Calderdale CCG have a published Public and Patient Involvement and Experience Strategy which sets out the CCGs approach to involving local people and the legislation the CCG must work to. 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.
During 2017/18 we have involved just over 4,250 local people in the development and design of local services. The CCG produce a separate engagement annual report which can be downloaded here. This report provides more information on how we involve people, who gets involved and how we use the information we gather. The report has link to reports and websites where more information can be found.
Below you can find details of our previous engagement and consultation activity, what you told us and what we’ve done with this information.
This report pulls together all the engagement and consultation activity that has taken place across Calderdale and Greater Huddersfield during March 2013 to August 2018 on services that directly or indirectly relate to hospital services. The key emerging themes including equality from all this work will be used as a baseline to support the development of future services.
People told us:
The information has been gathered from feedback on a number of service areas and programmes of work, these are:
- Cardiovascular disease
- End of Life
- Specialist Nursing
- Other Generic
- Seamless home from Hospital
The report summarises what people have told us and any equality considerations and provides a link to any published report.
What we are doing
The aim of the report is to catalogue all the views gathered so that we can understand what people are telling us about local NHS hospital services and use this information to inform any future design or development.
The report highlights the wealth of intelligence that already exists and supports the approach of using what we already know before embarking on further engagement.
This report however does not mitigate the need to continually involve people at each stage of service development. If there are gaps in reach, audience and intelligence more work will be done to ensure the information is gathered.
Calderdale and Huddersfield NHS Foundation Trust, NHS Calderdale Clinical Commissioning Group and NHS Greater Huddersfield Clinical Commissioning Group are working together on a new engagement that focuses on Calderdale and Huddersfield NHS Foundation Trust A&E departments, interviewing patients anonymously about their experiences of using the two departments.
Community Voices and Engagement Champions have attended the A&E departments in Calderdale and Huddersfield to have face to face conversations with a diverse range of people that represent those who are using the department. Alongside this, we are reviewing existing data from our previous engagements, as well as:
- Patient Advice and Liaison Service (PALS) and complaints data.
- Care Opinion and NHS Choices postings.
- Friends and Family Test.
By using existing data held by our organisations, we are able to listen to and consider the views of a wider range of the local population without the need for a large-scale public consultation.
The purpose of the interviews is to build a ‘snapshot’ of one week in A&E and allows us to understand what we need to do to ensure that we can support people in the local community to seek alternative help, rather than having them travel to hospital. The hope is that this engagement will suggest improvements to how the departments can work to better serve patient needs.
We have been using a survey to help structure the interview. As part of this we are piloting a revised equality monitoring section that includes a question asking if people are in receipt of any benefits. We are asking this question to help us understand if being on a lower income affects experiences of services or health. With permission, a short follow up survey will be conducted by doctors a week after Community Voices and Engagement Champions have visited the department to gain a full view of the patient experience, which will contribute to the next steps.
The data collected from the interviews, alongside the review of existing information, will be used to create a report of findings. No confidential information will be shared, but the report will be made publically available with feedback provided to those who request it.
What we are doing
A follow up survey conducted by community volunteers recruited through ‘Engagement Champions’ will now take place with patients who attended A&E. Once this survey is complete, the findings will be published and the hospital (CHFT) and CCG will work together to identify improvements to services.
Update on the project
Community Assets (Community Voices and Engagement Champions) attended the A&E departments over a one week period. Community Assets who attended the sessions were supported in this role by hospital staff whilst they interviewed patients and carers. A coding system for the survey was used to maintain anonymity for patients.Respondents to the survey were also be given the opportunity to take part in a follow-up survey.
The key themes from existing data and the engagement were as follows
Reasons for attending A&E
- People often report that they have sought advice from a health professional prior to attending A&E, and that they have been advised to attend A&E. Either because they have a health condition that needs to be dealt with urgently; that A&E is the best place to receive the care that they require; or they have been advised to attend if their condition doesn’t improve.
- Many people attend as they have been unable to get an appointment with their GP, or if they have been offered an appointment they don’t want to wait as they are concerned about their condition and want to be seen quickly; or the appointment is at a time that isn’t convenient for them. And for some people their health condition has occurred in the evening or at the weekend and as such they have been unable to access their GP practice.
- A few people attend A&E as they are not happy with the advice and or treatment they have received and want a second opinion.
- Some people don’t seek advice as they feel that A&E is the right place for their condition.
