Overview of the UK Vision Strategy Leads Meeting (England)
Overview of the UK Vision Strategy Leads meeting (England)
Introduction
On 18 October 2011 we held the second collective meeting of UK Vision Strategy leads, and those with a keen interest in the Strategy, in England. The purpose of the day was to provide updates on the national welfare and health changes, updates on the UK Vision Strategy and to hear directly from the leads of their own experiences in delivering the Strategy.
The day was held in central London and attended by 26 people covering over thirty areas across England and was a direct response to local leads telling us they wanted to hear more about what was happening across the country.
Overview
Stephen Remington, Chief Executive for Action for Blind People, provided a welcome to the day as Chair of the UK Vision Strategy England Implementation Group (EIG). Stephen told the group that he was pleased to be the new EIG Chair and was looking forward to understanding more about the work of the local groups.
Stephen promoted the newly launched 'Seeing it my way' consultation. More details are at
Anita Lightstone, Programme Director, UK Vision Strategy, provided an update on work over the past six months:
- At Vision UK 2011, Michael Sobanja, Chief Executive, NHS Alliance launched commissioning guidance for eye care and sight loss services. This guidance was developed by a cross sector action group led by UK Vision Strategy and is designed to improve commissioning of eye care and sight loss services in the new NHS. The guidance is at
- UK Vision Strategy is leading on a project targeted at GP Practices to increase awareness of the access and communication requirements of people with sensory loss and/or learning disability. Access Awareness has delivered seven sessions across England and is facilitated by trained Practice Managers supported by local voluntary sector groups. These have been well received and links are starting to be forged between practices and local voluntary organisations. For more information, please contact Phil Ambler at .
- The EPIC project now covers 12 areas across England with a number working to publish their local Strategies early next year.
- UK Vision Strategy is involved in a project to tackle the current threat to rehabilitation services. Jenny Pearce, Chief Executive, Vista provided a further update on this project later in the day.
Douglas Smallwood, clinical commissioning support team, NHS Midlands and East, provided an update on clinical commissioning and, in particular, how to engage with the new clinical commissioning groups (CCGs). A copy of Douglas' presentation is provided with this overview.
Douglas advised that the focus in the new NHS is on health outcomes and quality standards. Staff from the current Primary Care Trusts (PCTs) are aligned with CCGs.
CCGs will need to prove they have the means to be able to commission and will need to be granted authorisation from the National Commissioning Board (NCB) to do so. The end result is delivery of the QIPP agenda. Quality will be defined by clinical outcomes, safety and patient experience.
Whilst Andrew Lansley has said budget is secure for the NHS it does not account for the year on year cost increases. The challenge becomes managing ever increasing levels of demand coupled with increased costs.
Douglas discussed the development of clinical groups towards authorisation. The full detail of this development is available on the Department of Health website at http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_130293
The size of CCGs will be important. Whilst larger groups may have larger budgets available they may be less responsive due to their size. Smaller groups might be more agile but be restricted as they are able to command less resource.
To support CCGs there is a large push to provide leadership development. Good structures and processes need to be in place to ensure CCGs are effective and efficient whilst maintaining or improving quality.
Voluntary sector groups should seek to understand the current needs of CCGs. The voluntary sector should address the whole of QIPP (http://www.dh.gov.uk/en/Healthcare/Qualityandproductivity/QIPP/index.htm) when making approaches to CCGs.
There is a strength within the voluntary sector of providing patient advocacy. This should be promoted to the CCGs when trying to engage with them.
Promotion of prevention of sight loss and how voluntary sector can support this could be of interest to CCGs.
Until April 2013 it will be difficult to establish who is best to deal with. This will vary from area to area until this time whilst new structures are embedded.
Elizabeth Lynam, Head of Dentistry and Eye Care, Department of Health, provided an update on the future of NHS commissioning of eye care services. A copy of Elizabeth's presentation is provided with this overview.
The NHS and Social Care Bill has now passed its Second Stage in the House of Commons. The move to clinical commissioning groups widens clinical input so that the focus is not so fully focused on general practice. An overview of the new reporting structure was provided and is available in the attached slides.
Within the new NHS there has to be a lot of direct commissioning by the National Commissioning Board. For eye care there might be one or two specialised services.
There are no plans to change collection of GOS data.
As development continues the four bodies (Public Health England (PHE), Health Education England (HEE), Department of Health and National Commissioning Board) will have to work together.
Diabetic retinopathy is likely to be the responsibility of Public Health but it will be commissioned.
Health and Wellbeing Boards will inform Local Authorities and the NHS who will work together to develop Joint Strategic Needs Assessments.
Local professional networks (LPN) are new and will be:
- An integral part of the NCB local team
- A vehicle for clinically led and clinically owned delivery of;
- Quality improvement
- Best outcomes for patients that reflects local need
- Best use of NHS resources
- Planning and designing integrated care pathways
- Oral health strategy and oral health improvement
- Leadership and engagement
They will ensure clinical leadership is at the heart of the local operating model.
The design proposals for LPNs describe those functions where clinical expertise and leadership can add most value within local commissioning operating model.
Within the clearly defined parameters of a single operating model for primary care, the vision for LPNs is that they could deliver:-
- Quality improvement – benchmarking, peer support, clinician to clinician conversation, endorsement of ‘what’s good’
- Transformation – clinically-led local implementation of national and informing/influencing from local to national
- Clinical expertise into planning and strategy – key relationships with Health and Wellbeing Boards, CCGs, Local Authorities, PHE
- Local clinical expertise and voice to commissioning decisions
- Leading re-design and integration locally
- Clinical leadership and engagement
There will be an LPN for eye health. NB: It was noted by delegates that these seemed very similar to local UK Vision Strategy groups.
