Page 1 of 38

Patient and Public Engagement

Annual Statement of Involvement
April 2012 March 2013









Page 2 of 38

Contents

Page

Acknowledgements 3
Introduction 4
About Us 4
Our Approach 5
Changes to NHS Commissioning 8
Duty to Report Requirements 8
The Patient and Public Engagement Annual Report 9
Consultations Undertaken April 2012 to March 2013 10
On Your Doorstep 10
Relationship Matrix 11
Equality Delivery System 12
Calderdale and Huddersfield Strategic Review - Children 14
Calderdale and Huddersfield Strategic Review Planned Care 16
Calderdale and Huddersfield Strategic Review Unplanned Care 18
Calderdale and Huddersfield Strategic Review Long Term Care 21
Patient Participation Directed Enhanced Service (DES) 23
Safeguarding 25
Urgent Dental Care 26
Care Programme Approach 28
Creative Minds 29
Employment Matters 30
Folly Hall Environmental Project

32
Rapid Access Intervention and Discharge 33
Travel and Transport 34
Welfare Room 35
Projects planned for 2013-14 36
Calderdale CCG Contact Details 38




Page 3 of 38


Acknowledgements

We would like to thank all of the individuals and organisations who have taken part in our
consultation and engagement activities over the past year, and shared their experiences of
using local services. Your contributions have helped to inform our commissioning decisions,
ensuring your local NHS continues to provide quality and responsive services.

This report gives us the opportunity to tell you what consultations have happened over the last
year, what you told us in those consultations and what we have done with the comments you
made.




















Page 4 of 38

Introduction

The NHS has just gone through a major reconfiguration. Calderdale Clinical Commissioning Group
(CCG) was established in shadow form in 2011 and started to take over the responsibility for
commissioning and planning some local health services together from NHS Calderdale, Kirklees
and Wakefield District Cluster Primary Care Trust. The CCG was formally established in April 2013
and is now responsible for ensuring that people living in Calderdale have access to high quality
health services.

Under section 24A (1) of the NHS Act 2006, Primary Care Trusts had a statutory duty to report
annually on engagement activities relating to commissioning decisions. This duty has transferred
to CCGs. It covers the period from 1 April 2012 to 31 March 2013, but includes details of planned
engagement activity for 2013-2014.

About us

Calderdale Clinical Commissioning Group (CCCG) became a statutory body on 1st April 2013. We
cover 26 GP practices and commission healthcare for a population of 213,000. We have a budget
of 265 million and our Vision is:

'To achieve the best health and well-being for the people of Calderdale within our available
resources'.

Our Values are:
Preserve and uphold the values set out in the NHS Constitution.
Treat each other with dignity and respect.
Encourage innovation to inspire people to do great things.
Be ambassadors for the people of Calderdale.
Work with our partners for the benefit of local people.
Value individuality and diversity and promote equity of access based on need.
Commission high quality services that are evidence-based and make the most
of available resources.
Encourage and enable the development of care closer to home.
In 2013, the CCG approved its Patient and Public Engagement and Experience Strategy which sets
out our plans for the next three years. It is also in place to ensure that we adopt a whole system
approach to supporting this work. The strategy will provide clear direction to our work in relation


Page 5 of 38

to Patient Experience and Engagement. It is accompanied by an implementation plan containing
outcomes, targets and timeframes. Our strategy will enable us to meet our responsibilities under
the Health and Social Care Act 2012:
putting patients at the heart of everything we do
focusing on improving those things that really matter to our patients
empowering and liberating clinicians to innovate, with the freedom to focus on improving
healthcare services and,
The recommendations of the Francis Report.

The strategy shows that we are committed to ensuring that we actively engage with patients, the
public and other key stakeholders to ensure that the commissioning, design, development,
delivery and monitoring of healthcare in Calderdale meets the needs of our population. By
listening to patients, and learning from their experience of health care we can understand what
really matters to people.


Our Approach

0ur approach to public engagement and consultation is to ensure that we use a variety of
different mechanisms, methods and approaches to engage with people. We need to understand
how we can best involve people, when they need to be engaged or indeed want to be engaged.
We want to make sure we hear from all the people and communities in Calderdale - everyones
opinions matter. We understand that the way we ask for people to share their views can make a
big difference to who responds so we will ensure we design our patient experience and
engagement processes with this in mind. We will also use equality monitoring to assess the
representativeness of the views we have gathered and where there are gaps or we identify trends
in opinion these will be looked into and plans made to address them.
The Annual Report for Involvement is our opportunity to present the work undertaken, catalogue
our activities and present any changes as a result of this work. This report will be published on
our website and circulated to our member practices and key stakeholders. We also have a number
of other mechanisms in place to manage our engagement activities and gather your views, these
are highlighted below.

Patient and Public Engagement and Experience (PPE&E) Steering Group
The purpose of the Patient Experience and Patient and Public Engagement Steering Group is to
shape, steer and advise on any engagement and consultation activity.





Page 6 of 38

Calderdale Health Forum
The Calderdale Health Forum has been set up by Calderdale CCG as a forum to gather together
representatives from each of the member practices patient reference groups (PRGs). PRGs are
made up of patients from the practices, and they meet regularly with the practice manager. The
Health Forum meets quarterly to ensure that we can gather all practice representatives together
to inform them of our plans, consider and proposals and engage with them on any decision
making.

Health Connections
Health Connections has been set up to help the CCG engage with health-focussed third sector
organisations. The aim of the project is to support the third sector voice in commissioning and to
use their communities to ensure we reach local people at a grass roots level.

Relationship Matrix
Our relationship matrix has developed to make sure we have up to date contact details of
community and voluntary groups from a variety of locations across the district. This matrix
ensures that we engage with groups representing the nine protected equality characteristics.

Calderdale CCG website
Calderdale CCG has a website which provides information to the public including a section called
Get Involved. As a CCG we will fully use our website to inform of our plans to engage, raise
awareness of any consultation activity and also provide opportunities to become involved. This
website is updated on a regular basis so we can regularly report on the outcomes of all
consultations and what we have done as a result of our engagement activity.

