How have the public influenced commissioning of healthcare in Aylesbury?

I asked my local Clinical Commissioning Group (Aylesbury Vale CCG) a question about providing examples of how the public has influenced commissioning in advance of their board meeting in public on Thursday April 10th.

Here is the reply from their clinical leads:

My Question: Can you please give examples of where the voice, opinions and experiences of patients and the public has influenced decisions made when commissioning services?

Christine Campling:

We did extensive public consultation on the inter mountain project by focus groups and questionnaires. There was full support for changing the range of options on outpatients to a mixture of face to face, telephone and Skype like consultations. We are currently running questionnaires on pain clinic projects, as we are redesigning the pain pathway.

Stuart Logan:

We have met with Patient Groups in the South Locality for their input into Live Well particularly the Haddenham Patient Participation Group.

We are involving Diabetes UK in the diabetes service redesign. They will have patients at the Stakeholders meeting in May inputting into the redesign process from day 1.

Juliet Sutton:

When they were doing a full review of Occupational Therapy and Speech & Language Therapy services for children, they went out and spoke to a lot of parents of children using the service.  Parents wanted shorter waiting times, a more responsive service, improved technology and access to health professionals in settings closer to them e.g schools and children's centres. All these views were incorporated into the new service design and there have been great improvements in the service since then. The children's physiotherapy service is currently under review and once again the views of parents and carers are being taken into consideration when making recommendations for service improvements.

We are currently undertaking a review of the services provided for children with complex needs/disabilities. Parental feedback is a large part of this process and their comments are being taken very seriously when planning future more integrated care. Single point of access is a recurrent theme from the feedback we have received and this will be one of our main objectives with future recommendations.

Lesley Munro-Faure:

commissioning plans are driven by localities and each locality has members of the public sitting on them who input into all the decisions that are made.

My comments: 

I had hoped that I might get a list of things the patients & public has said or suggested and a another list showing what the CCG had done as result of the comments from patients. 

I had also hoped that I would get examples showing actual changes in how services are commissioned instead I seem to have got examples of consultations & involvement in redesigning services. And there is nothing wrong in seeing examples of patient participation in redesign.

There are examples of good work especially with the work done by the therapy services for children.

The last paragraph of their reply puzzles me.  There are three localities in the CCG and I know that one of them does include members of the public in the group.  But the other two locality groups consist of clinicians only.  Anyway this last paragraph does not give examples of how the public have influenced commissioning.

I will follow up this answer at the board meeting and I will blog about it if anything new is mentioned.

How Health and Wellbeing Boards can involve the public

It is difficult to get the public involved in decision making about the big, strategic issues in Health and Social Care.  We are much more interested in things that concern us at a personal level.  

The Health and Wellbeing Boards that exist in shadow form in all local authority area are intended to promote the health and wellbeing of all residents in their area. Through the production of a needs assessment they will set the priorities for health and social service commissioning so that the best possible outcomes are obtained for local people. 

Or something like that anyway. 

The members of the board come from the local councils, health and social service managers and one member from Local Healthwatch. They are expected to involve the public in their work 

So I thought I would give them a few of my ideas, a few basic principles on how to involve the public. 

1. The Health and Wellbeing Board must know what it means by 'involvement' AND the purpose of such involvement.
2. The board must inform the public about its ideas on involvement and the purpose of public involvement.
3. The board must inform the public about what it can and cannot do with the results of the involvement process.
4. The board should use lots of different methods to involve the public.
5. The board should involve the public at an early stage in the development of ideas and plans.
6. The board should involve the public all through the process of developing plans.
7. The board should try to ask specific questions rather than vague ones.
8. The board should think and act 'locally' (small scale).
9. It will be more productive to look at single issues, conditions, treatments or groups of patients.
10. Use existing networks, service user groups, charities & voluntary sector organisations.
11. Face to face, informal events tend to be more successful than formal ones.
12. Go out to people, go to the workplace, the schools, clinics  shops, clubs & wards.  Do not expect people to come to you.
13. Use language that people understand, no jargon, and ask short questions.
14. The board must feedback to the public what information in gets through involvement and how it uses it.
15. The board will need to inform people and educate them about how decisions are made and how evidence is used.
16. Read the literature and research on patient and public involvement.
17. Patients and the public are different and so they will need different approaches .
18. We, the public will NOT be 'representative'.. 

 Any more ideas would be welcome.  Feel free to contribute.

Lay Person's guide to Commissioning Healthcare

A Lay Persons Guide to Buying Healthcare

The Government's recent reforms of the NHS in England have changed many things.  These changes are intended to improve the quality of care provided by the NHS and ‘to offer doctors and nurses the opportunity to play a major role in improving local health and wellbeing’.

One of those changes is that healthcare will be bought or ‘commissioned’ for all those who live in England by new organisations called Clinical Commissioning Groups (CCGs).

All GP practices in England must belong to a CCG.  There will be 212 CCGs in England.

The CCGs will buy:

Elective (planned) Hospital Care (outpatients and inpatients),

Urgent and Emergency Services (A & E),

Community care and rehabilitation services,

Mental Health Services,

Learning Disability Services,

The Government provides a certain amount of money that the CCG will use to buy our healthcare. The CCG will decide how that money is spent.

The CCG will decide how much of each service to buy and where it will buy it from. So it has to choose which hospitals will provide our health care. They will be required to use any provider who is qualified to provide health services. This could be from NHS hospitals or it could be from private companies.

Commissioning is more than just simply buying healthcare.  It is also about discovering what are the needs of the population, identifying the services required to meet those needs, deciding how services should be provided (pathways) and setting quality standards.

The CCG will then agree a contract with the service provider on an annual basis (April to March).  Some contracts, especially those with private providers, will last for longer than a year, perhaps up to 5 years.  Negotiations on contracts will usually start in the summer and are expected to be signed by the end of March in each year.

The price for each outpatient appointment and each treatment & operation is set by central Government.

Having bought the care the CCG will need to make sure that it gets what it paid for, both in the amount of care (the number of outpatients and inpatients, the number of tests etc.) and also the quality of care that is provided for patients.

The CCG also has to make sure that the quality of care improves each year.

The Government expects that each year the CCG must break even financially.

Some services will be commissioned by a national organisation called the NHS Commissioning Board.  These include GP services, Pharmacies, Dentists and specialist services.

CCGs will be run by a board which has GPs as members, as well as a nurse and a hospital consultant.  There are also two lay representatives and a number of other board members who will look after the finances and other activities.

Most of the managing of the contracts and the administration will be carried out by another organisation called the Commissioning Support Unit/Service.

The CCG will be held to account by its member practices and also by the National Commissioning Board.

The CCG is required to involve patients and the public in decisions about how it commissions our healthcare.  I assume that it will do so through the Patient participation Groups but also through public meetings, surveys. The CCG may also involve patients through service users groups and voluntary organisations. One of the roles of the lay representatives on the board is to act as champions for patient and public involvement (Health and Social Care Act 2012 Section 14u).

So if you want to influence how health care is delivered in your area I suggest you join your Practice Participation Group.