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Our approach and principles

We are committed to ensuring that patients’ needs are at the heart of everything we do. In order to ensure that we reflect our population we aim to have effective patient, carer and public involvement embedded in our work and in our planning processes

We follow a set of guidance issued by NHS England which outlines best practice for enabling people to voice their views, needs and wishes, and to contribute to plans, proposals and decisions about services.

Within this section you can find out about how patient and public engagement is embedded through all of our processes.

Involving People Strategy

The Involving People Strategy is a joint strategy with a shared set of principles with our partners for involving people across Calderdale – supporting the delivery of Calderdale Cares, Wellbeing Strategy and Vision 2024. Calderdale Involving People Strategy is central in helping the CCG embed the voice of patients, carers, families, staff and the public everything we do. This is a key part of upholding our legal requirement and ensuring we have taken the time to consider all insight and feedback.

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Joint strategy helps us to build system wide engagement and communication – and the principles of strategy are the foundation by which local people can expect to be involved by any organisation in Calderdale

The strategy will create a platform for the sharing of knowledge and information from both services to communities and communities to services and alter the relationship services have with local people and local people have with services.  The strategy sets out where we believe we are, what we need to do to move forward and how we will make this happen.

We will not create new mechanisms but simply use the resources already in place to create an integrated approach.  The vision will be to transfer resources and identify opportunities to develop skills with local people so that any future strategy is developed by local people for local people. 

This strategy has been developed in partnership with Local Authority, VCSI Alliance, North Halifax Partnership and providers.  And has been tested with public audiences such as Calderdale Health Forum (Patient Participation Group (PPG) network), Children and Young People via the local authority. 

The strategy describes a narrative for involving people which sets out:

  • An approach
  • A set of principles
  • A way of working that we can all use

The CCG will use the strategy as a vision and describe our legal obligations, our governance and assurance, methods and approaches, which can be found in the involving people section on this website.

Three enablers will also support the strategy:

  • Communication – firstly in relation to involving people but more widely in how and when we communicate with our audiences to prepare them for the conversations that will take place
  • Peoples experience – the stories we create and share
  • Equality and Inclusion – ensuring we reach our diverse communities
Principles

Involving local people

A set of principles are described in the strategy to ensure that local people can be clear about what to expect if they get involved.  These principles have been based on the Calderdale Council and CCG approaches and incorporate the 4 rules.  The terms used in the principles relate to local people, population, community and locality and refer to protected groups.   These terms are defined as:

  • Local people or population: people who live in Calderdale
  • Community: The area or place where people live where there are interests in common
  • Locality: the wards and towns of Calderdale that have been grouped together into 1 of 5 localities
  • Protected groups: people who are protected by law under the Equality Act 2010: age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion and belief, sex and sexual orientation

The principles are:

Keep local people informed:

  • Be open and transparent in the sharing of information
  • Ensure that people receive timely information
  • Make sure information is in appropriate formats and considers the needs of all protected groups as defined by The Equality Act 2010
  • Co-design information with communities to ensure tone, presentation and language are reflective of the population 

Develop solutions together:

  • Communities are engaged at the development stage of the commissioning process
  • Engage with local people, service users and carers on the design of solutions and services; having local people fully involved in the design of services
  • Use co-production techniques to support genuine meaningful involvement  

Demonstrate active listening:

  • To listen to and involve local communities on decisions which may significantly change the way services are currently provided
  • To find creative ways to listen which promote opportunities for gathering views from local people who are seldom heard including those protected under the Equality Act.
  • To listen to concerns, complaints and queries and act on any feedback.

Creating opportunities for everyone to be involved:

  • Be clear about what people can and can’t influence and explain why
  • Local people are heard through representation on appropriate project boards and steering groups
  • Continue to build the capacity for the local voice in communities by sustaining and building on existing networks.
  • Appropriate methods and approaches are used to involve communities
  • Continue to find ways to reach those who aren’t currently involved, and ensure all communities have the opportunity to become involved.
  • Improved processes in place to share knowledge and information

Responding and providing feedback:

  • Keep people informed so they know what we are doing at each stage  
  • To provide feedback to the local community so they can see the results of their involvement using approaches such as ‘you said, we did’
  • Ensure communities receive timely and appropriate information and communication
  • Being aware of our environment and considering how to make the most of our assets to optimise social value

Communication:

  • Keep the channels of communication transparent and open
  • Use ongoing methods of communication to keep people informed
  • Make sure communication reaches all our local population by using a range of methods and approaches
  • Ensure that communication is in plain language, jargon free and appropriate for the target audience and considers the needs of all protected groups as defined by The Equality Act 2010

Working in partnership with key stakeholders

As a CCG we are committed to working in partnership with our partner organisations, providers, staff, public, patients and carers. We already have a good relationship with a number of key stakeholders including the third sector and we want to continually work with and invest in our partnerships to help us deliver the Involving People Strategy.