Patient Advice and Liaison Service (PALS)
PALS help the NHS to improve services by listening to what matters to patients and their families,
and making changes when appropriate. PALS provide the following functions to the population of
Calderdale:
Providing the public with information about the NHS and help you with any other health-related
enquiry
Helping resolve concerns or problems for those using the NHS
Providing information about the NHS complaints procedure and how to obtain independent help if
the person decides they want to make a complaint
Providing information and help for example: support groups outside the NHS
Improving the NHS by listening to concerns, suggestions and experiences ensuring that people who
design and manage services are aware of the issues raised
Providing an early warning system for NHS Trusts and monitoring bodies by identifying problems or
gaps in services and reporting them.



Page 7 of 38

Health Watch
Healthwatch is the new consumer champion for both health and social care. It exists in two
distinct forms local Healthwatch and Healthwatch England. Local Healthwatch is an
independent organisation and Calderdale CCG is working alongside the service to ensure that it
forms part of our engagement of the local population. The aim of local Healthwatch is to give
citizens and communities a stronger voice to influence and challenge how health and social care
services are provided within their locality.

Patient Opinion and NHS Choices
Patient Opinion is a feedback platform for the public so they can share their story or experience of
healthcare services. Anyone can post an opinion on the website. NHS Choices also provides a
similar facility. Calderdale CCG will search these facilities by provider to listen to what patients are
saying about NHS services.

National and Local surveys
National and Local surveys take place throughout the year from various providers and local GP
practices. Patients are encouraged to contribute to these surveys. The public can use surveys to
have their say on current services and Calderdale CCG is able to use such surveys to understand
the patients view of the service. In addition surveys can be used collectively to inform
commissioning decisions.

Real time feedback and Id just like to say
We work closely with our provider organisations to set up systems to monitor patient views of
services as close to them receiving it as we can. These surveys help us to understand in real time
what is happening in the service and how patients are finding the care and treatment they
receive. In addition the CCG website features a feedback form Id just like to say, which patients
are encouraged to complete. This form is also circulated by staff at public events. Information
gathered by both of these mechanisms are stored on databases and used to inform
commissioning decisions.

Service redesign activities
Throughout the year we actively promote any activities for people to become involved. In
addition we ask if people would like to have their name stored on a people bank so we can
contact individuals directly about healthcare services.





Page 8 of 38


Changes to NHS Commissioning

The Health and Social Care Act 2012 sets out the governments proposals to modernise the NHS.
There are two simple principles at the heart of the Act that patients should share in every
decision about their care and those responsible for patient care should have the freedom and
power to lead an NHS that delivers continuingly improving care.
As part of the changes, GPs have taken over commissioning responsibilities from primary care
trusts. Calderdale CCG is chaired by Dr Alan Brook and the Chief Officer is Dr Matt Walsh.
CCGs are responsible for planning and buying most NHS services for patients including community
services, mental health and hospital care. They will be overseen by NHS England who will hold the
CCGs to account for the quality of outcomes they achieve and directly commission services such as
primary care. The CCGs need to demonstrate that they are working closely with patients. This
report is part of that process.

Duty to report requirements

The information required is set out in Real Accountability, the guidance published by the
Department of Health in 2009. This not only applies to formal consultations on service changes,
but to any activity where patients or the public are asked for their views on particular proposals or
issues before a decision is made.

The duty to report requires CCGs to report on consultations undertaken:
by the CCG, NHS trusts or NHS foundations trusts, that are independent of the CCG, but
where the outcome will influence the commissioning decisions of the CCG
by the specialist commissioning group for the strategic health authority area, which will
have an impact on the commissioning decisions for the CCG
by shadow Clinical Commissioning Groups which have an influence on the commissioning
decisions of the PCT
Jointly with another organisation through an integrated management arrangement, such
as with a local authority, on commissioning decisions by the CCG.
The guidance stipulates that the following information needs to be included for each consultation:
Who did we consult?
The issues or proposals which people have been asked to give their views about
Information made available to people during a consultation


Page 9 of 38

A summary of the feedback obtained or received and the range of views expressed by
different people
Commissioning decisions and relevant decisions taken by the CCG following the
consultation
An explanation as to how views were taken into account when decisions were made and
how feedback influenced the decisions taken. This should include whether anything was
commissioned differently as a result of the feedback received and main issues considered
on which it was not possible to act, and the reasons why.


The Patient and Public Engagement Annual Report

When there are decisions to be made which affect how local NHS services are commissioned, we
make sure we talk to those patients who will be most affected and for those larger pieces of work
we make sure the general public are made aware of any proposals so they too have the chance to
have their say. We carry out one-off pieces of work as well as involving patients and the public on
an on-going basis through the partnership arrangements we have in place with local patients and
communities.

The report includes all consultations that have been undertaken and completed during 2012/13,
including any that started before 1 April 2012 or that started during the period of this report, but
are not yet completed. It also includes details of the consultations planned for 2013/14.





Page 10 of 38

Consultations Undertaken April 2012 to March 2013

On your doorstep event with the Voluntary and
Community Sector
June 2012
Even as a shadow organisation, we were keen to look at new ways of engaging. We started our
engagement events with the Voluntary and Community Sector and held our first On your
Doorstep event in June 2012 as part of our training programme for practice staff.


Who did we consult?
We used the Engagement Teams contacts, including the Relationship Matrix and Voluntary Action
Calderdale to invite as many organisations as possible to attend the event.

What did we ask?
The events were arranged to give the VCS organisations the opportunity to hear about the CCG
and its priorities, challenges and plans for the future. The CCG was also keen to hear about the
work that the voluntary and community sector do.

Every group that attended the event was given the option to be allocated a table to display
information about their work and achievements and have the opportunity to talk to CCG members
and our staff about potential offers for the future in a short 10 minute pitch. This was done in a
speed dating style, to ensure that each VCS had the opportunity to speak to a number of CCG
representatives.

What did they tell us?
The main issues raised by the VCS organisations and CCG members and staff were:
Need for funding
The need to raise awareness of their services within primary care
Desire to work with the CCG
Opportunities to provide services for the CCG
The usefulness of having a VCS organisation directory with brief details of each charity/
voluntary organisations services offered to be available for primary and secondary care
providers
The potential for the CCG to support VCS projects going forward.



Page 11 of 38

What did we do?
The CCG used 750,000 worth of non-recurrent funding as a grant to the third sector to set up a
Health Connections umbrella project to support the voluntary and community sector sustain and
capacity build itself over the next three years. Money within the grant was also used to fund one-
off schemes through non recurrent business planning and small grant schemes all of which are
designed to develop a sector which is business ready.

