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Contents

1. Contents and background………………………………………………....4

2. Developing the infrastructure for engagement & participation……..6

3. Engagement and participation activity…………………………………..11

4. Meeting the individual participation duty………………………………..22

5. Forward plans for 2016/17………………………………………………….24

6. Healthwatch Kingston statement………………………………………….29

7. Appendices……………………………………………………………………Attached

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Message from the chair

I would like to welcome you to our 2015/16 annual engagement report outlining the

engagement work that we have carried out during the year.

Kingston CCG want people to live longer, healthier lives. Patients and the public are at

the heart of everything the NHS does, and we want to ensure that public, patient and

carer views and voices are at the heart of the way we commission our local healthcare

services.

We have a clear vision that the people of Kingston should be supported to look after

themselves and those they care for; have access to high quality, joined up physical and

mental health and care services, when they need them; and we need to deliver better

health outcomes within our budget. We value people being able to say I’m heard, I’m

healthier, and I’m cared for.

In 2015/16 we have continued to achieve through engagement, and this report

highlights some of our key successes. However, we know we can do more and we

have ambitious plans to improve patient and public engagement through a new

Communications & Engagement Strategy.

We would like to thank everyone who has contributed and engaged with Kingston CCG

over the last year, giving us their views and thoughts. We would also like to thank our

partners for working with us to engage, and we look forward to working with you more

over the coming year.

Dr Naz Jivani

Chair, Kingston CCG

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1. Context and Background

NHS Kingston Clinical Commissioning Group (CCG) is a membership organisation,

made up of 22 local GP practices serving people across the Royal Borough of Kingston

upon Thames.

Health needs in Kingston

Kingston is a small outer London borough. Our population is an aging and relatively

affluent one, but this hides small pockets of relative deprivation.

Population

Kingston has the third smallest population of all the London boroughs, with an estimated

resident population of 169,958 (2014) which is projected to grow by 10.6% over the next

10 years. There are 202,708 people registered with Kingston GPs (March 2015).

Our population is ethnically diverse with 26% from Black and Minority Ethnic (BME)

communities (2011 Census). The main BME groups in the borough are Indian/British

Indian (4%), Sri Lankan (2.5%), African (2.3%) and Korean (2.2%). The Korean

population in New Malden is estimated to be the largest in Europe. At the latest school

census the school-age population in Kingston was 36% BME.

Kingston is the second least deprived borough in London after Richmond upon Thames

(2015 Indices of Deprivation). There are differences in areas however, for example

people in the least deprived wards live on average 7 years longer than those in the most

deprived (JSNA 2015).

Kingston health

People in Kingston are healthier overall than the national or London population, but the

population is an aging one; 13.2% are aged 65 and over.

The top 3 causes of death are cardiovascular disease, COPD and cancer; 1 in 70

people in Kingston are living with cancer.

An estimated 21,470 Kingston residents suffer from a Common Mental Disorder (CMD),

which is around 13% of the population. 1.2% of the population have a form of dementia

(an estimated 1,929 Kingston residents); the most common is Alzheimer’s Disease.

There are around 13,288 carers in Kingston - 8.3% of the population. 4.4% of these are

under 24 years of age.

In the borough 6% of Reception children (aged 4-5 years) and 15.4% of Year 6 children

(aged 10-11 years) are obese. Particular hotspots are Chessington, Old Malden and

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Norbiton. By Year 6, 28.5% of children in Kingston are above a healthy weight and at

an increased risk of health complications in later life. Although the prevalence of

overweight and obese children in Kingston is below both the national and regional

prevalence, there is still a doubling between Reception and Year 6 in Kingston that is

also seen nationally.

Over 1 in 5 (20.9%) of Kingston residents are estimated to drink at increasing risk -

that’s above the London average of 15.8%.

More details on Kingston’s health can be found in the Joint Strategic Needs

Assessment (JSNA) web pages

(https://www.kingston.gov.uk/info/200365/joint_strategic_needs_assessment)

Our vision

We want people to live longer, healthier lives.

Kingston CCG are clinically led by local GPs, and supported by a highly experienced

managerial team. We work together to improve the health of Kingston people and we

plan and buy high quality healthcare services. We are committed to working with our

partners across the NHS, social care and voluntary sector to improve the health and

wellbeing of local people.

Our corporate vision is that the people of Kingston should be supported to look after

themselves and those they care for; have access to high quality, joined up physical and

mental health and care services, when they need them; and we need to deliver better

health outcomes within our budget. We value people being able to say I’m heard, I’m

healthier, and I’m cared for.

We have four high level corporate objectives focused on: Better health, better care,

sustainability and leadership.

Our vision for engagement in 2015/16 was that organisations responsible for health and

care services in Kingston and their partners in the voluntary sector will work together as

partners to make sure that the people of Kingston are listened to and have their say

about what will help them to stay healthy and happy. People’s opinions will be clearly

reflected in the way that services are designed and delivered.

