JSNAs, which has inspired me to write with some basic JSNA info for you!

Joint Strategic Needs Assessments (JSNA): What’s that then?
JSNAs are generally big fat documents with lots of accompanying documents.  Sometimes they are big fat web-based “E-tools” – different things happen in different areas. Either way, they are:

  • Joint: Jointly researched and written by the local NHS and local authority (council) but also involving other partners;
  • Strategic Needs Assessment: Assessing the health and wellbeing needs of local people in order to strategically inform commissioning decisions (what services do we need?).

They are local documents looking at the local area – and every local authority area has to have one.  Or as the Department of Health puts it:

The Local Government and Public Involvement in Health Act 2007 requires PCTs and local authorities to produce a Joint Strategic Needs Assessment (JSNA) of the health and wellbeing of their local community.

JSNAs tell the local story: they include a great deal of data in terms of statistics about the local population from as many sources as the JSNA team can get their paws on.  The idea is to compile as full a picture as possible about what is happening in the local area in terms of health, wealth, housing, social care, education, age, caring responsibilities, demographics, and as many things as you can craft into a pie chart or bar graph as humanly possible. It also includes lots of qualitative data and information from local people about their views of life in the area.

JSNAs are re-published every three years, which involves lots of new research and report writing (and more bar charts). This is called a “refresh” of the JSNA.

How do I find my local JSNA?
If you don’t already have a copy taking up most of your desk, then you should be able to find your local JSNA by searching your local authority’s website. It might be hard to find this document, or it might be split into smaller documents. If you can’t find it, drop your local friendly LINk commissioner an email and ask where you can find it (and maybe whine a bit about it not being easily accessible on their website).

What is the JSNA used for?
The JSNA is used to inform commissioning of services. For example, if there is a lack of mental health provision in one area, then the JSNA would provide the evidence to support commissioning a service there.

Are JSNAs staying in the new reformed world of health and social care?
The JSNA is one of the few things that will survive into the new reformed world intact: with both the same name and the same – but enhanced – function.  The JSNA will be the research that underpins and informs the Health & Wellbeing Strategy, which will be the ‘actions’ that come out of the ‘research’ of the JSNA. The Health & Wellbeing Strategy will be the responsibility of the Health & Wellbeing Board, which, as I’m sure you are bored of hearing by now, will comprise commissioners of both Health and Social Care, with the added bonus of a HealthWatch Representative to be the voice for local residents at the commissioning table.

One thing that will change is that in the future, responsibility for the production of the JSNA will be given to the local authority, as PCTs are being abolished.  (In the past, some PCTs have lead on producing the JSNA.)

What does this have to do with the LINk?
Every areas JSNA is different. But ideally, JSNAs should include ‘the public voice’; a reflection of what local people say about health and wellbeing.  This is where the LINk can come in. The LINk should work closely with the JSNA project team in order to ensure that the local voice is heard and represented in the JSNA. There are many ways of doing this. You could create a survey specifically to gather information for the JSNA. You could collect information and stories from local people, or feed in the issues that you already have. You could run workshops or public events.

Working with voluntary groups:
The JSNA is a very important piece of work for voluntary, community and user-led groups (civil society groups). This is because those groups are often excellent sources of what is working, and what is not working, in the local community. They may know where there are gaps in services. It is also important for voluntary and community organisations because through the JSNA they can raise awareness of the needs that they are meeting in the local community. What would happen if they were not providing their services? What would happen if existing services were no longer commissioned through them?  This is a great opportunity to drive those points home to the people who actually commission services.

The LINk could help by coordinating a means for voluntary and community groups to have their say in the JSNA: perhaps through meetings, or through surveys, or through establishing a ‘civil society forum’. You can also make sure that civil society groups know about the JSNA by publicising  information through your newsletters and informing people who their key contacts into the JSNA should be.

Websites for useful information:

What to do with this data:

  • Find your JSNA: Look up your local JSNA on your council’s website.
  • Find out who your JSNA Leads are: You should have one in the NHS and one in the local authority (very possibly someone with ‘Information’ in their job title).
  • Find out what is happening in your area with regards to the JSNA: Different areas have different timescales. Some areas might “refresh” their JSNA regularly, perhaps looking at certain themes or certain smaller areas. Find out what is happening in your area.
  • Email councillors and ask them how they are using their JSNA to inform their decisions and debate: Some might look at it regularly, in order to back up their decisions. Others might not have heard of it. Now is the time to remind people that the JSNA is going to be an essential part of service planning in the future.
  • Plan how you will contribute to the JSNA: There are some Best Practice Examples here to give you some ideas.
  • Plan how you will involve user-led, voluntary and other organisations: How will you raise awareness of the JSNA? How can you bring commissioners and these groups together? And how will you make sure that groups from across all sectors of society are represented and have the chance to have their voice heard?

What the NHS has got to do in the next year

The NHS Confederation is a useful source of briefing papers about goings-on in the NHS.  A couple of months ago I was sent their briefing paper (a handy cut-out-and-keep Guide) on ‘The Operating Framework 2011-12″ – in other words, ‘What the NHS has got to do in the next year’.

NHS Confederation Briefing Paper

Download A Handy Guide to ‘What the NHS has go to do in the next year’

>> Download the briefing paper  ‘The operating framework for the NHS in England 2011/12’ here

This briefing paper  simplifies a lot of complicated information about the major changes that will occur in the NHS over the next year (and beyond).

The next year (April 2011-April 2012) is sometimes referred to as the ‘transition year’ because it is the first full financial year that the NHS will be in transition from the old structure to the new, reformed structure.

The big change of course is that health services will not be commissioned via Primary Care Trusts (PCTs) but will be commissioned via doctors, who will be getting together into ‘consortia’. But there are lots of other changes, too, and this paper is the easiest way of getting your head around all of this information in one sitting. It explains how the NHS has got to save money, change structure, move from PCTs to GP Commissioning Consortia, turn all Trusts into Foundation Trusts, transform Public Health and squillions of other enormous and complicated tasks – and it explains all of this in a mere seven pages.

Who are the ‘NHS Confederation’?
“The NHS Confederation is the independent membership body for the full range of organisations that make up the modern NHS.  We have over 95 per cent of NHS organisations in our membership including ambulance trusts, acute and foundation trusts, mental health trusts and primary care trusts … We support the NHS to deliver high-quality services and improve the nation’s health and well-being.”  (From their website at www.nhsconfed.org)

Now I should point out that generally, NHS Confederation Briefing papers aren’t usually accessible to the public.  But I really, really wanted to put this one on the datagoat blog as I think it’s super-useful, and luckily for us, the NHS Confederation agreed that it was a good idea: “We generally like to keep most documents confidential so that it’s clear to members that they have had benefits from being members that are not available to the wider public. However, we think that making the operating framework briefing available to LINks will help our members because it will contribute to better scrutiny by local LINks.”  So a big thanks to the NHS Confederation for putting this really useful document in the public domain.

What to do with this data:
Sit down and read it.  Stick it on your wall. Put it in your handbag to re-read while you are waiting for your bus. Send the above link to all your LINk chums and anyone that might be interested in the NHS reforms. Wow your friends at dinner parties with your amazing grasp of the changing NHS landscape.  (Can you tell that I like this document?)

Now if only all information and consultations that came out of the Department of Health was summarised for us by the NHS Confederation, public scrutiny would be a far more managable task…