Management Report
Appendix number: 55
Appendix title:
External Reference Group (ERG) of Healthier
Together Assurance Report
1
th
Date of paper:
11 February 2015
Subject:
External Reference Group (ERG) of Healthier Together Report
Decision / Opinion Required:
Information
Author of paper and contact details:
Ken Griffiths and Cath Broderick on behalf of the External
Reference group
Purpose of paper:
To report on the process of pre-consultation engagement from August 2012 through to the Public
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Conversation in 2013 and formal consultation for the Healthier Together programme from 8 July 2014 to
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30 September 2014 (responses received up to 24 October 2014)
The item has been discussed
previously at these meetings:
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In draft form 17 December 2014
2
Title
External Reference Group Report
Author
Cath Broderick and Ken Griffiths on behalf of the External Reference Group
Version
V4
Target
Audience
Healthier Together Committees in Common
HTP
Reference
th
Date Created
6 February 2015
Date of Issue
6th February 2015
Document
Status
(Draft/Final)
Final
Description
File name
and path
S:\Transformation\SERVTRAN\HealthierTogether\Boards&Subgrps/ExternalReferenceGroup(E
RG)/ERGreport/ERGHealthierTogetherfinalreportV4.Feb15.docx
Document History:
Date
Vers
ion
Author
04/12/
2014
V1
Cath Broderick/Ken Griffiths
First draft circulated to ERG members for review and
comment
10/12/
2014
V2
Cath Broderick/Ken Griffiths
Second draft incorporating feedback from ERG
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members. Presented to CiC 17 December 2014
19/01/
2015
V3
Cath Broderick/Ken Griffiths
Third draft incorporating feedback from CiC and ERG
members.
06/02/
2015
V4
Cath Broderick/Ken Griffiths
Fourth draft incorporating feedback from ERG members
th
including at ERG meeting on 26 January 2015.
Approved by:
Notes
N/A
3
External Reference Group of Healthier
Together
Final Report to Committees in Common
February 2015
4
Contents
Page
1.
Executive Summary
7
1.1
Background
7
1.2
The Key Questions
7
1.3
The External Reference Group
7
1.4
The evidence base
7
Our observations
8
1.5
Pre-consultation engagement
8
1.6
Interim engagement – the ‘Public Conversation’
8
1.7
The Healthier Together consultation
8
1.8
The ERG, governance and decision-making
9
1.9
Our Conclusions
10
1.10
Our Recommendations
12
The External Reference Group of Healthier Together Report
16
Report Preface
17
2.
Introduction and background
18
2.1
Safe and Sustainable and Healthier Together
18
2.1.1
Timing of the consultation
18
2.2
Challenges and scrutiny
19
2.3
The ERG, governance and external scrutiny
19
2.3.1
The evolution of the ERG
19
2.3.2
Purpose
20
2.3.3
Meetings and membership
20
2.4
The key questions
21
2.5
The evidence base
21
Our Observations
22
3.
Pre-consultation communications and engagement
22
3.1
Policy and best practice
22
3.2
The Healthier Together approach
23
3.3
Criteria Development sessions
24
Observations
25
4.
25
Interim engagement – the ‘Public Conversation’
Observations
26
5.
The Healthier Together consultation
27
5.1
The strong patient and public engagement test
27
Observations
28
5
5.2
Documents, materials, resources and events
30
Observations
30
6.
The ERG, governance and decision-making
31
6.1
Updates and information
31
6.2
Single point of contact and feedback log
31
6.3
Support and communications
32
6.4
Roles and influence
32
Observations
32
7.
Our Conclusions
34
7.1
Meeting good practice guidance and the ‘Strong patient and
public engagement Test’
34
7.2
Conclusions
34
8.
Our Recommendations
37
9.
Next steps
39
List of Appendices
40
6
External Reference Group of Healthier
Together
Final Report to Committees in Common
February 2015
Executive Summary
7
1
Executive Summary
1.1
Background
•
•
•
•
1.2
The success or failure of NHS reconfiguration programmes depends on good
communications and engagement. As a result stakeholders and the public want to be
confident that best practice is used for the process of engagement and consultation
and the way that proposals and options are developed.
The Healthier Together programme recognised that governance structures and scrutiny
were required to provide this perspective on the programme.
This report covers the process of pre-consultation engagement from August 2012
through to the Public Conversation in 2013 and formal consultation for the Healthier
Together programme from 8th July 2014 to 30th September 2014 (responses received
up to 24th October 2014.
This report is based on the deliberations and discussions of the External
Reference Group (referred to in this report as the ERG) during its meetings
together with feedback during production. The ERG has been known also by
other names such as the External Assurance Group.
The key questions
This report is framed around four Key Questions that reflect the ERG’s role in scrutinising
the processes and mechanisms to engage and communicate with local people about the
case for change and in the consultation process.
Questions about the engagement and consultation processes:
•
•
•
How effective was the pre consultation and conversation period process in terms
of engagement and influence?
Was the Healthier Together consultation open, transparent, equitable, and robust
and did it meet good practice guidance?
Did the Healthier Together consultation satisfy the four Reconfiguration Tests,
specifically in relation to strengthened patient and public engagement?
A question about the governance and scrutiny process for Healthier Together and the role
and functioning of the ERG:
•
1.3
How effective were the governance and decision making processes for Healthier
Together?
The External Reference Group
This External Reference Group was set up to scrutinise and provide independent feedback
on the communication and public engagement processes relating to Healthier Together to
ensure that the public discussion was open, transparent, equitable and robust. This
included publishing a final report to state whether they feel this had been achieved.
1.4
The evidence base
8
To ensure that the ERG deliberations, observations, conclusions and recommendations
were informed by robust evidence the ERG members considered a range of evidence,
both written and from direct reporting.
Our observations
The following observations are summarised from the more detailed text in the main report.
1.5
•
•
•
•
1.6
Pre-consultation engagement
Overall a range of activities were provided to support engagement and
communications and many are those listed in good practice guidance.
There were opportunities to build a wider range of innovative methods, including
deliberative approaches such as Citizens’ Juries to provide more in depth exploration
of issues.
The number of opportunities to be involved were comparatively low in some
areas, varied across the Greater Manchester area and the accuracy of recording of
numbers and level of engagement has been challenged.
Good practice guidance tells us that building on current activity and on the
networks, contacts and skills of local voluntary and community organisations and
local Healthwatch will achieve more comprehensive and enduring patient and public
engagement that meets the Reconfiguration Tests measures.
Interim engagement – the ‘Public Conversation’
By late 2013 it was realised that the interaction of primary care and integrated care on
hospital proposals needed more discussion and it was decided to hold a period of
conversations with the public. These took place between January and April 2014.
•
•
•
1.7
Evidence to measure the effectiveness and impact of the conversations has been
difficult to locate. These observations are based on five of the feedback reports and
direct involvement in activities.
Overall the approach to the conversations period was based in good practice in that it
utilised local networks and the contacts and activities of CCGs, local authorities and the
voluntary and community sector.
Experience of delivery and impact is varied with different levels of activity, content of
the conversations and method of reporting. Some of the content focused on Healthier
Together but others were more concerned with local issues.
The Healthier Together consultation
The strong patient and public engagement test – reach and engagement
•
•
•
Guidance recommends the use of joint approaches with local authorities, local
Healthwatch, voluntary groups and other organisations that have existing relationships
with local communities. The stated approach of Healthier Together was to use the CCG
networks and encourage joint working but results varied across Greater Manchester.
Stronger central direction on the way that partners at a local level could be
engaged and better communication about the approach and materials available for
engagement would have brought more even engagement across the areas.
There was a need to build early relationships at the pre-consultation stage. This
has benefits for sustained and effective approaches to engagement in formal
9
•
•
•
•
consultation to ensure that the consultation met the requirements of the Strong patient
and public engagement test. This relationship has been uneven and is due, in part, to
organisational and personnel changes and also to changes in the focus and content of
consultation.
Overall the range of activity is comprehensive, uses most of the techniques
outlined in the good practice guidance and there is a welcome emphasis on the use
of digital and social media.
However there are gaps in the type of engagement methods used and the impact
and influence of others is unclear. The use of deliberative methods such as Citizens’
Juries, as in other stages of engagement, would have allowed more in depth
exploration of the issues and engaged citizens in the debate.
Healthier Together was aiming for 50,000 responses across Greater Manchester,
based on previous similar consultations and the wider range of communication
channels and techniques including social media that were to be used. The reported
final total of individual responses via questionnaires submitted was some 23,616
(22,451 after validation). The total number of responses using all formats, including
survey responses, written submissions and pledges was 29,347. More than 450
engagement events attracted over 23,500 people. However, there are no laws
governing the minimum number of responses and the original aim may have been over
ambitious. We comment later in Conclusions on the size of the response.
As in many consultations, there was variability in the level of response with the
strongest numbers coming from parts of Greater Manchester where communities
felt directly affected by service change. Apart from social media and marketing
approaches, more methods, including deliberative approaches, could have been used
to obtain a balanced geographical spread of views.
Documents, materials, resources and events
•
•
•
•
•
The consultation document was seen as too complex and there was some
confusion about what was included. Language and descriptions are important and
there needed to be more clarity, consistency and simplicity in the way services,
redesign and change were described in the document.
Information produced for the website was more accessible.
We recognise that the development of options in a redesign of services is complex and
difficult to explain. However proposals and options need to be clear and
unambiguous to avoid triggering suspicion about content.
Questions in the response form were often too complex with several questions
conflating two issues resulting in confusion for the respondent and the danger of
unclear responses.
The key issues from our observation of Public Listening Events are:
o lack of consistency in the delivery of information in presentations.
o variation in format and style of events.
o early meetings were often too long, lacking opportunities for genuine
involvement of diverse groups. This improved as the presenters became more
experienced and issues were raised with the central team.
o variation in use of the video during the presentation was explained by clinicians
not being aware of the need to use the video, forgetting to play it or not able to
use the technology.
10
•
1.8
•
•
•
•
•
•
•
•
o many of the issues related to accessibility of venues and the environment being
too large or too crowded.
Overall, our view on whether the consultation and the methods for
communication were open, transparent, equitable and robust reflects the
variability of approach generally. We feel that many of the issues highlighted here
were addressed during the consultation but more rigorous planning and training for the
delivery of events and better preparation of materials with patients and the public would
have addressed many of the criticisms regarding accessibility of documents and
resources.
The ERG, governance and decision-making
The ‘confused landscape’ and lack of clarity on the need to work with both local
Healthwatch, as a body with statutory functions, and with the ERG as a scrutiny body
for engagement and communications in the Healthier Together consultation, had a
significant impact on the development of defined roles and relationships. There needed
to be a definition at an early stage of the distinction between the two groups and clarity
about where roles and influence overlapped. In the event, the strong presence of
Healthwatch on the ERG was a benefit as Healthwatch members formed the majority
of the group and carried out a great deal of work at meetings, attending events and
contributing to this report.
Healthwatch needs to be recognised as a partner with statutory functions around
the patient and public voice. There was a sense in the Healthier Together process that
local Healthwatch was regarded as another ‘stakeholder’ in the same bracket as the
voluntary and community sector.
The administrative support to the ERG was helpful. However, it is clear that regular
involvement of a member of the Healthier Together team improved communication and
requests for information.
ERG members have considerable skills, knowledge and experience and would have
been able to contribute more to the development of materials and resources at an
earlier stage if involved in a timely manner. We feel that had the ERG been involved in
other areas earlier on then the end product would have been improved.
Members were experienced in committee working, interpretation of information and
contributing to complex issues however more support was needed for members in
both information needs and ensuring that their skills were utilised effectively.
Early development work was needed to ensure that the role and responsibilities of
the ERG were clear. In future arrangements Terms of Reference, duties and
relationships need to be understood and agreed by all parties and adhered to
throughout the whole process. Support and development for members is important
in enabling them to deliver the duties set out.
The ability of the ERG to function effectively and fulfil all its duties from the pre
consultation phase through the conversation period to formal consultation was
significantly affected by lack of information and dedicated support. This was
eventually recognised and a dialogue established on the needs of the group.
With hindsight the feedback log could have been created earlier – even during the
pre-consultation period. Better planning between the ERG and the Healthier Together
team could have achieved this.
11
•
•
•
1.9
The ERG recognises that many of the issues raised regarding the delivery of the Public
Listening Events were recognised and addressed during the consultation process,
demonstrating flexibility and responsiveness from the Healthier Together team. We
found the Healthier Together team generally responsive to our suggestions and to
those of others of which we were aware. This included arranging additional events,
amending presentations and answering queries that concerned us. The feedback log
gives some examples of these.
The identification of a named Associate Director as a single point of contact
between the ERG and the central Healthier Together team was extremely helpful.
Support for reflection on the ERG experience, in fulfilling its duties and delivering the
ERG duties and report writing, was put in place and this has been welcomed.
Our Conclusions
It should be noted that all of the available guidance provides only broad pointers to
effective engagement rather than specific measures to assess engagement and
consultation. For example, Transforming participation in health and care states ‘There are
many ways in which people might participate in health depending upon their personal
circumstances and interest’. This guidance, and Planning and delivering service change
for patients (NHSE, 2013) recommends that a range of opportunities for participation are
provided, as not everyone will want, or be able, to participate in the same way.
These conclusions draw together some key messages we want to emphasise;
1.
Throughout the pre consultation, public conversation period and formal consultation
evidence produced by the Healthier Together team would suggest that the range of
engagement activity represents a fairly broad spectrum of involvement methods and
opportunities with many of the methods listed in guidance. We feel that a great deal
of effort and enthusiasm was demonstrated by the Healthier Together team but that
this was sometimes fragmented and resources not always utilised effectively.
Although we believe that early, better planning for engagement and consultation
activities would have avoided some of the less effective methods and activities
highlighted in this report, we want to recognise the flexible and responsive approach
from the Healthier Together team and willingness to address plans and
methodology with learning throughout the process.
2.
Materials, events and information are better designed when the ‘audience’ for those
resources are involved in design and testing. Healthier Together did not always take
the opportunity to test methods and materials with patients, the public, communities,
the voluntary sector, local Healthwatch and the ERG.
•
•
•
Work with the ERG and patients and the public would have extended the
accessibility of the range of different formats for information and consultation.
More co-production and user led activity with local people when designing
the options, information and consultation materials would therefore have
been beneficial.