Resources

The membership of the CCG’s Governing Body includes a Lay Member who has

responsibility for Patient and Public Engagement (PPE). The Chair of Healthwatch is a

non-voting member of the Governing Body.

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The CCG employs a full time Patient, Public Engagement and Equalities (PPE) Lead.

The portfolio sits within the Quality and Governance team, overseen by the Director of

Quality and Governance. The CCG also has communications services provided by

South East CSU which comprises 0.6 WTE Communications Lead (25 hours) and 0.4

WTE Communications Manager (15 hours). The PPE Lead works closely with

communications colleagues.

2. Developing the Infrastructure for Engagement and Participation

Structures

Until March 2015 the engagement structure operated as below:

In early 2015 a review was carried out and the Governing Body changed governance

structures to reflect a drive towards partnership working on engagement across health

and care organisations and the voluntary sector. These actions included:

- Cease engagement reporting to IGC and report directly to the Governing Body

- Establish a Strengthening Community Voice Steering Group including partners

(Public Health, Adult Social Care, Healthwatch and Kingston Voluntary Action)

- Run a borough wide deliberative event, the ‘Strengthening Community

Engagement Conference’. This would be an opportunity for commissioners,

providers and service users to come together and discuss how health and care

engagement could be strengthened across Kingston. The event took place in

May 2015 with over 55 people attending.

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The governance structure from April - June 2015 operated as below:

At the June 2015 Health and Wellbeing Board, a paper was presented which further

built on the proposals for closer working between the CCG and partners, with the

Strengthening Community Engagement Steering Group to be a workstream within the

Active And Supportive Communities project of the Kingston Coordinated Care

Programme.

Since that time however a number of changes emerged during the remainder of 2015

and into 2016 with both the Council and the CCG reviewing their respective

communications and engagement functions. There have also been a number of

personnel changes in the period since then and both the Council and the CCG are in

the process of developing revised communications and engagement strategies and

structures. It is intended that both strategies, being developed in September 2016 will

have alignment where appropriate.

South West London Collaborative Commissioning

Kingston CCG is part of the six CCG collaborative which is working together with

hospitals, mental health, community care services, local councils, people and patients to

develop a 5 year Sustainability and Transformation Plan to improve health and services

across SW London. The Governing Body Lay Member for PPE sits on the

Collaborative’s PPE Steering Group, which ensures there is effective lay involvement

and public and patient engagement in the programme. In addition to this the local

Healthwatch organisations and voluntary sector representatives also sit on the group.

Direct engagement with patients and the public from April 2016 will also be supported

including a Grassroots Engagement Programme; details are included in Section 4.

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Processes

There are a number of core engagement processes that support the structure.

Patient Participation Groups (PPGs) and Primary Care Forum

All GP practices in Kingston have been encouraged to establish a Patient Participation

Group. In 2015, approximately half the practices had an operating PPG.

Linked to the PPGs and as part of the development of Kingston’s Primary Care Strategy

in April 2016 a quarterly Primary Care Forum has been established. A member of the

Forum will be elected to sit on the Primary Care Commissioning Committee, thus

ensuring the patient voice is able to feed into and influence decision making.

In 2016/17 the CCG will be developing its resources to support patient engagement and

strengthening the patient voice within the engagement structures; these include:

- Developing a range of resources for use at GP practice level including best

practice guides for developing PPGs, templates and draft terms of reference

- Supporting practices who want to set up virtual PPGs and use social media

- Widening the scope and increasing promotion of the Primary Care Forum

Kingston CCG meetings

Governing Body meetings are held in public and at different sites across Kingston to

encourage accessibility to the public. The public are able to ask questions and at the

discretion of the Chair, contribute to debate. The agenda, papers and venue are all

posted on the CCG website.

From summer 2016 in addition to the Governing Body the Primary Care Commissioning

Committee will be meeting in public, increasing accessibility to the public of decision

making.

Public Forum

The public forums were open meetings with a focus on receiving feedback and input on

a specific area of commissioning as well as providing updates of key issues and

messages from the CCG. In April 2015 we held a ‘Beating Cancer’ forum. The

establishment of the Primary Care Forum in 2016 has provided a new opportunity for

patients and the public to continue to engage with us and provide feedback on services.

Online

The CCG website includes a ‘Have your say’ page with a feedback form and dedicated

email address. www.kingstonccg.nhs.uk

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We have 5,500 followers on Twitter (Sept 2016) and our social media strategy is a key

part of our revised Communications & Engagement Strategy to increase opportunities

for two way conversations and engagement with patients and the public through a

variety of social media methods.

