Patient Participation
Strategy
November 2014
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Participation Strategy
Foreword from Nicolas Small, Chair of Herts Valleys CCG
Here at Herts Valleys Clinical Commissioning Group (CCG) we want to encourage and facilitate the
maximum possible participation of patients and local people in our work. And we want to make it
easy and rewarding for people to work with us.
This is because we are genuinely committed to making your views count. We know that we will
only get things right if we hear from, listen to and are influenced by you, the people who use the
health services we commission on your behalf.
There is strong evidence that tells us that health services are better when people who use them
are involved in their design. The Francis report into the failures in care in mid-Staffordshire
showed only too clearly that insight gathered from the public - listening to patients and families helps to improve services and outcomes and can help highlight when things are going wrong.
We know though that the NHS is a complex organisation to understand and that this can put
people off trying, so our participation strategy sets out our plans to embed participation in our
work and how we can work together to make your contributions really count. We also know that
certain groups of people are less likely to get involved and our new strategy will help us direct our
energies to encouraging those groups – such as children and young people – who we don’t hear
from often enough.
Overall this strategy signals a renewed and increased focus on the voice of patients and local
people; we will work hard across our organisation to put into practice our commitment to
broadening the base of our public involvement and to making those contributions really count.
We will produce a summary of this strategy for wide circulation among local people living in west
Hertfordshire.
Dr Nicolas Small
Chair, Herts Valleys Clinical Commissioning Group
November 2014
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Participation Strategy
1. Executive summary
This strategy document sets out how Herts Valleys CCG will approach patient and public
engagement. A number of key elements characterise our new approach which seeks to make
us a genuinely patient-centred organisation:
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We will broaden the range of people who actively engage with us, seeking
contributions from those whose voices are generally less often heard.
Our engagement activities will centre on tangible, specific issues and we expect the
input from patients and the public will similarly be focussed on their own actual
experiences.
We want every engagement with Herts Valleys to have a clear purpose and genuinely
influence what we do.
We want to offer a range of different opportunities for people to participate in our
activities, recognising the diversity of ways that people choose to communicate and will
focus on tangible, specific issues.
Herts Valleys will ensure that we feedback thoroughly to those who become involved in
developing plans and giving us views – making clear what has changed as a result.
We seek to ensure that the views and experience of patients, public and carers have an
impact on all areas of our work – including our projects, programmes and service
quality monitoring.
An implementation plan will be developed following the finalisation and sign off of this strategy
document.
Note: The terms ‘participation’, ‘engagement’ and ‘involvement’ are used more or less
interchangeably during this paper.
2. Developing this strategy
In developing our strategy and working towards the completion of this document, the following
have made significant contributions:
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Herts Valleys Patient and Public Involvement (PPI) Committee members
Local people - participants at a specially convened conversation event in September 2014
Our public membership, via Herts Valleys Voices (our stakeholder e-bulletin)
Herts Valleys readers panel – stakeholders who comment on draft materials
Hertsmere locality patient group
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Participation Strategy
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Watford and Three Rivers locality patient group
St Albans and Harpenden locality patient group
Dacorum locality patient group
Practice membership via the weekly GP e-bulletin
Clinical leaders through the Commissioning Executive
Herts Valleys staff, through meetings and our team briefing system, OneBrief.
3. Links with other strategies and areas of work
This Participation Strategy is connected to and is designed to work alongside a number of other
areas:
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Communications strategy
Communications and engagement with GP membership
Quality strategy
Equality strategy
Strategic plan
Carers strategy
Clinical strategy.
4. National and legal framework
A number of national and legal drivers help provide a framework around our approach to involving
local people in commissioning.
Key amongst these is the Health and Social Care Act 2012. Under the terms of this legislation
commissioners are expected to:
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Make arrangements for and promote participation in care and treatment through
commissioning activity;
Make arrangements for the public to be engaged in governance arrangements by ensuring that
the CCG governing body includes at least two lay people;
Listen and act upon patient and carer feedback at all stages of the commissioning cycle – from
needs assessment to contract management;
Publish evidence of what ‘patient and public voice’ activity has been conducted;
Engage with patients and carers and the public when designing or reconfiguring services,
demonstrating how this has informed decisions.