- Those people that attend A&E at the evening and weekends often aren’t aware of where else they could seek medical advice and support.
Quality of service in A&E
- People report high levels of satisfaction with the service they receive in A&E and praise staff for their quality of care. Although some felt that staff seemed rushed which impacted on the waiting times and the quality of the care provided, and felt more staff would improve this.
- Many described long waits to be seen; to receive their test results; and to be discharged. If the waiting times for each of these had been shortened this would have improved their experience. They also wanted staff to keep them informed of expected waiting times.
- When asked what they expect out of their visit to A&E, people report that they want to be able to access the appropriate diagnostic tests to support them in being provided with a diagnosis of their condition so they can be provided with the appropriate advice and treatment / medication.
- Seating provided in waiting areas was described by some as being uncomfortable.
Alternatives to A&E
- Many people report that if they had been able to access a GP appointment at a time that was convenient to them they may have not attended A&E. Suggestions were made to be able to access GP appointments early morning, evenings and weekends but they want to be able to access these appointments the same day.
- People have also suggested if GP practices were able to undertake diagnostic testing such as blood tests, x-rays, scans and treat minor injuries this would reduce the need for people to attend A&E. Some suggested having a minor injuries unit or a 24 hour walk-in centre.
The engagement process has provided NHS Calderdale CCG, NHS Greater Huddersfield CCG and Calderdale and Huddersfield NHS Foundation Trust with the views and suggestions of the public, to help understand why people attend A&E and what support people could or should receive in the local community to support a reduction in visits to A&E.
The findings can be read in the report: A Week in A&E engagement report.
This report will also go to the A&E delivery board who will use the findings of the report in the future planning of A&E services.
There has been no previous engagement on psychological services.
In 2017, South West Yorkshire Partnership NHS Foundation Trust (SWYPFT) gave notice to the therapists providing art therapy in Calderdale, with a view to art therapy stopping. As SWYPFT had not undertaken any prior engagement with service users and following a report on the decision to give notice to Overview and Scrutiny Committee, service users were then invited to provide evidence of the impact the withdrawal of art therapy would have on them. This evidence was pulled together by service users into a submission which was received and discussed by the OSC.
One of the outcomes of the OSC discussion was a recommendation that the CCG should undertake a review of adult psychological services. Engagement is a key part of that review.
The engagement process started on 13th March 2018 and was due to finish on 24th April 2018. However due the low responses received the survey remained live until the end of July 2018 to encourage further responses.
People told us:
The CCG received 175 responses to the survey and the findings are set out below.
The services people had most used are as follows, with the highest rating included:
- Counselling (50%) – rated as good-excellent by 50%
- Cognitive Behaviour Therapy (45%) - rated as poor by 54.3%
- Art Therapy (23%) - rated as good-excellent by 80%
- Self guided help (19%) – rated as poor by 52.5%
- Interpersonal Psychotherapy (8%) – rated as good-excellent by 61.1%
- EMDR (7%) – rated as good-excellent by 58.8%
The services that had only been used by 2-3% of respondents that could not be rated due to low numbers were: Integrative Therapy, Acceptance and Commitment Therapy and Cognitive Analytical Therapy.
People told us that services scored higher (ranked 4-5) were because:
- People felt like the therapist was interested
- People felt safe - trusting the process and therapist
- Staff were competent, non-judgemental, compassionate and well qualified
- The service worked in supporting the client and there were positive outcomes
- The service promotes long term improvements and has a positive impact on the individual and wider relationships including family, friends and other healthcare professionals
- Quick access to the service including booking an appointment
- Access to the service is ‘open ended’ no restrictions or boundaries
- The service was accommodating to the persons needs
- The service supports recovery providing practical coping strategies and being person centred
People told us that services scored lower (ranked 1-2) were because:
- Waiting time to access the service, particularly for longer term support
- The service did not last long enough to have a benefit or support an outcome
- Staff attitude was poor
- Access to the service was impersonal, face to face is preferred
- Staff did not have the skills, lack of confidence in staff ability, skill or experience
- Inconsistency in staff and ability, relationship was poor
- Staff changes
- The service was not right for the persons condition
- Lack of trust in therapist or service
- The service did not result in a positive outcome, for some it made a condition worse
- Services are short term and focus on symptoms rather than root cause
- Not enough self-help groups
- The service could not help me with my needs – some describe these as complex or when they were very unwell
Respondents (49.7%) told us they would like to travel between 15-30 minutes to receive a service but some (36.88) would travel between 30-60 minutes.