Partners

Kingston CCG works closely with partner organisations including Kingston Council, the

Kingston Health & Wellbeing Board, Healthwatch Kingston and other south west

London CCGs as part of the South West London Collaborative Commissioning. The

CCG is a partner with Kingston Council in the Kingston Coordinated Care Programme.

Through these partnerships the CCG has delivered engagement programmes and

activities which will be detailed in section 3.

The CCG has attended a number of community meetings to talk about the CCG and

what it does and to hear feedback on people’s experiences of health services during

2015/16. These meetings include:

- 2 x Neighbourhood Conversations

- Neighbourhood Committee meetings

We have continued to build up our engagement database of local people and

organisations to broaden the range of people the CCG engages with.

Strengthening Community Engagement Conference

In May 2015 the CCG took part in a partnership based conference looking at how to

strengthen health and care engagement in Kingston. 55 providers, commissioners and

people who use services attended a workshop on 21st May 2015.

The workshop style event included discussions to explore the way we reach out to

people, what works well, what works less well and what are the challenges to effective

engagement. It also explored how we are engaging with all groups within the

community of Kingston, and considered how we could improve engagement with harder

to reach groups.

Key themes arising from the workshop discussions include:

- Need to be skilled in cultural awareness

- Language can be a barrier

- Use of jargon / acronyms disengages the general public

- ‘Usual suspects’ get involved with all organisations

- Consultation fatigue if too many activities

- People want to see results and real change

- Organisations need to do more joined up engagement / avoid duplication

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- Lack of understanding about local services

- Cultural change required: professionals need to see engagement as part of their

day job

Example of key theme feedback from the session

The feedback from the event was shared amongst the partners with a greater

commitment for more joined up working around engagement in 2016/17, and are being

used to help inform the new Communications and Engagement Strategy for the CCG.

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3. Engagement and Participation Activity

This section details the engagement projects and initiatives that Kingston CCG

undertook during 2015/16.

A significant amount of face to face engagement activities took place in 2015/16. The

main avenues for promoting these projects and activities and inviting patients and the

public to engage include: emails and letters of invitation to people on our contacts

database, through PPGs and Practice Managers, through our partners in the voluntary

sector, council and Healthwatch. We have used the Council’s community noticeboards

for posters around the borough. We have increased our use of social media and used

Twitter and Facebook for sending out alerts and adverts in local newspapers.

Developing the Primary Care Strategy

During 2015/16 the CCG developed a new strategy for Primary Care services in

Kingston. The five year strategy describes our plans for primary care in Kingston and

public and patient engagement has been an integral part of the strategy development.

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Kingston CCG engaged with a range of local people and other stakeholders in the

development of the strategy. To support the development of the strategy we used

information from a range of sources including outputs from the Voice of the Customer

project; data from patient surveys focused on GP practices and enter and view.

In addition a series of bespoke public engagement events were held to hear the views

of local service users to help shape the strategy. Two workshops were held in October

2015 including one in the evening to maximise accessibility to the public, with 57

attendees across both.

What did people tell us at the workshops?

Summarised below are the major themes and suggestions that emerged from the

events, and these have been used to feed directly into the development of the strategy.

Key issues emerging from the workshop were:

- Appointments are not long enough and too many unattended appointments

- Limited access to translators

- Long waiting times for an appointment

- Problems registering with a practice of choice

- Complex complaints system

- Needs of carers not understood

- Lack of information about treatment and care

- Poor access to sites and lack of facilities

- Attitudes from staff

The workshop identified actions for improvement including:

- Practices should have a non-medical specialist that can signpost to services and

support in the local community

- The strategy needs to have people at the heart of the vision

- More focus on partnership

In addition to the main theme areas suggested, people at the workshops also told us we

should consider the following:

- Prevention needs to be included

- Emphasis on a non-medical rather than medical model

- More consistent standard of care is needed across GP practices

- Support the notion of empowerment of patients and more participation by

patients

- Improve communication

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The feedback from engagement activities has been directly used to shape the Primary

Care Strategy, which can be viewed on the CCG website www.kingstonccg.nhs.uk

In addition and in response to the feedback to increase patient participation the Primary

Care Forum has been established, with meetings held in February and April 2016 as

part of the engagement programme to involve residents in the commissioning of

Primary Care Services.

The meetings are held quarterly and residents have the ability to inform the CCG of

areas they wish to discuss in advance which has resulted in real change. For example

following a challenge from Kingston Diabetes UK as part of the discussions, the CCG

has changed the steps being taken to support practices completing the National

Diabetes Audit.

The forum has also identified a disparity in how PPGs are facilitated and supported. In

2016/17 the CCG will be working with practices, existing PPGs and local communities

to provide support and guidance to ensure PPGs thrive and are empowered to provide

feedback to the practice.

There is a place identified on the Primary Care Commissioning Committee for a

representative from the Primary Care Patient Forum. Once filled, this will directly

ensure patient engagement and influence commissioning and decision making in

Primary Care.