The Act also requires us to promote the NHS Constitution. And in turn the NHS Constitution states
that people have the right to be involved, directly or through representatives, in the planning of
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Participation Strategy
healthcare services, the development and consideration of proposals for changes in the way those
services are provided and in decisions to be made affecting the operation of those services.
Other national policy drivers and legal requirements include:
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NHS England: Transforming participation in health and social care, 2013
NHS England: Everyone Counts: planning for patients 2014/5-2018/19
Annual reporting requirements from NHS England
Equality Act 2010
Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny)
Regulations 2013 and Guidance 2014.
Herts Valleys CCG will comply with all the regulations required and be mindful of good practice
around involvement. Additionally, we will seek to exceed regulatory requirements and to involve
patients, carers and local people in such a way as to develop and demonstrate excellent practice.
5. Herts Valleys- our strategy and objectives
We want engagement with local people to form an integral part of the business of our
organisation. So everything we do around participation is intended to support the strategic
objectives of Herts Valleys and to align with our values.
5.1 Strategic Objectives
Objective 1 -To deliver clinically sustainable and affordable services that meet the changing needs
of the population and address inequalities.
Objective 2 - To improve the quality of services and deliver better patient outcomes and
experience.
Objective 3 -To work with our partners to transform health and social care through the effective
use of joint funding.
Objective 4 -To improve engagement with member practices, patients, the public and carers and
to ensure this is embedded within the CCG governance structure.
5.2 Guiding Principles
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Local people are supported to stay well, preventing ill health
Patients and carers are empowered to take an active part in their own care
Care in the right place – at home, or as close to home as possible
Patients will experience services which are joined up.
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5.3 Our Values
These values are the six things that matter most to us at Herts Valleys CCG and these were arrived
at following discussions with staff, GPs, and patient members of the PPI committee .
1. Being: Caring and respectful.
This means we.....
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make sure that consideration of the impact on patient care is at the heart of all our
decision-making
treat everyone - including colleagues - with courtesy, listening to and respecting
everybody's opinion
support colleagues and partners
2. Having: Ambition, courage and high standards.
This means we.....
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do things that are going to make a positive difference to local people
are optimistic that as a team - with partners and the public - we can change things
expect ourselves and each other to produce high quality work
are not be afraid to do things differently to improve patient care
3. Making sure we: are open, transparent, honest and straightforward.
This means we.....
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share our mistakes; and are prepared to say ‘sorry’
acknowledge that mistakes happen – and learn from them
give each other honest and straightforward feedback
Celebrate and share good practice when things have gone well
4. Working: with partners and the public – as a team.
This means we.....
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actively involve partners and local people in planning and decision-making - in genuine
partnership
ask for people’s views and act on what they tell us
explain how we’ve reached decisions
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Participation Strategy
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co-operate fully and enthusiastically with colleagues in other teams to achieve aims
appreciate everybody’s contribution
5. Empowering and energising: clinicians, staff and local people.
This means we.....
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encourage and support new ideas
let colleagues and teams get on with projects
embrace and encourage enthusiasm
6. Learning: to be the best we can.
This means we.....
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understand that we can always do better
learn from others about how to do things better
spend time learning new things
6. Current arrangements for participation at Herts Valleys
We have a well-established model for involving local people. This operates on a number of
different levels with members of the public and patients working with us in a range of ways.
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Public membership which offers patients regular information, through a combined health and
social care newsletter – Herts Valleys Voices. This is distributed to approximately 1400 people
every two months, with supplementary bulletins (Herts Valleys Voices extra) containing key
pieces of information or invitations sent out to ensure the information is current and up to
date. Opportunities for involvement are a key feature of both bulletins and each has included
invitations to conversation events, patient stories workshops and clinical strategy events. A
recent survey about this communication has told us that the bulletin is well received and we
know that it generates ongoing engagement.
The People Bank through which patients with long term conditions, their carers and those
with an interest in specific areas of work are asked their views on a range of issues and to take
part in projects. Previous involvement has included patients and carers bringing their
perspective on respiratory, diabetes, end of life care and nursing homes service redesign.