Where can you find more information on this work?
This can be found by visiting the website of Health Connections in Calderdale.


Relationship Matrix

The relationship matrix provides a detailed breakdown of the relationships the engagement team
has developed in the local area. This relationship matrix is not a mailing list but the detailing and
tracking of those key relationships which support the day to day business of the engagement
team. A relationship is defined as a two way conduit, built on mutual understanding and trust
which has evolved over time.


How has the Relationship Matrix been created?
The relationship matrix has been created as a result of extensive mapping and networking. Using
the nine protected characteristics outlined in the Equality Act 2010 as a baseline, we note the
primary characteristic for all organisations we have contact with. The nine protected
characteristics are:
Age
Disability
Sexual Orientation
Religion and Belief
Race
Pregnancy and Maternity
Marriage and Civil Partnership
Sex (gender)
Transgender.






Page 12 of 38

Who can use the Relationship Matrix?
The relationship matrix is used as a tool by the Communications and Engagement team to assist
customers and colleagues in reaching the organisations which engage with patients, carers and
the public on an on-going basis.

This is done by working directly with an enabler who has links into or who works for, the group
or organisation. This is the primary relationship. The enabler ensures that any correspondence
is shared with their members, volunteers and client group.

On completion, the matrix was reviewed to ensure that our engagement processes included
relationships with groups representing the nine protected characteristics.


Equality Delivery Service

The Equality Delivery System (EDS) has been designed by the Department of Health to help NHS
organisations measure their equality performance, and understand how driving equality
improvements can strengthen the accountability of services to patients and the public.

It supports NHS Calderdale CCG to identify local needs and priorities, particularly any unmet needs
of populations, and allow particular groups of patients to assist in the commissioning of services to
deliver better health outcomes.

It will also help NHS organisations to demonstrate compliance with the Equality Act 2010.

At the heart of the EDS is a set of 18 outcomes grouped into four goals;
1. Better health outcomes for all
2. Improved patient access and experience
3. Empowered, engaged and well-supported staff
4. Inclusive leadership at all levels.
One of the features of the EDS is that it relies on organisations working with local interests to
assess organisational performance. This engagement will strengthen existing relationships and
build new ones, ensuring that patients and the public have a voice in the grading and setting of
objectives for the organisation.






Page 13 of 38

Who did we consult?
A consistent approach to engagement was carried out across NHS Calderdale, Kirklees &
Wakefield District. A short questionnaire was developed to use generically across the cluster and
six events were organised, two within each cluster area. In total 22 people attended all six events,
with 8 people attending in Calderdale, 11 people attending in Kirklees and 4 in Wakefield.

To ensure effective engagement with local interests the Equality team worked closely with the
Engagement team to;
recruit representative communities and local people to attend the local events
visit community groups and give out flyers and questionnaires
attend events to raise awareness of the EDS and the upcoming events.
Those who returned the interest forms were sent an invitation to attend the 2 events for their
chosen cluster area and to be part of an Equality Panel to help grade and set objectives for the
organisation. They were also asked what their area of interest was aligned to the nine protected
characteristics.

Staff Engagement
Engagement with staff was also undertaken to ensure their views and experiences also
contributed to the final two goals of the EDS:
1. Empowered, engaged and well-supported staff
2. Inclusive leadership at all levels.

What did we ask?
The engagement focused on the following goals with local interests:
1. Better health outcomes for all
2. Improved patient access and experience.

Event 1
Participants were presented with the organisations self-assessment of each of the 18 outcomes
and overall assessment for Goals 1 and 2. They were then asked to consider the evidence
presented and grade the organisation using colour coding voting cards whilst giving feedback on
their own or their service users experiences of NHS services from their interest areas among the
nine protected characteristics. (Appendix 3, Grading Template)

Event 2
Participants were presented with the collated grades and feedback from the previous meeting and
were asked to seek agreement. As there were some different people at each event, this allowed


Page 14 of 38

for people to catch up on what had happened and also feed in their views should they disagree
with the grade given. Some grades were adjusted.

Those present then looked at the areas of weakness for the PCT concerned. They gave feedback
about what would make a difference to those areas and we agreed priority areas for action.

To assess our progress against the above two goals a staff survey was developed and shared with
all staff via the electronic newsletter as an article and a link to the survey.
This was circulated twice with limited success. There were nine respondents from Calderdale and
two from Kirklees and Wakefield. To address this, feedback was also extracted from the national
NHS staff survey, which is undertaken every autumn.

What did we do?
The EDS is a new process and this was the first time it was used. To have undertaken the grading
in the manner described in the handbook would have been unworkable within the timescales we
were working to. It is recognised that narrow timescales had a negative impact on the process;
however this practical and accessible approach was developed to create a baseline of information
to be used within the first year and in future years. The process will be evaluated and lessons
learned to influence future implementation.

Where can you find more information on this work?
We pulled together a report and this can be found at http://www.calderdaleccg.nhs.uk/get-
involved/


Calderdale and Huddersfield Strategic Review Children
September to January 2013

As part of the Calderdale and Huddersfield Strategic Review we consulted with a wide range of
young people on unplanned care services in Calderdale and Greater Huddersfield. The Strategic
Review is a review of current services across 7 partner organisations. These organisations
comprise of Calderdale CCG, Greater Huddersfield CCG, Calderdale and Huddersfield Foundation
Trust, Calderdale MBC, Kirklees LA, Locala and South West Yorkshire Partnership NHS Foundation
Trust.


Who did we consult?
Engagement evidence was gathered from three main sources:



Page 15 of 38

An Unplanned Care survey which was circulated throughout children and young peoples
networks and completed through one to one interviews.
Evidence from other engagement activities undertaken in the last three years.
Patient feedback and enquiries over the last three years, gathered from Complaints and
Patient and Advice Liaison Service information.

This broad, inclusive approach was designed to maximise the use of all feedback and views
provided by children and young people, and ensure good representation from all sections of the
community, including a wide range of views from the protected groups as set out in the Equality
Act 2010.

We worked closely with council colleagues to support the distribution of an unplanned care survey
throughout local networks. The survey was also taken out to a variety of young people settings
throughout Calderdale and Greater Huddersfield where children and young people were
interviewed using the survey on a one to one basis. We received 254 children and young peoples
views including 12 parents.

What did we ask?
We asked for children and young peoples views on unplanned care services using a survey and
gathered general views on health and social care services.