Respondents have told us what the most important aspects of care are:
- Compassionate Staff (88.7%) and seeing the same person (88.6%) were a top priority for the majority of respondents.
- A service that responds quickly to a person’s need (75.4%)
- Being able to choose the type of support a person receives (72.2%)
- Being clear on what outcomes the support will provide (71.6%)
- A safe place (70.9%)
- Being able to book a convenient appointment time for my life (68.1%)
When asked what was the most important aspect of a service, people told us:
- Treatment that lasts for as long as is needed and suitable to the persons needs
- Holistic care
- Staff who are caring with the right skills and information
- Longer term support
- Appointments and waiting times
- Suitable environments
The support people would like to see commissioned is:
- More services that are long term including services not clinically led – use the voluntary sector more
- Specialist sexual violence services and for those who been sexually abused
- Peer support services such as Andy’s man club
- Adult ASD services and ADHD support
- More IAPT services and links to substance misuse
- More specialist support for those who have experienced severe trauma such as refugee and asylum seekers
- Services suggested were: neurofeedback, sensorimotor psychotherapy, art psychotherapy, long term EMDR, trauma informed yoga, hynoanalysis, IMET, NLP, Psychdynamic music and drama therapy, mindfulness, CFD, gardening, outdoor therapy, art therapy, DBT, reflexology
- More drop in sessions
- Work place based services
- Support and education
- More money in to the services currently provided before looking at others, reduce current waiting list
- Out of hours support – helpline, face to face
- Young people’s service and services that can support victims of child abuse
- Eating disorder and bereavement support groups for all ages
- Campaigns to reduce stigma
- Help and support for carers and families
- Help and support in community settings such as parent and toddler groups, schools and gyms
- Support which is personalised
- Support for flood victims
- More staff and workers to support the gap between IAPT and secondary care services
- Additional CPNs and more crisis support
- More support from the GP
What we are doing
The next steps for the CCG will be to consider all the views and feedback along with the EQIA to inform the future of adult psychological services in Calderdale.
The findings will be shared through internal governance and with the Mental Health Innovation Hub. The report will be published and the next steps explained following consideration of the findings.
People told us the areas of improvement they would expect to see from the service and identified solutions to inform the service specification.
People told us:
- They would like the right good quality equipment first time
- Equipment that supports independence and consideration of lifestyle and a wider range of equipment
- 24/7 repair service for all that is responsive and includes same day repair service for complex wheelchair users
- Well trained staff and a clear referral process and information about what to expect, when and how
- Complex service users and children and young people who have changing needs over time getting planned reviews regularly and timely re-assessments
- Timely honest communication, including calling people back, and updates on progress
- Accessible communication – type talk, language interpreters (including staff who can speak different languages) and more use of technology
- Regular clinics in other areas and settings and appointment bookings managed in a timely way
- Fast track appointments for urgent needs
- Holistic approach to providing information for people who use a wheelchair – multiagency approach to creating information to support people
- Personal budgets, equipment and advice on buying equipment independently
- Comprehensive training on the use and maintenance of equipment
- Employ service users in the organisation, look at a the role of the voluntary and community sector in providing non clinical services with a clinical partner
- Develop service user led service evaluation, principles and information and robust monitoring of the service involving service users
- Investment in the service to keep people healthy and well
- Look at areas where people can contribute costs – rental equipment, topping up funding and personal budgets
- Recycle and repair
What we are doing
The CCGs have worked together to understand the findings from all the engagement. This included findings from Healthwatch and previous engagement in Autumn 2017.
Using the information provided the CCGs can now work with the current provider to support service improvements and continue to work together to develop a new service specification.
Work to develop a specification will continue in October at a workshop aimed at service users, carers and families. The purpose of the workshop is to help develop and co-design the service specification.
Following the workshop a service specification will be developed.
Wheelchair Services Report on pre-consultation engagement work: August 2018 661.47 KB 48 downloads
Wheelchair Services Report on pre-consultation engagement work carried out by PCAN...
NHS England are making extra funding available to CCGs for use in order to improve access to GP services, by offering more appointments with GPs and Nurse Practitioners.
To help us to offer more appointments at times and locations that would be suitable for service users, we’d like to know your views on services as they are at the moment, how you access them currently, and how you’d like to access them moving forward.