Patient Representatives sit on programme groups, looking at and implementing service
change. And each of our four localities has a patient group, made up of membership from
practice patient groups. Each of those localities in turn sends two representatives to our
Patient and Public Involvement (PPI) Committee. This committee acts as a committee of the
main Herts Valleys Board and one of the patient locality representatives sits on the Herts
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Participation Strategy
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Valleys Board. In addition, we have a Lay Board Member - a patient champion - sitting on the
main board and she chairs the PPI committee.
Reader Panel - We have established a successful reader panel of patients who comment on
draft CCG information for patients and the public before it is finalised and printed or
published. The purpose of the panel is to ensure that CCG publications are clearly written, are
easy to understand and contain no jargon. The panel has proved popular with readers and CCG
staff alike.
7. What we’ve done
Within this framework, we have run a range of activities through which we have heard the views
of patients and local people and worked to ensure that the voices of those patients have
contributed to decisions we have made and projects we have progressed.
7.1 Events and workshops
We were delighted that over 200 people – many of whom were patients and members of the
public – attended two focussed events in 2013 on the development of our clinical strategy.
We have run a full programme of ‘conversation events’, bringing together a range of people,
including GPs and local residents, to discuss a variety of health topics, ensuring that all views are
heard and fed into commissioning activity. These events are often run in partnership with
voluntary organisations such as Alzheimer’s Society, Diabetes UK and Carers in Herts. Recent
events include: supporting patients with diabetes, Dementia Friendly communities and carers. In
addition we held an event in Watford that focussed on ‘what do we need to keep us healthy’. The
event attracted over 100 participants from the African and Caribbean and Asian communities. In
July of this year a conversation event gave participants an opportunity to contribute to the work
we are doing to develop a commissioning plan for the Dacorum locality.
A separate public event was held with Diabetes UK in October 2013 to discuss forming a local
support group and we held a workshop to develop ways to use patient and carer stories in the
commissioning cycle.
7.2. Clinical programmes and service redesign
 The Planned and Primary Care Programme - now incorporating work around older people’s
services - has benefitted from significant input from patients and carers. Towards the end of
2013, we worked alongside Healthwatch Hertfordshire to establish the Patient Connections
Group which provided valuable input into the development of the End of Life strategy and by
helping produce patient and carer materials for advance care planning. The Patient
Connections Group is now part of a wider planned and primary care network which is a key
strand of the planned and primary care programme. Through the network, patients are
continuing to make an impact, for example through their contributions around which services
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Participation Strategy
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to include in the Primary Care Plus model. Patient feedback into the redesign of phlebotomy
services was also considerable and helped drive the move to the delivery of these services at
local practice level. The recent procurement of respiratory services benefitted from
considerable constructive involvement from patients who sat as full members on project
groups and whose role included scoring bids to deliver the new service.
The Urgent Care Network includes patient representatives who are encouraged to participate
fully in discussions round the table. This year work has included a group exercise to identify
winter funding priorities for 2014 with feedback on spend during 2013. The programme team
also ran two well-attended stakeholder events in 2013 and 2014 and the national Emergency
Care Intensive Support Team (ECIST) have commended Herts Valleys for its approach to
involving patient reps in its urgent care programme work, which is seen as good practice.
The Mental Health and Learning Disability programme engages with patients and public
though organisations such as Viewpoint, Carers in Herts and Herts Self Advocacy Network.
The Children, Maternity and Young People’s programme has worked with Healthwatch
Hertfordshire to recruit a Youth Ambassador to act as a champion for children and young
people. The programme held a focus group for parents who had experience of using new
children’s pathways being piloted in hospitals, for example for bronchiolitis and
gastrointestinal conditions.
7.3. Locality patient groups
Herts Valleys works with four active locality patient groups; each of the four localities has an active
patient group, made up of membership from the local area and are working towards establishing
relationships and membership from all practice patient groups. The locality patient groups take
part in conversation events and send two representatives to the PPI committee – see below. Each
locality patient group gets involved in different ways; one example is Dacorum’s group having an
active patient representative on the steering group that oversees the development of the
Dacorum Commissioning Plan.