What did they tell us?
Young people told us:
Involve us in planning and delivering services/activities, for example as peer mentors and
educators and in decisions about our care.
Have the right adults working with us (people we can trust, who we can talk to in
confidence, who are not judgemental, who like young people). Use the people who we
have contact with the most to provide health messages.
Support our parents, carers, siblings and friends so they can support us.
Provide young people friendly venues in our local area, on line or through youth
centres/workers and the places we go to.
Because of transport issues, we need local venues, close to home and available at the
times we would like such as straight after school in our lunch break or Saturday mornings.
For specialist services we are happy to travel up to 30 minutes.
We want to know what we can expect from a service (clear information, use a variety of
ways to get the information through, use young people). We want information on the
things we want to know about such as sexual health, drugs and alcohol, diet, lifestyle and
emotional issues.




Page 16 of 38

What did we do?
The findings of the consultation exercise were considered by the Childrens working group. The
findings have been used to help shape business cases for the work stream and ensured that young
people have a voice in the future of service reconfigurations that will continue throughout the
coming year.

Where can you find more information on this work?
We pulled together all that was said on the day and prepared a report. This can be found at
http://www.rightcarerighttimerightplace.nhs.uk


Calderdale and Huddersfield Strategic Review Planned
Care
September to January 2013

As part of the Calderdale and Huddersfield Strategic Review we consulted with a wide range of
stakeholders on planned care services in Calderdale and Greater Huddersfield. The Strategic
Review is a review of current services across 7 partner organisations. These organisations
comprise of Calderdale CCG, Greater Huddersfield CCG, Calderdale and Huddersfield Foundation
Trust, Calderdale MBC, Kirklees LA, Locala and South West Yorkshire Partnership NHS Foundation
Trust.

Who did we consult?
Engagement evidence was gathered from three main sources:
Planned Care engagement event held in January 2013.
Patient feedback and enquiries over the last three years, gathered from Complaints and
Patient and Advice Liaison Service information, together with a review of local patients
posts on the Patient Opinion website.
Evidence from other engagement activities undertaken in the last three years.

This broad, inclusive approach was designed to maximise the use of all feedback and views
provided by Public, Patients, Carers and Local Voluntary and Community Groups, and ensure good
representation from all sections of the community, including a wide range of minority groups.

The Planned Care engagement event was attended by a mix of individual service users and those
representing patient groups and organisations involved in supporting or delivering services,
including the third sector. The circulation of the invitation included the engagement teams
relationship matrix, local third sector networks and CCG mechanisms such as the Patient
Reference Group Network / Health Forum and local PRGs.


Page 17 of 38


What did we ask?
Following the introductory presentations, participants were split into five break-out groups to
promote discussions on what they felt makes a good service. People were encouraged to think
broadly, with basic structure provided to the discussion through the focus on the questions:

1. What Matters to you?
2. What do you want to keep?
3. What could be done differently?

Other discussed themes included:
Prevention.
Holistic care planning focused on personal needs and goals, with regular reviews.
Personalised care.
Staff attitude/culture.
Timely and effective diagnosis/referral for early intervention.
Effective communication between staff and patients and between staff/organisations.
Care co-ordinator role single point of contact.
Support for carers.
Third Sector (voluntary and community groups) involvement in support and service
provision.
Patients and public involved in commissioning decisions.
Social care funding adequately supported and managed.
Travel and parking considerations.
Inconsistent access and lack of integration of IT systems across healthcare system.

What did they tell us?
There are a number underpinning themes which were evident across the whole range of
engagement evidence gathered. These are described below:
Focus on moving more services to be community based more care in or close to the
home, with consideration for ease of location and adequate parking/public transport
access
Timely and consistent access/ referrals to services available round the clock choice of
appointments, with minimum changes/cancellations, and on time
Early and effective diagnosis and intervention
Collaborative care planning (treat the person as a whole), supported by regular reviews and
patients engaged in decisions about their care
Co-ordinated/integrated care, underpinned by effective communication between services and
staff-patient.


Page 18 of 38

Single point of contact/ co-ordinator role.
Consistently high quality of care provided by friendly, helpful and pro-active staff.
Provision of Information on patients condition and treatment, the care pathway process,
and available local support services (directory of services).
Supported self-management, including Assistive Technology.
Emotional, psychological and practical support, including support for carers and adequate
social care funding.
Commissioning needs to involve local patient and wider public representatives, and focus
funding on all aspects of patient support, including voluntary sector services and self-
management support.

What did we do?
The findings of the consultation exercise were considered by the Planned Care working group.
The findings have been used to help shape business cases for the work stream and ensured that
the public have a voice in the future of service reconfigurations that will continue throughout the
coming year.

Where can you find more information on this work?
We pulled together all that was said on the day and prepared a report. This can be found at
http://www.rightcarerighttimerightplace.nhs.uk


Calderdale and Huddersfield Strategic Review
Unplanned Care
September to January 2013

As part of the Calderdale and Huddersfield Strategic Review we consulted with a wide range of
people on unplanned care services in Calderdale and Greater Huddersfield. The Strategic Review is
a review of current services across 7 partner organisations. These organisations comprise of
Calderdale CCG, Greater Huddersfield CCG, Calderdale and Huddersfield Foundation Trust,
Calderdale MBC, Kirklees LA, Locala and South West Yorkshire Partnership NHS Foundation Trust.

Who did we consult?
Engagement evidence was gathered from three main sources:
Unplanned Care survey conducted over the period November 2012 to January 2013.
Patient feedback and enquiries over the last three years, gathered from Complaints and
Patient and Advice Liaison Service information, together with a review of local patients
posts on the Patient Opinion website.


Page 19 of 38

Evidence from other engagement activities undertaken in the last three years.

This broad, inclusive approach was designed to maximise the use of all feedback and views
provided by public, patients, carers and local voluntary and community groups, and ensure good
representation from all sections of the community, including a wide range of minority groups.

The survey was conducted over a two month period from mid-November 2012, with the final
surveys completed on 16 January 2013. The general survey was distributed in paper form to
individuals via a wide range of participating organisation across Calderdale and Greater
Huddersfield. These included local community groups, organisations and their distribution
networks, local venues (e.g. a primary school, toddler group, and womens activity centre).

In addition, the survey was also made available to the public in web form, accessible through the
external websites of the partnership programme organisations. 93 forms were returned via this
channel. In total, 1,339 general surveys were gained during the engagement process.

