Wandsworth Clinical Commissioning Group: A Strategy for Delivering Effective Patient and Public Involvement (PPI)
Introduction
The Wandsworth CCG is committed to working with the people and communities of Wandsworth in an open and transparent way to ensure that we commission high quality healthcare. Although we are at an early stage in our development, we have been identified as a PPI ‘pathfinder’ and have been exploring different ways to ensure that effective PPI is embedded into our work. In order to support this, we have held two large workshops to engage with patients, carers, community groups and partners about the principles and objectives the CCG should adopt. This consultative approach has led to a number of principles and expectations forming part of our ‘Patient Voice’ (appendix 1) which commits the CCG to a shared vision of PPI with our local population.
Vision
The Wandsworth CCG’s vision for effective PPI is that we will involve the people and communities of Wandsworth in our decision making and priority setting. We recognise that patients, carers and service users have valuable expertise and insight which we will use to inform service redesign and commissioning decisions. We will strive to empower communities to develop sustainable approaches to health improvement and promotion.
Successfully implementing this vision will lead to demonstrable improvements in how we work with our local community. Specifically, effective PPI will mean that:
Commissioners will:
· Involve patients, carers and the public in decision-making
· Use the insight of patients and carers to improve patient care
· Support patients to make decisions about their own health
· Ensure that all the providers we commission services from support our principles
Patients, carers and the public will:
· Understand what services are available and how care is delivered
· Know how decisions are made and how to become active partners in the decision making process
· Know how to get help and support in maintaining healthy lifestyles and managing their own conditions
Principles
To deliver these goals, we agreed a number of principles in collaboration with patients. They form the basis of how we intend to engage with our local community. The thinking behind these were drawn from two patient events held during 2011 to ensure that patients were brought in at the start of the journey. These are described in more detail in appendix 1, however they can be summarised into three points:
i) Ensuring that patient and public involvement leads to improvements in commissioning and services
The details of how we will achieve this are described in appendix 1 and will be expanded through the work of the PPI Clinical Reference Group (see below). In summary, we aim to involve patients and the public in co-creating solutions to add value to the commissioning process. We will provide support to representatives and individuals to enable them to do this.
ii) Involving seldom heard groups
The CCG is conscious that traditional modes of engagement are considered inaccessible to some groups of people, and that particular care needs to be taken to ensure that we reach out to and engage with seldom heard groups. This includes people whose first language is not English, people with physical sensory or learning disabilities that may impede participation, and people whose financial, personal or social circumstances or their caring responsibilities make it hard for them to make their views heard. We have begun to identify and work with some seldom heard groups through a small grants scheme administered through the Wandsworth LINk. A report describing the output from this work is attached in appendix 2. This work is being extended through 2012.
iii) Supporting self-management (Tier 0)
Our health needs assessment shows the burden of disease related to long-term conditions and the extent of health inequalities. We recognise that supporting self-management is an important way of improving the health of our population, keeping people well for longer, of ensuring people can be in control of their own care and of ensuring health care resources are used to greatest health benefit. We will develop and promote the Expert Patients Programme to increase access and we will evaluate other self-management programmes such as Co-creating Health to expand the profile of self-management approaches we offer to people.
We will ensure that patient education and self-management underpins all new patient pathways as they are developed and we will work with Public Health to develop health promotion programmes.
Modes of engagement
Wandsworth has a diverse population and the CCG aims to engage a range of people from all backgrounds, ethnicities, ages, genders and geographical locations. To do this effectively we plan to use both established and innovative methods. The list below provides an overview of the approaches we plan to take. This is not an exhaustive list and we will continuously review how we are doing with patients, carers and other stakeholders to ensure we maintain a dynamic approach.
1. Providing information
This approach helps to ensure that the public and local communities have the information they need to understand and access services, and to provide information about planned developments. This will support patients and carers to make the best decisions they can about the care they receive, and will enable the public to hold the CCG to account for its decisions.
Information can and is shared through a number of routes such as leaflets, newsletters, websites and social media and meetings.
2. Consultation
We aim to develop and improve our interactive processes whereby the organisation provides information whilst receiving views, ideas and experiences from the public. The feedback received can then inform our commissioning decisions. Consultation can be conducted in a number of formal and informal ways such as focus groups, public meetings, surveys or questionnaires, polls, interviews or through social media.
3. Involving patients
This is a more active process than consultation and implies that the public and local communities work in close partnership with the CCG to agree outcomes and plans. This could be through using patient groups (either based around specialty / disease group, population group or service area) which will be supported and encouraged. However, other routes for involving patients, carers and service users will also be explored, such as co-creation approaches, virtual groups, citizen’s juries and lay representatives on decision-making or advisory bodies.
PPI structures
The CCG has designed a structure aimed to ensure that PPI will be embedded throughput all groups and processes that will influence our major commissioning priorities, recognising that there are many different ways that people can make their views heard.
The CCG has created a number of Clinical Reference Groups (CRGs) to lead on specialist areas of commissioning such as mental health or diabetes. In parallel with these CRGs, a PPI Clinical Reference Group will be created (see attached Terms of Reference, appendix 3) to be chaired by the Lay Member for the CCG Board with responsibility for PPI, with the GP Lead for PPI as Deputy Chair and supported by the CCG PPI Manager. The PPI CRG will bring together a group of key stakeholders in PPI, including a lead GP for each Locality, representatives from Public Heath and the Local Authority, and patient / carer representatives (including from the Wandsworth LINk and then HealthWatch), to oversee the development and implementation of key actions to deliver the CCG’s vision for PPI.
The PPI CRG is formally accountable to the CCG Board, and will report progress against its work plan annually. Each Locality will appoint one GP PPI lead who will spend one session a month to work on PPI activities. They will be responsible for representing the locality perspective and for supporting their locality to develop effective involvement and engagement in all aspects of care planning and delivery.
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CCG Accountability Structures for PPI
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Action plan and monitoring
This document, which outlines our overall approach and signals our intentions, must be supported by a detailed action plan and clear accountability arrangements. This will be a living document which will be adapted according to the changing context, and will be updated and reviewed at regular intervals.
The detail of the action plan will be developed and agreed by the CRG and will cover the following work areas:
· Ensuring CCG staff effectively engage with the public and local communities
· Developing PPI at Locality level
· Developing new modes of engagement (including through technology)
· Ensuring engagement in pathways redesign and service changes
· Ensuring involvement in strategy and priorities
· Engaging hard to reach groups and vulnerable communities
· Reducing inequalities through greater involvement
· Promoting and supporting self-care and self-management
· Developing effective partnerships with HealthWatch
· Working with partners (e.g. community and voluntary groups) to ensure active engagement of patients and carers in their own care
· Considering approached to co-production
Oversight of the action plan will rest with the PPI CRG who will report progress to the CCG Committee. We will use a number of tools to determine whether the strategy leads to an improvement in levels of engagement with the public and local communities of Wandsworth – for example, the PPI evidence log, Equality Analysis, and feedback from patient and carers through annual surveys and workshops.
List of Appendices:
Appendix 1: The ‘Patient Voice’. Feedback from engagement workshops.
Appendix 2: Seldom heard groups report
Appendix 3: PPI Clinical Reference Group terms of reference
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