Healthwatch Kingston, Kingston Voluntary Action, Lymphoma Association, Patient

Participation Groups, Richmond & Kingston ME group and Councillors have been

involved as part of the recruitment and promotion of the forum.

Gosbury Hill GP health led centre consultation

The CCG conducted a public consultation from 15 September to 10 November 2015

into proposals to relocate the urgent care service at Gosbury Hill GP health led centre

(GH) to Surbiton Health Centre (SHC); and to reconfigure the GP appointment service

as a Walk in Centre operating 36 hours a week covering peak demand/periods.

The CCG consultation was held in conjunction with NHS England, who was consulting

on the closure of the GP patient list attached to the urgent care service during this

period.

Feedback from the consultation showed that local people supported the relocation of

the service providing urgent GP appointments to Surbiton Health Centre, and also

supported the closure of the small practice list.

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The CCG used a variety of different methodologies to maximise the level of involvement

and engagement of service users, patients and the public. Presentations were made at

Neighbourhood Committee meetings, events and drop in sessions were held giving

people the opportunity to ask questions and encouraging them to complete the

consultation survey questionnaires online or in print. We worked with the Council and

the voluntary sector (Healthwatch, Kingston Voluntary Action, Fircroft Trust, Kingston

Carers Network and others) to publicise and engage their networks in the consultation.

The consultation asked local people on their views on two aspects: closure and

dispersal of the registered patients list; and relocation and reconfiguration of the urgent

care appointment service to a new location. This is a selection of engagement activities

that took place:

Digital - Consultation page on CCG website - Survey Monkey self-completion questionnaire - Facebook consultation page and reminders - E-newsletter distributed by Kingston Voluntary Action - Tweet visit to Kingston University Fresher’s Fair

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- Tweets - Audio version of questionnaire on CCG website

Briefings

- GPs, practice managers, practice nurses - Councillors - Local media and Council RBK Matters - Direct mail to 300 residents - Adult social care distribution lists - Schools and children’s centres newsletters - Cascade via partners (including Healthwatch, Neighbourhoods, Kingston

Hospital, Your Healthcare, Korean community group and media - Surrey Comet)

Print/displays

- 6,500 print run of questionnaire booklet and 200 posters sent to GP practices, libraries, community centres

- Display at All Saints Church and in Children’s Centres

Face to face events

- Presentation to 3 Neighbourhood Committees - Patient Forum - Gosbury Hill GP centre PPG - Partnership event with Kingston Voluntary Action

Drop in sessions

- Kingston University Fresher’s Fair - Registered patients at Gosbury Hill GP clinic - Travellers site Swallow Park Close - Refugee Action - Kingston Churches Action on Homelessness - Malden Centre - Korean group meeting - Surbiton Children’s Centre - Surbiton Health Centre

Feedback from the consultation showed that local people supported the case for

change and the relocation of an improved urgent care service for unregistered patients

to Surbiton Health Centre. We received 377 individual responses to the online and

paper consultation survey, 17 group representations and a further 34 written

submissions. Just over six in 10 respondents agreed with the proposal to relocate and

reconfigure the urgent GP appointment service to Surbiton Health Centre. (Source:

Gosbury Hill GP Led Health Centre Public Consultation Findings - Executive Summary

of Findings, Anne Millman Associates, 2015).

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Running concurrently with Kingston CCG public consultation was the NHSE

consultation on the closure and dispersal of the current GP patient list at Gosbury Hill

GP Led Health Centre (circa 2,000 patients). Feedback from the consultation also

supported closing and dispersing the practice list. 40 patients and relatives attended

the two organised patient consultation events on 20 October and 28 October 2015.

The results of the consultation gave a clear steer to the CCG to:

- Close Gosbury Hill GP led clinic and disperse its patients registered list to

neighbouring GP practices

- Create a new service at Surbiton Health Centre offering walk-in appointments

and same day appointments - to be piloted in 2016/17 as part of the STP

The proposed 3-day provision has been subsequently revised to 2 days (Saturday to

Sunday) 8am to 8pm to reflect national developments and STP plans in 2016/17 leading

towards 7-day primary care access across Kingston. This has been supported by

further public engagement in 2016/17.

An example of the questionnaire and the summary consultation report are attached as

Appendix 1.

Kingston Coordinated Care (KCC)

Our flagship programme for the integration of health and social care, KCC is based on

the findings from our Voice of the Customer project which began in 2014. The Voice of

the Customer initiative was an in depth engagement project which sought to seek a

better understanding and insight into people’s experience of using health and social

care services, focusing on how they could be improved in the future, and how people

could be best supported to stay healthy, independent and resilient.