What did we ask?
We asked people to complete a survey on their choice of unplanned care, their experience of
unplanned care and their preferences for future unplanned care services.

What did they tell us?
There are a number underpinning themes which were evident across the whole range of
engagement evidence gathered. These are described below, and are evidenced in detail in the
sub-sections of the report, as appropriate:
Patients did not always feel that they knew where best to go to access the care they
needed.
GPs and community-based health care elements were often closed when the patients
needed to access them, forcing them to go elsewhere, despite their preferences to use
these services. Other access issues, most commonly related to availability/choice of
appointments, were also commonly raised by patients.
Patients found the system fragmented with poor continuity of care passed round from
pillar to post, sometimes returning to A&E and other services on multiple occasions**.
There was a need identified to build a more patient-centred approach and particularly to
improve discharge and hand-on processes.
Delayed diagnosis and/or mis-diagnosis.
Some concerns that staff not sufficiently caring and did not take patients concerns about
their health seriously enough, or consider their individual circumstances and needs.
Inconsistencies in standards/quality of care received - patients consistently cited high
standard/quality of care as important, but quite often report big inconsistencies in services
or along different stages of their pathway.


Page 20 of 38

A number of examples of poor communication/ information provided to patient on their
condition and subsequent management, and sometimes between different areas within
the wider healthcare system at various stages of the patient pathway.
Several cases where patients felt they were inappropriately discharged from A&E and were
subsequently readmitted to hospital shortly afterwards.
Patients placed high value on rehabilitation services/ being supported to self-manage/
manage their condition at home.
Several groups of patients, most notably those with long term conditions, regularly used
and reported poor experiences of a number of aspects of emergency and urgent care
services. This further highlighted the importance of effective management of long-term
conditions within the urgent care and wider local healthcare system. This review also
highlighted the need to put in place better plans to cater for disadvantaged groups such as
elderly people and/or those with cognitive impairment, and families with young children,
who all featured heavily as users of urgent care systems, across the evidence base.
Issues were raised about making better use of supporting technology, for instance telecare
facilities and problems related to health professionals having limited (and variable) access
to patient information available at point of contact.
Other problems, mentioned predominantly in relation to A&E attendance, were patients
concerns about long waits and not being told how long they would have to wait/ reasons
why, and some patients were concerned that they received no, or inadequate pain relief.

What did we do?
The findings of the consultation exercise were considered by the Unplanned Care working group.
The findings have been used to help shape business cases for the work stream and ensured that
the public have a voice in the future of service reconfigurations that will continue throughout the
coming year. An example of how this work has shaped future service provision is evident through
the unplanned care work which has taken place earlier this year.

Where can you find more information on this work?
We pulled together all that was said on the day and prepared a report. This can be found at
http://www.rightcarerighttimerightplace.nhs.uk










Page 21 of 38

Calderdale and Huddersfield Strategic Review Long
Term Care
September to January 2013

As part of the Calderdale and Huddersfield Strategic Review we consulted with a wide range of
Stakeholders on Long Term Care care services in Calderdale and Greater Huddersfield. The
Strategic Review is a review of current services across 7 partner organisations. These
organisations comprise of Calderdale CCG, Greater Huddersfield CCG, Calderdale and Huddersfield
Foundation Trust, Calderdale MBC, Kirklees LA, Locala and South West Yorkshire Partnership NHS
Foundation Trust.


Who did we consult?
Engagement evidence was gathered from three main sources:
Long Term Care engagement event held in December 2012.
Patient feedback and enquiries over the last three years, gathered from Complaints and
Patient and Advice Liaison Service information, together with a review of local patients
posts on the Patient Opinion website.
Evidence from other engagement activities undertaken in the last three years.

This broad, inclusive approach was designed to maximise the use of all feedback and views
provided by Public, Patients, Carers and Local Voluntary and Community Groups, and ensure good
representation from all sections of the community, including a wide range of minority groups.

The purpose of the Long Term Care event was to ensure that the care stream had an opportunity
to engage with the public as part of the pre consultation process. The event provided an
opportunity for care stream members to share the areas they wanted to look at as part of the
review and present the messages already given by the public to check they were still relevant.

The event invitation went out through the relationship matrix and to a cross section of
organisations that are well placed to provide a view on Long Term Care services.

What did we ask?
The event included presentations from the care stream members, with the afternoon organised as
themed workshop discussions using case studies on:
Assistive technology
Self-care, and;
Integrated Care


Page 22 of 38


In addition there was a general theme table which was used to discuss any other issues the
attendees wanted considered as part of the review. Following the discussions a number of
themes emerged.

What did they tell us?
There are a number underpinning themes which were evident across the whole range of
engagement evidence gathered. These are described below:
Have to assess peoples needs and personal objectives holistically up-front no one size
fits all.
Effective care planning and on-going collaborative decision making (i.e. keep involving the
patient) this will aid common vision of service user, carer, family healthcare professionals
etc, and make integration more achievable.
Training and on-going education provided to patients, and their carers and families, to
better understand their condition and support elements such as self-care, assistive
technology etc.
Need to improve access to services and appointment systems, with greater availability
outside normal working hours.
Information on services provided needs to be made more accessible (touched on above,
e.g. independent brokerage for DP etc).
Single point of contact for patient is widely covered and, where, available, model is
generally highly praised (e.g. Cancer, Respiratory) again this works on several level (single
point of contact for assessing needs, planning, and co-ordinating day-to-day care, single
point of access to information on available services, activities, choice etc).
Integration of care is so important to ensure high standards of care, efficiency and good
patient experience (e.g. lots of good ones hospital discharge, integration of self-care
elements with other elements, intermediate care facilities etc).
Continuity of care/service is a recurring theme, on several levels (on personal level, helps
user to have contact with the same staff each time, build relationship and understanding,
on wider level, continuity of service avoid lots of short-term contracts, delays, gaps in
service provision etc).
Put greater emphasis on quality of services and the care they provide. Balance out quality
vs. cost get value for money, but dont just go for cheapest option.
People consistently advocate the need to have services close to home and embedded
within their community.
People generally happy to embrace elements of self-care/management supported with by
appropriate assistive technology, provided this is tailored to their needs and adequately
supported within the wider health care system on an on-going basis, i.e. not just as a direct
placement for some other care element, and left to get on with it.


