Ensuring effective engagement​

To ensure meaningful engagement, NHS Croydon CCG monitors the demographics of who has been engaged, how satisfied participants were with the engagement and the difference the engagement has made.

Monitoring engagement

Croydon is a diverse borough geographically, socially and economically with lots of opportunities for residents. However, not all our residents are able to enjoy the same access to these opportunities due to areas of significant social and economic deprivation – particularly in the north and south east of the borough.

Why do we monitor engagement?

The CCG monitors its engagement activities to understand:

  • How many people have been engaged with
  • Whether these people broadly represent our communities, particularly those with protected characteristics under the Equality Act 2010

We aim to be confident that all groups have equal opportunities to have their views heard and this information is reported to the Quality Committee on a quarterly basis as part of the regular scrutiny of public and patient involvement (PPI).

The quarterly PPI report details the main findings from engagement activities and the impact the feedback we gather has on planning and commissioning services. It gives the senior management team the opportunity to scrutinise the views of local people and satisfy themselves that we have met our duties to involve.

How do we find out what local people think of our engagement activities?

We also ask local people to tell us what they think of our engagement activities. We do this by:

  • Asking participants at events to complete an evaluation form
  • Asking small groups such as the One Croydon Service Users and Carers Group to tell us what they think our plans and reports following engagement activity
  • Asking our partners in health and care, including the community and voluntary sector, to feedback on our work.

We are open and transparent about the findings from engagements and feedback the key findings to participants by email, by returning to groups we have spoken to and publishing reports on our website.

Improving our feedback processes

This year, we have worked closely with our partners to improve our feedback processes to make them more creative and engaging. For example, we are using infographics to make it easier for patients and the public to understanding the key findings from engagements around our local health and care plans [link to summary plan], including how we have responded to suggestions. Similarly, South West London CCGs have developed an infographic showing findings from a recent pharmacy survey conducted with the People's Panel. [link to people's panel feedback] We used a child and young person friendly slide pack to present findings to schools around an engagement we conducted for mental health and wellbeing.

Accessible engagement

People are only able to participate fully if information is accessible to them.

During 2019 we have proposed changes to the way we work and we have been keep to pilot both materials and to ask local people and our stakeholders what they think of our engagement plans.

A Health and Care Plan for Croydon

The Croydon Health and Care Plan brings together NHS partners the council and the community and voluntary sector to look at where we can best work together prioritise targeted interventions to make the biggest difference to local people.

Following our borough event in 2018, we produced a draft document in early 2019. Healthwatch Croydon ran an event and we hosted an online survey about the draft document. Overall, 80% of survey respondents felt they understood the document, however several key changes were suggested.

  • People asked for a high level summary so they didn't have to read all the detail
  • People asked us to make it clear this was a One Croydon plan rather than a CCG plan
  • People asked us for more information about workforce and financial implications.

All these comments fed into and are reflected in our final Croydon Health and Care Plan

In March 2019, Healthwatch wanted to know what people thought about the engagement methods for the new Integrated Community Networks as One Croydon expands its work from over 65s to a whole population approach.

Initially, Healthwatch organised workshops and advertised them widely where we heard:

  • This was the wrong engagement approach: the workshops were poorly attended as a result.
  • Participants were confused by the explanations given about ICN+ and Primary Care Network structures.
  • Participants suggested that we should provide outlines of changes from the residents' perspective instead of from the point of view of services.
  • Healthwatch recommended more simple questions and different engagement methods.

As a result of this feedback, the next round of engagement will:

  • Be conducted as outreach – going where people are instead of expecting them to come to workshops.
  • Include case studies showing how the new ways of working can make a difference to people's quality of life.
  • Avoid discuss staff structures and teams and instead focus on the impact on people



Feeding back changes

When people have taken the time to tell us what they think of services and proposed changes, it's vital that we respond to their comments and that we check whether any changes we make in response to engagement meets the expectations. When we are in doubt, we meet again with participants to double check.

This year, we co-designed several new communication materials using insights from local people and returned with new draft materials to demonstrate our response and also to test acceptability.