We engaged with 80 customers and over 100 health and social care front line staff in 30

structured workshops, starting in November 2014. The aim was to:

- Hear the direct views of customers about the things that are most important to

them, understand their specific needs, determine the importance of, and

performance in relation to, those needs and understand the impact on them if

those needs are not met

- Allow staff the opportunity to go through the same process and to raise issues

that currently constrain their ability to meet the needs of customers

The engagement method was based around face to face dialogue using open

questions. The client groups who were able - such as older people, carers and those

with mental and physical disabilities were invited to formal workshops for up to 3 hours.

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For other groups - such as people with dementia and those who are housebound, the

techniques were modified and adapted to maximise their ability to participate. The

following key milestones were met during 2015/16 to take implementation of KCC

forward.

In May 2015 the Voice of the Customer report was published with four key themes

identified as significant areas for improvement:

- Understanding

- Co-ordination

- Control

- Quality

In July 2015 the Design Team was established to work on bringing together services

based on the findings of the Voice of the Customer engagement activities; a new, more

integrated way of working, bringing together hospital, community, primary care, social

care and mental health providers to deliver the new model of care.

We organised a public playback event in January 2016 when 100 people attended to

hear the feedback from the Voice of the Customer initiative. In terms of what is

important to help people keep healthy, independent and resilient the Voice of the

Customer participants said they wanted to be part of a community, have a support

network of family and friends, belong to social groups and have an active social life.

The Voice of the Customer detailed report is attached in appendix 1.

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Following on from this event in January 2016 a multi-agency Care Pathways group was

established to develop the required new ways of working. Early on in their work the

group established eight golden principles for working and they are:

1. Understand the person as completely as possible; as early as possible

2. Good quality, timely, shareable information about the person

3. Minimise hands off - both for information and the person

4. The best decision, at the best time by the best possible person/team

5. As a person being supported, I will always know what will happen and when, and

to go back to if needed

6. Coordinated care - all the way through

7. Keep listening to the person - all the way

8. I will work with the person and their relatives/carers to the extent of my capability

The Active and Supportive Communities strategy is a cornerstone of KCC. The findings of the Voice of the Customer work have been used to develop the new commissioning outcomes embedded in the four new service contracts awarded to support the delivery of this strategy.

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Partnership work with Public Health

Equality & Diversity in NHS Services for Kingston residents - ‘how are we doing?’

Through a partnership project with the Council’s Equalities & Community Engagement

Team (ECET), the CCG engaged with the Korean community in Kingston who are a

significant and seldom heard group within the borough. The Council’s Korean Link

Worker and translators attended an event in 2015 where the Korean attendees were

able to assist the CCG in grading of four goals linked to equality and diversity. The

attendees had never fed into a panel of this kind before and reflected afterwards that

this was a new experience and they gained new understanding of how the process of

equality and diversity is delivered in health services.

The Korean Link Worker fed back that two of the attendees became volunteers with the

ECET team following this event, and were keen to learn more about community

engagement as a result.

In addition to this, ECET worked in partnership with CCG to facilitate engagement with

the local Gypsy Traveller community around the proposed changes to Gosbury Hill GP

led health centre. Engagement was achieved through a direct visit to Swallow Park

Travellers Site in October 2015, 4 questionnaires were completed on site, 2 via phone

conversation and 2 submitted through the post. The community shared strong views

about convenience in accessing health services with particular regard to proximity and

opening times of primary and urgent care services in Kingston.

‘Moving Away from Pain’ pilot

The Moving Away from Pain Pilot was a partnership pilot between Kingston Hospital’s

pain clinic and public health. The pilot aimed to increase participation in physical

activity for patients with chronic pain and evaluate if they types of exercise sessions

offered would benefit this cohort.

56 patients attending the pain clinic were invited to provide feedback around activities

they would like to participate in to help manage their condition, and were invited to take

part in the pilot. Following the consultation with patients, themes around pilates, dance

and aqua classes emerged. As a result, the pilot activities consisted of Aquacise - 2

courses delivered over 12/13 weeks; and Pilates and dance - 2 weekly classes with

participants opting for 1 class over a period of 12 weeks.

Outcomes of the pilot were focused on patient attendance, physical activity levels,

general health, pain levels, emotional health and programme expectations. A summary

of the key outcomes for each of the activities is summarised below:

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Aquacise- 91% attended the course and completed (adjusted for varying start and finish

times and complexity of conditions). Post programme, 53% of patients showed an

improvement in their general health; 55% who had experienced severe-very severe pain

pre programme had reduced their levels to moderate (24%) post programme. Top

programme expectations amongst this group were to improve physical wellbeing and

fitness levels, along with flexibility and coordination.

Pilates and dance- 75% of patients completed the 12 week programme, with a higher

attendance rate amongst the Pilates class, and dance classes were poorly attended.