Page 23 of 38

It is also important to support carers, providing them with respite and practical advice and
support.
Provide and encourage support groups and link patients with like-minded individuals with
knowledge and experience of their condition important for emotional, psychological and
practical support. Also include transport considerations within range of practical support.
Commissioning needs to involve local patient and wider public representatives, and focus
funding on all aspects of patient support, including voluntary sector services and self-
management support.

What did we do?
The findings of the consultation exercise were considered by the Long Term Care working group.
The findings have been used to help shape business cases for the work stream and ensured that
the public has a voice in the future of service reconfigurations that will continue throughout the
coming year.

Where can you find more information on this work?
We pulled together all that was said on the day and prepared a report. This can be found at
http://www.rightcarerighttimerightplace.nhs.uk


Patient Participation Directed Enhanced Service (DES)
April 2012
The Patient Participation DES spanned two years from 1 April 2011 until 31 March 2013 and was
aimed at making sure that patients were involved in decisions about the range and quality of
services provided and, over time, commissioned by their practice. It aimed to encourage and
reward practices for routinely asking for, and acting on, the views of their patients. This included
patients being involved in decisions that led to changes to the services provided or commissioned
by their practice, either directly or in its capacity as gatekeeper to other services. The DES aimed
to promote the proactive engagement of patients through the use of effective Patient Reference
Groups (PRGs) and to seek views from practice patients through the use of a local practice survey.
The outcomes of the engagement and the views of patients were published on each participating
practices website.

The information presented here was from the activities that the GP practices undertook during
April 2011-March 2012. This information was then made available for the shadow CCG to view in
April 2012.




Page 24 of 38

Who did we consult?
Out of the 26 practices in Calderdale, 17 practices signed up, of these all submitted an outcomes
report and published it on their practice website. From the information provided we are aware
that at least 278 patients in Calderdale are involved in a PRG. Of the 17 PRGs, 10 (63%) are face to
face, 2 (12%) are virtual and 5 (25%) are a combination of face to face and virtual.

What did we ask?
The patient survey was developed with the PRG to ensure that the questions being asked
represented patients priorities. The main priorities for the PRGs in Calderdale were:
Being able to reach the surgery to make an appointment in particular the telephone system
Ability to make an appointment and an appointment with their preferred GP.
Attitude of reception staff
Opening times of the practice
Waiting room
What did they tell us?
All of the 17 practices that participated in the DES undertook a patient survey. The results from
the surveys showed the following to be of particular concern to patients:
being able to make appointments with their preferred GP within 48 hours
longer opening hours
waiting rooms to be pleasant environments which provide up to date information on services
available at the practice
the lack of privacy and confidentiality when talking to the receptionist
Lack of car parking
The surveys also highlighted a lack of patient awareness of the different ways of making an
appointment; services provided by practices and the opening hours of practices, in particular
extended opening hours

What did we do?
Each practice that participated in the DES was responsible for developing an action plan for their
Patient Participation Group. The CCG has used the information from the practices to inform
development in Primary Care.

Where can you find more information on this work?
The reports were published on each participating practices website.




Page 25 of 38

Safeguarding consultation
April September 2012
Voluntary Action Calderdale delivered a survey on safeguarding to voluntary and community
sector organisations and public providers. The survey was delivered in order to obtain views
which would support future safeguarding practices.

Who did we consult?
Voluntary Action Calderdale consulted a number of organisations working with vulnerable adults.
This included both staff and service users; the types of service consulted met the following
criteria:
Services working with older people
Services working with mental health service users
Services working with substance misuse
Services working with young adults
Services working with adults with a learning disability.
What did we ask?
We asked staff and service users what needed to happen to make services safe. This included
how to report abuse, what would happen if it was reported and the best way to ensure people felt
safe in doing so. In addition we also asked about safeguarding training, if people knew what it was
and had received it, and the best way to sign post people to report abuse.

What did they tell us?
Staff told us that they had either had some or very little safeguarding training, in most cases staff
did not know training could be offered. Service users wanted to understand how safeguarding
concerns were dealt with and clear information on what would happen if an incident was
reported.

What did we do?
We listened to what people told us and offered training to all staff in the first instance, in addition
the feedback went to the joint board for safeguarding and an action plan to ensure publicity
advice and information is appropriately delivered will start this year. Members of the public who
represented their views in the consultation have also been asked to join a safeguarding network
which will continue to shape future commissioning arrangements and identify the best approach
to preventing safeguarding issues. This will continue throughout 2013/2014.

Where can you find more information on this work?


Page 26 of 38

You can find out more information about this work by visiting the Calderdale CCG website on
www.calderdaleccg.nhs.uk

Urgent dental care
1 February 2013 - 26 April 2013

Unplanned or urgent care services are provided in West Yorkshire for people who are resident in
or visiting the area and do not have a regular dentist but need to access treatment quickly. The
service is also used by people who need dental treatment but cannot access their regular dentist,
for example during the weekend or over a bank holiday. There are currently five different services
across West Yorkshire and the contracts for these come to an end on 31 March 2014. A new
service needs to be put in place across the whole of West Yorkshire. The views of Calderdale
residents were sought as part of this process.


Who did we consult?
A total of 547 responses were received from West Yorkshire. Those respondents with a
Calderdale postcode, numbered 224 (40% of the total population consulted). Those people who
were consulted included representation from the following:
Patients and the public
GPs
Dentists
Childrens centres
Voluntary sector
Equality monitoring suggested representation from a wide range of service users across a large
area of West Yorkshire, including Calderdale.

What information did we give?
Members of the public were asked about the urgent dental care service in the Calderdale area.
They were invited to give their views on whether they knew about the service and if they had
visited a dentist urgently, what their experience had been and how easy it had been to get their
appointment. Questions were also asked about which times of day would be preferable to attend
an emergency appointment and what the travel arrangements would be.

What did they tell us?
A significant number of individuals were not aware of the urgent, unplanned dental service and
almost 75% had not used the service. It is not clear how many people were registered with a


Page 27 of 38

dentist and whether those that had not used the service had received treatment from their own
dentist during a normal working week. Of those people that had used the service, most said it had
been easy to contact and find, with the majority responding that they had been able to get an
appointment. Most people had been seen during the day between Monday to Friday and had
been satisfied with the service. Preferences for times of appointments were fairly evenly split, but
the majority of people would prefer a morning appointment given the choice.