Better communication, partnership working and involvement across all
agencies, including the voluntary sector, local Healthwatch and
community/cultural groups when designing the options, information and
consultation materials was required.
12
3.
In any consultation when options name specific areas where service change is
perceived to be greatest there will be a higher level of interest and response from
local people and organisations. As a result the numbers interested and responding
to the consultation were skewed towards those areas most affected by change.
There is a need to understand what the population thinks about the proposed
changes right across the region covered. The process could have addressed this
imbalance by:
•
4.
Although Healthier Together reports inform us that the same range of methods was
used across the area and that patients and the public had a similar experience in
terms of engagement opportunities direct experience tells us that there was
variation in terms of engagement and consultation across the Greater Manchester
area. We feel that:
•
5.
There was a need to ensure that the opportunities to hear messages about
Healthier Together at events were uniform and that people in different
locations had the same experience of the consultation event.
The Healthier Together Consultation Equalities Review (v 5.7) report informs us that
specific activities were developed to reach diverse communities and groups with
protected characteristics as suggested in Transforming participation in health and
care. These activities often relied on meeting with existing groups and developing
designated focus groups.
•
•
•
6.
Taking opportunities to develop deliberative methods such as Citizens’ Juries
that would have allowed in depth exploration of the evidence and proposals.
Methods that provided views from across the geographical area would have
given even greater strength to feedback and avoided the inevitable focus on
individual areas where the population felt that they would experience most
change.
Although more energy and innovation was used in those areas where
interest and responses were low we believe that even more effort should
have been made to engage with protected equality groups as well as other
groups that are less likely to participate (in particular people aged 70 plus,
children and young people, people with different beliefs and faith, and people
from a wide range of ethnic backgrounds).
In some areas, particularly those demonstrating the highest levels of
deprivation, specific proactive approaches in partnership with local
authorities, local Healthwatch, voluntary groups and other organisations with
existing relationships with local communities would have brought benefits.
In addition, more effort should have been made to engage with the ‘hospital
services population’ which is different from the local population. This group
includes regular users of services, Trust governors and members and those
people involved in Trust engagement structures. This would have provided a
more accurate idea of what would improve the patient experience for people
using those services.
It is difficult to assess whether the numbers quoted represent a significant
achievement. We repeat that there is no target number or percentage of population
13
identified as a measure in any of the guidance above. The Healthier Together post
consultation reports compare the response (via the consultation form) favourably
against similar consultations such as Trafford. We are aware that early in the
process, the Healthier Together team had stated an aim to achieve around 50,000
responses and if this was still the aim then the consultation response did not
achieve that target but the total number received was still a significant response
from questionnaires and other written formats.
As highlighted earlier in this report, the number of responses targeted may have
been over ambitious and in our view it is more important to develop targets,
standards and objectives for successful engagement and consultation in
conjunction with local and key stakeholders at the outset. In doing so, measurement
of success would be more realistic and agreed by all involved.
7.
There is no legal requirement or guidance that specifies the establishment of an
External Reference Group to provide feedback and input regarding the engagement
and communications process. However, it has been widely accepted as good
practice and as part of the range of opportunities for participation and to shape the
engagement process. We provide detailed comment in this report on the
establishment of the ERG and the way we were informed and supported to deliver
our remit. Our conclusion here is that there should have been more development at
an early stage to define the remit of the group and better support and development
throughout the process (as happened in the latter stages).
8.
We find, therefore, that Healthier Together, evidenced in reports of the engagement
and consultation process, across the pre consultation stage through to formal
consultation partially met the requirements of good practice set out in guidance.
However direct experience revealed that this was not uniform and this view must be
qualified by the caveats identified in points 1 – 7.
We want to emphasise that all of the available guidance provides only broad
pointers to effective engagement, rather than specific measures to assess
engagement and consultation. There are no Key Performance Indicators (KPIs) and
there is no baseline of activity or required response rate expressed as a percentage
of population in the affected area to use as a measure of success.
Standards for engagement and consultation are meant to be developed on the
basis of what is proportionate, based on the numbers affected. For example, a
specialist service change will affect considerably fewer people than a wide spread
change to primary care services. Standards would also address what is appropriate
and works best locally, that is methods and approaches to meet the needs and lives
of different communities. Our conclusions are therefore based on what we feel
would have worked best across the Greater Manchester area.
1.10
Our Recommendations
These recommendations should be taken into account for the development of future
governance and decision-making processes, engagement and communication around the
implementation of Healthier Together and any future engagement and consultation
processes in Greater Manchester regarding service change and improvement.
Project thinking
14
Think of the exercise as a project. This means for example:
•
•
•
•
•
Make the bounds of the proposal clear.
Try not to change it, but if you do, make the change crystal clear and justify it.
Get all parties involved and agreed at the outset.
Agree standards and objectives for the engagement and consultation process with
key stakeholders so that agreement regarding the measurement of success is
achievable.
Allow plenty of time for detailed planning.
Communications with partners
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•
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•
•
•
Use partner networks and build upon existing relationships.
Think laterally to find new communications avenues and partners.
Communicate with partners by two-way dialogue, not just by presentations.
Define clear and agreed communications routes and methods.
Ensure there is clarity about the way you want stakeholders to be involved and at
what level.
Be clear where the split lies between partners to avoid the ‘confused landscape’
between local Healthwatch, the ERG and voluntary and community organisations.
Agree clear responsibilities and reporting methods with partners, especially when
delegating tasks and events.
Be clear with partners of expectations on both sides.
Governance structures
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•
All the groups within a new structure, whether Oversight and Assurance or Task
Teams, need to have clear, defined Terms of Reference from their inception.
Terms of Reference and duties need to be understood by members of the groups.
There is a development phase for each group and this needs to be supported from
an early stage so that all members are able to contribute fully. Support and
development should be provided by the Healthier Together team with appropriate
external support and training as defined.
Utilise the skills, experience and knowledge of members at all stages of the groups’
tasks.
Define how the work of the group(s) will be used within the Healthier Together
programme and decision making process.
Define how the groups within the governance structure relate to the wider
engagement landscape across Greater Manchester, for example Foundation Trust
Governors and Members, local Healthwatch, CCG and local authority community
engagement, participation and panels.
Communications with public
•
•
•
•
•
Develop and test materials and resources for consultation and engagement with
patients and the public.
Put the arguments simply and on one sheet of paper.
Get facts out early on and bust the myths.
Make the objectives and benefits clear.
Keep paperwork and web information simple.
15
•
•
•
•
•
Relate these simply and clearly to the objectives.
Create opportunities for genuine listening.
Ensure responses are clear and well-publicised.
Avoid any suggestions of secrecy such as ‘private’ sessions.
If private sessions are used, explain why.
Engagement methods and reach
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•
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•
•
Engagement should be proportionate and appropriate. Communities, groups and
individuals need to be involved in the way that suits them so methods should be
designed to match needs and communication preferences.
The use of deliberative methods for in depth exploration of the evidence and
proposals gives even greater strength to feedback and befits the achievement of
the objective to have a dialogue with Healthier Together, and to ‘create a
movement’ for citizens to have a say in their health and care.
Build a wider range of innovative methods. For example, in developing
proposals and understanding the case for change, Citizens’ Juries are a wellevidenced method that can be used to explore public perceptions and build their
recommendations into proposals.
Build on local engagement and networks and utilise partnerships, build on
current activity and the assets within local communities. Local community,
voluntary, CCG and Healthwatch networks could have had a stronger role.
Where all those sectors work together effectively numbers increase significantly and
a wider range of methods can be used.
Don’t just play the ‘numbers game’ but ensure that engagement is
meaningful. Counting the number of people involved is useful in identifying the
reach of consultation but some methods provide more valuable and well evidenced
feedback even though numbers involved are lower. Agree a proportionate
(numbers) and appropriate (methods) engagement strategy with key stakeholders
so that success can be measured.
Ensure that steps are taken to address variability in responses across the
geographical area by using proactive approaches and balanced deliberative
methods.
Ensure there is learning from early engagement through to formal
consultation. The impact of early engagement in pre-consultation needs to be
seen in later approaches to engagement.
Demonstrate how feedback from engagement at all stages has had an impact
on the content and decision-making process.
Thank people for taking part and give them feedback on their suggestions.
Consider a telephone hotline and Frequently Asked Questions system.
Public events
Although in a consultation these are by no means the whole input, they are highly visible
and can set the whole tone of the exercise. It is therefore vital to get them absolutely right
and to be consistent and clear in approach. Here are just some areas to plan for:
•
Keep control of events yet allow true dialogue.
16
•
•
•
•
•
•
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•
Plan events in time and in detail.
Make sure public events are publicised fully, correctly and with sufficient notice,
both online and in print media.
Use checklists for speakers and locations.
Some people will use public events to complain, so allow for this in planning.
Find audience-friendly locations.
Rehearse events, considering using partners as a test audience.
Train presenters in objection handling and dealing with difficult situations.
Have a running order for events, with an MC/Chair to keep to it.
Have a ‘Frequently-asked Question’ list, such as that in the Healthwatch Wigan
Consultation response, and use it to brief the speakers.
Build on this list as the project rolls out.
Create a live web-based feedback area to share experiences.
Administration of feedback
Keeping control of the paperwork and electronic documents that are created in a project of
this size is a prerequisite to its success. The following should be considered;
•
•
•
•
Make sure feedback is preserved and accessible.
Create a structured library/database of relevant documents.
Have a named responsible archivist/administrator in charge of this library.
Manage contact lists and mailing lists centrally.
Follow-up actions
Apart from the follow-up required by the project, here are some actions to consider:
•
•
•
•
Create contact lists for further feedback or for future projects
If not already planned, develop public feedback routes such as regular stakeholder
meetings and events.
Ensure that items that emerge from feedback and are capable of early resolution
are followed up.
Look for early wins in such feedback. The issues may have been raised because
the public had no other opportunity to raise them. They may not need to wait for the
full project delivery before they are solved, and they could support arguments for
improving standards.
17
External Reference Group of Healthier
Together
Final Report to Committees in Common
February 2015
18
19
The Report Preface
By any measure, with a target population of around 2.8million people, tens of thousands of
health professionals, and organisations from the health, local governments, voluntary and
community sectors, the ambitions and challenges for Healthier Together were immense.
The programme took place in a changing NHS landscape with Primary Care Trusts (PCTs)
being replaced by Clinical Commissioning Groups (CCGs) during the lifetime of the pre
consultation process.
Organisations that would have a significant impact on Healthier Together and engagement
such as Local Involvement Networks (LINks) in 2012 were replaced in 2013 by local
Healthwatch organisations that largely mirrored Local Authority areas.
Healthier Together was a huge project to create and to manage. It is not surprising that
from time to time not everything went smoothly and dates slipped. In its feedback in this
report, the External Reference Group (ERG) acknowledges these difficulties, yet wishes to
put on record its observations of matters that could have been handled better. We will
however note those things that went well and most of all we hope to deliver a report that is
balanced, open and fair.
The scope of our report
This report is framed around four Key Questions that reflect the ERG’s role in scrutinising the
processes and mechanisms to engage and communicate with local people about the case for
change and in the consultation process.
Questions about the engagement and consultation processes:
•
•
•
How effective was the pre consultation and conversation period process in terms of
engagement and influence?
Was the Healthier Together consultation open, transparent, equitable, and robust and
did it meet good practice guidance?
Did the Healthier Together consultation satisfy the four Reconfiguration Tests,
specifically in relation to strengthened patient and public engagement?
A question about the governance and scrutiny process for Healthier Together and the role and
functioning of the ERG:
•
How effective were the governance and decision making processes for Healthier
Together?
Identifying and collecting information associated with the Healthier Together programme and
requirement to write this report has presented difficulties for the ERG.
There has sometimes been conflicting information between published claims and of personal
experience of some members, but the ERG has not had the time and resource to investigate all of
these systematically and fully, so we have tried to strike a balance, to draw attention to areas
where availability of better information would have helped, and to make recommendations for
better record-keeping in the future.
The report has been compiled jointly by Cath Broderick, We Consult, and the Independent Chair,
Ken Griffiths and is based on the deliberations and discussions of ERG members. Further
20
information regarding the engagement and communications processes for Healthier Together is
drawn from the Greater Manchester Healthwatch and CCGs Learning Event October 2014 and the
responses of Greater Manchester Healthwatch organisations as independent commentators on the
conduct of the consultation.
The draft report was considered by the Committees in Common (CiC) on 17th December 2014 and
the final version of the report was considered at the CiC February meeting. This body is to be
replaced by the Healthier Together Joint Committee of the Greater Manchester CCGs in the
proposed revised governance structure. Comments from CiC members have been noted and
further consideration was given to those comments by the report authors and ERG members.
Following a review by ERG members, further revisions were made to the draft report. The final
version will be considered for agreement at the ERG’s January meeting.
The observations, conclusions and recommendations of the report should inform the development
of the revised governance structure and new groups to deliver oversight and assurance for the
decision making phase of Healthier Together.
Our recommendations are based on learning from the whole process and experience of
engagement and communication for Healthier Together. Most of all we want to contribute to the
development of strong governance and engagement structures for the decision making stage of
Healthier Together and beyond.
We frequently refer to partnership and dialogue in this report. At a time when the governance
regime is changing, we see this draft report as an opportunity to conduct a dialogue with respect to
our findings. In the time we had available and with some information coming to us late in the day,
we do not claim that this report is the final word. We may have misunderstood or omitted important
information. We suggest that we use this draft as a basis for a dialogue and extend it to provide a
better basis for the work of the ERG or its replacement in the future.
2
Introduction and background
2.1
Safe and Sustainable and Healthier Together
Greater Manchester has a long history of ambitious and far-reaching engagement and consultation
around the major reconfiguration of health and care services, for example Making it Better,
covering changes to services for women, children and babies across Greater Manchester, and A
New Health Deal for Trafford. With a population of around 2.8million Greater Manchester has some
of the poorest health in the country and there is major variation in health outcomes. The size and
diversity of communities across the area presents some significant challenges for understanding
the issues affecting health and wellbeing, and in engaging with different sectors of the population.
In 2012 the ‘Safe and Sustainable’ programme was initiated with the aim of improving standards
for the safety and quality of health and care services in Greater Manchester. The vision was
articulated with the phrase ‘for Greater Manchester to provide the best health and care in the
country’.