Patients were asked pre programme how many days per week they undertook at least

30 minutes of physical activity per day, and the majority (35%) managed one day. Post

programme this figure decreased to 20% with some patients increasing to at least 3 or 4

days per week. Lastly, a decrease of 30% in the severity of pain post programme was

reported suggesting these activities had some improvement on pain levels and the

ability to self-manage with physical activity.

Patient feedback was collected following the pilot with similar themes arising:

‘It was helpful for back pain’

‘The Aqua instructor catered for everyone’s needs’

‘I enjoyed the social element of meeting other people with pain and similar conditions‘

‘My mobility and back pain improved’

The evaluation was shared with all partners involved in the pilot, and the Get Active

team regularly attend Kingston Hospital Pain Clinic programmes to provide information

to patients around activities available to them. As a result of this pilot, it became

apparent that this cohort of patients benefited from a tailored activity which was not only

enjoyable but assisted in a number of ways (improved pain levels, increased

participation in physical activity and provided a social element). The Pilates and Aqua

classes are now offered as part of the Get Active Exercise on Referral programme

delivered by Public Health Kingston, for Kingston residents.

Consultation about depression, self-harm and suicide Through the mental health services commissioned by the CCG, Public Health held a consultation relating to depression, self-harm and suicide between June - November 2015.

The aim of the consultation was to assess the needs of individuals who live in the borough aged 11+, affected by, or at risk of, depression, self-harm and suicide, either directly as the affected individual or as family and friends.

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Participants were asked about a range of key issues including their experience of local services, barriers to services, what worked well and what could be improved. During the consultation period the following was achieved:

- 16 1:1 interviews with individuals with personal experience of depression, self-harm and suicide between 18 - 68 years old

- 11 1:1 interviews with people affected by the depression, self-harm and/or suicide of a family member

- 6 focus groups with professionals and family members - 64 adults completed the online survey - 73 young people completed the case study questionnaire - A review of academic literature and epidemiological profile of depression, self-

harm and suicide in the borough was produced The recommendations and findings from the consultation feedback have been used to inform the new Mental Health Strategy.

Neighbourhood Conversations

In partnership with the Council, CCG staff facilitated discussion about local health

provision at Neighbourhood Conversations held in New Malden and Surbiton.

Neighbourhood Conversations are part of the Council’s drive to improve engagement

with its residents and are informal events held three times a year in the four

Neighbourhood areas.

The events were well attended and the feedback from these events have been fed into

the Council’s Neighbourhood Community Plans and to health commissioners and

services to address the priorities identified.

Priorities identified by participants at the event include:

- Wanting to be better informed about preventative health care

- Reducing inappropriate attendances at A&E

- Develop digital access to services

- Reduce waiting times for GP appointments and referrals to specialist care

- Where new housing is built ensure capacity planning takes place for access to

GP surgeries

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Maldens & Coombe Neighbourhood Conversation, residents discussing local health services, 15 March

2016

The events were promoted extensively through social media by both the Council and

the CCG via Twitter and Facebook, and through the Council’s website in addition to

leaflets in community buildings, shops, youth centres and posters in community

noticeboards.

There are plans to continue this partnership approach to engagement with Kingston

Council.

4. Meeting the Individual Participation Duty

This section details the work that Kingston CCG has undertaken to promote the

individual duty to support patients being in control of their own health.

Expert Patient Programme

Kingston CCG employs a part-time Expert Patient Programme (EPP) course manager.

In 2015/16 95 participants with chronic health conditions went through the Expert

Patients Programme Chronic Diseases Self-management course. The aim of the EPP

is to give participants the skills and self-confidence to become better self managers and

engage effectively in shared decision making.

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To inform patients, carers, clinicians and others of and to increase referrals to the

service the EPP is promoted through community events, groups and meetings. Last

year the EPP manager worked with MIND in Kingston, Healthwatch, Kingston Voluntary

Action, Kingston Independent Living, Arthritis Care, Stay Well and presentations to

cardiac and pulmonary rehabilitation sessions. A substantial number of the participants

are recruited in this way, and partners assist with promotion.

In 2015/16 the EPP promotional materials have been translated into Korean, to engage

with the significant Korean population in the borough. In addition all the course material

has been translated into Korean, enabling the community to access the EPP. An entire

self management course was delivered in Korean. In 2015/16 9 Koreans participated in

the course.

EPP Course Manager and Self-Management course participants, 2015.

Personal Health Budgets

Kingston CCG has issued a total of 30 Personal Health Budgets (PHBs) for adults

between Jan 2014 and March 2016. Twenty-six of the PHBs issued have been all or

part Direct Payments. Direct Payments provide the greatest level of control for individual

service users. In addition, 1 PHB was provided to children/young people over the same

period.

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During 2015/2016, 20 adults received PHB, of which 17 were all or part Direct

Payments. As at March 2016 Kingston CCG was ranked 11 out of 32 London CCGs in

terms of number of PHBs provided. In addition, 2 PHBs were provided to children/young

people over the same period.

