WARRINGTON HEALTH CONSORTIUM
“No Decision about me without me”
PUTTING PATIENT EXPERIENCE AND PUBLIC ENGAGEMENT AT THE
HEART OF CONSORTIUM BUSINESS – A DISCUSSION PAPER
INTRODUCTION
1. This paper outlines some suggested approaches for the Consortium Board to
consider as it develops its approach to engaging patients, carers, services
users and the public.
2. Warrington Health Consortium has been formed from all the 28 GP providers
that serve the people of Warrington.
3. The Health and Social Care Bill spelled out the responsibilities and duties of
GP Consortia. They have responsibility for improving mental and physical
health and preventing illnesses in the population for which they are
responsible. The must arrange for the provision of health services to such
extent as it considers necessary to meet the reasonable requirement of the
persons for whom it has responsibility.
Consortia have a duty to:
 Function effectively, efficiently and economically
 Secure improvement in quality of services
 Reduce health inequalities and increase patient involvement
 Obtain appropriate advice
 Prepare commissioning plans ahead of each financial year, in
consultation with the Health and Wellbeing Board.
4. Warrington GPs recognise that if they are to discharge these responsibilities
then information about the experience of patients using the health services
they commission on their behalf and understanding the views of the general
public will be critical.
5. Warrington Primary Care Trust has developed several tools and undertaken
much work upon which the consortium can build to take forward it’s agenda.
One of these was the adoption of a simple commissioning cycle tool. The
engagement of services users, carers, and the general public is essential to
each stage of the cycle.
Putting Patient Experience & Public Engagement at the Heart
Of the Consortium Business
Warrington Health Consortium
9 February 2011
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Strategic Planning
6. The needs of the population as a whole will be described through and by the
process of developing the Joint Strategic Needs Assessment for Warrington.
This will be developed in partnership with Warrington Borough Council. It will
provide a snapshot of and information about trends in the health and
wellbeing of the population using demographic and epidemiological data.
However, this ‘hard’ information needs to be supplemented by more
qualitative data about the experience of people using services. So we will use
qualitative research, rapid appraisal and community development type
approaches to enrich the material we use for developing strategic plans.
Procuring services
7. To describe the services we need, what, how, when and where we would like
them delivered requires an understanding of the experience patients have of
services as currently offered, which will inform what needs to be different.
8. In addition we would want to continue the practice of the Primary care Trust in
ensuring that services users or representative groups such as LINKS are
actively involved in the assessment of bids for services and in their award.
Monitoring and Evaluation
9. Finally, we can measure the clinical outcomes of the services we commission.
We can benchmark their efficiency against other providers but it is only by
listening to patients’ experience that we can fully appreciate whether or not
the services are delivering as we require.
PATIENT EXPERIENCE
10. Understanding patient experience and being able to use this information to
improve services is a very important element of improving quality and
managing commissioned services. The Primary Care Trust has laid
foundations by including the requirement for real-time patient experience
surveying to be part of the Commissioning for Quality (CQIN) elements of
contracts with our main acute and community providers. Through contract
Putting Patient Experience & Public Engagement at the Heart
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Warrington Health Consortium
9 February 2011
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performance the trusts are asked to demonstrate changes they have made in
consequence of this feedback. This feedback is not routinely considered by
service commissioners. Such feedback is not available from primary care
services.
Recommendations
a) That the consortium confirms their intention to continue to include
patient experience within the quality components of contracts.
b) That the consortium considers whether to extend real time feedback to
primary care services.
11. The Primary Care Trust has established a direct feedback web site.
www.warrington-pct.nhs.uk/publicinfo/patientexperience
This allows an open access opportunity for any patient, service user or carer
to feedback about any of their experiences of health care in Warrington.
Further work is required to ensure that this information is collated and fed
back to commissioners and to contract performance managers in order to
inform the commissioning cycle as described.
Recommendations
c) That the consortium continues their support for the use of this web
site.
d) That they require their commissioning support team to undertake a
further programme of awareness raising and promotion amongst the
users of Warrington services.
e) That the consortium requires their commissioning support team to put
in place systems and processes to collate the data obtained and
feedback to commissioners and performance managers.
12. In addition to these direct feedback vehicles there are a range of other ways
in which the experience of patients, service users and carers are captured.
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Patient complaints: - received by all providers, and ON occasion
directly to the Primary Care Trust, and in future the consortium.
Patient Advocacy and Liaison Services (PALS) – based in each
provider.
Local Involvement Networks (LINKS) – independently resourced and
based in the community.
National Patient Surveys
Provider led Patient Experience Studies
Patient Stories to the Consortia Board
Walking in the footsteps of the patient with the patient
Putting Patient Experience & Public Engagement at the Heart
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Currently there are limited systems in place to pull together information from
all these sources, triangulate and turn into useful intelligence to inform
commissioners or performance managers.
Putting Patient Experience & Public Engagement at the Heart
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Warrington Health Consortium
9 February 2011
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Recommendation
f)
That the Consortium require their commissioning support team to put
in place systems and process to collate and triangulate information
about patient experience from the range of sources in order that it can
inform commissioning decisions.
g) That the consortium board build on the experience of the Primary
Care Trust and listen to a patient story at each board meeting.