This was an ambitious aim. The project drew attention to changing needs, long-term conditions
and rising demand. It demonstrated the local success of centralisation, for instance in stroke
services. It drew attention to variation in practices and outcomes, and to the difficulty of improving
quality against significant financial challenge. The conclusion was that whole system change was
needed to do things differently and improve quality and outcomes. The need to work collectively
was highlighted.
21
Public discussion was scheduled for the second half of 2012 and pre consultation commenced in
August 2012, with a formal consultation scheduled for post-April 2013. During 2013 the project was
renamed as Healthier Together, but the messages remained the same.
2.1.1
Timing of the consultation
The timescales for Healthier Together to go out to full public consultation were repeatedly
delayed. The programme was initially planned to go out to public consultation in the spring
of 2013 (Nicola Onley report to NHS Greater Manchester October 2012), this slipped to
‘late 2013’ (Leila Williams report to GM Board in March 2013). Further plans were made to
push back formal consultation to January 2014 but this transformed into a ‘conversation’
that took place between January – April 2014 with the explanation that there was a need to
examine integrated care implications. Local and European elections in May 2014 further
delayed plans and the eventual timing of the consultation was 8th July – the end of
September 2014. Responses were accepted until 24th October 2014 to acknowledge the
holiday period included in the original timescale.
2.2
Challenges and scrutiny
There are many challenges when major change to health and care services is being
considered. Reconfiguration of health and care often results in public concern, confusion
about the drivers for change, political opposition, and controversy. Many programmes
have faced significant difficulties in communicating the case for change and engaging
meaningfully with the public and stakeholders. The success or failure of NHS
reconfiguration programmes depends on good communications and engagement. As a
result stakeholders and the public want to be confident that best practice is used for the
process of engagement and consultation and the way that proposals and options are
developed.
Challenges to the process of developing proposals and the way consultation was
conducted are often based on a number of issues:
•
•
•
•
•
the timing and level of meaningful engagement in the content and development of
proposals from the start of the process through to decision making.
the extent and manner of public engagement in reaching all communities of interest
and place across the area affected by the programme.
the timing of consultation or public events.
the accessibility and accuracy of the materials and resources to support engagement
and consultation in the programme
the level of consideration given to the impact on equalities or protected groups.
It is therefore, essential that NHS change programmes ensure that they have an external
perspective from stakeholders and the public on not only communications and
engagement but also the governance of the process for developing proposals and
consultation.
22
The Healthier Together programme recognised that governance structures and scrutiny
were required to provide this perspective on the programme. The way this was developed
is described in this report together with observations on its rigour and effectiveness.
This report explores the history and findings of the External Reference Group (ERG) for
Healthier Together set up to scrutinise the processes and mechanisms to engage and
communicate with local people about the case for change and in the consultation process.
2.3
The ERG, governance and external scrutiny
The inception of governance structures and external scrutiny of the Healthier Together programme
took place in a changing NHS landscape. In 2012 Local Involvement Networks (LINks) were
bodies with statutory powers for patient and public involvement in the NHS and social care. By
2013 they had been replaced by local Healthwatch organisations that largely mirrored Local
Authority areas. There are 10 local Healthwatch organisations operating in the 10 local authorities.
In April 2013, Clinical Commissioning Groups (CCGs) and NHS England replaced the functions of
the previous Primary Care Trusts and Strategic Health Authorities. The CCGs of Greater
Manchester formed a body that became known as the Committees in Common (CiC), to meet the
objective of working collectively. The CiC existed in shadow form for most of 2013 and became
formal in January 2014. The Chair of the ERG was invited to sit on the CiC as a non-voting
member.
2.3.1
The evolution of the ERG
In July 2012 a group called the ‘External Assurance Group’ was set up by the Healthier
Together programme to scrutinise and provide feedback on its communication and
engagement processes. Its Terms of Reference are attached in Appendix A. These are in
draft form but two current members of the ERG who also belonged to the External
Assurance Group assure us that these were presented to and accepted by the group.
However a written record of this cannot be traced. Unfortunately, absence of such written
records has made it difficult to prepare parts of this report, and this is one example.
These Terms of Reference refer to membership including a number of bodies such as
representatives from LINks, local councils, carer organisations and the Voluntary and
Community Sector. In spite of efforts to achieve this, the spread of membership was never
as wide as intended. As LINks evolved into Healthwatch and the External Assurance
Group became the ERG, Healthwatch members formed the majority of regular ERG
meeting attendees and contributed greatly to its efforts, including work on this report.
Returning to evolution of the ERG, on 8th November 2012 a meeting was held at the
Mechanics Institute in Manchester to re-boost interest in and support for an External
Reference Group. Around 20-30 attendees included several members of Greater
Manchester LINks. There was support for an external scrutiny group for the engagement
and communication process for the programme and it was agreed to progress with the
ERG.
23
A public engagement called the ‘Big Conversation’ for Healthier Together had already
started with events in Bury, Stockport, Manchester Centre, Wigan, Salford and Rochdale.
Attendees included members of the public, representatives of patient groups, third sector
representatives, LINks and CCGs.
On 5th March 2013 the Clinical Strategy Board endorsed the future governance
arrangements for the Healthier Together programme (the programme forerunner of the
Committees in Common). The Board directed that Terms of Reference for the ERG should
be drawn up (also shown in Appendix A). However, these Terms of Reference dated 4th
June 2013 are in draft form and after investigation in 2014, we could not find a record of
formal acceptance. Nor do any current members of the ERG recall this happening. Due
to forthcoming governance legislation in 2014 it was decided to take a pragmatic approach
and continue with the ERG operating in its current form and to confirm before the
consultation launch in July 2014 that the ‘duties’ element of the Terms of Reference stood,
allowing for organisational and legal changes. These duties are substantially the same in
both documents in Appendix A.
2.3.2 Purpose
This External Reference Group was set up to scrutinise and provide independent feedback
on the communication and public engagement processes relating to Healthier Together to
ensure that the public discussion was open, transparent, equitable and robust. This
included publishing a final report to state whether they feel this had been achieved.
2.3.3 Meetings and membership
The first meeting proper of the ERG was on 31st January 2013, with a presentation on
Healthier Together, the case for change and an update on public engagement. About ten
people attended, mostly from LINks. A briefing document from Healthier Together stated
that ‘It is anticipated that options for change will go forward to formal consultation in
Summer 2013’.
It should be noted that in writing this report the evidence on the dates for the start of formal
consultation has revealed conflicting start dates, ranging from Spring to Summer 2013. We
will comment on this variation and confusion in our observations.
Although meetings of the ERG were suggested for the forthcoming months, the next
recorded meeting was on 19th June 2013 with eight attendees. The date for the
consultation appeared to have slipped.
The next ERG meeting was on 12th September 2013 when the communications and
engagement plan was presented and the date for the launch of the consultation was stated
as January 2014.
ERG meetings then continued monthly with two extra meetings when the consultation
actually started (July 2014) to plan observations of public events, and two extra meetings
to plan production of this report.
Members of LINks originally sat on the ERG and members of Healthwatch followed this
example. Other members have been regular contributors to the work of the ERG, for
24
example local authority Councillors. The attendance by members including the chair
ranged from six to twelve, averaging nine. A list of attendees at ERG meetings is provided
at Appendix B. Some members attended only one or two meetings. The wider
membership to include the voluntary sector is not reflected in the attendance.
2.4
The key questions
In order to provide a framework for their deliberations ERG members identified a series of
detailed questions at meetings on 5th and 12th November 2014. The questions have been
used to inform the key questions considered by the ERG in formulating this report:
How effective was the pre consultation and conversation period process in terms of
engagement and influence?
•
•
Identify how the feedback of pre consultation, stakeholder events and the
conversation period shaped the content of the proposals and consultation document
How effective were engagement methods used in pre consultation and were
successful methods utilised in the formal consultation process?
Was the Healthier Together consultation open, transparent, equitable, and robust
and did it meet good practice guidance?
•
•
•
•
•
How accessible and clear were materials produced to support the public
discussion?
How effective were all engagement methods used in both informing and obtaining
feedback from patients and the public?
How was information about Healthier Together and the consultation communicated
and how were the views and feedback achieved from people with protected
characteristics?
Did the engagement and communication processes satisfy statutory duties
including the Duty to Involve and Consult and the legal definitions set out in the
Health and Social Care Act 2012 Section S14Z and the Public Sector Equality Duty
(Equality Act 2010)
Did the engagement and consultation processes meet good and best practice
guidance set out in
o Transforming participation in health and care (NHSE 2013) supported by
Real Involvement (DH 2008)
o Planning and delivering service changes for patients (NHSE, 2013), and
o The Cabinet Office Consultation Principles (2012)
o The Gunning Principles (applicable to all public consultations since 2001)
Did the Healthier Together consultation satisfy the four Reconfiguration Tests (often
referred to by their earlier name of the Lansley Tests), specifically in relation to
strengthened patient and public engagement?
How effective were the governance and decision making processes for Healthier
Together?
•
How influential were the ERG recommendations on process, accessibility, the
approach to public events, resources and documents in the development of the
consultation and during the consultation process?
25
•
2.5
Was the process for involving key stakeholders effective and robust throughout the
pre consultation, conversation and formal consultation process?
The evidence base
To ensure that the ERG deliberations, observations, conclusions and recommendations
were informed by robust evidence the ERG members considered a range of evidence,
both written and from direct reporting. This included reports produced by the Healthier
Together team pre and post consultation, responses from local Healthwatch to the
consultation, feedback from CCGs and local Healthwatch from the Healthier Together
Learning Event, and feedback from the experience of consultation:
•
•
•
•
•
•
•
•
•
Healthier Together Pre Consultation Business Case Appendix 9: Stakeholder and
Public Engagement Record
GM CCGs Healthier Together Local Conversation Engagement Feedback
(identified Heywood/Middleton/Rochdale, Salford, Stockport, Oldham, Trafford
reports)
Healthier Together Post Consultation Reach and Engagement Report November
2014
Healthier Together Consultation Equalities Review Report 2014
Response to the Healthier Together Consultation, Healthwatch Wigan, October
2014
Feedback log on issues raised by ERG members re public events
Analysis of observation reports of ERG members attending public events
Report of key outcomes and actions, Greater Manchester Healthwatch and Clinical
Commissioning Groups Learning Event 20th October 2014
Presentations, materials and resources used in the Healthier Together consultation
Our observations
This section of the report provides a short factual overview and description of the different
stages of engagement and consultation, the governance process and the objectives of the
Healthier Together programme. Each section is followed by the observations of the ERG
underpinned by the Key Questions set out in Section 2.4.
Sections 3 – 5 focus on the engagement and consultation process and Section 6 outlines
our thoughts and experience of the Healthier Together governance structures and role and
functioning of the ERG.
3
Pre Consultation communications and engagement
3.1
Policy and best practice
The Health and Social Care Act 2012 sets out that the NHS has a duty to involve and
consult people in decisions about their health care and when planning or changing
commissioned health and care services. Key to effective engagement and consultation is
the message that patients, public, staff should be engaged throughout the development of
proposals from an early stage through to implementation.
26
Best practice guidance used to judge the range, quality, effectiveness and appropriateness
of pre consultation engagement includes:




Transforming participation in health and care (NHSE 2013) supported by Real
Involvement (DH 2008)
Planning and delivering service change for patients (NHSE, 2013)
The Cabinet Office Consultation Principles (2012)
The Gunning Principles (applicable to all public consultations since 2001)
The best practice guidance set out Transforming participation in health and care (NHSE
2013) supported by Real Involvement (DH 2008,) stresses that engagement should seek
to build a continual and open dialogue, with opportunities to shape and contribute to
proposals from the beginning of the process. Guidance recognises that services are better
designed around the needs of patients, service users and carers when they are involved in
the commissioning process.
This guidance, and Planning and delivering service change for patients (NHSE, 2013)
recommends that a range of opportunities for participation are provided, as not everyone
will want, or will be able to, participate in the same way. A spectrum of opportunities and
options for engagement, from giving information to seeking views and deliberating on
issues collectively, should be provided at the pre consultation stage, not just in formal
consultation. The guidance suggests that these could include:
•
•
•
•
•
•
•
•
Online survey tools.
Regular e-bulletins.
Information posted locally in health settings and disseminated through local
organisations.
Using local authority newsletters.
Dedicated events to enable discussion about proposals.
Seeking views from the community at local events or venues, for example attending
festivals, markets, schools, leisure centres or libraries.
Building on current activity and the assets within local communities and collaborating to
identify issues and find solutions together.
Proactive work through local voluntary and community sector organisations including
small grass roots organisations.
Transforming participation in health and care (NHSE 2013) supported by Real Involvement
(DH 2008) tells us that proactive work with patients and the public from the initial planning
stage and reaching out to diverse communities needs to happen so that plans are
genuinely influenced. Local Healthwatch is a key stakeholder and partner with a wide local
network and knowledge of engagement methods. CCGs need to work closely with local
Healthwatch to ensure that they reach and engage groups and communities.
3.2
The Healthier Together approach
Throughout this report, and in assessing compliance with the guidance detailed in Section
3.1 above, the ERG has been reliant on the written evidence provided in the reports
produced by the Healthier Together team pre and post consultation. To balance this we
have also used direct feedback from those involved in engagement and consultation,
particularly local Healthwatch. At the end of this section we comment on the differences
between documented activity in reports and direct experience.
27
Evidence we used included Section 5 of Part 1 of the Pre-consultation Business Case that
sets out the Healthier Together overview of engagement from August 2012, including
patient and public engagement. Other evidence produced by the Healthier Together team
includes Appendix 9 of the PCBC ‘Stakeholder and Public Engagement Record’ reporting
from the Healthier Together perspective the details of the events held with output and how
it was used, including key themes.
This document expresses concerns that although there is statutory guidance around
consultation, there is ‘little around pre consultation’. However, the same principles apply to
pre consultation activity as for formal consultation and the ERG has used this guidance to
underpin its deliberations. The Healthier Together report states that pre consultation
engagement planning drew on ‘lessons learned from previous reconfiguration
consultations, best practice guidance, Equality Act 2010 and NHS North West Assurance
Framework’.
The documents lists methods, approaches and channels used, including:
•
•
•
•
•
•
•
•
•
•
•
•
Open public meetings. (14)
Bespoke locality based focus groups. (28)
Stakeholder briefing sessions.
