​You said we did (are doing)


During 2018-19 CCG Commissioners, Project Managers and the Engagement team have talked with hundreds of residents of all ages, people who work in Croydon health and care services, community and voluntary sector representatives, stakeholders and partners about the services we currently commission and how we can make them better so that they are more responsive to local people's needs and can support them to meet their ambitions for their own, and their families, health and well-being.

The table below gives a very brief summary of what people told us about the services we currently commission and how we can meet the challenges facing health and care services across Croydon in the future.

A detailed breakdown of who we spoke to as well as where and when are available here

 

What you told us What we have already done What we will do
Helping you to stay well ​ ​
People need help to avoid becoming ill in the first placeThe CCG have worked closely with the local authority to promote JustBe. Croydon Council runs JustBe to help people to adopt healthier lifestyles by supporting people to stop smoking, become more physically active and eat more healthily.

A priority identified by all health and care partners in Croydon is supporting people to adopt healthier lifestyles. This priority will form part of the CCG's 5 year operating plan (due to be published in March 2019).

 

The plan has been developed after on-going engagement with local people and staff.

People need easily accessible information on how to stay well and organisations that can help them to do thatThe CCG's Health Help Now App and website have been updated to include a more interactive section on local health and care support services and has introduce a prominent link to the national Change 4 Life campaign on the front (landing) page.

We will continue to work with doctors and other people who work in the local NHS to help make sure that the App and website changes and is updated to meet the needs of Croydon residents.

 

If you have any comments or have ideas about improvements, you can send an email to the development team through the website or app

 

Residents need more help to stay well throughout their lives

In 2017 the CCG funded a Social Prescribing programme in one network (Thornton Heath). Social prescribing is a way of enabling primary care services to refer patients with social, emotional or practical needs that GP cannot help with medicines, to a wide range of non-clinical services.

 

Patients are prescribed sessions offering fitness, debt advice and counselling, for example, to combat illnesses such as diabetes and social isolation.

 

The pilot was very successful in supporting patients improve their physical and mental health. It has also received a lot of local and national media attention highlighting the innovative approach Croydon as taken to supporting its residents to stay well.

 

It's important to know that you don't need to visit your GP to take part in any of the activities.

Throughout 2018 social prescribing has been rolled out across all Croydon GP networks and GP Practices.

 

To help make sure that social prescribing is localised all six network areas have a 'Social Prescribing Board'. The Board is made up of local residents, local community and voluntary sector representatives and health and social care workers.

 

More details of Croydon's networks can be found here

People need practical support to stay well and to connect with organisations that can help them to do that

NHS Croydon CCG fund Croydon Voluntary Action (CVA) to develop a Community Connectors Programme. Community Connectors are volunteers recruited from local communities who help to support local people to access health and well-being services, which includes everything from local sports and leisure groups to housing and employment advice and support.

 

The CCG have also funded CVA to develop and manage an on-line directory of services called Connect Well Croydon. The search engine is populated and maintained by a team of volunteers.

 

The Croydon GP Collaborative have rolled out a Care Navigator training programme for GP Practice staff to help them to support patients to find information on non-medical issues affecting them. Current Care Navigators include Practice Nurses, Healthcare Assistants and GP reception staff.

The One Croydon Alliance have developed the Local Voluntary Partnership programme which will help very small and/or informal community based organisations work together and develop their work.

 

The Care Navigator programme will continue to train and support Practice based staff to develop the knowledge and skills to effectively signpost patients to community based support.

People who have long term illnesses or conditions need more support to manage their conditions better

The CCG has supported four local people to complete the Expert Trainers course so that they can run six week 'Expert Patient Programmes' (EPP).

 

EPP is accredited by Stanford University, one of the world's top universities, and has been evaluated nationally as a programme that helps people to more effectively manage long term health conditions such as chronic obstructive pulmonary disease, like emphysema which cause breathing problems, and diabetes.

 

Two trained volunteers held Croydon's first EPP six week sessions in January 2019.

Another course is planned for April 2019, with further training opportunities planned for local residents in the summer 2019. Please contact Croydon-GetInvolved@swlondon.nhs.uk for more details on future courses.
Closer partnerships with the Community and Voluntary Sector ​ ​
The CCG need to work together better with community groups as that's who residents rely on to help them day to day.

The CCG already fund several voluntary organisations as part of our core work.

 

These organisations include:

 

  • Croydon Voluntary Action (Community Connectors programme & Connect Well Croydon)
  • MIND Croydon (Community Hub)
  • HearUs (Mental Health service user advocacy project)
  • Croydon BME Forum (Community Development worker)

 

Age UK Croydon is a partner in the One Croydon Alliance.

 

The One Croydon Alliance, which includes the CCG, have developed Local Voluntary Partnerships (LVPs) as part of the Active and Supportive Communities work stream.