PUBLIC ENGAGEMENT
13. The terms engagement and consultation are often misunderstood because
they are so closely interlinked. When we talk about engagement we mean
talking and interacting with an individual, community or population on a
specific topic or series of issues with the intention of the output helping us
form a way forward or develop a series of options. This may be proactive e.g.
as part of a programme of service reviews or reactive e.g. in response to a
topic raised in the media.
Consultation
14. Consultation is a formal process that statutory organisations are required to
undertake where it is considered that a service proposal is considered to be a
Significant Change to service delivery that affects the public or patients. It is
usually a 12 week formal process that reports through the Overview and
Scrutiny Committee for Health of the local authority.
Ladder of Participation
15. Working with the public whether as patients, or in community groups or third
sector for a, public meetings etc is often described as a Ladder of
Participation – see Appendix 1.
16. Understanding these possible levels of engagement provides a framework to
use when considering the range of ways in which we can engage.
No Decision About Me Without Me
17. “No Decision about Me without Me” Starts for the individual patient in the GP
consulting room. It describes an approach to patient care that assumes a
relationship of equals who each bring something different to the encounter.
The patient brings their perceptions of needs and issues, along with their own
life experience and competencies. The GP bringing their technical knowledge,
skills and competence, alongside their own life experience and personal
competence. It assumes that information will be shared, that the GP will hear
what is being said by the patient, and can respond with information that is
accessible and understandable to the patient. It assumes that there will be
discussion as to the range of possible options available in diagnosis,
investigation and management plans.
18. This nature of relationship should continue along the patient journey into
secondary care and social care support.
Putting Patient Experience & Public Engagement at the Heart
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19. The same principles apply to our consideration of the needs and perceptions
of services, and the way in which we try to find solutions to those problems.
i.e. to understanding service requirements and commissioning services to
meet the needs. Hence the importance of engagement.
Engagement Mechanisms
20. The Primary Care Trust has a well-established network of relationships and
organisations with which it has worked to secure engagement as it has led
the commissioning of services. The consortium has these foundations upon
which to build.
21. The year one Commissioning Strategic plan was developed with considerable
public involvement and engagement. With over 10,000 responses to a
household questionnaire, deliberative events, focus groups with hard to each
groups and specific meetings with third sector and other community groups.
Much of this work was undertaken in partnership with colleagues form
Warrington Borough Council.
22. Some of the key vehicles for engagement will be
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Neighbourhood Areas Boards
Neighbourhood Area Health Groups
User and Carer Forums
Town Centre & Orford Park Patient & Public User Group
Local Involvement Network (LINKs) to become Health Watch from
2012
3rd Sector Hub
Overview and Scrutiny Committee
Health and Wellbeing Board with elected members
Vulnerable Communities – User Groups
Neighbourhood Area Boards
23. Warrington Borough Council as part of its Neighbourhood and Community
Strategy has developed Neighbourhood Boards. These are formed out of
third sector, voluntary, residents, local councillors, statutory organisations,
and local care provider representatives.
24. It is proposed that members of the Consortium Board will also become
members of Neighbourhood Area Boards to ensure the Health and Wellbeing
Strategy and NHS Commissioning Strategic Plan are alive within the
neighbourhoods and that there is a golden thread running through from the
system wide health strategy to local area plans
25. It is proposed that GP leads use these boards and other community force to
actively engage with the communities to discuss service strategy, experience,
needs and values and gain first-hand the public’s view on the health services
they commission.
26. The health and active working groups (sub-committees of the neighbourhood
boards which are tasked with leading local health forward) will continue to
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have membership from public health staff. The public health staff will ensure
that regular updates from the groups are reported through to the GP lead for
inclusion in Board discussions.
27. In addition the Neighbourhood Boards hold community engagement
meetings. These are locality based and run through the neighbourhood
teams, feedback is reported through to working groups and board as
necessary. The engagement function of the GP consortia will ensure that
health is present at these meetings as and when necessary and that the
feedback direct from the community is reported through to GP leads and
commissioning.
Recommendation
h) That the consortium board support the proposal for board members to
link to a neighbourhood board
i) That the consortium requires the Public Health team to continue to
support the healthy and active working groups
Practice Patient Participation Groups
28. In addition GP practices bring their own models of engagement. There are
currently 9 practices with their own Patient Participation Groups.
Recommendation
j)
That the consortium will actively encourage and promote practices to
establish their own patient group in order to both influence internal
practice improvement and wider service development across the town.
k) That the consortium encourages links between Practice Participation
Groups and the Community Engagement groups.
Local Involvement Network to become Health Watch (2012)
a) The existing roles of LINKs include:
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Promoting and supporting the involvement of people – that is, the
public, patients and service users in the commissioning, provision and
scrutiny of local health and social care services,
Obtaining the view of people about their need for and experiences of
local health and social care services;
Enabling people to monitor and review the commissioning and
provision of care services;
Raising the concerns of local people and those responsible for
commissioning, providing, managing and scrutinising services.