Conventional media channels.
Social media engagement.
Information sharing using newsletters and bulletins.
Patient Panels established for Hospital and Out of Hospital work streams. (6
meetings)
Independent scrutiny of the consultation process.
A number of meetings specifically around transport and access were held between
November 2012 and November 2013.
Voluntary sector meetings and forums.
Wider stakeholder meetings.
Development of a ‘comprehensive’ stakeholder database.
The report states that feedback was collected to inform the development of the Future
Model of Care, the draft Primary Care Strategy and Community Based Care Standards.
The section lists the key themes identified:
•
•
•
•
•
•
•
Communications.
Transparency.
Sustainability.
Likelihood of delivery.
Self care.
Quality.
Access. (to primary care and to emergency departments)
It is reported that feedback was collected and used dynamically to influence plans at every
stage.
The information provided above and the claims made for the range and effectiveness of
the engagement methods and their impact is taken directly from the Pre-consultation
Business Case document. Our observations provide a more critical analysis from the
28
experience of the ERG members, local Healthwatch and others involved in the
process.
For example, as late as November 2013 the stakeholder database described still had
contact details for local LINk organisations that had been abolished in April 2013 and held
no contact information for local Healthwatch organisations. Local Healthwatch is
recognised as ‘the independent consumer champion for both health and social care’.
Healthwatch exists at local level to give citizens and communities a stronger voice to
influence and change how services are provided within their locality. Their omission from
the database brings doubt upon its strength.
The Pre-consultation Business Case states that a monthly newsletter and a weekly
‘integrated care’ newsletter were produced. Local Healthwatch, as key stakeholders in the
programme, report that they can find little evidence of these publications and express lack
of confidence in their regularity.
3.3
Criteria Development Sessions
Three independently facilitated events were held in September/October 2013 and were
attended by ERG members. The audiences were large, covering a wide range of
stakeholders. Criteria were developed in teams by attendees for input to the option
development process. Weighting factors for the various criteria identified were arrived at
by guided discussion.
A follow-up session was held on 11 April 2014, again with a very large audience including
ERG members. An update on the Healthier Together programme was given to the
audience, including the options development process and use of the criteria. Their
feedback on decisions made and those open to influence were sought and encouragement
was given to remain engaged in the decision-making process. Concerns were collected
on a ‘worry wall’ for further analysis. Themes included;
•
Access and transport.
•
Ensuring patient is at the centre.
•
Lack of mental health.
•
Staffing, resource and expertise issues.
•
The presentation of complex information and true involvement of the public.
•
Concerns over specialist sites and how they are decided.
Observations
The Healthier Together programme used the guidance current at the time of pre
consultation in planning the process, for example Real Involvement and the Four
Reconfiguration Tests.
However, we have a number of observations regarding the implementation of the process
based on direct involvement and the available reports of engagement activities:
1.
The Healthier Together pre consultation phase provided a range of engagement
activities that seem to use methods and approaches listed in best practice
29
guidance. However there are gaps in the range of opportunities; it is surprising that
most of the methods were meetings and information giving based. It would have
been useful to see wide scale survey methods underpinned by other qualitative
approaches that built on local engagement with communities
2.
The details produced in the Pre-consultation Business Case of methods and
approaches to engage with individuals and communities has been challenged by
local Healthwatch as the key stakeholders for patient and public involvement and by
ERG members. For example, the accuracy of the Stakeholder Database and the
regularity of newsletters are questioned. There was considerable variation in the
level of activity across Greater Manchester
3.
There were opportunities to build a wider range of innovative methods. For
example, in developing proposals and understanding the case for change, Citizens’
Juries are a well-evidenced method that can be used to explore public perceptions
and build their recommendations into proposals. There were opportunities to use
focus groups and road shows more effectively and in larger numbers and build
more meaningful and influential engagement
3.
For a period covering over one year the number of opportunities to be engaged
were comparatively low and there was variation in the geographical spread. For
example, 28 bespoke focus groups in localities and with specific communities were
held. In some areas, such as Oldham, only one focus group was held, with a
maximum of four groups in some areas. There were 14 public meetings with 960
people involved and in some areas only one open public meeting
4.
Recording of numbers and activity has been challenged, for example in Wigan
no numbers were available for the attendance of the one public meeting. Two focus
groups and three voluntary groups engaged are recorded but all of those groups
have rejected this involvement and report that meetings were cancelled or missed.
At this stage, and without further evidence, it is difficult to examine the statistics in
more detail but we would question their validity and emphasise that accurate
recording is important
5.
The involvement of voluntary sector organisations and local Healthwatch is
noted. However more comprehensive engagement could have been achieved if the
considerable networks, contacts and skills of these key partners, together with the
CCG engagement teams, had been used. Guidance tells us that the effective way
to learn about local issues is to build on current activity and the assets within local
communities. More proactive work through local voluntary and community sector
organisations would have brought greater numbers into the pre consultation
process and built a network and bank of organisations for engagement in the
consultation phase.
4
Interim engagement – the ‘Public Conversation’
The launch of the consultation was changed from Spring or Summer 2013 (see our
observations on conflicting dates) to the end of the year, but even this date had become
doubtful by the Autumn. A main factor was the need to consider Primary Care change as
a precursor to, or at least in tandem with, hospital change. Therefore a project that had
30
originally been driven by the need to improve hospital standards was extended to include
Primary Care, with many implications of scope and complexity. In particular it repositioned
Healthier Together as covering whole system health and social care reform, thus
extending the span of a project that was already huge.
The end-of-year launch was replaced by a ‘public conversation’ in January-April 2014 to
prepare the way for a consultation later in 2014. This was to be delivered locally with a
central message. A major workshop was held in Manchester Town Hall in association with
AGMA on 18th November 2013, attended by communications and engagement leads from
local authorities, CCGs, providers, voluntary organisations, transport organisation and
many others. ERG members attended.
The purpose of the workshop was to assist the localities in planning the conversation, and
to understand the central resources available. These included a support pack and a
framework for holding events. However, it was clear that delivery was to be by the
localities recognising that different considerations applied to different localities. Thus there
was scope for tailoring the material to each locality.
Further meetings with communications leads on 12th December 2013 and 27th January
2014 built on these sessions, giving guidance in running the conversation.
Observations
1.
The rationale for the conversations was the differences between localities and
this emerged in what happened in each one. This is evident in the final reports from
the localities
2.
Evidence from the conversations has been difficult to find. We have located
five of the feedback reports from the Healthier Together files and they differ in size
from a few pages to over a hundred, with copies of feedback forms from the events
run. This would have given the Healthier Together team a vast amount of
information, albeit in a somewhat mixed form. Therefore the exercise must be
considered a success in informing the public and getting feedback. Rigorous
recording of activity and feedback centrally so that it impacts on future proposals is
vital
3.
It is worth noting that some items of feedback were about issues that could have
been resolved now, for example ‘operations cancelled because of unsterile
equipment’. In our conclusions we will refer to the way that ‘current’ issues can be
managed and built into local engagement and improvement activities
4.
ERG members attended the meetings with communications and engagement
leads and commented on the process. There was significant support to local
engagement and communications teams from the Healthier Together team, but the
lack of comprehensive early planning was evident. Responsibilities at a local level
were somewhat unclear and some processes needed to be designed to cover
feedback. The Healthier Together team took this into account and by the 27th
January meeting a feedback form had been designed
5.
The approach to the conversations period was based in good practice in that it
utilised local networks and the contacts and activities of CCGs, local authorities and
the voluntary and community sector. An example would be the Salford report that
31
demonstrates conversations across the geography and interests of the community
utilising Community Committees, community occupational therapy groups,
residents’ groups, Resource Centre staff and participants, learning disabilities
groups and many other stakeholders
6.
However, experience was mixed and the local Healthwatch network fed back that
the content of the ‘conversations’ varied considerably, with some focusing heavily
on Healthier Together and others more concerned with local issues and barely
mentioning the Healthier Together programme
5
The Healthier Together consultation
The Healthier Together team moved on to securing the necessary approvals, including
from NHS England, to allow the public consultation to go ahead. The Healthier Together
public consultation was finally launched on 8th July 2014. The consultation ended on 30th
September 2014. The ERG had suggested that the date for the end of formal consultation
should be extended and this had initially been rejected. However, there was a subsequent
decision to accept responses until 24th October 2014 in recognition of the inclusion of
August, a holiday period, in the timeframe.
The objectives of the Healthier Together consultation are set out in the Post Consultation
Report: Reach and Engagement, November 2014 as:
1.
Improve local understanding about current provision of healthcare services
across Greater Manchester
2.
Generate awareness and understanding around the case for change for the
redesign of the identified clinical services (A&E, Acute Medicine and General
Surgery)
3.
Work in partnership with CCGs and local authorities to provide opportunities for
active, open dialogue allowing patients and the public to consult on the proposed
changes to healthcare in Greater Manchester
4.
Position the dialogue in the context of whole system reform; primary care,
integrated care and hospital care
5.
Create a movement in which Greater Manchester citizens are motivated to
become involved with deciding what future services will look like
Best practice guidance used to judge the range, quality, effectiveness and appropriateness
of the Healthier Together public consultation engagement includes:





Transforming participation in health and care (NHSE 2013) supported by Real
Involvement (DH 2008)
Planning and delivering service changes for patients (NHSE, 2013)
The Cabinet Office Consultation Principles (2012)
The Gunning Principles (applicable to all public consultations since 2001)
The Four Reconfiguration Tests (DH 2010)
We also assess, from a patient and public perspective, whether the Healthier Together
consultation achieved its objectives.
32
5.1
The strong patient and public engagement test – reach and engagement
The Healthier Together Post Consultation Report: Reach and Engagement presented to
the CiC in November 2014 summarises the ‘communications and engagement strategy’
and concludes that ‘the reach of the consultation was extensive’. The programme of
consultation events was designed to be varied to engage with as wide a cross-section of
the Greater Manchester population as possible and to appeal to different groups.
The statistics and description of engagement and communications activity is provided in
full in the document. However, it should be noted that following the three month
consultation a total of 23,616 completed questionnaires were received by post and online,
further validated to 22,451. There were 5,248 signatures on three petitions, 658 responses
from a household survey and 894 ‘pledges’. More than 450 engagement events and
activities were held in every district, attracting over 23,000 people.
The range of engagement activity listed includes:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Public Listening Events.
Healthier Together Question Time.
The Feeling Event.
Staff Listening Events.
Staff drop-in sessions and open days.
Transport events.
Integrated Impact Assessment events – group sessions with protected characteristic
representatives.
Voluntary sector briefing.
Visits to community venues, groups and activities.
College engagement.
On street public engagement.
Quantitative research.
Use of social media.
PR, broadcast and print media engagement.
Digital activity and e-bulletins.
Key103 bus.
The Best Care Ambassadors.
The ERG was involved directly in monitoring the way that the Public Listening Events were
conducted, their accessibility, consistency and effectiveness.
ERG attended most of the 19 events held across Greater Manchester and surrounding
areas and noted the attendance varied from one to over a hundred, the average
attendance stated in the Healthier Together Reach and Engagement document being 55.
The audiences were mostly white middle-aged to elderly. Audiences tended to be high in
areas where the local hospital was a candidate for specialist status and low where there
was no issue (or where previous consultations had been held and perhaps people were
tired of the process). Most locations were good, but sometimes they were unsuitable
because of size (often far too big) or poor location.
Originally planned to be one per locality in Greater Manchester, they were extended to
cover outlying areas and in some localities were duplicated according to demand.
33
In the early events some slides were too detailed and the presentations too long.
Sometimes the questions from the floor took over the flow of the event to no-one’s benefit.
However, the team took heed of the feedback and presentation time was reduced and
control improved. This did not solve all the problems of negative audiences but it helped.
Observations
1.
Guidance recommends the use of joint approaches with local authorities, local
Healthwatch, voluntary groups and other organisations that have existing
relationships with local communities and have successfully worked together with
local people in the past. There is evidence that Healthier Together aimed to use the
CCG networks and encouraged joint working with voluntary and community sector
organisations.
The results varied across the Greater Manchester area and in many cases the role
of local Healthwatch was vital in that they worked jointly with partners to develop
stronger and more innovative engagement. However, it should be noted that it is not
the role of local Healthwatch to conduct consultation on behalf of NHS
organisations but they have significant knowledge of local communities and
understand methods for engagement of populations.
The approaches demonstrated differences and we heard feedback from CCGs and
voluntary sector organisations involved in the Greater Manchester Healthwatch and
CCGs Learning Event, October 2014, that there was a lack of communication about
the approach and materials available to engage with local communities. A stronger
central lead to the way that partners at a local level could use their personnel
resources more effectively and create larger engagement teams would have been
helpful.
2.
The range of activity is fairly broad and the numbers quoted are quite strong
although the aim was to achieve around 50,000 responses. There is a welcome
emphasis on the use of digital and social media and this approach reflects the
increasing use of those media to engage and give views. As emphasised
elsewhere, the use of deliberative methods, such as Citizens’ Juries, for in depth
exploration of the evidence and proposals would have given even greater strength
to feedback and befitted the achievement of the objective to have a dialogue with
Healthier Together, and to ‘create a movement’ for citizens to have a say in their
health and care.
3.
The use of Ambassadors was designed around this premise, although we feel
there was a lack of clarity in their role and we are unsure what impact their
recruitment and involvement had on the consultation. The aim was to recruit 1000
ambassadors, but we are told 425 were actually recruited. At the time of writing we
have been unable to find out what they did to advance the programme. We would
expect that their contact details are still available because they would seem to
represent an extremely valuable resource in the future to build citizen engagement.
4.
A voluntary sector briefing session is listed as part of the approach to engage with
this sector in recognition of their vital role in consultation and to work collaboratively
with Healthier Together to reach wider and more diverse groups, not normally
engaged. 40 people attended from 36 organisations. We feel that more could have
34
been done to engage with the voluntary and community sector across Greater
Manchester.
5.
Part way through the consultation the Healthier Together team demonstrated
flexibility and responsiveness in addressing the need to reach groups with
protected characteristics who may not attend public events or use the wide range of
activities available.
6.
Even though public meetings were only part of the many channels of
communicating with the public, they were nevertheless important because of their
visibility. Perhaps the key factor we noted was their variability. It is clear that
significant training and standardisation of approach is needed to provide consistent
opportunities for patients and the public to be involved.