Additional GP appointment slots may be delivered as routine pre-bookable appointments at evenings and weekends. This may not be in your local surgery, but would be offered at other locations across Calderdale.
People told us:
A summary of the key findings from the engagement are listed below:
· The top four aspects of service that were seen as the most important (ranking 8-10) in order were:
- Good care and treatment 92.6%
- Being able to book an appointment 90.7%
- A clean and safe place 73.7%
- Staff being able to see my medical history 69.8%
- Location 59.6%
- Having my communication needs met 53.3%
· The least important aspects of a service (ranking 1-3) were:
- Bi-lingual staff and interpreters 60%
- Easy access to the building 57.8%
- This trend did not hold true for disabled people who rated access highly (score 7 and above) and Asian/Asian British people who rated bilingual staff highly.
- There were a good number of respondents (48.7%) who stated they would travel between 15-30 minutes to receive a service, 43.5% stated they wanted to travel under 15 minutes. Looking at the table the results show that 62.8% of those responding travel by car to an appointment, this may account for people being prepared to travel up to 30 minutes.
- For equality there was a difference in people ability or preference in terms of travel times, some of the groups were more likely to walk, use public transport or taxi’s than the overall sample. This may have impacted on people choice about how long they were able to travel.
- Respondents told us that for a same day appointment the most convenient time for the majority of people responding (60.9%) would be 6:30-8pm Monday to Friday. With 67.6% stating they would not attend an appointment from 6:30am to 8:00am.
- The results for equality confirmed this finding.
- For those responding to additional appointments on a Saturday there was no clear time that was presented as the most convenient. For both routine (23.2%) and same day appointments (21.5%) the time of 10am-12noon seemed to be the most popular option, with 8am-10am not being favoured by some (27.4%). Looking at the data it would appear that most of the times offered would be favoured by a good majority of the population. For Sunday a similar picture emerged with no clear indication of preferred times.
- There were some differences in preference by equality group, but this mainly followed the trend outline above, with a distinct preference for appointments on a Saturday rather than Sunday. Disabled and older people were less keen on early morning and later afternoon appointment
- The majority of respondents still prefer face to face contact (96.6%). The most favoured technology was the telephone (34.3%) with other types of technology using internet technology only favoured by 27.4% of those responding.
- Telephone appointments were second choice, with Asian/Asian British people putting this at near 50%. Using apps and online were least popular with Asian/Asian British, disabled people and carers.
- Most people responding would wait until the practice (47.6%) is open or use NHS 111 (40.6%) or go to the pharmacy for advice (30.6%). There were still a significant number of responses who would go to A&E (20.5%).
What we are doing
The findings from the engagement will be used to inform the development of a specification which will improve access to GP services across Calderdale. The specification will take into consideration the findings from previous and recent engagement to ensure any development are informed by public views.
Consideration would need to be given to the location and facilities of any extended services, with practices needing adequate parking and locations on or near public transport links. The number of people walking, over 20% of the respondents may mean that they live locally to their practices or that they have no other means of transport, as this was not asked we cannot speculate.
A timeline for these developments will aim to ensure that arrangements are in place for extended access in Calderdale in Spring 2018.
Further information on the progress of these developments will be available on the CCG website and through local practice websites and information mechanisms.
Any improved access will be publicised using a clear communication plan.
The findings of this work will be shared through our existing networks and the report published in the get involved section of Calderdale CCG website. Visit www.calderdaleccg.nhs.uk for more information.
Calderdale CCG has an overall budget allocation of £312million to “commission” or buy, health and care services. The CCG wanted to talk to local communities to gather ideas on how the CCG can reduce waste and save money whilst keeping the high quality services we need and; how we can reduce our spending on pharmacy services. The engagement process was delivered to help the CCG understand local communities’ views, comments and ideas on two specific areas. The areas were:
- How the CCG could reduce waste and save money whilst keeping high quality services that were needed
- How the CCG could reduce spending on pharmacy services
You told us
From 987 people who responded most people had ideas and suggestions on how we could reduce waste and save money. In addition people wanted to reduce pharmacy waste and the use of lower value medicines. There was a clear indication from the findings that further conversations should take place to make decisions in these areas.
What are we doing
The results of engagement were considered by the CCG and shared widely with all stakeholders. The findings were used to identify areas of service change that the CCG could consult on to help reduce unnecessary spending. People told The CCG that they wanted to see prescribing based on clinical effectiveness.