LPNs will be in place by April 2013.
Andrew Kaye, Policy and Planning Manager, RNIB provided an overview of the current situation with the Welfare Reform bill and raised the importance of supporting the Hardest Hit Campaign.
As organisations and individuals we need to:
- Challenge the 20 percent budget cut to Disability Living Allowance (DLA).
- Ensure the benefit that replaces DLA, Personal Independence Payment (PIP), meets the needs of blind and partially sighted people.
- Make sure people receive contributory Employment Support Allowance (ESA) for as long as they need it to assist them with their pathway towards work.
In October, twelve major events to support the Hardest Hit Campaign took place in cities across the UK: Belfast, Birmingham, Brighton, Bristol, Cardiff, Edinburgh, Leeds, London, Manchester, Newcastle, Norwich and Nottingham.
More information about the Hardest Hit Campaign can be found at or
Mike Brace, Chief Executive, VISION 2020 UK provided a closing message based on the acronym STRATEGY:
- Stamina/Strategy: it is tough currently but you have to keep going
- Thinking: need to provide information to local influencers to give them something to think about
- Research: rights and responsibilities, nationally the research is starting to provide an evidence base
- Attitude: how do you change attitudes to increase the prominence of eye care and sight loss provision
- Togetherness: joining up and influencing initiatives
- Empowerment: getting people heard especially concerning important issues such as the removal of school nurses which creates issues
- Goal setting: we very rarely come together to set goals, to get into Joint Strategic Needs Assessments so how can we work together to get a better profile?
- You: change will only happen if you continue to make a difference.
Feedback from group work
In the morning, those attending were split into three groups to discuss their own experiences of developing and implementing action plans and local Vision Strategies. Below is a collection of the feedback recorded on flipcharts by the groups:
Top tips collected from groups:
Perseverance: hang on in there. It is difficult finding who to speak to and can be a long term task.
Passion: having a leader/champion
Collaboration: engaging people, keeping momentum
How to influence:
- Get through to the powers that be
- This isn’t extra work
- Using other areas to get attention (for example, falls and smoking)
- Holding on to linkages ‘when the lights go out’
Pathway
- Identifying gaps and links
Pressure to link to other strategies
- Sensory, capacity issues
Don’t panic! Develop the partnerships gradually. Keep addressing what you want.
Quick, cheap wins – only find them through dialogue
Don’t lose the bigger picture – opportunity to learn about other partners’ priorities
Verbatim comments from flipcharts:
Finding the finance to implement
Main costs incurred to implement the Strategy?
Don’t be purist about timescales
Plans into action:
Who do we engage with?
Flux makes difficult
EPIC lead at PCT
Health lead hasn’t led!
EPIC has provided spine
Work with whoever will listen
Priorities changing
UKVS – PCT got support chief executive
London – short strategy aimed at QIPP. Headline for eye health.
Some responses “Thank you but we will do.”
Need key champion to go the extra mile
Re-invigorate group of champions to ‘recharge’ strategy.
Can you go too far too quickly? No – if you achieve stuff!
Building relationships – succession plans.
Continuous progress on national strategy
Need to use Seeing it my Way
Financial responsibility to do?
Takes time to build collaboration
Process of writing local strategy takes a long time
Chip away/thorn in side
Have to be really committed to the Strategy
Big plus to get Director of Public Health involved
Look at wider issues
National team can support
Build local leads
Difficult to evidence efficiencies
Future accountability - more difficult. Three chunks of budgets.
All have knock on effects. How to manage this?
Reducing costs – no cost activities
Use universities to provide research information.
Sharing outcomes really important
Rehab figures discussed at ADASS.
Talk to national team – gives boost
Peer support – use national team
Growing number of local strategies being produced: use for support.
Get – national name, someone from national team
Leeds – difficult to release funding
LOC representatives – passionate
Merge – ideal – LOCS, eye health, LVSCs
Strength from moving groups together
LVSCs to UKVS groups
Malcolm – wider group (incorporated old collaboration)
Tower Hamlets – LVSC challenging to find commitment.
Reform into another group
Don’t waste energy with separate groups
Constantly review make up
Sensory – deaf services important.
Successes
Starting early - straight to action plan
Realise joining dots and linkages (smoking, falls, equalities, long term conditions, etc). Emphasises that it is not extra work.
- right people in the room
- had plan
- own business plan and UK Vision Strategy drove actions
- keeping threads and links during change getting links into new structures
- you have one chance with commissioners
- use disability and sensory
- be aware PCT and commissioners don't have knowledge / experience about eye health and sight loss
- wellbeing boards: routes in?
- equalities good way in
- one stop shops
- one page pathway / referral routes (identify gaps)
- PCT stakeholder forums = useful way in to clinical commissioning groups
- which services go to clinical commissioning groups and National Commissioning Board
- talk to managers not rec chair of clinical commissioning groups
- voluntary sector forums can be helpful
- commissioners don't know each other's competing priorities
- difficulties of working a "sensory loss" team: very different ways of working between deaf and visual impairment
- sharing back office / sharing infrastructure
- pressure on voluntary sector
- GP access useful to get in GP frontline
- Health and Wellbeing Boards - setting JSNA but often want to hear joint sensory
- sense that "long queue of different interest groups"
- engagement "managed" by clinical commissioning groups
- focus on how to influence / get to clinical commissioning groups: what helped: going straight to plan
Phil Ambler
Operations and Information Manager
UK Vision Strategy
18 November 2011