“Healthwatch Calderdale is passionate about involving Calderdale’s residents in designing, delivering and developing health and care services. We know that we do this best when we work in collaboration with other organisations, like Calderdale CCG, Calderdale Council and the voluntary and community sector, so that we can reach as many people as possible to gather views and offer valuable opportunities. The Involving People Strategy describes Calderdale as a place where health and care staff and services will listen to what you think, support you to contribute and work with you to adapt and change; Healthwatch is glad to see commitment to this approach across organisations in Calderdale.” Chief Executive

Our providers and partners have a wealth of local knowledge and relationships as well as other partnerships in which we can tap into to ensure we reach the population of Calderdale. We know that our third sector colleagues are better placed to help us reach grass roots communities and our partners can help us reach patients and service users. We need to grow these relationships to ensure everyone contributes to the delivery of the Involvement People Strategy.

“NHS Calderdale CCG has shown leadership and innovation in how it engages with the local voluntary and community sector. From investing in a local engagement champions programme, to inviting voluntary and community representatives to be part of strategic boards and working groups, the sector feels connected, included and valued as a partner and stakeholder.”  Chief Executive Officer, Voluntary Action Calderdale.

We will develop partnerships that will help us to come together formally and informally to achieve some common purpose. We understand that partners don’t have to be equal in skills, funds or even confidence, but what we want to develop is a mutual trust in each other and share commitment to the future of health and care in Calderdale.  We acknowledge that building trust and commitment takes time.  We will use a number of mechanisms to develop partnerships:

  • We will work collaboratively on specific projects and ensure membership is reflective of the local population, drawing on the expertise of those members
  • Continue discussions with partner, patient groups and communities to build up trust and confidence
  • Look to the local community when we want to talk to local people and invest in the skills and relationships which already exist
  • Work with local people to develop our plans and proposals for service redesign or development.
  • Work with service providers commissioned by the CCG to turn recommendations based on analysis of patient experience into actions for service improvement.

We want the relationships to develop as partnerships as we acknowledge partners as co-providers of services. We need our partners to help us to support the aim of developing active citizens who feel they can participate and have a voice in the provision and design of local NHS services.

Governance, assurance and monitoring

CCGs have statutory duties to involve the public in commissioning.  Calderdale CCG seeks both internal and external assurance that we engage with the right people, at the right time, over the right issues.  Internally, decisions on the commissioning of, or changes to health and cares services must be approved by internal committees and/or during Governing Body meetings, which are held in public.

The CCG assurance process has been designed to provide confidence to stakeholders and the wider public that CCGs are operating effectively to commission safe, high quality and sustainable services within their resources.

Internal

Governing Body (GB)

The governing bodies’ role is to ensure that we uphold the approach that is set out in the Involving People Strategy and that evidence of assurance is provided by commissioning managers regarding public involvement and patient experience activity in any proposed plans to change the way services are provided, delivered or commissioned in the future.

In addition to the governing body we have a number of mechanisms in place to demonstrate robust governance that supports the approach, delivery and audit all of engagement activity. These are:

Patient and Public Involvement Lay Representative

The lay member plays a key role through the appropriate governance processes including being a member of the governing body.  The lay member’s role is to ensure that

The voice of all members of the local population continues to be heard and that the interest of patients and local communities remain at the heard of discussions and decisions.

Quality, Finance and Performance Committee (QFPC)

The Quality Committee oversees the progress against the Patient Experience and Patient and Public Engagement agenda.

Quality team – Communications, Engagement, Equality and Quality (CEEQ) Advisory Group

The CEEQ advisory group is a primary gateway to access communications, engagement, equality and quality information, guidance and support to enable the work of the CCG.  The advisory group ensures that programmes of work take due consideration of any statutory requirements around involvement and equality.