Following a process of consideration the CCG consulted on a range of products that fit the criteria identified in engagement. The public helped the CCG determine the list of products that would be included in the consultation by providing feedback at the engagement stage.
Following on from the Everyone’s NHS engagement the CCG's Medicines Management team identified options for consultation. The consultation was on medicines and products that the CCG may want to consider not continuing to prescribe in the future. These products were branded medicines, lower value medicines and products such as sunscreens, baby milks, and creams for unwanted hair and Gluten free products.
You told us
From the 1,377 people who responded there was evidence to suggest that most people agreed with the decision to stop funding the majority of items on which the CCG consulted. There was a general agreement across all products that the CCG needed to prevent an impact on people who have a low income children, young people and frail elderly and measures should be in place to ensure they are protected. There was also a theme that GPs should use clinical judgement case by case. People want to see more prevention, more information and greater communication to people to ensure impact is reduced.
What are we doing
The results of this report were used along with other clinical evidence to help to inform a decision on whether to continue to prescribe each of these items. The consultation findings were presented to internal committees.
The CCG Governing body made a decision following this process to stop prescribing all the items consulted on with the exception of gluten free products. Following the outcome of a national consultation NHS England recommended that bread mixes remain on prescription. Calderdale CCG decided to support this recommendation and retain bread mixes on prescription.
The current provider in partnership with the CCG and Healthwatch engaged with service users. This was as a direct result of a number of issues raised by service users, carers and families. We wrote to all services users who had used the service in the last two years and circulated a survey to key stakeholders and publicised through Healthwatch.
You told us
From the 287 responses people told us that there were a number of improvements that were reported to ensure the current service meets the needs of all service users. The main themes raised from the engagement are:
The key areas of improvement are identified as:
- Waiting time from assessment to receiving a wheelchair – particularly for children and young people and those using powered wheelchairs
- Waiting for an assessment – particularly for children and young people, and those with long-term health conditions
- Getting issues resolved easily and quickly
- Repair service
- Communication (written and verbal) information
For children and young people, carers and families and service users who’s needs change over time, timely access, good information and communication were the most reported improvements required. For people who had used the service less frequently the service received more positive feedback.
What we are doing
Calderdale CCG is using the findings from the engagement to further inform a new service specification. This specification will be developed with clinicians and key stakeholders. The current provider has already identified areas of improvement from the report; including improving communications and information. We will also be talking to people further about the development of a service specification in Spring 2018.
NHS England committed an additional £500 million by 2020/21 to fund additional access to GP services. This includes routine appointments for evenings and weekends to meet the needs of the local patient population. We used a number of approaches to reach people including GP practices and GP patient reference groups, Engagement Champions, social media and a paper and online survey.
You told us
From 1,489 who responded, people told us that for a same day appointment the most convenient time for the majority of people (60.9%) would be 6:30-8pm Monday to Friday. With 67.6% stating they would not attend an appointment from 6:30am to 8:00am. At weekends for both routine (23.2%) and same day appointments (21.5%) the time of 10am-12noon seemed to be the most popular option. People also told us what they valued most when using the GP practice and anything else they want the CCG to consider.
What we are doing
The findings from the engagement will be used to inform the development of a specification which will improve access to GP services across Calderdale. The specification will take into consideration the findings from previous and recent engagement to ensure any development are informed by public views. Consideration will be given to the location and facilities of any extended services. A timeline for these developments will aim to esnure that arrangements are in place for extended access in Calderdale in Spring 2018.
NHS Calderdale CCG and Calderdale Council arranged a number of engagement activities and events on the future provision of care homes in Calderdale. The aim of the project is to create a vision for Calderdale and understand what’s important to people of Calderdale as they get older.
You told us
People told us what a good care home looks like:
- People want the right staff who are skilled, trained and supported. Staff who are caring and compassionate and understand cultural needs and beliefs. They also want to see good management and homes that are staffed at all times.
- Quality of care was a significant factor to respondents. They want to see continuity of care with good quality standards and choice and be involved in their care and planning. Care that meet the needs of physical, social and mental health requirements.
- People said their environment was important to them with clean, well decorated, modern and good facilities. They want to feel safe, looked after in a warm friendly and loving environment that feels like their own home.
- Being in heart of the community was also important to people. To be near family and friends and local amenities.