In respect of travelling to the service, there was a fairly even split between those who would use a
car and those using public transport and the majority of respondents would prefer any future
service to be within 15 30 minutes travelling distance. It was not clear whether this would be
from home or from a place of work. The majority of respondents also felt it would be useful to
have a choice of venue, although 27% would not have found it helpful to have a choice of venue.

In respect of the qualitative data that was received regarding any other comments about the
service, the most important issue appeared to be access to the service, either for disabled users,
or in terms of ease of location, car parking, or in respect of proximity i.e. how near it was to the
respondent. Issues relating to the quality of treatment and the appropriateness or otherwise of
treatment were also mentioned.

What did we do?
This work has helped inform the West Yorkshire Unscheduled Dental Care service specification.
This specification will be used during the tendering process.

Where can you get more information about this work?
The final report detailing all survey responses and recommendations can be downloaded.

















Page 28 of 38

Care Programme Approach (CPA)
Improving the quality of care
South West Yorkshire Partnership NHS Foundation Trust

Who did we consult?
Service users, carers, staff in a series of workshops together with the annual CPA audit.

What information did we give?
We asked service users, carers and staff:

Are you involved in your own care plan?
What are your experiences of care plans?
Do you know what a CPA review is?
What are your experiences of CPA reviews?
This was done in order to listen to experiences of individual service users and carers and to
develop a shared understanding of:
Good practice
Ways of working together in producing care plans
Reviews of care

Service user, carers and staff also took part in visits to services at Manchester Health and Social
Care Trust and Lincolnshires NAVIGO Health and Social Care which are deemed to be flagship
providers in terms of care planning

What did they tell us?
Very detailed work from which 4 key themes emerged:
Person centred care co-production/Engagement/Involvement
Effectiveness
Language
Clinical

What did we do?
A report of findings was submitted to the Executive Management Group and changes will be put
in place in the forthcoming year.

Where can you get more information about this work?
Visit South West Yorkshire Partnership NHS Foundation Trust website for more information.


Page 29 of 38


Creative Minds
Developing creative approaches in health services was
created in 2011
South West Yorkshire Partnership NHS Foundation Trust


Who did we consult?
Service users, carers, staff in a series of consultation events.

What information did we give?
Service users and all others involved were asked what they thought about the creative minds
strategy and its process for example becoming a partner of creative minds and what should be
supported and how?

What did they tell us?
Feedback was very good and has created great interest. Events are well attended like creative
minds live at the Packhorse Gallery in Huddersfield which saw 150 people take part in a whole
range of creative activities. People also said that they would like events to mark the Olympics.

What did we do?
A wide variety of projects have been supported within services and with local partners like HOOT,
AIM and S2R. Events were organised to help celebrate the Olympics, a magazine was published
which highlights the work of the projects and the impact made.

Where can you get more information about this work?
Visit South West Yorkshire Partnership NHS Foundation Trust website for more information.












Page 30 of 38


Employment Matters Project
In 2012 the Trust employed a service user to take on this project. The idea is to help the Trust to
become a more exemplary employer for people with mental health issues, learning disabilities and
hidden impairments and to support workers in helping people to gain employment elsewhere.

South West Yorkshire Partnership NHS Foundation Trust


Who did we consult?
Service users, carers, staff, partner organisations. We conducted a series of workshops. There was
also a workshop on this subject at our Hidden Impairments conference in November 2012.

What information did we give?
Stakeholders were asked the following questions:

What do you think are the health benefits of working?
Do you think volunteering is a good route back to employment?
How could the Trust become an employer of choice for people with mental health
conditions, hidden impairments and learning disabilities?
What could the Trust do better to help people using its services to progress towards
employment?
What did they tell us?
The responses were very positive from nearly all participants, including service users.
Nearly everyone said that working led to increased confidence and self-esteem, which is crucial
for good mental health.

Participants were mostly in favour of using volunteering as a way of getting into employment. In
particular, the opportunity to learn new skills and gain experience for future employment was
emphasised.

There was general agreement that the most important thing the Trust should do is to treat
potential, new and existing staff as individuals, understand them and try to meet their needs.
Reasonable adjustments were seen as key, and many different kinds of adjustment were
suggested, including:
- Flexible working hours
- Awareness raising in the workplace to increase understanding and reduce stigma


Page 31 of 38

- Specialist technology for people with hidden impairments
- Phased returns
- Increased informal supervision

The importance of skilled managers was emphasised. Managers should have appropriate
awareness and lead by example; and ensure the wellbeing of their staff is considered by
encouraging a healthy work/life balance, taking regular breaks and so on.
Several barriers were identified:
- Job adverts and applications being available only on NHS Jobs was seen as a barrier. Many
people dont have access to the internet or are not computer literate, and this shouldnt
prevent people from applying.
- The need to provide several years worth of continuous employment history is difficult for
many people with disabilities and health conditions
- Traditional job interviews are often very difficult for people with mental health conditions,
learning disabilities and hidden impairments. Alternatives, such as working interviews and
job trials should be considered.
Many other ideas to increase employment opportunities within the Trust for people with mental
health conditions, learning disabilities and hidden impairments were suggested, including:
- Increased use of job sharing
- Easy read job descriptions and contracts
- Part time jobs with only a few hours.
Another suggestion was that the Trust should ask all the organisations it contracts to do work for
them to sign up to Two Ticks (Positive about Disability) and Mindful Employer.

What did we do?
In 2013 we launched the Employment Matters magazine, a website and toolkit. These
incorporated the learning from the workshops, work with our Human Resources team and
vocational workers. As a result a request from members of the Trusts Hidden Impairments Project
(which includes service users and carers) conditions like ADHD, ASC and ADHD were included in
Employment Matters.

Where can you get more information about this work?
Visit South West Yorkshire Partnership NHS Foundation Trust website for more information.








Page 32 of 38



Folly Hall Environmental/Service Improvements
South West Yorkshire Partnership NHS Foundation Trust


Who did we consult?
Services and carers at dialogue groups in Folly Hall during 2012.

What information did we give?
Following the Folly Hall visitor survey conducted in late 2011/early 2012 an action plan was put
together on improvements which could be made. These were shared with the dialogue groups for
discussion.

What did they tell us?
Feedback was positive with people already recognising the improvements like the screening of the
caf area and the adjustments to the reception desk. Services users and carers were willing to
come forward to be part of any inspection/project teams

What did we do?
Most of the improvements are complete. In terms of inspection the Trust is moving towards
incorporating the use of the 15 steps test which would place public involvement at the centre of
inspection processes.

