Sunday, 11 June 2017

Learning from Dorset CCG for the STPs

Despite all my complaints as a teenager to the contrary, Dorset is quite forward thinking, and it has demonstrated this in its approach to transformation in the local NHS. In mid-2014, the Dorset Clinical Commissioning Group (CCG) decided to take pre-emptive action to maintain health and wellbeing, quality services and to avoid a looming gap in local NHS finances and began a Clinical Services Review (CSR). With the aim of supporting people in Dorset to lead healthier lives, Dorset CCG recognized that significant, meaningful and effective engagement and involvement with local people who use services was essential. As with any project on this scale, engagement and involvement needs to be multifaceted. I was most involved in one these facets, as Chair of the Patient, (Carer) and Public Engagement Group (PPEG).

As the national conversation moves apace around Sustainability and Transformation Plans (STPs) and calls for engagement, involvement and coproduction grow louder, I wanted to share our learning in this context. We didn't get everything right, but I am really proud of the impact of the PPEG.

In Dorset, the STP has been build on the CSR programme, which covers the same geopraphical footprint, and has been out to formal consultation.

The journey of PPEG as a group of people who are all passionate about health and wellbeing in Dorset has been one of rich conversations that bring together the different demographics, geography and diversity of Dorset. Our role was as an independent critical friend to the CCG, to provide oversight, advice and guidance across the CSR and how and when to have conversations with the wider public about the CSR.

Here are the key points we learnt along the way…

Co-designing how the group fits in the overall structure of the programme
A group with such a strong membership needed strong links to the programme, and this was co-designed. We looked at who could take our message to different forums, such as the Governing Body, and ensured we had seats at the most important tables to take our discussions to the heart of the CSR. As ever more complicated flow diagrams were created around the process, the PPEG was always included from day one. As strong and independent as our group was, it was no isolated island.

Completing the feedback loop (You Said, We Did)
As a group, we had 20 meetings over the two and half years, and maintaining motivation and momentum was really important for us - we needed to ‘see’ the impact of our conversations. We started meetings with You Said, We Did sessions, to challenge speakers to be able to update us on how they had used our conversations to effect change. This was our real-time thermometer of how meaningful our meetings were. 
The key outputs of the PPEG were:
-       Co-designing the evaluation criteria of different models of hospital configuration
-       Calling for the Need to Change document to outline the rationale for the programme to engage local people
-       Creating principles to guide meaningful and effective consultation
-       Creating Guide for Person-Centered Discussions to be used across all transformation work-streams
-       Advocating for further detailed work on community modeling, greater integration with social care and mental health services.

Sense of collaborative ownership of the programme
Interestingly, we didn’t realize how valuable this was until we became victims of our own success and another programme of transformation locally wanted to link with PPEG. This was sort of shoe-horned in, rather than co-designed from the outset. As a group, we felt confident with the remit and scope of the CSR and the work streams within it. With additional programmes added to our work, we felt we lost that sense of collaborative ownership of the programme that was so important. In the context of our local STP, with three components of Integrated Community Services, One Acute Network and Prevention at Scale, this was too much for us to feel that we had a grip on to make a meaningful impact, and there wasn’t the sense of relationship that helped us plan these sessions. This has directly informed plans for the next phase of engagement with the STP.

Planning meetings
Each meeting took considerable resource from the Engagement Lead to ensure there was a clear sense of purpose to the meeting, an ‘ask’, and that it would be meaningful. We avoided presentations and question & answer sessions, but that took time! There was also important administrative support commited by the CCG to ensure the necessary paperwork around meetings was sorted, which was welcomed and valued by the members.

Strong relationships
At every level, the PPEG benefited from strong relationships with various different groups within the CCG.
One of the Lay Members of the CCG Governing Body was a very active and valued member, feeding back the GB the points raised by the group. This link was very valuable, and meant that the Chair of the CCG has a good understanding and appreciation of the PPEG, and met with us when requested.

The key players in the CSR project management team were all well known to PPEG as a group – they would attended meetings themselves, rather than send junior deputies, and felt approachable. This was exemplified in how they used the PPEG feedback to start every meeting with over 150 clinicians through the process, and included us as equal partners with local Trusts on panels.

Most of our day to day contact was through the Engagement and Communication team, from director to leads and officers. This relationship was central to the success of the group, as it was faciliatory and enabling without influencing us.

The role of Chair was contracted, and reimbursed in line with other external contributors to the CSR such as clinicians, which was important as it clearly demonstrated the equal respect patient voice was given within the CCG as an organization.

Importance of briefing speakers
As the programme progressed and different speakers came to present various aspects of the CSR, we became very familiar with the narrative and facts. So when new people came to present to us, as patients, carers and public people, we found ourselves being told what we already knew again and again. It was good that they were explaining things in a non-clinical way, acknowledging that we were a non-professional group, but it was tedious and devalued the knowledge and experience we had built over the months as a group. In some situations, the information hadn’t been tailored, and our underlying assumption was that they had seen patients and carers as a homogenous group who needed the basics. The reality was very different – different messages are needed for different people. To address this issue in the context of our meetings, we created a brief for speakers, which among other things, asked them to check what level of understand we already have on a topic before hand. In the wider level of the consultation as planned, we helped the CCG have different levels of detail on the proposals, so people could access the information that matched their interest, time and understanding.

As the CSR is now evolving into the STP, the next phase of the engagement process is building on all of this learning. The more the CCG valued the PPEG, the stronger and more influential the group became, which in turned increased the respect and importance of PPI within the CCG – a great experience of growing and learning together.

None of the achievements of the PPEG would have been possible without the members of the group, the support of David Jenkins, Lay Member, and especially Frances Aviss – thank you all.


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