29. The Health Bill describes the transformation of Local Involvement Networks
into Health Watch thereby taking the memory, skills, networks and experience
into the new body. It is proposed that in addition Health watch would have
additional functions:
Putting Patient Experience & Public Engagement at the Heart
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Warrington Health Consortium
9 February 2011
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Provide advice and information to enable people to make choices
about health and social care which local authorities can commission.
A role for Health Watch as an organisation which will be formally
represented on the local Health and Wellbeing Board.
A role for Health Watch in relation to public health functions.
A closer and more formal relationship with the Care quality
Commission through Health Watch England that will be established as
an independent body within Care Quality Commission.
A role in relation to the engagement and involvement activity carried
out by GP commissioners, including the ability to contribute to the
Joint Strategic Needs Assessment that underpins commissioning
decisions.
Recommendation
l)
That the GP Commissioning Consortia actively engage and
communicate with LINKs and in the future Health Watch over health
strategy and patient experience.
The 3rd Sector – Big Society
30. The role and influence of the 3rd sector in Warrington is powerful and has the
ability to engage and empower communities across Warrington. We have
approximately 1200 3rd sector organisations in Warrington from the very small
to significant 3rd sector organisations like Warrington Disability Partnership.
31. The Primary Care Trust has again developed a base of relationship and
working with the third sector as evidenced in the third sector compact. There
are strong links to the 3rd Sector Hub. Current policy direction suggests that
the role of the 3rd sector will grow as the public sector shrinks and that we
need to make sure the sector has the capacity, skills and infrastructure to fulfil
expectations.
Recommendation
m) That the consortium requires its commission support team to continue
and further build upon the established network relationships with the
third sector.
Overview and Scrutiny Committee (Health and Social Care)
32. The Overview and Scrutiny Committee is the body within Warrington Borough
Council that is charged with reviewing and challenging the actions of the
consortium in relation to its commissioning of health services. This will be a
continuation of this role in relation to the predecessor Primary Care Trust. The
Chair and Accountable Officer of the Consortium have already started to
attend this important group, and have met with the health leads for all parties
to establish this relationship.
Governance
Putting Patient Experience & Public Engagement at the Heart
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33. It will be important that through all the governance arrangements of the
consortium we evidence our processes for, and the outcomes of our use of
patient experience and public engagement in the task of commissioning
services for the people of Warrington.
Putting Patient Experience & Public Engagement at the Heart
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Warrington Health Consortium
9 February 2011
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Further developments
34. Board members may be aware from their own networks, experience or
reading of other ways in which we could build upon existing practice to further
enhance our patient experience and engagement approaches.
35. As Consortia develop it is likely that further examples of best practice will
emerge across the country.
Recommendation
n) That the consortium require their commissioning support team to
continually review the literature for emerging examples of best
practice and bring any such back for consideration by the board.
Next Steps
36. The Accountable Officer will identify a lead officer within the commissioning
support team to have responsibility for taking forward this agenda.
37. The commissioning support team will develop a work plan to deliver the
agreed recommendations of the Board.
Dr Sarah Baker
Accountable Officer
Warrington Health Consortium
February 2011
Putting Patient Experience & Public Engagement at the Heart
Of the Consortium Business
Warrington Health Consortium
9 February 2011
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APPENDIX 1
Table 1 – Ladder of Participation
Citizen
Decisions
Local people are the decision makers for issues such as
planning, policy making
and managing
with no
intermediaries between them and the source of funds.
Delegated
Power
Citizens hold a clear majority of seats on committees with
delegated powers to make decisions and the power to assure
accountability of programmes etc.
Partnership
Power is redistributed through negotiation between citizens
and the power holders. Planning and decision-making
responsibility are shared.
Co-option
Co-option of local people onto committees allows citizens to
advise or plan, but retains the power holders’ right to judge
the legitimacy or feasibility of advice.
Supporting
Local
Initiatives
Supporting independent community based initiatives to help
communities develop and carry out their own plans. This is
the most “empowering” stance – provided people want to do
things for themselves.
Acting
Together
Acting together may involve short-term collaboration or
forming more permanent partnerships with other interests. To
act together effectively partners need to trust each other as
well as agreeing on what they want to do.
Deciding
Together
Deciding together means accepting other people’s ideas, and
choosing from the options you have developed together.
Deciding together can be difficult as it can mean giving people
the power to choose without fully sharing the responsibility for
carrying decision through.
Consultation
Consultation is a higher level of involvement than information
giving. You may be asked for views and perceptions on the
problems, offered some options, allow comment, take account
and then proceed. Consultation is appropriate when you can
offer people choices on what you are going to do - but not the
opportunity to develop their own ideas or put plans into action.
Information
Information giving underpins all other levels of participation,
and may be appropriate on its own in some circumstances.
Information giving is essentially a “take it or leave it”
approach. However there are likely to be problems if all you
offer is information and people are expecting more
involvement. It is important to use language and ideas which
the audience will find familiar and be clear about why you are
informing rather than consulting.
Putting Patient Experience & Public Engagement at the Heart
Of the Consortium Business
Warrington Health Consortium
9 February 2011
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