Individual PHBs for adults range in annual values from £31k-£160k. The CCG and the

council have a joint contract with Kingston Centre for Independent Living (KCIL) to

support people who take their PHBs or Personal Budgets as Direct Payments. KCIL

also monitors spending of direct payments by PHB holders.

The CCG has been gradually increasing the provision of PHBs with the aim that all

people living in the community who are eligible for Continuing Health Care are offered a

PHB. At any one time this equates to approximately 60 people. Experience to date is

that successful long term outcomes rely on intensive case coordination support in the

early stages, and, for some people, on a continuing basis.

The CCG is monitoring the learning from the national Integrated Personal

Commissioning work to inform its decisions on how PHBs could be extended beyond

Continuing Healthcare, should resources become available to do this.

5. Forward Plans for 2016/17

Mental Health Strategy

The CCG and Kingston Council have been working closely with Kingston Healthwatch

to co-produce a Mental Health Strategy for Kingston. For the first time, the strategy is

being co-produced with people who have mental health problems and their carers,

drawing directly on their lived experience. A wide range of other stakeholders have also

taken part in the process.

The five year strategy will cover prevention, early intervention, self-care, treatment and

recovery. It will take account of the wider determinants of mental health such as

housing, employment and debt. It will look at the basis of wellbeing, the

interrelationship between lifestyles and mental health and ways to tackle the stigma of

mental health.

The strategy will also look at how mental health services are currently performing and

how they should be improved to provide accessible and seamless care and be well-

integrated with other services. The strategy will look at community assets and how

support can be delivered differently.

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Working in partnership the CCG, Council and Kingston Healthwatch have set up a

mental health steering group to plan and implement the work required to co-produce,

develop and implement the strategy during the early part of 2017. An initial launch

event took place in April 2016 and was attended by a large number of participants

including service users and their carers and other stakeholder organisations including a

wide range of third sector organisations and voluntary groups.

Five co-production workshops have been planned to progress the work involving a wide

range of stakeholders including service users and carers. The work to co-produce the

strategy follows the stages outlined in the diagram below which shows the objectives

and expected outcomes from each of the workshops. There are six stages to be

covered in the five workshops with the aim of having a draft strategy produced by the

end of the calendar year and a final version by the end of 2016/17 which once agreed,

the CCG and Council will jointly deliver over the next five years. More detailed

information on the outcomes and impact of the workshops, outreach sessions and

feedback questionnaires will be included in the 2016/17 Duty to Involve report. To date,

approximately 240 people have been involved in shaping the strategy.

CCG Communications & Engagement Strategy

Following the formation of a new team of staff covering engagement and

communications during 2016, the CCG are now currently revising our Communications

and Engagement Strategy due to be approved by the Governing Body in January 2017.

The refreshed vision within the strategy is ‘to establish Kingston CCG as an innovative

organisation that listens constantly, communicates and engages effectively and

supports the delivery of improved health and care outcomes for Kingston people’.

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The key objectives described in the strategy are linked to our CCG corporate objectives

and are summarised in the table below:

Corporate objective Communications and Engagement objectives

Better Health 1. Increasing awareness and understanding amongst patients and the

public about local health and care services in Kingston. [Choose well, Get the right treatment and Stay Well messages]

2. In partnership with Public Health, to support campaigns and action which will seeks to reduce inequalities in health outcomes. [diabetes, obesity, smoking, antimicrobial resistance]

3. Use patient and carer experience to improve the quality of services and patient care

Better Care 1. Support patients and the public to make informed choices when accessing health and care services.

2. Increase awareness and engagement amongst patients, public and key stakeholders around the work to improve out of hospital services in Kingston, including primary and social care.

3. To inform and engage people on our work on local clinical priorities including mental health, dementia, cancer, and learning disabilities.

Sustainability 1. To increase awareness and engagement around the sustainability

challenges facing the NHS locally.

2. Promote and embed communications and engagement standards and best practice amongst CCG staff, supporting them to deliver key priorities.

Leadership 1. Improve communications and engagement with CCG staff to

support them to develop their skills, encourage innovative behaviours and become organisational ambassadors.

2. Engage and involve patients and the public in decision making and ensure ongoing and effective conversations.

3. Work together with partners to share and use patient and public feedback to improve patient experience in Kingston

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The outcomes identified in the revised strategy include:

- Informed and involved patients and interested public

- Creating and maintaining mutually beneficial partnerships with the public and

other key stakeholders

- An external reputation for being a responsive and fair organisation

- Embed NHS Kingston CCG a local leader for the NHS

- An active and engaged membership, who has a trusted relationship with the

CCG

- Motivated and engaged staff, who feel trusted and supported

The strategy will include a high level action plan and a summary of the key proposed

activities relating to engagement is included below.

