North East Lincolnshire Health and Care Partnership - Talking, Listening & Working Together - feedback from the July workshop

On July 1^st, the Humber and North Yorkshire Integrated Care System (ICS) with an Integrated Care Board became the statutory NHS body responsible for health and care in our area.  The North East Lincolnshire Health and Care Partnership (HCP) bring together NHS planners, health and care providers, population health experts, the council and voluntary services to deliver health and care which optimises the health and wellbeing of people of all ages locally.

Our Health and Care Partnership wants to ensure that local people and communities are engaged and involved in developing health, care and wellbeing priorities and plans

On July 6^th we held the last of three workshops we held to explore with community members we can all Talk, Listen and Work Together to improve health, care and wellbeing in North East Lincolnshire and make the most of this new approach to planning heath and care by involving our patients, service users, carers and communities.

The workshop was facilitated by Sally Czabaniuk, Engagement Lead with North East Lincolnshire Health and Care, and Dr Ekta Elston, Clinical Lead for NEL Health and Care Partnership with the support of colleagues from partner organisations and Healthwatch North East Lincolnshire.

The session was in two parts – for the first half slides click here

We began with a summary of your feedback from the previous two sessions where you told us what was important to you about health and care.

Dr Elston presented information about the HCP Professional’s Forum and how eight Teams of clinicians and partner organisations are going to work together to improve… 

1. Urgent care and Emergency Care
2. Intermediate and transitional care – patients needing services for a particular ‘episode’ of care
3. Integrated community Teams - disease prevention and management
4. Elective care – planned medical and surgical
5. Safeguarding – adults and children
6. Mental Health – adults and children
7. Women & Children’s – maternity and paediatrics
8. Learning Disability & Special Education Needs and Disabilities (SEND) – adults and children

Dr Elston told us about a national initiative called ‘virtual’ wards which enables certain types of patients to get the care they need at home safely and conveniently, rather than being in hospital. In the first of our discussion groups, we looked at the concept of virtual wards and what should be considered when developing this service.

Participants asked a number of questions throughout the morning and via the questions box provided. These questions and answers with be published in due course.

You said – about the concept of virtual wards

• In favour of virtual wards- selecting the right people is important. Agree as a concept but need to consider how it is managed and other factors such as carers.
• Personal experience of virtual wards- fantastic care from nurses. Need to involve wider family in discussions.
• Excellent idea if everything is set up effectively. The patient has got to be happy/ comfortable with being in a virtual ward. Some people only want to see a GP and it will be similar with this, will every patient be happy with this? Culture change.
• Good because you are in your own home. ‘Happier with your own germs’.
• Virtual wards- people being able to receive care at home is a plus.
• Intent is positive if being used in the right way.
• Yes, would rather have care at home with the right support than be in hospital.
• Being on a virtual ward may reduce patient anxieties.
• A quieter environment at home for sleeping.
• If there isn’t support at home- would want to be in hospital.
• Conditions which require high-level of input would need to be in hospital.

You said – about what should be considered when developing the services

Communication

• Press coverage of virtual wards is negative which could influence views. There is a need for more informed public info.
• People need to fully understand what a virtual ward is- the way that we do now (following Ekta’s presentation). Communication to people about what virtual wards are.
• Communication being possible between all parties for consent etc
• Experience of some of the issues patients receiving longer term (frailty/EoL) care at home had encountered:
  • Need for joined up comms
  • Need for carers to be more involved in decisions rather than just the patient themselves
  • Need for a single point of contact to raise issues/problems with

Assessment/Suitability for Virtual Care

• Not just an assessment of person but of the whole family/ situation. Understanding additional strain that virtual wards can put on family/ carers.
• Conversations with patients being considered for a virtual ward need to be thorough.
• Worry about carers/ family managing.
• Is there someone at home to support (who knows what they need to do/ what is expected of them?)
• Need for social care input around shopping/ensuring food in the cupboards
• Someone to pop out on errands (i.e., purchasing household fuel tokens if these are used etc)
• Role of VCSE in fulfilling some of the above.
• There would be costs involved for the individual that they wouldn’t incur in hospital – food, household utilities etc. Also, additional utility costs if equipment needed to be used.
• Discussions need to be had with the people at home.
• Are patient and family ‘singing off the same sheet’?
• Consensus that we would feel safe, but it depends how mentally sharp you are. Some people get confused about the medicines they are taking. ‘People have got to be with it to be on a virtual ward’.
• In terms of equity- if a patient hasn’t got family/ a support network will they have to go to hospital anyway even if they would have preferred to stay at home?
• The ‘home environment’ will impact whether people can manage- where is the kitchen/ bathroom/ access.
• There would need to be IT infrastructure suitable for a patient to come home to so the teams would have access to WIFI etc. The patient would need to be IT savvy.
• Clinical behaviour and judgment. Individual consultants will have different attitudes to risk. Confidence issue - are patients confident to go in that pathway and are consultants willing to put them down that pathway?
• Consultants do not know the individual patients, and nobody wants to go to hospital. Patients may say or think they are of sound mind, but thorough assessments will need to happen to ensure the safety of the individual.