What are we doing
The findings from all the engagement activity has been shared with all stakeholders at two events which took place in March. Throughout spring and summer 2017 there will be more work with providers on care home provision. The information gathered will be used to inform this work and the conversations will continue.
The CCG wanted to engage local people on how local pain management services are currently provided. Services need to be in line with all the latest evidence and NHS guidance and any changes to local services as a result of this need to be understood. A survey was sent to all patients who had use the service in the last two years.
You told us
From the 114 people who responded patients are satisfied with the services they receive from pain services. There was positive feedback included for following services:
- Orthopaedic service for an injection or surgery
- Chronic pain service for injection therapy
- Chronic pain management programme
People also told us:
- GP service, Physiotherapy and other NHS Services was rated positively
- Most want to manage their own pain and be independent
- The aspects that would improve the service as noted within feedback included more varied treatment and many wanted greater promotion of patient choice.
- Many would benefit from shorter waiting times
- Improvement in staff communication and attitude to patients were also noted
- Better advice and support was suggested as an aspect that would improve pain services.
What we are doing
The engagement will ensure commissioners are able to understand what can be done to develop new approaches to pain management. We want to look at helping people to manage their own pain and keep people independent in the future.
This model is to work mainly within the community provision of optometry services within the community. It will enhance the community schemes and allow patient choice and right care in the right environment. Reduce clinical waiting times and referral to treatment times, shift outpatient activity from the acute trust to the community. The CCG used a survey to engage with patients on their thoughts of community optometry services.
You told us
Most people completing the survey had recent experience of using the service. 66% of those responding had used the service in the last year.
- From those responding 40% of patients had a condition that required long term monitoring at the hospital and 59.5% did not.
- From those patients responding 71% were happy to receive the monitoring with a local optician with 21.4% stating they would prefer to still be seen at hospital.
- The GP practice was a preference for two respondents with two people stating other. The other were stated as:
- Opticians who are more qualified
- Depends on situation as to who I would want to see
What are we doing
The findings from the engagement activity will be added to any existing engagement which has already taken place in Calderdale and Greater Huddersfield. The feedback from this and any other engagement activity will be used to inform and develop the SLENT model further and future pathways:
- Consulted with clinicians and communications specialists and developed marketing material to further promote and inform the general public of the services available to them within the community.
- We informed GP receptionists to sign post patients to Optoms for eye conditions.
- A developed pathway that has factored in what patients have identified with traveling times and where they would like to get treated also to reduce consultant waiting times.
A review of the SWYFPT trust wide Rehabilitation & Recovery Services has taken place over an 18 months period, initially focused on the future of the existing rehabilitation units. Calderdale MBC and the CCG want to consider where trust services can be most effective to support the wider rehabilitation pathway. VAC liaised with Calderdale CCG to draw up questionnaires aimed at gathering the views of service users, advocates, carers, family members and Staff.
You told us
All those interviewed felt that services like Lyndhurst are a necessary part of the recovery pathway. Service users are aware they have a Recovery Plan at Lyndhurst that gives their lives structure and focus and that staff play a positive role in helping and supporting them as they progress through their recovery pathway.
It is recognised in by all surveyed that having compassion, understanding, a caring, empathetic nature, patience and being a good listener are the overriding skills that a person needs to work in Mental Health. It is clear, certainly amongst the staff we spoke with, that if it is to happen, ‘Care in the Community’ in this field should include the service user having 24/7 access to Mental Health Services.
What are we doing
The findings from engagement were presented at a Rehabilitation and Recovery Programme Board. It was agreed at the board that a workshop should be set up to ensure the findings were considered as part of the proposed clinical model. A workshop took place in May 2017. In addition Lyndhurst received a full copy of the report findings to share with participants.
The Right Care, Right Time, Right Place programme is the commissioners' response to the case for change that was developed as part of a services review undertaken in 2013. Following extensive engagement in 2015/16 a consultation on the proposals for service change took place in 2016/17. A full consultation document, survey and accompanying summary and easy read documents were produced to explain the proposals. A consultation ran for 14 weeks from 15 March to 21 June 2016 on the future of hospital and community services in Calderdale and Greater Huddersfield.