7.
Healthier Together was aiming for 50,000 responses across Greater Manchester,
based on previous similar consultations and the wider range of communication
channels and techniques including social media that were to be used. The reported
final total of individual responses via questionnaires submitted was some 23,616
(22,451 after validation). The total number of responses using all formats, including
survey responses, written submissions and pledges was 29,347. More than 450
engagement events attracted over 23,500 people. However, there are no laws
governing the minimum number of responses and the original aim may have been
over ambitious. We comment later in Conclusions on the size of the response.
8.
We want to emphasise the variability of the response from different areas of
Greater Manchester. In any consultation interest is strongest in locations that feel
directly affected by service change. Only three CCG areas had over 2000
responses, whereas in some areas responses were as low as 500. It is important to
address that natural variability by undertaking proactive engagement with all
communities. We are aware of the approach to use social media and marketing
approaches to spread awareness however, other methods need to be deployed to
obtain a balanced view. Deliberative methods recruiting people from across the
whole geographical spread are one way to do this.
9.
Building early relationships at a pre-consultation stage has benefits for sustained
and effective approaches to engagement in formal consultation and meets the
requirements of the Strengthened patient and public engagement test. This
relationship has been uneven and is due in part to organisational and personnel
changes and also to changes in the focus and content of consultation.
5.2
Documents, materials, resources & events
The core vehicle for stakeholders, patients and the public to understand the case for
change, current services and the vision for future health and care is the consultation
document. This is supported by a range of resources and materials that interpret the
messages for a wide range of audiences.
For Healthier together this included the consultation document, leaflets, e-bulletins,
advertisements in print and broadcast media, media articles and the presentations for
public listening events.
35
Observations
Feedback from local Healthwatch, those involved locally in events and from the ERG
observation Listening Events results in a number of observations.
1.
Concerns were expressed about the accessibility of the consultation document. It
was seen as too complex and there was some confusion about what was included.
For example, the vision for integrated and primary care reforms was described but
did not form part of the formal consultation process.
2.
Language and descriptions are important and there needs to be clarity,
consistency and simplicity in the way services, reconfiguration and redesign of care
are presented. Shifting use of terminology and changes to content of consultation
did not always help understanding. The use of ‘speciality’, ‘specialisms’ and
‘specialised’ interchangeably caused much confusion with the public.
3.
Local Healthwatch organisations across Greater Manchester had recognised that
the consultation document needed to be more accessible and clear if members of
the public were to be engaged. In response Healthwatch Oldham and Healthwatch
Tameside produced a four-page briefing (Appendix F) that was adopted by most
Greater Manchester Healthwatch organisations as an effective communication
resource. The Healthier Together team also used the briefing.
4.
Information produced for the website was more accessible in that the division
between sections and areas under consideration were more obvious.
5.
It is recognised that the development of options in a redesign of services
consultation is complex and difficult to explain. Proposals, options and descriptions
of services need to be clear and unambiguous or consultations can be challenged.
The document provides a significant quantity of text to absorb before asking
respondents to answer the question regarding the number of specialist hospitals.
The complexity of text can trigger suspicion and more focus should be given to
clarity of messages. For example, including Rochdale Hospital and Trafford
General on the map in the consultation document did not help as it was only in the
small print that it was mentioned that it was not included in the change programme.
6.
The quality of the questions has been highlighted in that they often make
statements that cannot be challenged or conflate two issues and ask for a yes/no
answer. An example would be ‘We believe health and care services should be
provided to a reliable, high standard every time for you and your family. This
requires a change to the way services are currently provided. Do you agree or
disagree that change is needed?’ If this question was used to elicit a claim that
‘75% back the proposals’ then there is a danger that this will be challenged.
7.
ERG members attended most of the Public Listening Events and completed
feedback forms. Some emerging themes included:
•
•
•
lack of consistency in the delivery of information in presentations.
variation in format and style of events.
early meetings were often too long, lacking opportunities for genuine
involvement of diverse groups. This improved as the presenters became more
experienced and issues were raised with the central team.
36
•
•
variation in use of the video during the presentation was explained by clinicians
not being aware of the need to use the video, forgetting to play it or not able to
use the technology.
many of the issues related to accessibility of venues and the environment being
too large or too crowded.
Many of these issues were addressed during the consultation however rigorous
planning and training for the delivery of events is vital, including development of
skills in facilitation and communication training.
6
The ERG, governance and decision-making
The Healthier Together programme recognised at an early stage that as part of the
process there needed to be external assurance from a stakeholder, patient and public
perspective. We have described the origins of the ERG and described the duties of the
group. This section examines the way that the ERG influenced and monitored Healthier
Together processes. We also look at the relationships and needs of the ERG within the
governance structure.
6.1
Updates and information
In order to fulfil our duties the ERG needed regular updates and information on the
progress and content of pre consultation, Public Conversations and formal consultation.
General updates were provided regarding the Healthier Together project, with special
presentations including Transport, materials for the ‘locality conversations’ held in JanuaryApril 2014 and for the consultation itself in July-September 2014. We also received a
presentation from ORS, the organisation that managed the consultation process.
A representative from the Healthier Together team attended every regular monthly
meeting. Also the Director of Service Transformation and the Programme Director of
Healthier Together each attended two meetings at and around the consultation period.
The ERG team was invited to the launch and was generally kept informed of or involved in
most aspects of the consultation. Our views and observations were taken into
consideration as the process developed. Early on we formally requested that the
consultation period should be extended because of the Summer holidays, but this was not
agreed to. However, we note that the response period at the end of the consultation was
extended, which mitigated this somewhat.
Members of the ERG requested information on occasions and there were sometimes
delays in responding, with one clear example relating to transport taking around 6 months
to be provided. Availability of reports and information from the pre consultation phase and
Public Conversation period were difficult to find.
6.2
Single point of contact and the feedback log
Two steps were taken soon after the launch to improve communications with the central
team. These were, firstly, the identification of a named Associate Director as a single point
of contact between the ERG and the central Healthier Together team and secondly, the
creation of a dedicated website area for the ERG containing a feedback log.
37
These approaches were put in place to overcome a problem identified early on during the
consultation that ERG members were reporting issues to various members of the central
team with little feedback. This caused duplication and wasted effort, as well as uncertainty
as to whether reported problems had been fixed. The steps that were taken solved these
problems. They also helped to create a better working relationship between the ERG and
the central team by achieving clarity of communication. The feedback log is included as
Appendix E to this report.
6.3
Support and communications
The ERG is very grateful for the administrative support from the Healthier Together (HT)
team and in the later stages of consultation there was recognition of the need for
consistent input from the Healthier Together programme team to ensure that the ERG
could fulfil its duties. Indeed, communications were sometimes difficult due to personnel
changes within the Healthier Together team and three different chairs of the ERG.
The ERG members had a range of skills and experience and were keen to comment and
contribute to developing parts of the programme. Although we were given copies of
materials for the consultation, it was usually too late for us to supply meaningful comment.
One exception to this however was the Consultation Document itself, which we were able
to comment on in good time. Much has been said about the complexity and scope of the
consultation document itself. Along with other stakeholders, we took part in its design.
However, not everything we proposed was accepted, but that is probably inevitable when
so many parties were involved with varying views. A smaller dedicated task force might
have produced a better final product, but then stakeholders might have complained about
lack of involvement. This is probably a situation when there is no ideal solution.
Regarding marketing materials, we generally saw these as they came into use, so we had
little opportunity to influence them.
The same was true of the initial materials for public meetings. We believe that in this case
we should have been involved in the preparation of these items, perhaps by taking part in
dress rehearsals of presentations for public meetings. However, when the meetings
started, we took part in debriefs and submitted suggestions for improvement and we found
the central team responsive.
6.4
Roles and influence
There are specific duties for the statutory patient and public engagement bodies in any
engagement and consultation process around health and care services. At the start of the
pre consultation period Local Involvement Networks (LINks) had this role replaced by local
Healthwatch. In the early phase there was good engagement with LINks and the Healthier
Together team initially attended meetings of Greater Manchester Healthwatch network as
these bodies replaced LINks. However, at least one Healthwatch does not recall such an
attendance, so these may have been sporadic. The situation became more unclear as the
ERG met regularly. Invitations to individual local Healthwatch meetings to discuss
Healthier Together were also missed, often at short notice.
Quite generally, there seemed to be confusion regarding the way that the Healthier
Together team related to local Healthwatch and the ERG, with a misunderstanding of the
roles and influence of both bodies.
38
The remit and responsibilities of the group and governance structures seemed unclear at
times. We have expressed concerns about the influence of both local Healthwatch and the
ERG and the effectiveness of the governance structure. Later in the consultation
responses to the issues raised have meant that relationships and understanding about
influence of the ERG and Healthwatch have improved.
Observations
1.
The ‘confused landscape’ and lack of clarity on the need to work with both local
Healthwatch as the statutory body and with the ERG as a scrutiny body for
engagement and communications in the Healthier Together consultation resulted in
a significant impact on the development of defined roles and relationships. There
needed to be a definition at an early stage of the distinction between the two groups
and clarity about where roles and influence overlapped.
2.
Healthwatch needs to be recognised as a partner with statutory functions
around the patient and public voice. There was a sense in the Healthier Together
process that local Healthwatch was regarded as another ‘stakeholder’ in the same
bracket as the voluntary and community sector.
3.
The administrative support was helpful however it is clear that regular
involvement of a member of the Healthier Together team improved communications
and requests for information.
4.
ERG members have considerable skills, knowledge and experience and would
have been able to contribute more to the development of materials and resources at
an earlier stage if involved in a timely manner. We feel that had the ERG been
involved in other areas earlier on then the end product would have been improved.
For instance, we suggested that we could act as a trial audience in rehearsals for
the public event presentations for the consultation. However, the timing of the
launch prevented this. As we note later the early public consultation meetings were
not as good as they could have been and perhaps a dress rehearsal could have
avoided this. This was an opportunity missed by the team.
5.
Members were experienced in committee working, interpretation of information and
contributing to complex issues however more support was needed for members
in both information needs and ensuring that their skills were utilised effectively.
6.
Early development work was needed to ensure that the role and responsibilities
of the ERG were clear. In future arrangements Terms of Reference, duties and
relationships need to be understood and agreed by all parties and adhered to
throughout the whole process. Support and development for members is
important in enabling them to deliver the duties set out. Management needs to
ensure that members are prepared to commit to regular attendance and they are
representative of a wide range of stakeholders.
7.
The ability of the ERG to function effectively and fulfil all its duties from the pre
consultation phase through the conversation period to formal consultation was
significantly affected by lack of information and dedicated support. This was
eventually recognised and a dialogue established on the needs of the group.
39
8.
With hindsight the feedback log could have been created earlier – even during the
pre-consultation period. Better planning between the ERG and the Healthier
Together team could have achieved this.
9.
The ERG recognises that many of the issues raised regarding the delivery of the
Public Listening Events were recognised and addressed during the consultation
process, demonstrating flexibility and responsiveness from the Healthier
Together team. We found the Healthier Together team generally responsive to our
suggestions and to those of others of which we were aware. This included
arranging additional events, amending presentations and answering queries that
concerned us. The feedback log gives some examples of these.
The identification of a named Associate Director as a single point of contact
between the ERG and the central Healthier Together team was extremely helpful.
10.
11.
Support for reflection on the ERG experience in fulfilling its duties and delivering the
ERG duties and report writing were put in place and this has been welcomed.
7
Our Conclusions
Each section of the report concludes with our observations on the topic and issues
explored. This section draws together points framed around the key questions, existing
policy and good practice and underpinned by the available evidence.
7.1
Meeting good practice guidance and the ‘Strong Patient and Public
Engagement’ Test
We looked at the process of engagement from pre-consultation through to formal
consultation and examined available documented evidence from the Healthier Together
team’s reports. We also heard from local Healthwatch organisations across Greater
Manchester and looked at their views on the engagement and consultation processes over
the Healthier Together programme. In addition to discussions in the group sessions as part
of the report planning process, the Chair of the ERG talked to Members of the ERG individually as
part of the review of the draft report.
Our observations provide detailed comment on the scope and effectiveness of
engagement and consultation. In conclusion, the following is our view on whether the
engagement and consultation process overall was in line with the best practice guidance
set out in:
•
•
•
Transforming participation in health and care (NHSE 2013) supported by Real
Involvement (DH 2008,)
Planning and delivering service change for patients (NHSE, 2013)
The ‘Strong patient and public engagement’ test of the Government’s Four
Reconfiguration Tests as set out in the 2014/15 Mandate from the Government to NHS
England
40
It should be noted that all of the available guidance provides only broad pointers to
effective engagement rather than specific measures and therefore assessing whether the
engagement and consultation process meets best practice is often subjective. For
example, Transforming participation in health and care states ‘There are many ways in
which people might participate in health depending upon their personal circumstances and
interest’. This guidance, and Planning and delivering service change for patients (NHSE,
2013) recommends that a range of opportunities for participation are provided, as not
everyone will want, or will be able to, participate in the same way. A spectrum of
opportunities and options for engagement, from giving information to seeking views and
deliberating on issues collectively, should be provided at the pre consultation stage, not
just in formal consultation.
Although a list of potential methods and options are suggested Transforming participation
in health and care does not include a baseline of activity or required response rate
expressed as a percentage of population in the affected area to use as a measure of
success. Standards for engagement and consultation are meant to be developed based on
what is appropriate and works best locally.
The ‘Strong patient and public engagement’ Test informs commissioners that when
planning to involve patients and the public they should think about ‘proportionality and
appropriateness’ and points towards Transforming participation in health and care for
further guidance on public participation.
7.2
Conclusions
The discussions with individual members of the ERG reflect the range of perceptions on
the effectiveness and scope of engagement and consultation:
‘Totally impressed, something different, not perfect but they had a good crack at it’
Lacked fitness for purpose, confusion re role of panels’
‘Number of responses impressive, recommend fewer big events and more smaller
targeted ones’
‘Not all perfect, mixed’
‘Consultation great, but concerned that what they want won’t be reflected in choice of
specialist hospitals’
‘Made great efforts and was better than previous consultations’
‘Expected number of responses was 50,000, so is 23,000 significant?’
‘Engagement was strengthened because overall lots of people attended meetings.