Annual statement of Involvement (ASOI)

The ASOI gives us the opportunity to share engagement and consultation activity that has taken place over a period of 12 months (usually April to March).  The report sets out what people have told us and what’s happened as a result of people sharing their experiences and the feedback that they have given.  This report is received through all our internal committees’ above and is published on our website.

External

Calderdale Communications, Engagement and Equality Collaborative (CEEC)

A collaborative of communications, engagement and equality professionals from key partner organisations is currently being established to facilitate and co-ordinate Calderdale wide projects, communications, involvement and equalities – a do once approach for Calderdale Cares Placed Based Partnership. It will support the various Integrated Care System workstreams and any Calderdale system-wide campaigns, involvement and engagement/consultation.

Overview and Scrutiny Committee (OSC)

OSCs have a role in reviewing and scrutinising matters relating to the planning and provision of health services.  CCGs must consult their local OSC when considering any proposals for a substantial development or potential changes of a health service.  The OSC may scrutinise such proposals and make recommendations to the CCG or refer to the Secretary of State for Health.

Legislation and responsibilities

The CCG is accountable to the public, communities and patients it serves.  As part of our governance and assurance that we involve the people who live and work in Calderdale; in our work, there are a number of statutory duties that we must follow.  The duty to involve local people is set out in sections 242 and 244 of the Health and Social Care Act 2012, The NHS Constitution and the Equality Act 2010.

‘Public involvement in commissioning is about enabling people to voice their views, needs and wishes and to contribute to plans, proposals and decisions about services.’ (NHSE 2018)

Health and Social Care Act 2012

The Health and Social Care Act 2012 makes provision for Clinical Commissioning Groups (CCGs) to establish appropriate collaborative arrangements with other CCGs, local authorities and other partners. It also places a specific duty on CCGs to ensure that health services are provided in a way which promotes the NHS Constitution – and to promote awareness of the NHS Constitution.

Specifically, CCGs must involve and consult patients and the public:

  • In their planning of commissioning arrangements
  • In the development and consideration of proposals for changes in the commissioning arrangements where the implementation of the proposals would have an impact on the manner in which the services are delivered to the individuals or the range of health services available to them, and
  • In decisions affecting the operation of the commissioning arrangements where the implementation of the decisions would (if made) have such an impact.
  • The Act also updates Section 244 of the consolidated NHS Act 2006 which requires NHS organisations to consult relevant Overview and Scrutiny Committees (OSCs) on any proposals for a substantial development of the health service in the area of the local authority, or a substantial variation in the provision of services.

The Equality Act 2010

The Equality Act 2010 unifies and extends previous equality legislation. Nine characteristics are protected by the Act, age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion and belief, sex and sexual orientation. Section 149 of the Equality Act 2010 states that all public authorities must have due regard to the need to a) eliminate discrimination, harassment and victimisation, b) advance ‘Equality of Opportunity’, and c) foster good relations. All public authorities have this duty so partners will need to be assured that “due regard” has been paid through the delivery of engagement activity and in the review as a whole.

The NHS Constitution

The NHS Constitution came into force in January 2010 following the Health Act 2009. The constitution places a statutory duty on NHS bodies and explains a number of patient rights which are a legal entitlement protected by law. One of these rights is the right to be involved directly or through representatives:

  • In the planning of healthcare services
  • The development and consideration of proposals for changes in the way those services are provided, and
  • In the decisions to be made affecting the operation of those services.

We also follow statutory guidance issued by NHS England which outlines best practice for patient and public involvement.  The guidance supports staff to involve patients and the public in their work in a meaningful way to improve services.

Commissioning cycle

When planning or buying local health services, we must take the views of local people, patients and carers/families, as well as the people who represent them and our staff into account.

We are committed to ensuring that everyone’s needs are at the heart of everything we do. We follow a set of guidance issued by NHS England which outlines best practice for enabling people to voice their views, needs and wishes, and to contribute to plans, proposals and decisions about services.

The diagram below describes how we make sure involvement is embedded in our commissioning decisions.

Strategy

This strategy is central in helping NHS Calderdale to achieve its commissioning function so that we can ensure that we place patients and the public at the centre of all our commissioning decisions.

We need to ensure that our commissioning cycle (diagram 1) builds in patient and public engagement and experience at each stage.