7.4. Patient and Public Involvement (PPI) committee
The PPI Committee, chaired by a lay Board member and PPI lead, provides assurance to the Board
that patient and public participation in Herts Valleys is diverse, substantial and generates real
benefits. The committee receives regular reports on patient and public engagement events,
patient participation in our strategic programmes and in the design and procurement of key
services. The committee has overseen a project to help strengthen practice patient groups (see
below). The committee has recently contributed to the development of the Herts Valleys ethical
commissioning prioritisation framework. In addition to locality patient representation, the
committee benefits from the membership and participation of a representative from Healthwatch
Hertfordshire.
7.5. Development of Practice Patient Groups
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Participation Strategy
A key project underway this year and led by the PPI Committee, is one that focuses on practice
patient groups. The project, funded by NHS England, is identifying and making contact with
groups, sharing best practice, developing a toolkit, and establishing networks with this ever
increasing number of local people.
7.6. Social Media
We have been developing the use of social media, with a particular focus on Twitter, to extend the
reach of our work to new audiences. @HVCCG has nearly 2,000 followers and in addition a
number of staff and GP clinical leads have established individual accounts to support this presence
on Twitter. Together, our Twitter accounts have 3,000 followers.
7.7 Patient Stories
The Herts Valleys engagement and quality teams worked together with partners to hold two
successful workshops to consider how patient stories could be used to strengthen the role that
patient experience plays in commissioning services. We were joined by patients and
representatives from partners and voluntary organisations. All Board meetings in public now
include a slot where a particular patient story is presented for discussion.
7.8. Patient Leadership
We worked with a number of local partners to develop and deliver a patient leadership
programme to enable patient representatives to become strong influencers. And more recently
we have launched more tailored sessions for members of our own PPI committee.
7.9. Award
At Herts Valleys, we have been keen to ensure that the diversity of our local population is
reflected in the way that we engage with patients and the public and we have done this by having
conversations with those groups whose voices are less often heard. In March 2014 Herts Valleys
CCG, together with partners Healthwatch Hertfordshire, Viewpoint and Herts County Council, was
shortlisted for an NHS England Excellence in Participation Award for work undertaken with the
Trans community in Hertfordshire.
8. Vision and objectives of participation strategy
This strategy has a number of key objectives:
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To support the delivery of Herts Valleys’ clinical strategy and system strategic review –
through the delivery of activities and a framework to hear and act on the views of local
people;
To develop an ethos of engagement and a patient-centred approach throughout the CCG;
To maximise the impact of public and patient engagement;
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Participation Strategy
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To encourage transparency and accountability;
To strengthen and forge relationships across the community.
We aim for these objectives to deliver our broad vision for participation:
“Patients, carers and people living in west Hertfordshire will have many and varied opportunities
to influence our work and the decisions we take. The ways that people will participate in our
work will reflect the diversity of our population. We seek to work in partnership with local
people, operating with transparency and making sure that people’s contributions make a
genuine and significant difference.”
It is important that we deliver this strong public participation for a number of reasons:
 Engaging with people – forging relationships and listening to views – helps us understand
the patient perspective. We know from the Francis report into the failings at midStaffordshire that this is vital to good care, outcomes and a better patient experience;
 Good patient and public engagement provides us with something of real value – an insight
that is key to successful service re-design;
 Genuine and constructive engagement in monitoring and improving health services can
lead to more trusting and confident relationships.
9. Key principles and themes
During the course of developing our refreshed strategy, a number of key principles and themes
have emerged, particularly out of our discussions with local people and patient representatives. It
is these themes that inform the development of our framework for engagement and the activities
that we will put in place for the delivery of that participation.
1. We need to broaden the range of local people who contribute to our work. There are too
many groups who currently do not engage with us or do so in a very limited way. This
includes, among others: children and young people, those in full-time work, people from
ethnic minorities. We will work with Healthwatch Hertfordshire to help us engage with
these groups who are ‘seldom heard’. Our approach will need to involve ‘going out’ to
people, with less reliance on attendance at our own meetings and events. This approach
will support the drive to reduce health inequalities. See appendix two for a summary of our
population profile.