Where can you get more information about this work?
Visit South West Yorkshire Partnership NHS Foundation Trust website for more information.















Page 33 of 38


RAID Project (Rapid Access Intervention and Discharge)
South West Yorkshire Partnership NHS Foundation Trust


Who did we consult?
Dialogue groups and a focus group with staff, service users and carers

What information did we give?
Service users were given on outline of the idea and were asked to comment. At the focus group
more detailed plans were unveiled and shared for comment. Information was shared on the
findings of research undertaken on different RAID models and approaches. We discussed the
business case and processes.

What did they tell us?
People agreed that it was a good idea and were pleased it was being put forward. People
volunteered to be part of the focus group. People wanted to be involved in the project in
particular areas, for example staff recruitment. People hoped it would be a success.
We had discussions on response times, locations and makeup of staff. We discussed proposals for
peer support. It was agreed that the target age group would be restricted to adults (for now).

What did we do?
Steering group built up the business case with this information which has been accepted in
principle and work streams are now underway.

Where can you get more information about this work?
Visit South West Yorkshire Partnership NHS Foundation Trust website for more information.














Page 34 of 38

Travel and transport issues for service users and carers
South West Yorkshire Partnership NHS Foundation Trust


Who did we consult?
Discussions took place in dialogue groups with service users and carers. Focus groups held with
service users, carers and staff in August 2012.

What information did we give?
We asked people to talk to us about public transport and tell us:
1. What are the issues?
2. What are the solutions?

What did they tell us?
It is a complex picture. These issues isolate people in the community. They prevent people from
getting visitors when in hospital. They prevent people from doing what would benefit them in the
community. There is not a great understanding of solutions.

What did we do?
Website information was provided on a range of transport and travel solutions. This work has
raised the profile of these issues across the Trust. We have made better connections with
transport providers. Our public information project team is currently working with service users
and carers on accessibility information for our venues.

Where can you get more information about this work?
Visit South West Yorkshire Partnership NHS Foundation Trust website for more information.















Page 35 of 38


Welfare Reform
South West Yorkshire Partnership NHS Foundation Trust


Who did we consult?
In dialogue groups and other forums many service users and carers and staff have expressed grave
concerns about the adverse effects of welfare reform. So a focus group was set up in July 2012 at
Folly hall for service users, carers and staff. Subsequently issues have been revisited in dialogue
groups and in meetings with staff and joint events with the public.

What information did we give?
We asked people to tell us:
1. What are the concerns?
2. What would people like as a solution?
3. What is the picture, locally, across the trust and what is our response so far?
4. What does the future look like?

What did they tell us?
People are very concerned. It is putting a strain on services and the public we serve. The public
want us to be proactive. They want us to think ahead. They want us to support them through the
processes. Staff wanted mechanisms in place which will enable them to support people.

What did we do?
An array of information and advice was made available on the Trust website and in on the intranet
for staff. This was based on the feedback from the focus group and dialogue groups. At a local
level we have been working with services and partner organisations like the DWP and
commissioner Ian Smith on how best to manage the support people need. In response to requests
we have had discussions at dialogue groups about volunteering, permitted work, employment
issues, welfare reform and benefits.
On a trust wide level we have produced a report for EMT based on solutions from services and the
public across the Trust. This was taken to EMT in August 2013. A meeting has been scheduled for
late September to look at an action plan. Regular updates have been given in dialogue groups.

Where can you get more information about this work?
Visit South West Yorkshire Partnership NHS Foundation Trust website for more information.





Page 36 of 38


Projects planned for 2013 2014

Public and patient engagement and experience strategy and implementation plan


In Calderdale we have recently consulted with key stakeholders on our Patient and Public
Engagement and Experience Strategy. The strategy was sent to all PRG group members, through
our relationship network and shared directly with Calderdale Health Forum and the Governing
Body. We will continue to share our plans in this way and revise content based on the feedback
we receive.

Strategic plans


We are required to publish these documents and to make sure that we have your feedback; we
will engage on these later on this year, starting with the Calderdale Health Forum members
initially and sharing with our key stakeholders we will reflect on the comments made.

Equality Delivery System (EDS)


The Equality Delivery System (EDS) has been designed to help NHS organisations measure their
equality performance, and understand how driving equality improvements can strengthen the
accountability of services to patients and the public.

It will support us to identify local needs and priorities, particularly any unmet needs of
populations, and allow us to assist in the commissioning of services to deliver better health
outcomes. As part of this work, we will be engaging with local people and groups in September
2013.

Francis Report


The publication of the Francis report has been an important milestone and we will work to ensure
that the recommendations made are reflected in our work. To co-ordinate this, we will develop
an implementation plan and share this with our Health Forum members and public and patient
safeguarding group due to be established in November 2013.




Page 37 of 38


Calderdale and Huddersfield Strategic Review


The Calderdale and Huddersfield Strategic Review will continue to dominate the main focus of our
engagement and consultation activity. Four work streams will shape business cases using public
reference groups, engagement and co-production will feature strongly and we will consult
formally on any changes to the way services are provided and delivered.

Call to Action


The National Call to Action local conversations will take place locally throughout September to
November. A report of findings will be sent to NHS England and information will be used locally to
support our local transformation work as part of the Strategic Review.

Service Transformation


Service transformation areas requiring engagement and consultation so far come under the
Locally Enhanced Service and Direct Enhanced Service. We will be engaging with service users on
Vasectomy services and talking to women on womens services.

Unplanned Care in Calderdale will continue to be part of a formal consultation process. We have
already engaged with 2,500 people on unplanned care and intend to reach out to the wider public
to consult on the future options for the service.
















Page 38 of 38


Contact details

If you are interested in getting involved in the work of Calderdale Clinical Commissioning Group or
would like to share your views on local health services, please contact us on the following details:

Address:

NHS Calderdale CCG
5
th
Floor F Mill Dean Clough Mills
Halifax
HX3 5AX
Telephone: 01422 281300

Facebook:
calderdaleccg

Twitter:
@NHSCCCG

You can find out more about us and have your say about local health services on our website,
www.calderdaleccg.nhs.uk


If you would like a copy of this report in another format
such as large print, audio tape or another language,
please contact the Communications Team on 01422
281300.