In late 2018, we ran focus groups with two large demographics we knew where not using the Talking Therapies service as much as we would expect: older people and working age men. Older people told us their GP was key to encouraging them to use the service so the Talking Therapies team liaised with GPs to encourage greater uptake. The working age men, by contrast, wanted communication materials to be more eye-catching, have more male orientated imagery and to be disseminated digitally.


In February 2019, we reconvened the working age male focus groups to test their opinions of our draft Instagram advert, updated leaflet and digital information sheet. While most of the materials met with their approval, they wanted some changes to the Instagram advert. More importantly, they pointed out that the information sheet had two columns which meant they had to scroll across the sheet on their mobile phone. The information sheet was changed to one column.

Children and young people's mental health and well-being

We ran focus groups with children and young people to develop the communication materials for an online mental health service 'Kooth' for schools. Once again, we tested the materials we developed in response to the initial discussions through a second round of focus groups. The first round of focus groups were run with year 5 and 8s in all six South West London CCG boroughs. Participants were asked about the language they would use to describe feelings and emotions. We mocked up posters and an animation using insight from the focus groups and tested these with year 8 groups.

They told us they want the posters to use pictures of real people, avoid overly colourful designs and use positive phrasing. In particular, the participants wanted the tag line to be changed from 'Are we OK London?' to 'Are you OK, Croydon?' The posters were updated to take CYP views into account.

In February 2019, we reconvened the working age male focus groups to test their opinions of our draft Instagram advert, updated leaflet and digital information sheet. While most of the materials met with their approval, they wanted some changes to the Instagram advert. More importantly, they pointed out that the information sheet had two columns which meant they had to scroll across the sheet on their mobile phone. The information sheet was changed to one column.


Piloted communciations


Final Posters

Reviewing service delivery

Croydon CCG and partners are keen to close the loop to ensure commissioned service delivery is monitored. Service providers must monitor the satisfaction of users of their services as a standard component of their contract, this is done as required through the Friends and Family Test (FFT) and the CCG strongly encourage service providers to go further and introduce regular feedback opportunities including in-depth surveys, patient group meetings and focus groups to discuss specific service related issues.  

Additionally, where appropriate, we review the impact of service changes. For example, we are extending out of hospital intravenous antibiotics treatment. A survey conducted prior to the extension raised a potential issue with the patient transport service. In response, we will monitor any transport issues following implementation to identify problems early. Moreover, post treatment surveys will be provided to all patients to ensure ongoing review and development of the service.

What do patients think of our engagement functions?

In addition to making sure local people's views feed into service change and deliver, we also ensure people have a voice in developing and assessing our engagement function. CCGs have a duty to complete an annual assessment of our engagement functions through the Improvement and Assessment Framework. In 2019 we undertook this work with input from our patient representatives to ensure our self assessments matched the views of local residents. We held a workshop chaired by our lay representative for Patient and Public Engagement to assess the CCGs performance against the five domains.

Communicating the impact

Throughout 2019, Croydon CCG commissioners, the engagement team and our partners have talked to hundreds of patients, local residents and representatives from the community and voluntary sector. We think it is important for those we have engaged with to know the difference their contributions have made. We collate the impact of engagements on policies and service delivery across the commissioning teams, feeding back key changes in the form of 'You Said, We Did, We Will be Doing'. The full table is made available on our website.

In addition, we like to feedback the impact of long term engagement directly to those who have given their time or will be affected by the outcomes. Since 2018, we have been working with BAME grassroots organisations to design better mental health service for adults. At the third grassroots workshop in May, our Lay Member gave a presentation outlining how participants' views have helped to shape the future of mental health services and have been integrated into the Mental Health Strategy.  


Additionally, in October, our Lay Member and Mental Health commissioning team attended a community organised conference on BME mental health services to share the impact of the grassroots workshops and the direction of travel for the Mental Health strategy. This allowed for the CCG to hear broader community views about the work to date.

You said; we did

Although much of our engagement throughout 2019 has been focused on the changes taking place to our structures, we have continued to engage with patient and the public around our services. You can read more about how we have responded to specific feedback here