Informed & Involved:

- Primary Care engagement - support for PPGs and GP practices to expand their

reach and effectiveness and options to expand the Primary Care Forum to

increase participation levels (link to social prescribing)

- Develop engagement brand and materials for engagement activities

- Define our social media approach and use as an engagement tool allowing for

two-way conversations

- Build our database of patients and public to increase levels of communication

and engagement opportunities

Partnerships:

- Further develop links with key community groups/voluntary organisations and

deliver grassroots engagement programme with partners focusing on seldom

heard groups

- Develop a calendar of community engagement events exploring options for

delivering joint engagement activities, linked to key prevention and health

promotion campaigns

- Work with key partners such as RBK and Kingston Hospital to deliver joined up

engagement activities. The CCG will be an active partner in the future of

community engagement work being led by the Council’s Communications Team

and are already working with the Council’s Communities Team to establish joint

work around engagement activities at a Neighbourhood level and with hard to

reach groups.

Engaged staff:

- Support and guide CCG staff to choose appropriate engagement processes and

activities at different stages of the commissioning cycle

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- Embed communications and engagement within the organisation by providing

training and skills guides

Feedback and evaluation

We are committed to integrating engagement throughout the commissioning cycle and ensuring the views of patients and the public are reflected in the services we commission. All feedback received through engagement and participation activities will be recorded and shared with appropriate commissioners and providers.

We will encourage co-design and collaborative activities as much as possible to ensure

patients and the public are empowered and involved as partners so they shape how

services are commissioned and delivered.

Designing the All Age Learning Disability Service

Over summer 2016 consultation and engagement activities took place to support the All

Age Learning Disability Programme and particularly the development of the:

- All Age Learning Disability Service

- All Age Learning Disability Strategy

- Workforce Development

A range of techniques were used including workshops which focussed on people’s

aspirations, current and future support as well as scope to work differently in the future

focusing on three pathways; Education to Employment, Independence and Health. The

feedback from participants is being fed into the development of the All Age Learning

Disability Programme.

Grassroots engagement programme

Working in partnership with South West London Collaborative Commissioning (SWLCC)

and Healthwatch Kingston, from April 2016 the CCG have been delivering a programme

of grassroots engagement activities, targeted at reaching seldom heard groups to

inform the development of the Sustainability & Transformation Plan (STP). Working

with voluntary sector groups we are reaching into our local communities and developing

conversations with groups including the homeless, refugees and asylum seekers, older

people and people with disabilities about their experience of local health services. The

feedback is recorded and will be fed into the development of the STP and local health

commissioners. The programme is running until the end of 2016/17.

Kingston Council closer working

The Council are one of our key partners and we already jointly commission services

through the Kingston Coordinated Care programme. During 2016/17 we will be

exploring and firming up our partnership approach to engagement, and we are an active

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partner in the future of community engagement in Kingston workstream, being led by

the Council’s Communications Team. We are already working closely with the

Communities Team to establish and deliver joint engagement activities including

Neighbourhood Conversations and with hard to reach groups.

Primary Care - strengthening PPGs

PPGs bring benefits to the practices that have them as they help to improve services

through suggesting how time and resources could be used more efficiently. PPGs can

work to help the whole patient community by arranging transport for older or disabled

patients, running self-help and wellbeing activities, promoting healthy lifestyles and self-

management, particularly for minor everyday illnesses. They provide a valuable

feedback tool for the practice and improve communication between practices and their

patients.

In Kingston approximately half the GP practices currently have active PPGs and over

the coming year the CCG will support PPGs and practices to expand their reach and

effectiveness.

6. Healthwatch Kingston Statement

Healthwatch Kingston is very pleased to continue working closely with Kingston CCG to

ensure that patients and service users have a positive experience of the treatment and

care they receive in both primary and secondary care settings. In the past months we

have been particularly encouraged by the CCG's positive response to re-shaping their

public engagement strategy and locating it within a wider Kingston approach. Public

engagement is key to sustaining improvements and achieving better outcomes with

investment in this field reaping dividends for health care commissioners, providers and

patients alike.

Our affiliate membership is growing, demonstrating that members of the community,

and our diverse communities in particular, continue to take a passionate interest in what

happens locally, and how health funds are spent. Therefore we will continue to build on

our active relationship with Kingston CCG, not only playing our part as a member of the

governing body, but also as an external challenger, bringing patient experiences both

good and bad to attention. We aim to provide an on-going patient and service user

perspective that will ensure that commissioners are kept fully aware of policy and

practice impact and outcome experiences. We look forward to another successful year

of effective partnership.

Stephen Hardisty, Healthwatch Kingston Manager, September 2016

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Appendix 1 - Engagement activities - further details

Gosbury Hill GP health led centre consultation

- Example of questionnaire

- Summary consultation evaluation report

Kingston Coordinated Care

- Voice of the Customer detailed report