You told us
We received 7,582 survey responses from local people which provided 40,000 comments to 11 questions. We also had in excess of 500 phone calls, letters, documents, texts and emails to read and 195 pages of transcripts from 3 public meetings and 8 petitions. In order to ensure the responses were fully considered, the CCG secured the services of an independent organisation Midland and Lancashire CSU (MLCSU) to analyse all the responses and produce a report of findings. From all the feedback received MLCSU told us there were six key areas that we needed to consider. The key areas for further work were:
- Travel and transport: Impact of increased travel times, in particular for access to emergency treatment at Halifax. Travel between Huddersfield and Halifax on the Elland bypass. People also mentioned public transport, travel costs and lack of car parking at CRH and ambulance responses.
- Clinical safety and capacity: People were concerned that lives could be put at risk from the need to travel further, the quality of care and the availability of treatment. How Urgent Care Centres would work with the Emergency Centre and the impact on GPs and the Ambulance Service.
- The rationale for change: People stated that the proposals are to save money, instead of to improve results. They were worried that the Private Finance Initiative (PFI) agreement at CRH had influenced the proposals. People wanted to know if staff at the hospital and other services, such as the Ambulance Service, supported the proposals.
- The consultation process: People were worried how the consultation was done and how decisions would be made.
- Understanding the proposed model: Some people did not understand the detail of the clinical model. People said there was not enough information on what it was and how it would work. People did not seem to understand the terms ‘emergency care’ and ‘urgent care’.
- The need for change: Some people agreed that change is needed, even though there are concerns. Suggestions were made about alternative sites, different ways of arranging services and improvements to services.
What are we doing
The Governing Bodies of NHS Calderdale Clinical Commissioning Group (CCG) and NHS Greater Huddersfield CCG met in parallel in public on Thursday, 20 October 2016 to reach a decision on the outcome of the consultation and next steps on proposed changes to hospital and community health services in Calderdale and Greater Huddersfield. The findings from the consultation were deliberated by the CCGs and considered by the Governing Bodies at this meeting.
The Right Care, Right Time, Right Place programme is the commissioners' response to the case for change that was developed as part of a services review undertaken in 2013. Following extensive engagement in 2015/16 a consultation on the proposals for service change took place in 2016/17. Following the consultation a stakeholder event was arranged to support the CCG in deliberation of the consultation findings. A number of stakeholders had continued to work with us throughout the programme and we wanted to use the opportunity to engage them in the findings from consultation.
You told us
The findings from the stakeholder event are captured below. The findings include the key themes received from the table discussions. Key messages from each table were written on a ‘green flag’ and presented to the facilitator to read out at the end of the stakeholder event. The messages were;
- A&E versus urgent and emergency care – there needs to be a clear understanding of the differences. Communication and trust are needed and case studies and stories would help.
- Travel concerns – there needs to be some explanation of what A&E is and isn’t to help people understand.
- Need to communicate clearly and widely the model – the consultation suggests people still do not understand the urgent and emergency care model.
- Communicate how things will work in practice (the language we use is important) – help people to understand patient pathways, explain terminology, clarify things practically.
- Communication and culture shift– describe the bigger NHS picture and provide clear messages that hospitals are not always the answer. Make sure information is collaborative (everyone working together for both communities) and honest (including finance) to improve outcomes.
- Communicate the benefits and facts of the proposal - emphasise care closer to home.
- Need for change – clear understanding required, need to communicate.
- The rational for change needs a better explanation.
- Clinical case for change needs more describing - to help people understand how it affects ‘me’, this could include case studies.
- Clinical safety – emphasise the opportunity for new ways of working between hospital and GP practices and the use of new technology and better use of staff.
- The impact on GP services, including access – we need to start from the services closest to the individual and ensure community services are in place in order to design a secondary care system. This should be phased in and tested at each stage.
- Workforce planning – the system needs the right numbers of staff with the right breadth of competencies across a health and social care system. There needs to be the right balance between generalist and specialists and services need to be joined up.
- Recognition of the need for change and that all issues can be resolved – CCGs need to be sure that any issues identified can be achieved. The next stage is to win hearts and minds in order to progress further.
- 64% do not agree with the proposal – how will the CCG now flex the proposal and improve communication of any plans.
- We need to thank people for responding to the consultation – patients and public deserve a response.
What are we doing
The Governing Bodies of NHS Calderdale Clinical Commissioning Group (CCG) and NHS Greater Huddersfield CCG met in parallel in public on Thursday, 20 October 2016 to reach a decision on the outcome of the consultation and next steps on proposed changes to hospital and community health services in Calderdale and Greater Huddersfield. The findings from the stakeholder event and CCGs’ deliberation were considered by the Governing Bodies at this meeting.