However, attendance was patchy in different areas, in affected areas attendances were
better because people were worried but, in spite of efforts by Healthier Together staff
attendance was poor in some areas,
‘Process engendered parochialism….this was a regional thing but people were fighting
their own corner’
This variation in experience underlines the observations throughout this report and
underpins our conclusions. These conclusions draw together some key messages we
want to emphasise.
41
1.
Throughout the pre consultation, public conversation period and formal consultation
evidence produced by the Healthier Together team would suggest that the range of
engagement activity represents a fairly broad spectrum of involvement methods and
opportunities with many of the methods listed in guidance. We feel that a great deal
of effort and enthusiasm was demonstrated by the Healthier Together team but that
this was sometimes fragmented and resources not always utilised effectively.
Although we believe that early, better planning for engagement and consultation
activities would have avoided some of the less effective methods and activities
highlighted in this report, we want to recognise the flexible and responsive approach
from the Healthier Together team and willingness to address plans and
methodology with learning throughout the process.
2.
Materials, events and information are better designed when the ‘audience’ for those
resources are involved in design and testing. Healthier Together did not always take
the opportunity to test methods and materials with patients, the public, communities,
the voluntary sector, local Healthwatch and the ERG.
•
•
•
3.
Work with the ERG and patients and the public would have extended the
accessibility of the range of different formats for information and consultation.
More co-production and user led activity with local people when designing
the options, information and consultation materials would therefore have
been beneficial.
Better communication, partnership working and involvement across all
agencies, including the voluntary sector, local Healthwatch and
community/cultural groups when designing the options, information and
consultation materials was required.
In any consultation when options name specific areas where service change is
perceived to be greatest there will be a higher level of interest and response from
local people and organisations. As a result the numbers interested and responding
to the consultation were skewed towards those areas most affected by change.
There is a need to understand what the population thinks about the proposed
changes right across the region covered. The process could have addressed this
imbalance by:
•
4.
Taking opportunities to develop deliberative methods such as Citizens’ Juries
that would have allowed in depth exploration of the evidence and proposals.
Methods that provided views from across the geographical area would have
given even greater strength to feedback and avoided the inevitable focus on
individual areas where the population felt that they would experience most
change.
Although Healthier Together reports inform us that the same range of methods was
used across the area and that patients and the public had a similar experience in
terms of engagement opportunities direct experience tells us that there was
variation in terms of engagement and consultation across the Greater Manchester
area. We feel that:
42
•
5.
The Healthier Together Consultation Equalities Review (v 5.7) report informs us that
specific activities were developed to reach diverse communities and groups with
protected characteristics as suggested in Transforming participation in health and
care. These activities often relied on meeting with existing groups and developing
designated focus groups.
•
•
•
6.
There was a need to ensure that the opportunities to hear messages about
Healthier Together at events were uniform and that people in different
locations had the same experience of the consultation event.
Although more energy and innovation was used in those areas where
interest and responses were low we believe that even more effort should
have been made to engage with protected equality groups as well as other
groups that are less likely to participate (in particular people aged 70 plus,
children and young people, people with different beliefs and faith, and people
from a wide range of ethnic backgrounds).
In some areas, particularly those demonstrating the highest levels of
deprivation, specific proactive approaches in partnership with local
authorities, local Healthwatch, voluntary groups and other organisations with
existing relationships with local communities would have brought benefits.
In addition, more effort should have been made to engage with the ‘hospital
services population’ which is different from the local population. This group
includes regular users of services, Trust governors and members and those
people involved in Trust engagement structures. This would have provided a
more accurate idea of what would improve the patient experience for people
using those services.
It is difficult to assess whether the numbers quoted represent a significant
achievement. We repeat that there is no target number or percentage of population
identified as a measure in any of the guidance above. The Healthier Together post
consultation reports compare the response via the consultation form favourably
against similar consultations such as Trafford. We are aware that early in the
process the Healthier Together team had stated an aim to achieve around 50,000
responses and if this was still the aim then the consultation response did not
achieve that target but the total number received was still a significant response
from questionnaires and other written formats.
As highlighted earlier in this report, the number of responses targeted may have
been over ambitious and in our view it is more important to develop targets,
standards and objectives for successful engagement and consultation in
conjunction with local and key stakeholders at the outset. In doing so, measurement
of success would be more realistic and agreed by all involved.
7.
There is no legal requirement or guidance that specifies the establishment of an
External Reference Group to provide feedback and input regarding the engagement
and communications process. However, it has been widely accepted as good
practice and as part of the range of opportunities for participation and to shape the
engagement process. We provide detailed comment in this report on the
establishment of the ERG and the way we were informed and supported to deliver
our remit. Our conclusion here is that there should have been more development at
43
an early stage to define the remit of the group and better support and development
throughout the process (as happened in the latter stages).
We find, therefore, that Healthier Together, evidenced in reports of the engagement
and consultation process, across the pre consultation stage through to formal
consultation partially met the requirements of good practice set out in guidance.
However direct experience revealed that this was not uniform and this view must be
qualified by the caveats identified in points 1 – 7.
8.
We want to emphasise that all of the available guidance provides only broad
pointers to effective engagement rather than specific measures to assess
engagement and consultation. There are no Key Performance Indicators (KPIs) and
there is no baseline of activity or required response rate expressed as a percentage
of population in the affected area to use as a measure of success.
Standards for engagement and consultation are meant to be developed on the
basis of what is proportionate based on the numbers affected. For example, a
specialist service change will affect considerably fewer people than a wide spread
change to primary care services. Standards would also address what is appropriate
and works best locally, that is methods and approaches to meet the needs and lives
of different communities. Our conclusions are therefore based on what we feel
would have worked best across the Greater Manchester area.
8
Our Recommendations
This section provides recommendations drawn from our observations and the conclusions
from Section 7.
These recommendations should be taken into account for the development of future
governance and decision-making processes, engagement and communication around the
implementation of Healthier Together and any future engagement and consultation
processes in Greater Manchester regarding service change and improvement.
Project thinking
Think of the exercise as a project. This means for example:
•
•
•
Make the bounds of the proposal clear.
Try not to change it, but if you do, make the change crystal clear and justify it.
Get all parties involved and agreed at the outset.
•
Agree standards and objectives for the engagement and consultation process with key
stakeholders so that agreement regarding the measurement of success is achievable.
Allow plenty of time for detailed planning.
•
Communications with partners
•
•
•
•
•
Use partner networks and build upon existing relationships.
Think laterally to find new communications avenues and partners.
Communicate with partners by two-way dialogue, not just by presentations.
Define clear and agreed communications routes and methods.
Ensure there is clarity about the way you want stakeholders to be involved and at what
level.
44
•
•
•
Be clear where the split lies between partners to avoid the ‘confused landscape’ between
local Healthwatch, the ERG and voluntary and community organisations.
Agree clear responsibilities and reporting methods with partners, especially when
delegating tasks and events.
Be clear with partners of expectations on both sides.
Governance structures
•
•
•
•
•
•
All the groups within a new structure, whether Oversight and Assurance or Task Teams,
need to have clear, defined Terms of Reference from their inception.
Terms of Reference and duties need to be understood by members of the groups.
There is a development phase for each group and this needs to be supported from an early
stage so that all members are able to contribute fully. Support and development should be
provided by the Healthier Together team with appropriate external support and training as
defined.
Utilise the skills, experience and knowledge of members at all stages of the groups’ tasks.
Define how the work of the group(s) will be used within the Healthier Together programme
and decision making process.
Define how the groups within the governance structure relate to the wider engagement
landscape across Greater Manchester, for example Foundation Trust Governors and
Members, local Healthwatch, CCG and local authority community engagement,
participation and panels.
Communications with public
•
•
•
•
•
•
•
•
•
•
Develop and test materials and resources for consultation and engagement with patients
and the public.
Put the arguments simply and on one sheet of paper.
Get facts out early on and bust the myths.
Make the objectives and benefits clear.
Keep paperwork and web information simple.
Relate these simply and clearly to the objectives.
Create opportunities for genuine listening.
Ensure responses are clear and well-publicised.
Avoid any suggestions of secrecy such as ‘private’ sessions.
If private sessions are used, explain why.
Engagement methods and reach
•
•
•
•
Engagement should be proportionate and appropriate. Communities, groups and
individuals need to be involved in the way that suits them so methods should be designed
to match needs and communication preferences.
The use of deliberative methods for in depth exploration of the evidence and proposals
gives even greater strength to feedback and befits the achievement of the objective to have
a dialogue with Healthier Together, and to ‘create a movement’ for citizens to have a say in
their health and care.
Build a wider range of innovative methods. For example, in developing proposals and
understanding the case for change, Citizens’ Juries are a well-evidenced method that can
be used to explore public perceptions and build their recommendations into proposals.
Build on local engagement and networks and utilise partnerships, build on current
activity and the assets within local communities. Local community, voluntary, CCG and
Healthwatch networks could have had a stronger role. Where all those sectors work
together effectively numbers increase significantly and a wider range of methods can be
45
•
•
•
•
•
•
used.
Don’t just play the ‘numbers game’ but ensure that engagement is meaningful.
Counting the number of people involved is useful in identifying the reach of consultation but
some methods provide more valuable and well evidenced feedback even though numbers
involved are lower. Agree a proportionate (numbers) and appropriate (methods)
engagement strategy with key stakeholders so that success can be measured.
Ensure that steps are taken to address variability in responses across the
geographical area by using proactive approaches and balanced deliberative methods.
Ensure there is learning from early engagement through to formal consultation. The
impact of early engagement in pre-consultation needs to be seen in later approaches to
engagement .
Demonstrate how feedback from engagement at all stages has had an impact on the
content and decision-making process.
Thank people for taking part and give them feedback on their suggestions.
Consider a telephone hotline and Frequently Asked Questions system.
Public events
Although in a consultation these are by no means the whole input, they are highly visible and can
set the whole tone of the exercise. It is therefore vital to get them absolutely right and to be
consistent and clear in approach. Here are just some areas to plan for:
•
•
•
•
•
•
•
•
•
•
•
•
Keep control of events yet allow true dialogue.
Plan events in time and in detail.
Make sure public events are publicised fully, correctly and with sufficient notice, both online
and in print media.
Use checklists for speakers and locations.
Some people will use public events to complain, so allow for this in planning.
Find audience-friendly locations.
Rehearse events, considering using partners as a test audience.
Train presenters in objection handling and dealing with difficult situations.
Have a running order for events, with an MC/Chair to keep to it.
Have a ‘Frequently-asked Question’ list such as that in the Heathwatch Wigan Consultation
response, and use it to brief the speakers.
Build on this list as the project rolls out.
Create a live web-based feedback area to share experiences.
Administration of feedback
Keeping control of the paperwork and electronic documents that are created in a project of this size
is a prerequisite to its success. The following should be considered.
•
•
•
•
Make sure feedback is preserved and accessible.
Create a structured library/database of relevant documents.
Have a named responsible archivist/administrator in charge of this library.
Manage contact lists and mailing lists centrally.
Follow-up actions
Apart from the follow-up required by the project, here are some actions to consider:
•
Create contact lists for further feedback or for future projects.
46
•
•
•
9
If not already planned, develop public feedback routes such as regular stakeholder
meetings and events.
Ensure that items that emerge from feedback and are capable of early resolution are
followed up.
Look for early wins in such feedback. The issues may have been raised because the public
had no other opportunity to raise them. They may not need to wait for the full project
delivery before they are solved, and they could support arguments for improving standards.
Next steps
The proposed future governance processes for Healthier Together decision making
processes and beyond define a range of Oversight and Assurance, and Working/Task
Teams where patient, carer and public involvement is required.
The recommendations of this report should form the basis for the development of
governance structures and the working methods for the new groups within the revised
governance structure. Importantly the recommendations should form the basis for the
approach to involvement of patients, carers, the public and representatives from local
Healthwatch and the voluntary and community sector.
The report is written as a working document as a basis for a dialogue to finish the tasks of
the ERG including handover to the groups within the future governance structure. We
look forward to concluding our work with the Healthier Together team.
List of Appendices
Appendix A Healthier Together ERG Terms of Reference 2012 and 2013
Appendix B Membership of the ERG
Appendix C Healthier Together ERG list of observers
Appendix D Analysis of ERG Public Listening Event observations
Appendix E Feedback log
Appendix F What is Healthier Together About? Healthwatch Tameside & Healthwatch
Oldham
47
Appendix A
Healthier Together
External Assurance Group
Draft – Terms of Reference
Introduction
The Greater Manchester Healthier Together Programme is led by NHS Greater Manchester on
behalf of the 13 clinical commissioning groups across the conurbation. The Healthier Together
engagement process will bring together clinicians, patients, local residents and community groups
to influence options for new ways of providing health and care services.
This engagement exercise has been launched to gather people’s views on what they believe “best
care” looks like around 8 specific work streams, and to help them understand the clinical cases for
change. This feedback will enable clinically driven proposals to be developed alongside
patients/public views/experiences.
The engagement will therefore seek people’s views on potential changes to the way local services
are delivered, and the shift from hospital care to care in the community and care closer to home.
The engagement phase will warm up local communities; provide them with information and
opportunities to join the public discussion whilst ultimately informing the new stage of the process
which potentially could be a formal 12 public consultation.
The external assurance group
NHS Greater Manchester recognises that the views of stakeholders and the public are paramount
when planning health services and as a result, we are establishing a public reference group. This
new group will scrutinise and provide independent feedback on the communication and public
engagement processes relating to Healthier Together to ensure that the public discussion is open,
transparent and robust. This will include publishing a final report to state whether they feel this
has been achieved.
Reporting
The External Reference Group will report to the ??????????
The agenda and minutes of meetings will be agreed by the chair and circulated to all members for
approval and ratification.
Membership
•
Independent chair or representative
•
Representatives from NHS Greater Manchester Service Transformation Team (Comms and
Engagement Specialist)
•
GM LINk representative
48
•
•
•
•
GM Councillor
Carer representative
Those who expressed an interest at patient panel event
Representatives from voluntary and community sector
Attendance at meetings
Persons who are not members of the public reference group may attend at he invitation of the
chair
Servicing of meetings
NHS Greater Manchester will provide administrative assistance to service and organise meetings.