2. Engagement needs to be meaningful - it should change what we do. Genuine influence is
what we need. This will come from an in-depth partnership with the PPI committee and
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Participation Strategy
with projects where we co-design with patients. But sharper, briefer engagement – such as
via social media – will also have an impact on what we do.
3. The mechanisms we use for participation need to range from the full partnership
approach, such as ‘co-creation/co-production’ through to one-off, in- and- out kind of input
via, for example, social media. We should make all of those interactions meaningful and
influential.
4. Whilst our participation arrangements need to work within the existing local NHS
organisational governance arrangements, and those governance arrangements can provide
rigour to participation, we will also make sure not to stifle less structured contributions
from patients and the public and we will make the most of those. We will make it easy for
people to make a contribution.
5. When we involve local people -asking them to give us their time to contribute - we will
make sure we have a clear purpose in doing this and make clear to people what this
objective is and what they can expect.
6. People’s contributions will be more meaningful when they are based around real live issues
and specific proposals rather than theories or generalities– this will be our focus. And we
expect the input from patients and the public will similarly come from their own actual
experience.
7. There will be more support and rigour to project and programme engagement activity,
ensuring robust planning of engagement with local people and an approach that broadens
and deepens contributions that patients and members of the public can make. The Herts
Valleys engagement lead will advise colleagues.
8. We will make more use of Practice Patient Groups as a resource for involving patients.
9. Patients and public to initiate change too – not just respond to and give us their views on
things we already know we want to do. They should help decide priorities.
10. We will recognise that for people to contribute meaningfully, we need to provide them
with knowledge and information.
11. Working with partners will contribute to the success of this strategy. For example as we
work to integrate health and social care so our engagement should reflect this.
Healthwatch Hertfordshire will be a key partner and we will seek to work closely with our
main providers and voluntary sector and charities too so that we can collectively make the
most of opportunities to engage.
12. The feedback loop is critical - we need to make sure there is a clear and genuine ‘thank
you’ to all who participate together with clear information about what is changing as a
result of the participation and this will be made public. Effectively communicating the
impact that participation has had, will act as a trigger for further and wider engagement
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Participation Strategy
10. What will people participate in?
At Herts Valleys we want patients and local people to be in at the start of all the things that
matter. That is the only way that we will achieve our objectives. So for example, we want patients
to work with us on big scale service reconfigurations, on the procurement of new services and on
work that our quality team does with partners to improve the experience that local people have of
services. We want them to talk to us about key strategic plans and proposals and help us develop
our key pieces of publicly available information, such as our website.
A useful way of describing this is through the ‘engagement cycle’
10.1 As Herts Valleys analyses and plans for the future, we will engage with local people to
identify needs and aspirations. We will work with partners to deliver the patient voice in the
development of the Joint Strategic Needs Assessment (JSNA). And in the development of
priorities, strategies and plans, we will provide opportunities for patients, carers and the public to
initiate change. In addition, proposals will be reviewed by the PPI committee and by way of
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Participation Strategy
broader ‘conversation events’. For the forthcoming West Hertfordshire Strategic Review, we will
work with our partners to ensure that the broadest possible range of local people are given the
chance to contribute and to have an influence on outcomes.
10.2 To ensure patient and carer engagement to improve services, all programme and project
groups and boards will have public engagement as a central activity running through their work.
Engagement will be properly built into the structures and process for service re-design. For
example, business cases will outline plans to maximise public involvement – as appropriate to the
activity - and projects will begin with agreements on engagement plans and will monitor delivery
against those plans, including feeding back to participants regularly. The Herts Valleys engagement
lead will advise colleagues running projects on suitable engagement approaches and support as
appropriate. Methods of engagement for projects will include, for example: drawing on the
experience and expertise of the ‘people bank’ and will be expected to incorporate wider
engagement through conversation events and social media and to consider targeting audiences,
including the ‘seldom heard’. ‘Experience-based commissioning’ is expected to form a key strand
of this work, so that people’s actual experiences are captured and inform decisions. Coordinated
reports on projects and programme engagement activity will be presented to the PPI committee.