 

LVPs will provide a way to building knowledge, expertise and resources across small voluntary and community organisations. By working at a very local neighbourhood level it should be easier to support grass roots organisation who work with seldom heard groups and communities, including people who are socially isolated. The LVPs provide a way for very small groups to be part of wider conversations about local health and care service improvements and resources.

During winter 2019 the CCG will launch a Community Leadership programme. The programme will support the recruitment, training and on-going development of a wide and diverse group of patient representatives.

 

The representatives will ensure that the patient and public voice is embedded within the CCG's work, through involvement in programme boards and steering groups, for example. Additionally, quarterly meetings of groups representing seldom heard populations will be set up to create a regular dialogue between the CCG and local community groups representing Croydon diverse communities.

 

A small grants programme will begin in January 2019 to support very small local organisations to develop work through the One Croydon Alliance.

 

Services need to be more responsive to individual needs ​ ​
Services need to be more flexible to be able to offer different levels of support to people in their own homes. For example, when they are very poorly they might need more care in the home to get them better. Once they are well they may need help to access support groups and voluntary sector services based in the community.

Living Independently for Everyone (LIFE) is a One Croydon Alliance programme that focuses on helping Croydon residents have as much independence as possible following a hospital admission by assessing and caring for them in their home environments.

 

The LIFE team will arrange for a care worker to visit as soon as possible after discharge from hospital. Within 24 hours of arriving home an assessor from the LIFE team will visit and agree a more detailed care plan with the patient. The team will make sure your home is as safe as possible to help people to recover quicker and remain independent.  

 

In the LIFE service's first six months, 62% fewer patients needed care packages six weeks after hospital discharge and around 450 residents spent less time in hospital, or none at all.

 

Personal Independence Coordinators (PICs) visit patients in their own homes and provide the link between various health and care agencies, giving isolated people access to community groups and volunteering opportunities.

 

The aim is keep the person well which avoids them needing hospital care and helps them maintain their own independence and wellbeing.

 

The PICs offer dedicated support over a 12-week-period to find new activities or support services to improve a person's quality of life, health and wellbeing.

LIFE received a rating of "Good" from the Care Quality Commission (CQC) in 2018.

 

The PICs service was evaluated by Healthwatch Croydon as was assessed as a very valuable service which makes a very positive impact on service users' lives.

 

These two programmes will form part of the CCG's five year operating plan (due to be published in March 2019).

 

The plan has been developed after on-going engagement with local people and staff.

More services should be based in local GP Practices and Community settings
You should run more specialist clinics in local surgeries rather than sending everyone to Croydon University Hospital.Since January 2017 we have been planning to move lots of specialisms such as Ear, Nose and Throat and Dermatology clinics into the local community. We have done this by working with specialists, GPs and Patient representatives to redesign services to provide them much closer to peoples' home.

From Spring 2019 Croydon residents will be able to access a lot more services in GP Practices and other community settings.

 

We will continue to invest in placing more outpatient and specialist services in the community in the future.

New technologies - to make access and diagnosis easier and quicker for people ​ ​
The NHS should make much better use of technology to make it easier for people to access professionals virtually.

We know that the NHS hasn't exploited all the advantages that new technology offers as well as we could have in the past. But we have caught up now and are planning to be much smarter in our use of technology. For example in 2018 we introducing technology in Dermatology which will allow GPs to send images securely directly to specialist at the Hospital to advise on diagnosis and treatment.

 

This means a patient can be assessed and treatment commenced within two to three days instead of having to wait 12 weeks to be seen by a Consultant.

In 2019 the CCG will invest in more virtual services to support patients. For example, we have developed a business case to invest in video calling technology in care homes so that care home staff can access virtual face to face advice and support for Consultant Geriatricians to avoid residents being admitted to hospital unnecessarily.

 

In spring 2019 the CCG are also planning to implement "C the Signs" tool for GPs. 'C the Signs' is a decision support tool and uses artificial intelligence, combined with national evidence-based guidelines, to help GPs identify patients with cancer early.

 

The support tool can spot other, less obvious, signs and symptoms that feature in the early stage of cancers which means that patients can be diagnosed at an earlier stage and have an improved chance of recovery.

Access to Adult mental health services ​ ​
There are not enough crisis services in the community so people end up going to A&E rather than receiving the specialist mental health support they need in the community.

Mental Health Commissioners have worked with Clinicians, local Community and Voluntary sector groups and service users to develop a new model of community mental health services. This includes an 'Integrated Community Mental Health care hub model" and an "Enhanced Primary Care" service. The hub model will be locality based (in GP Network areas) and will include rapid triage and assessment services as well as a wide range of professionals and support services such as benefits, employment and peer mentoring.

 

Additional resources have been made available to develop additional capacity with the Home Treatment Team (HTT). The HTT services can help people experiencing mental health issues, remain in their home rather than in hospital. The support they can offer at home may include daily or twice daily visits, and help with medication and sorting out practical matters such as accommodation and shopping

A Business Case (the document which set out the impact, improvements in the quality of patient care and the resources needed for a project) has been written and will go before the CCGs Governing Body in March 2019.