A diagram represnting the commissioning cycle for health and care services in Calderdale.
Diagram 1: The Commissioning Cycle

We want to reach a point where we can ensure that every person in Calderdale is given the opportunity to have a voice in the decisions that are made to commission services and have an opportunity to provide feedback and comments on the services we commission. We will ensure that people are made aware of the impacts of their influence on the improvement of services. We want to ensure that as citizen’s people feel communicated with and informed and can engage in a meaningful way.

Calderdale CCG wants to create a system that allows for everyone who has a stake in healthcare services the opportunity to have a voice. We want to make sure that the public can influence the services we commission, input into the services we provide and help us to jointly develop specifications for services.

Having the voice of the public in all aspects of our commissioning work is vital – it ensures that we put local people at the centre of everything we do. We want to work with the public to design services that really do meet their needs. This is a key part of our job, and we are trying hard to find new ways to actively engage people in planning the services they are their families will access, both now and in the future.

Debbie Graham, Head of service improvement, NHS Calderdale CCG
Holding providers to account

As part of the CCG’s legal duty, we monitor our providers’ patient experience and feedback through a number of channels including contract monitoring meetings, clinical quality boards, service specifications and our engagement activities.

We capture feedback from service users about providers through compliments, complaints, patient experience feedback reports and the results from surveys. At clinical quality boards we work collaboratively to ensure we use patient experience   and feedback to contribute to quality improvement projects and commissioning decisions.  We request further qualitative information through our meetings with nursing and quality colleagues to provide more detailed assurance.

We also undertake visits to providers’ which allows us to use a range of measures to assess the quality of front line services. The visits include talking to both staff and service users about their views and experiences. 

Service user and public experience and involvement

Providers will be required to regularly and pro-actively seek feedback from people, using a range of different methods.   Wherever possible, collect service user experience information from a representative sample of appropriate protected characteristics.  The information gathered is used to inform continuous improvement.  

As part of the NHS Calderdale CCGs duty to involve we are required to provide a Patient & Public Engagement Annual Statement of Involvement report on engagement activity each year.   We ask our providers to complete a template for each piece of engagement and/or consultation work that they have delivered. 


Managing the quality and patient experience of our providers

The CCG monitors the quality of the services it commissions by undertaking both quality assurance and improvement processes. These include:

  • Reviewing performance indicators aligned to the three components of quality; safety, effectiveness and experience
  • Undertaking routine Quality Assurance visits with front line services and in response to concerns
  • Triangulating intelligence using a variety of measures and intelligence sources rather than relying on one or two, eg. Healthwatch
  • Identifying where performance suggests improvement is required and holding providers to account on their improvement plans

GP Practices Boundary changes and Practice mergers

We work closely with our GP practices to support engagement with their patients on practice mergers and boundary changes as well as supporting them to undertake Quality Impact Assessments for any proposed changes or amendments to existing services. 

We have developed toolkits and created templates for them to use along with a quick guide flowchart.

These resources help to promote a systematic way of assessing, understanding and including any possible impact on patients, the quality of their experience or the availability of healthcare options for them.


Committee structure: monitoring quality, patient satisfaction and the patient’s voice

  • Each of our Governing Body meetings feature a patient story (click here for details of previous meetings and their associated papers.)
  • Quality, Finance Performance Committee (QFPC) receives monthly reports on provider performance against their respective quality and performance schedules.
  • The Patient Experience Group (PEG) meets quarterly and sits across the Calderdale, Kirklees and Wakefield geographical footprint. Membership includes people with lived experience to bring the patient voice and to provide challenge, as well as representatives from providers, CCGs and partner organisations. The purpose of the group is to help shape and improve patient experience by:
    • Networking – developing and sustaining positive relationships across the group membership.
    • Collaborating – working together with providers to identify areas of good practice, areas of concern and actions for improvement.
    • Learning – sharing good practice across local providers as well as being mindful of the ongoing work of the West Yorkshire and Harrogate Health and Care Partnership as new plans are developed across the region.
    • Shaping – Setting, monitoring and driving the delivery of the patient experience priorities.
    • Minutes are shared with the QFCP for assurance.
  • Commissioning Primary Medical Services Committee (CPMSC) meeting occurs bi-monthly and has a pivotal role in receiving information to provide assurance on the quality and safety of primary care services.