10.3 As we embark on projects to procure services, we will seek and make use of the views of
patients and carers. Patients and local people will be actively involved in procurement and
contracting including developing tenders and participating in tender process panels to make
decisions. As with all programmes and projects - see above - project leads will draw up plans for
agreement on how members of the public will be involved with procurement. Direct
representation on steering groups and implementation groups is likely to form part of the plan,
and this will be enhanced by other forms of patient involvement - such as questionnaires, social
media – that are appropriate to the particular project. And again, the Herts Valleys engagement
lead will provide advice and a coordinating role between projects.
10.4 Finally, we will harness patient and public experience and pro-actively work with partners
including providers and Healthwatch Hertfordshire to monitor services. The quality team at Herts
Valleys will work with engagement colleagues so that this information is used most effectively and
in a joined up way. And information we get about people’s experience of services will also be used
as part of the work on design and procurement of new services.
11. The framework
We will put in place and coordinate a framework for this participation activity that builds on
existing arrangements. The framework will be as follows:
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Participation Strategy
Practice patient groups
network
Locality patient groups
PPI committee
People bank
Reader panel
Conversation events
Patient stories
Community events and
outreach
Social media and other digital
media
Public membership
For sharing good practice and a resource to gather views
on key issues. Face-to-face and electronically.
Resource to gather views on key issues, face-to-face and
electronically.
Oversight of engagement activity, providing assurance to
the Board. Plays a key role in reviewing strategic plans
and proposals, public information (such as website).
Generates proposals for priority projects and service
monitoring issues. See terms of reference, in appendix
two.
Resource to draw on patient and carer experienced-based
contributions to particular programmes and projects and
issues such as service redesign and procurement. Active
recruitment to this pool of expertise.
To review draft patient and public communications.
Active recruitment needed to this useful resource.
Two types of conversation events:
 Locality-based
 Issues-based, around programmes and projects
and service quality monitoring across the CCG
Experiences of patients and carers to be sourced, shared
and used to feed into service re-design, service
improvement. Explore Experienced Led Commissioning
approach.
Herts Valleys CCG will work with partners, including
Healthwatch Hertfordshire and the voluntary sector to
connect with those groups who are underrepresented.
The engagement will focus on particular projects,
proposals and issues. One of the groups on which there
will be particular attention is children and young people
and we will work with the Youth Ambassador and
colleagues in Hertfordshire County Council to deliver this.
We will use the Council’s ‘intelligence unit data’ and other
resources to help target engagements.
Campaign to acquire thousands of Twitter followers
amongst local people - to have conversations, generate
views around particular issues and projects.
Communicate via Herts Valleys Voices. Campaign to
increase membership numbers. Provide information,
request views on issues and encourage involvement in
projects and other activities. Include evaluation of
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Participation Strategy
Patient forum
participation – to highlight success and worthwhile
investment of time.
Explore holding an annual event, bringing together
representation from all strands of Herts Valleys patient
and public participation - to share engagement success,
receive reports on results of engagement and contribute
to Herts Valleys’ strategic planning.
12. Evaluating engagement
Each project or programme with an engagement plan will evaluate the effectiveness of the
engagement and will report on the impact that public and patients’ contributions have made. As
part of this, patients and the public themselves will be asked to give us their own views – on how
successful and meaningful they thought their own involvement was.
Each engagement activity will generate an evaluation report, based on the views of those
participating and will record activity such as:
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numbers attending meetings
level of involvement in questionnaires
profile – where available – of those participating
numbers of those joining in social media interaction.
The Herts Valleys engagement lead will coordinate and pull together evaluation reports for
discussion at PPI committee meetings quarterly. This composite evaluation will, in turn, be
presented to the main Herts Valleys Board as part of the annual report on engagement.
Appendices:
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Summary profile of Herts Valleys population
PPI Committee terms of reference
Equality and Quality Impact Assessment (EQIA) of Participation Strategy
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