Duties
(a)
Pre-consultation and throughout the consultation process
To oversee the processes and mechanisms implemented to engage and communicate with local
people regarding the Healthier Together cases for change
To attend the Healthier Together public discussion events as observers (on a rotational basis) to
check that information provided to the public is understood and that all those attending know
how to get involved in the public discussion
To review materials produced to support the public discussion and provide feedback and
suggestions to ensure all materials are clear and easy to understand and meets accessibility
guidelines
To provide feedback on draft publicity materials, as required, which may be used to publicise the
consultation and public meetings
To monitor the engagement/communication processes undertaken by NHS Greater Manchester
and assess whether these have been open, transparent, equitable and robust, especially in
relation to the Equality Act 2010, and Test 2 within the Reconfiguration Framework
(b)
Post engagement
To provide assurance that the collection of intelligence from the public discussions has been
gathered using a robust framework, and that subsequent reports to NHS Greater Manchester
Board are accurate and reflective of activity
To produce a report advising whether the engagement/communication processes have been
open, transparent, equitable and robust, especially in relation to the Equality Act 2010 and
forward to the NHS Greater Manchester Board
49
To advise on whether the results and feedback of the engagement process have been taken into
account by NHS Greater Manchester Board as it develops the preferred options
Version 1
13 July 2012
NC
Title
TERMS OF REFERENCE FOR THE HEALTHIER TOGETHER EXTERNAL
REFERENCE GROUP (ERG)
Author
Nicola Onley
Version
1.0
Target Audience
Service Transformation Groups & Committees
HTP Reference
HTP-040
Date Created
25-Apr-13
Date of Issue
04-Jun-13
Document
Status
(Draft/Final)
DRAFT
Description
The Clinical Strategy Board endorsed the future Governance arrangements for the
th
Healthier Together programme at its meeting on 5 March 2013. It directed that
detailed Terms of Reference, including membership be drawn up.
File name and
path
S:\Transformation\SERVTRAN\HealthierTogether\ProgMgmnt\Governance\20130531
ERG TOR Draft V10
Document History:
Date
Version
Author
Notes
13-Jul-12
0.1
N Onley
Draft Terms of Reference created
10-Jan-13
0.2
M Derry
Draft updated and reformatted
25-Jan-13
0.3
M Derry
Membership list updated
25-Apr-13
0.4
N Onley
Updated
31-May-13
0.5
S Livesey
04-Jun-13
1.0
Quorum arrangements included
Issued to Steering Group for noting.
Approved by:
50
51
THE HEALTHIER TOGETHER
EXTERNAL REFERENCE GROUP (ERG)
TERMS OF REFERENCE
Introduction
The Clinical Strategy Board endorsed the future Governance arrangements for the
Healthier Together programme at its meeting on 5 March 2013. It directed that detailed
Terms of Reference, including membership for all governance groups be drawn up. The
Healthier Together Governance arrangements are shown diagrammatically at Annex A.
Background
The Greater Manchester Healthier Together programme is accountable to the 12 clinical
commissioning groups across the conurbation. The Healthier Together engagement
process will bring together clinicians, patients, local residents and community groups to
influence options for new ways of providing health and care services.
This engagement exercise has been launched to gather people’s views on what they
believe ‘best care’ looks like around 4 specific work streams, and to help them understand
the clinical cases for change. This feedback will enable clinically driven proposals to be
developed alongside patients/public views/experiences.
The engagement will therefore seek people’s views on potential changes to the way local
services are delivered, and the shift from hospital care to care in the community and care
closer to home. The engagement phase will warm up local communities; provide them with
information and opportunities to join the public discussion whilst ultimately informing the
next stage of the process which potentially could be a formal 12 public consultation.
Purpose
Healthier Together recognises that the views of stakeholders and the public are paramount
when planning health services and as a result, we are establishing a public reference
group. This new group will scrutinise and provide independent feedback on the
communication and public engagement processes relating to Healthier Together to ensure
that the public discussion is open, transparent, equitable and robust. This will include
publishing a final report to state whether they feel this has been achieved.
52
Duties
(a)
Pre-consultation and throughout the consultation process
To oversee the processes and mechanisms implemented to engage and
communicate with local people regarding the Healthier Together cases for change.
To attend the Healthier Together public discussion events as observers (on a
rotational basis) to check that information provided to the public is understood and
that all those attending know how get involved in the public discussion.
To review materials produced to support the public discussion and provide
feedback and suggestions to ensure all materials are clear and easy to understand
and meets accessibility guidelines.
To provide feedback on draft publicity materials, as required, which may be used to
publicise the consultation and public meetings.
To monitor the engagement/communication processes undertaken by Healthier
Together and assess whether these have been open, transparent, equitable and
robust, in relation to the Equality Act 2010, the Section S14Z, Health & Social Care
Act 2012, and Andrew Lansley’s Four Reconfiguration Tests.
(b)
Post engagement
To provide assurance that the collection of intelligence from the public discussions
has been gathered using a robust framework, and that subsequent reports to the
Healthier Together Steering Group are accurate and reflective of activity.
To produce a report advising whether the engagement/communication processes
have been open, transparent, equitable and robust.
To advise on whether the results and feedback of the engagement process have
been taken into account by Healthier Together Steering Group as it develops the
preferred options.
Accountability
The External Reference Group will report to the Healthier Together Steering Group. The
agenda and minutes of meetings will be agreed by the chair and circulated to all members
for approval and ratification.
Attendance at meetings
Persons who are not members of the external reference group may attend at the invitation
of the Chair.
53
Membership
Membership of the ERG is set out below:
MEMBERS
Position
Independent Chair
Representatives from local Healthwatch organisations
Representatives from Greater Manchester Councils
Representatives from Greater Manchester Voluntary & Community Sector Organisations
Representative from Greater Manchester Centre of Voluntary Organisation (GMCVO)
Representatives from Healthier Together team (Communications & Engagement specialist)
Carer Representative
Patient / Service User Representative
IN ATTENDANCE
Provided by the Service
Transformation Team
Secretary
Quorum Arrangements
In order to constitute a quorum for any one meeting, a minimum of at least one member
from each of the representative organisations must be present.
Whilst the presence of a quorum is also sufficient to mandate any decision made at a
meeting, every effort will be made to enable all members’ opinions to be taken in to
account prior to a decision being made. The responsibility for deciding as to whether to
refer a proposal to the full membership rests with the Chair of the meeting.
54
Proposed Healthier Together Governance Arrangements
v10
Health and Social Care Reform Leadership Mechanisms across NHS and LA Organisations
CCG Association
Governing
Group
12 GM Clinical
Commissioning
Groups
GM Health &
Wellbeing Board
NCB – Area Team
Central Manchester
CCG
GM Provider
CEO Forum
Joint Overview
and Scrutiny
Lead CCG Healthier Together Committee
Health &
Wellbeing Boards
(AGM-CCG-HTC)
Healthier Together
Provider Reference Group
Healthier Together
Steering Group
External Reference
Group
Finance and Estates
Group
Transport and
Access
Working Party
IT
Innovation
Working Party
Communications
& Engagement
Working Party
Clinical Reference
Group
HR &
Workforce
Working Party
Key:
Accountable
Delegated to
Advisory
Service
Transformation
ERG Group Meeting Dates – 2013
as at 4 Jun 2013
Date
Time
Location
tbc
tbc
tbc
tbc
tbc
tbc
tbc
tbc
tbc
tbc
tbc
tbc
tbc
tbc
tbc
tbc
tbc
tbc
tbc
tbc
tbc
tbc
tbc
tbc
tbc
tbc
tbc
56
Appendix B
Attendees at ERG meetings
The following people attended ERG meetings form June 2013 onwards.
HW = Healthwatch
Name
Organisation
Barbara Barlow
Joyce Booth
Cllr Stella Smith
Cllr Joan Davies
Dr Gary Young
Jade Czuba
Marilyn Murray
Mike Lappin
Neil Walbran
Ann Day
Ruth Walkden
Rt Hon Sir Ian McCartney
Dr Marian Corns
Jack Firth
Dave Nunns
Saeed Anwar
Kathryn Cheetham
Peter Denton
Prof Eileen Fairhurst
Dr Ken Griffiths
HW Bury and patient representative
Stroke Association
Councillor Bury
Councillor Manchester
Patient representative
HW Oldham
HW Trafford
HW Stockport
HW Manchester
HW Trafford
HW Wigan
HW Wigan
HW Rochdale
HW Bolton
HW Wigan
HW Oldham
HW Salford
HW Tameside
Independent Chair
Independent Chair
57
Appendix C
Observers at events
The following people acted as observers at events. Most of these were public events
organised by the central HT team, but also included are some staff events, public events
organised by the local CCGs, Media Bus events, Integrated Impact Assessment events and
Transport events
HW = Healthwatch
Name
Organisation
Barbara Barlow
Stella Smith
Joan Davies
Gary Young
Alan Watt
Mike Lappin
Helen Fairweather
Ann Day
Ruth Walkden
Martin Broom
Marian Corns
Dave Nunns
Clare Mayo
Sir Ian McCartney
Ken Griffiths
HW Bury and patient representative
Councillor Bury
Councillor Manchester
Patient representative
HW Stockport
HW Stockport
HW Wigan
HW Trafford
HW Wigan
HW Wigan
HW Rochdale
HW Wigan
HW Salford
HW Wigan
Independent Chair
In addition, Jack Firth, Sir Ian McCartney and Peter Denton sat on panels at public events.
58
Appendix D
Event Observations
Public meetings
Even though public meetings were only part of the many channels of communicating
with the public, they were nevertheless important because of their visibility. Our
observations are therefore in Section 6.1 of the main text. We would add to this what
might seem to be a minor point but one which gave a bad impression, namely a
recurrent problem of the short video not being shown. This was not always due to
equipment failure, but sometimes due to finger trouble or simply the presenter
forgetting. Perhaps more rehearsal and a watchful MC might have helped.
We attended a number of other types of event involving the public or stakeholders
and add below our comments on these.
Public debates (or Question Times)
These were held towards the end of the consultation period. They seemed mostly to
be an improved way of communicating with the public compared with the meetings.
This may however be because by this stage the public had become more aware of
the issues, and perhaps because they saw that different views were on display.
There were twelve such events, with a stated attendance of 37 per event – less than
the public meetings, possibly because they were held in the evening. ERG members
were present at about half these events. The events differed greatly in style. In
particular, one event in Manchester was more confrontational.
Transport events
A running theme in the public meetings was transport so nine events were held with
stakeholder organisations to address these needs. This was more than originally
planned, as the team responded to demands, for instance organising one in High
Peak because of transport difficulties there. The stated average attendance was
nineteen.
ERG members attended a sample of these events. We noticed that frequently points
would be raised which could be solved now. For instance it appears that hospital
trusts have different policies towards assisting volunteer drivers to park while helping
their patients to access the hospital. This theme of ‘why can’t it be done now’
recurred in various forms in many parts of the consultation. This should be picked up
for the future, as it is often a way of illustrating the argument for raising standards. In
this case an improved service to volunteer drivers would help to reduce transport
issues and thereby potential barriers to change.
59
Because attendees were from knowledgeable stakeholders, the discussion at the
events we saw was informed. However, because invitations were given only to
stakeholder organisations, members of the public were excluded. Perhaps a way
could have been thought of to avoid this, as it became an issue with some people.
Integrated Impact Assessment Events
Ten of these events were run with a stated attendance of 16 people per event. These
were stakeholder events, with audiences recruited via CCGs and their networks.
Attendance was promoted and managed thoroughly, using email reminders. The
purpose was to evaluate the proposals on health outcomes for protected groups.
They were conducted by consultants Mott MacDonald. The ERG attended a sample
of these events..
The morning consisted of a half-hour version of the longer presentation at public
meetings. It seemed to lose little of the impact by being briefer. The round tables
would consider positive and negative impacts on the proposals, with charts on the
wall with a summary of what had just been said – a useful addition which could be
used at similar future events, as there was a lot to take in at the public meetings.
In the afternoon there was a drop-in session for people who could not attend in the
morning. Again, this is an example of what could be done in a future.
The report on these events has not been issued at the time of writing. However we
noticed once more that although the intention was to collect views on positive and
negative aspects of the change, in the sessions we saw people found it difficult to do
this and fed back things which were wrong now, a recurring theme in many of the
public communications events.
Key 103 Media Bus
This bus travelled to about ten locations – more than originally planned. We attended
four of these. They seemed to be very successful in reaching members of the public
which meetings would not attract. For instance, the bus at Ashton Market on a fine
market day must have been noticed by hundreds of people – young families taking a
day out during the school holidays, people having a break from work, and so on - an
age group which public meetings might not reach. People sat on benches completing
the consultation document, and the four Key 103 staff and two HT team members
held almost continuous conversations with the public. Interestingly, some people had
heard about the bus via social media on the day. It is very difficult to assess the total
impact of social media on the consultation, but this seems to be a good illustration of
how it can help to reach a younger age group.
A useful product of the media bus events was the recruitment of Ambassadors (see
Section 5.1). Many ambassadors were recruited due to the younger nature of the
members of the public who attended these events. However, we feel there was a
lack of clarity in their role and we are unsure what impact their recruitment and
60
involvement had on the consultation. The aim was to recruit 1000 ambassadors, but
we are told 425 were actually recruited. At the time of writing we have been unable
to find out what they did to advance the programme. We would expect that their
contact details are still available because they would seem to represent an extremely
valuable resource in the future to build citizen engagement.
Overall reach
Apart from events run centrally, many more were organised by local CCGs,
Healthwatch and third sector partners, using material provided by the central team.
We attended a sample of these but information was sometimes hard to find out.
Also a free concert was held in conjunction with Key 103 attracting a mainly young
audience of 280 people and over 160 consultation documents were completed. In
addition, opportunities were taken of having a presence at non-HT organised events
such as an Open Day at Wythenshawe Civic Centre (suggested by a local trust
governor via the ERG and quickly responded to by the central team).
Halfway through the consultation an audit was taken of hard-to-reach communities,
and steps taken to fill the gaps. This is described fully in a very detailed Equalities
Report mentioned elsewhere in this report.
It seems to us that a variety of opportunities were taken via a number of different
channels to reach different people in as many ways as possible.
61
Appendix E ERG Feedback Form
Last updated: 23/10/14
ID
Date
[dd/mm/yy]
Feedback/Query
[Please detail in
full]
Raised Responder
By
[HT Team]
[ERG
membe
r]
Outcome
1
14/08/14
Ann
Day
G Batchelor
2
14/08/14
Need another public
event in Trafford
South, possibly
evening.