Care Coordination and delivery

• Confidence - mechanism to keep formal and informal carers up to date. A way for carers to contact for more support.
• Organisation of services- timings, joining up support, trust between teams and carers knowing that when support is needed, it can be accessed.
• Continuity of care or co-ordinator. If there was a case co-ordinator or 1 point of contact would provide confidence
• There will be a whole list of staff and people involved in making this happen, but the admin/ care navigators are the most important. If they don’t get that bit right, it will all go wrong. Make sure all staff are right and well trained.
• Designated channel for support/ escalation would be required.
• How would power cuts be managed?

Other comments

People would need educating to ensure they are able to use a phone to photograph an injury and send it if needed. Need to get the balance right between virtual (in the digital sense) and reality.

Is this being done because of a shortage of beds?

Confidence and competence in the system.

Part 2

In the second half of the session, we continued to look at how we can involve people and communities in the work of the Partnership and specifically the Teams that are going to be working together on the big priorities in the 8 areas Ekta told us about in her presentation[1]

For the second half slides click here

Sally shared the feedback from the previous session and there was consensus in the room that we needed to…

• Provide flexible and accessible options for people to have their say in ways that they are comfortable with
• Target communications so people get information about what they are interested in in a way that suits them best
• Accord is a good way for people to tell us what they were interested in and for us to tell people what was happening
• Build relationships with community groups
• Enable people to ‘dip in and out of’ involvement opportunities – commit to short term projects
• Provide ‘hybrid’ options for face-to-face meetings and digital options (webinars)
• Keep conversations going and provide space for people who do not want to speak in meetings to have their say

Sally then presented some options for how this might be organised along with their potential advantages and disadvantages.

Liz Read, Chair of the Accord Steering Group then talked about the role of the group and what they have been working on over the last few years – such as being involved in developing the Zoom webinars the CCG held during Covid giving people up to date information about the local response to the pandemic and that these webinars can still be viewed on the Accord website.

In the second discussion group we asked you to consider these options and give your views.

You Said

• We like the idea of involving more people/Reflected previous conversations
• Preference for option 4. Not engage with everyone all the time but with the right people with the right experiences. Don’t like the idea of people being voted for. Option 4 is more informal but not exactly sure how it’s going to bring in experts by experience/ existing groups
• We don’t want to lose the legacy of Accord. It would be good to bring together lay members of different organisations (specifically invite constituents of member organisations). A mixture of option 1 and 4. Badge it as the Accord Steering Group still but specifically invite constituents of partner organisations to attend each time.
• Accord has shown many benefits. Make sure it is relevant in wider partnership and not just the CCG.
• Meeting and talking as we have done at these events has to be the ‘right track’.
• Accessibility- different community/ people - venue change? Venues/ locations to suit target audience.  Freeman street market conference/ meeting room.
• Should we be asking professionals if the ‘triangle approach’ works for them?
• VCSE doesn’t provide a voice of the people.
• Options 1 and 2 feel more like a ‘fixed’ group of volunteers. Option 3 plus offers more diversity and inclusion of people with experience of a service/ condition.
• Accord community 4+
• Prefer option 4 as this would provide the right balance of flexibility and assurance.
• It shouldn’t feel like a committee, but it can’t be too informal as then there would be no evidence the conversations had taken place.
• More people need to be involved, people who don’t necessarily come to events like this. This is more likely to encourage people to get involved.
• Use ‘trusted voices’ to get people involved.

What did we decide?

Most people agreed that options 3 or 4 provided the best mix of inclusive opportunities for people to have their say along with a mechanism for assurance and challenge around meeting the NEL Commitment.

Having a series of engagement opportunities throughout the year at different venues in the area using different formats (in person/virtual) would enable more people to get involved in topics that they are interested in,  As would with communities and community groups to plan and lead engagement activity in their local area.

Although a formal citizens forum with a set number of appointed or elected community representatives was not thought to be the way forward, there was agreement that the Accord Steering group with its number increased to potentially include patient and service user representatives from partnership organisation could provide a formal reporting route into the partnership through the Community Lay member role.

Next steps…

We would like to thank everyone who gave their time to attend and participate in these workshop – you have given us a lot to think about.  Thank you to our discussion group facilitators and note takers who helped us from Healthwatch and partner providers.  

We will now discuss the outcomes with members of the Health and Care Partnership, the Professionals Forum, the Accord Steering Group/Interim Patient Assurance Group.  We hope to be able to share a timetable of engagement activity to influence and inform the work of the Partnership with you in September.

We will also be looking to recruit new members to the Accord Steering group and will continue to email Accord members regular bulletins about health and care developments which we also ask our partners to share with their patients, members, and service users too.

Evaluation

We asked participants at these meetings to complete an evaluation form to help us under stand what you thought about the content of the sessions and the opportunities to have your say.

We are pleased to say that feedback was positive in particular you said the information provided by Julie Wilson (session 1), Helen Kenyon (session 2) and Dr Ekta Elston (session 3) had helped you to get a better understanding of health and care development locally and nationally.  It is important to us to keep Talking, Listening and Working Together so please let us know if you have any ideas for future engagement activities.

 

[1] Urgent care/Emergency Care; Intermediate and transitional care; Integrated community Teams - disease prevention/ management; Elective care; Safeguarding; Mental Health; Women & Children’s; Learning Disability & SEND