Numbers reported
at public event
included staff of
local Trust.
Barbara
Barlow
J Parsons
3
14/08/14
Joan
Davies
J Parsons
6
18/08/14
White text on pale
background colours
makes slides hard
to read.
Need list of
transport events
with locations and
dates
A Trafford evening event is being planned
Closed
for the 24th September, 6-8pm at the
Waterside Arts Centre in Sale – it is being
led by the CCG.
We will report all members of the public
Closed
who attend our public events. This will
include members of hospital staff who wish
to attend a public event and find out about
how the proposals will affect them.
However we would not intentionally count
members of Trust staff who have been
invited to the event by Healthier Together
to present or answer questions.
All our slide presentations were updated on Closed
13 August following this feedback at a
previous event.
Jack
Firth
J Parsons
This list has gone out by email this week
from Margery Berezowsky-Wilson.
Status
[Open/Closed
]
Closed
62
ID Date
Feedback/Query
Raised
[dd/mm/yy] [Please detail in full] By
Responder
[HT Team]
Outcome
Status
[Open/Closed]
7
18/08/14
There should be
more creative
thinking about
transport solutions
other than bus, tram
etc
Barbara
Barlow
J Parsons
Closed.
8
01/09/14
Barbara
Barlow
J Parsons
9
01/09/14
At the ERG meeting
last Thursday,
Barbara Barlow
raised the issue of
holding a transport
event at Bury, as
mentioned
before. She was very
strong on the need
for this as transport
out of the Bury area
is not good, and in
particular it is difficult
to get to the
Chadderton
event. Please can an
event be run actually
in Bury?
Regarding Transport:
In the Rochdale area
there was to be only
one event and that
Our Transport events have been designed
specifically with this purpose in mind. They
are stakeholder-only events being run in
conjunction with GMCVO, with the specific
purpose of thinking creatively and
generating solutions for the transport and
access issues which have been raised by
the public throughout the consultation.
The Bury Transport event was held on
Tuesday 21 October 2014. Feedback from
this meeting will be reviewed by ORS
alongside other meeting notes.
Marian
Corns
J Parsons
The transport event in Middleton was held
on the 4th September. Following this
meeting this was discussed with the CCG
but it was not felt necessary to hold further
Closed
Closed
63
was in Middleton.
Rochdale Borough is
widely spread out
and has different
issues in each of the
four different
Townships within the
Borough. There
needs to be well
publicised events in
Rochdale centre,
Heywood, Middleton
centre (e.g. the Arena
and not outside the
town centre) and
maybe two in the
Pennines area - e.g.
Littleborough and
Milnrow.
transport events in the area, in addition to
the public events that had already been
held in the region by the CCG and the
central team – see below:
CCG-led Events
•
Public Event, Butterworth Hall,
•
Milnrow Public Event, Heywood Civic
Centre
•
Informal Engagement at Desmesne
Community Centre,
•
Middleton Public listening event at
Wardleworth Womens centre
•
Public Event, Recovery Republic
Heywood
Centrally organised events
•
KEY 103 bus, Morrisons
supermarket, Heywood
•
Public listening event, Rochdale
Masonic Hall
•
Transport event, Middleton
64
10 04/09/14
Regarding the event
held in Heywood
yesterday – was it a
Healthier Together
event, and if so how
was it publicised?
(there was some
feedback at the event
that people were
given short notice)
Ken
Griffiths
J Parsons
•
Health Impact Assessment Event,
Rochdale
•
Healthier Together Question time,
Middleton Arena
•
Hurstead Nursing Home Rochdale
I can confirm that this was a CCG-led event
rather than a centrally organised one. The
CCG have come back to us and confirmed
that they did three press releases which
started in early August. These went in the
Rochdale Observer, Middleton Guardian,
Rochdale Online and Heywood Advertiser.
The Event was also advertised in a regular
‘Health Page’ which is included on a
monthly basis in all three of the above
papers.
Closed
The event has also been on the CCG’s
website and advertised via Twitter.
11 04/09/14
What is Healthier
Dave
Together doing to
Nunns
target groups such as
BME / Disabled /
LGBT?
Mell
Patterson
Mellanie Patterson is drafting an Equalities
Report (similar to the report prepared by
Imogen Blood for the Trafford
Consultation).
Closed
65
This sets out, for each protected group:
•
whether that group is likely to be
particularly impacted by the
changes;
•
barriers to participation by that
group;
•
mitigating action and targeted
activity that has been taken to
include that group, and
•
whether mitigating action has been
successful (i.e. has the response
rate been representative).
Where gaps have been identified in the
report (for example, if the response rate
from Muslim groups was lower than
expected), the team has taken action. For
example, Healthier Together attended two
Mosques on the 19th of September and a
Hindu member of the team contacted and
met with every Hindu temple in Greater
Manchester (there has also been additional
activity around disabilities groups, for
example).
66
12 18//09/14
ERG observer Dave
Ken
Nunns reported by
Griffiths
Twitter on the Wigan
public debate on 16
Sept. This drew two
immediate tweets
from people who
could not make the
event, saying the
immediate info was
the next best thing to
being there. This
suggests that more
similar use could be
made of Twitter. This
could include
informing the public
with headlines as the
post-consultation
work gets under way,
as well as putting
reports on the
website. Twitter is
much more
immediate and
digestible and both
have their place in
keeping the public
informed.
Jen
Parsons
I sent a note out to the team with this
feedback.
Closed
67
13 25/09/14
Marian Corns
reported that a
number of comments
had been made by
the public at a recent
event, questioning
why the Royal
Oldham Hospital had
been designated as a
specialist site in
Healthier Together
proposals despite its
less than favourable
reputation
Marian
Corns
Jen
Parsons
It was noted in the meeting that the reason
for the Royal Oldham Hospital being
designated in proposals as a Specialist
Hospital, is so that the Public Transport
travel standard of 75 minutes could be met
in the North East region of Greater
Manchester. The hospitals surrounding the
Royal Oldham that are within the scope of
Healthier Together have been put forward
as General Hospitals by their respective
CCGs in the proposals. These are
Tameside General; Fairfield General, Bury;
and North Manchester General.
Closed
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Appendix F
What is the Healthier Together consultation about?
Healthier Together is an NHS initiative across Greater Manchester. It covers all of the 10
Greater Manchester Council areas. It will also affect people who live close to Greater
Manchester and use hospitals in the area – for example people from the Glossop area.
Healthier Together aims to make sure that people in the area get ‘best care’. It is looking at
how the care we are offered can be improved for everyone. It is also looking at how the care
we receive can make the best use of tax payers’ money.
Why do they say we need to do this?
The Healthier Together team has spent the last two years researching the care we get now
and what the future needs of Greater Manchester’s population are likely to be. Their
research suggests that things can’t stay as they are because:
• The standards of care are very different in different hospitals and at different times.
The chances of recovering well from a major operation vary between different
hospitals, different types of operations and different times of day/days of the week.
• On average, people die younger in Greater Manchester than they do in some other
areas of the country. In both Tameside and Oldham people die younger than the
national average. In both boroughs, the average life expectancy varies by more than
10 years between different communities.
• Even though people don’t live as long in Greater Manchester as in other areas, they
are still living longer than they used to when the NHS was set up. Many people have
long term illnesses which they wouldn’t have survived with 30 or 40 years ago. The
NHS care and other support they receive has made this possible. This means that
more people need to use services than ever before.
• The choices people make about how they live their lives can also affect their health
and this can mean more people need to access NHS services. Smoking, diet, alcohol
consumption and (lack of) exercise all have an impact on our health.
• The world we live in has changed. We now take it for granted that we can do
shopping 7 days a week and we can access information 24 hours a day via the
Internet – information that most of us never even knew existed 20 years ago! This
means that, as a population, the times that we expect to be able to access services
have changed.
Even though all these things have changed, it’s extremely unlikely that there will be any extra
money to meet the increasing demands on NHS and other care services.
Healthier Together has developed some ideas about what needs to change and how this can
be done. These fall into three main areas:
1. Changes in primary care
2. Joining up care
3. Changing hospital services
These are looked at in more detail on the following pages.
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Changes in primary care
Primary care is the term used to describe NHS care that is your normal first step in getting
treatment. It includes services like:
• GP Surgeries
• Primary Care ‘walk in’ centres
• Out of hours GP services
• NHS dentists
• Pharmacists
• Optometrists
At the heart of the Healthier Together plans is the idea that many people who go to hospitals
for their care could be treated just as well (or even better) in a primary care setting that is
closer to their home. They have three aims for how primary care will be provided:
1. By the end of 2015, everyone who needs medical help will have ‘same day access’ to
primary care services, seven days a week.
2. By the end of 2015, people with long term, complex or multiple illnesses will be cared
for in the community where possible.
3. Community based care will be joined up between the different organisations
involved. There will be shared electronic care records and patients will have access to
these.
They also say that people will be able to see how well their local GP practice performs,
compared with local and national standards.
Joining up care
This is sometimes called ‘integration’. It means that NHS organisations, social services and
other organisations that provide care and support will work more closely together.
Healthier Together say this is about:
• Different health and care services in an area working together.
• People having access to services close to home – for example so they can have a
check up at a local clinic instead of going to a hospital.
• Services that people receive outside of a hospital setting – e.g. district nursing and
home care.
There are no definite proposals in the consultation. This is because services are different in
different parts of Greater Manchester. For example Oldham and Tameside have different
organisations providing care for their residents. Local consultations should be held in the
future to help you to have your say in how this is done in your area.
Some general aims have been agreed across Greater Manchester and these are:
1. To prevent people from becoming ill and to make sure that people have quick access
to services when they do need them.
2. To help people to look after their own health and to care for themselves at home
where possible.
3. To create a single point of contact so that when people need help they only have to
contact one organisation and give their information once.
4. To have local teams that work together to give people the care they need – working
across organisations.
5. To make sure that children who have long term health conditions have better access
to local support so they don’t need to go to hospital as often.
If you have heard of ‘Care Together’ or the ‘Better Care Fund’ these are about integration of
services but are not part of the Healthier Together consultation.
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Changing hospital services
The biggest part of this consultation is about hospital services. It’s really important to
understand that this isn’t about every service that’s provided in your hospital. The
proposals are limited to:
• Accident and Emergency – this is also sometimes called emergency care. This is about
the NHS care you need urgently or in an emergency and which cannot be provided by
your GP, primary care walk in centre, out of hours GP service or local pharmacy.
• Acute Medicine. This is the care people get when they are unwell enough to need to
be in hospital but are unlikely to need an operation. Examples of this would include
someone with pneumonia, a urine infection, etc.
• General surgery. Although this sounds like it covers a lot of things it’s mainly
concerned with the abdomen. It includes planned and emergency operations on the
abdomen and the assessment of abdominal pain. It does NOT include anything to do
with bones, breathing, blood circulation, women’s health, etc.
Any other services that your local hospital provides (e.g. maternity, heart, mental health,
orthopaedics, vascular, etc.) are not included directly in the Healthier Together hospital
proposals.
Healthier Together is proposing something they call a single service model this is based on
two principles:
1. Hospitals can work together to make sure that the most experienced staff can
provide best quality care across Greater Manchester.
2. There will be two types of hospitals providing A&E, acute medicine and general
surgery services. These will be General Hospitals and Specialist Hospitals.
General Hospitals will all provide A&E, acute medicine and general surgery services. For
many people this will still be the hospital they go to if they need to use one of these services.
General hospitals will work in partnership with specialist hospitals and senior doctors and
nurses from their specialist hospital will spend part of their time working in the general
hospital.
Specialist Hospitals will provide all the services that general hospitals provide. They will also
deal with more complex and serious cases. This means that sometimes a patient will be
treated in a specialist hospital instead of the general hospital which may be closer to their
home. This is because Healthier Together has evidence that survival rates and the changes of
a good recovery from the most serious cases are much better where all the specialist skills
and facilities are located together.
Some patients may be transferred between their general hospital and the specialist hospital
that it is partnered with. For example they may have major surgery in a specialist hospital
and be transferred to their local general hospital when they have recovered a bit but aren’t
yet well enough to go home.
One of the reasons Healthier Together is proposing that we have this system is because there
are not enough trained senior doctors and nurses to make every hospital in Greater
Manchester do what the specialist hospitals will do. We know that recruiting enough highly
qualified and experienced doctors and nurses has been difficult for several years and the
number of middle grade and junior staff coming through the system means this is unlikely to
change in the coming years.
Healthier Together proposes that standards of care will improve in all hospitals – whether
they are specialist hospitals or general hospitals.
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Healthier Together has looked at our existing hospitals, at where people live and what
services they are likely to need. For some hospitals, they have already decided whether they
will be specialist or general hospitals. For other hospitals they are asking for your views:
Specialist
General
Undecided
Manchester Royal Infirmary Fairfield General Hospital
Royal
Albert
Edward
Infirmary (Wigan)
Salford Royal Hospital
Tameside General Hospital
Bolton Royal Hospital
Royal Oldham Hospital
North Manchester General Wythenshaw Hospital
Hospital
Stepping Hill Hospital
Rochdale Infirmary and Trafford General Hospital will not change as a result of this
consultation.
The consultation is asking which of the hospitals on the ‘undecided’ list you think should be a
specialist hospital. Healthier Together say that we probably need one or two of these to be
specialist hospitals.
When thinking about how to answer the consultation questions you might find it helpful to
think about:
• Which hospital do you think of as your local hospital and what is expected to happen
to it?
• If you had do go to one of the specialist hospitals for treatment, how easy would it be
to get there and back?
• If you wanted to visit a family member or friend in one of the specialist hospitals, how
easy would it be to get there and back?
• If your local hospital is a general hospital, which specialist hospital would you prefer it
to be linked to – and why?
The full proposals can be accessed at www.healthiertogethergm.nhs.uk and the deadline for
giving your responses is 30 September. Because this is a complex set of proposals we
encourage you to spend some time thinking about your response. There will be a number of
ways to find out more about what it may mean to you before the end of September.
This briefing has been produced jointly by Healthwatch Oldham and Healthwatch Tameside.
For more information:
Healthwatch Oldham
Healthwatch Tameside
0161 622 5700
0161 667 2526
info@healthwatcholdham.co.uk
info@healthwatchtameside.co.uk
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