 

The Community Hubs includes a proposal for a Crisis Café in Croydon. The Crisis café will to provide people in crisis with a refuge and access to specialist support to avoid them having to go into hospital, with all the disruption that may cause them and their carer's.

 

 

 

 

Voluntary sector organisations must be fully involved in the transformation of mental health services

 

The CCG facilitates the Mental Health Partnership Board which consists of local community and voluntary sector organisations such as MIND and HearUs. The Partnership Board has been established for several years and they have helped to develop the Community Mental Health Hub model.

 

To help us to make sure that we included the voices of smaller organisations representing Black and Minority Ethnic (BME) communities the CCG held two very well attended Grass Roots Black and Minority Ethnic  Workshops to ask them to help us develop the plans for Community Mental Health Hubs.

In 2019 we will continue to work together with the smaller grass roots organisations representing BME mental health service users and our larger voluntary sector partners to make sure that Community Mental Health Hubs are co-produced with them.

 

 

You need to put more resources for mental health into GP services

The CCG funds CVA to run the Making Every Contact Count (MECC) and Community Connectors programmes in local GP Practices to support people with long term conditions, including low level depression and anxiety to get involved in community activities.

 

The mental health transformation business case includes resourcing for care navigators based in GP networks to support GPs and patient with mental health needs.

 

We are also actively promoting our local primary care mental health service, Croydon Talking Therapies within GP surgeries and the wider community.  We are also targeting groups who have historically not used the service as much as others.

A Business Case (the document which set out the impact, improvements in the quality of patient care and the resources needed for a project) has been written and will go before the CCGs Governing Body in March 2019.

 

Children's Mental Health Services must be more proactive and responsive ​ ​

A lot of teachers lack confidence when it comes to addressing or talking about mental health issues in children and young people. You need to work better with schools to improve teacher's confidence to help children and young people.

 

There is currently not enough support for children and young people's at the start of their lives.

 

We need more self-care mental health services for young people and peer support programmes  

As part of South West London Health and Care Partnership Croydon CCG was part of an engagement programme with children and young people at risk of self-harm. The engagement focused on testing ideas, developed with young people, to see which may have the biggest impact on supporting young people who are at risk of self-harming.

 

As a result of this the following two areas of work are a priority for CCGs to take forward.

 

  • An online directory of services to support Children and Young People experiencing mental health issues
  • An online counselling / peer support programme

For both of these programmes (to start in Spring 2019) there will be a number of opportunities for children and young people to influence product development and seeking wider feedback on any products testing.  

 

A group of schools in Croydon has been established to pilot the work in stages. All of the schools are asking young people at their school, and their parents, to help them develop an action plan to help them to better support their pupils to deal with life's challenges.

GP's and Primary Care Services ​ ​
It should be easier to see a GP at evenings and weekends

The CCG have worked with GP Practices in each of our six networks to make sure that each network has at least one GP Practice open from 8am to 8pm every day.

 

Croydon also has three GP Hubs with appointments available from 8am to 8pm every day of the year in south, central and east Croydon.

We are working with our local GP Practices to increase the number of Practices offering 8am to 8pm appointments across all networks in the future.
Croydon GP Hubs are great but not enough local people know about them South-west London Health and Care Partnership, who support the CCGs' communications function, have included the GP Hubs as part of their winter campaign and have produced pop-up banners, A5 cards as well as targeted Facebook campaign. The CCG has run a Croydon-specific Twitter campaign #WheresBrucetoday to make people aware of local GP Hubs, pharmacies and self-care support We will continue to highlight GP Hubs, 111 and extended GP access through social media and other local opportunities, for example, during outreach sessions.
You should make better use of Patient Participation Groups (PPG's) to help support Practices.

The CCG are keen to support the development of PPG's as we know how valuable they are, both to their individual Practices and wider communities.

 

The Croydon PPG network has planned, organised and delivered several very well attended patient information sessions across the Borough since October 2017. The CCG are very pleased to have been able to provide some (very) small resource contribution to this very important preventative health/awareness raising work.  

 

The Croydon PPG Network coordinator has conducted an audit of PPG coverage in Practices in Croydon (autumn 2018). This is accompanied by a report on the breadth and depth of PPG's visibility and work.

 

The CCG's Accountable Officer and Director of Quality and Governance have received the report and will arrange to meet with the Croydon PPG Network coordinator in early 2019 to look at how the CCG can work with the PPG Network to support the future development of PPGs in Croydon Practices.

 

The Croydon PPG Network have worked with Healthwatch Croydon to make contact with the CCGs member Practices about their work and to support PPG development across Croydon. Dr Agnelo Fernandes, our Clinical Chair, is working to help support the PPG Network coordinator and Healthwatch Croydon in accessing Practices in Croydon.

The Croydon PPG Network Coordinator and the CCGs Director of Quality and Governance have arranged to meet to discuss on how the CCG can support the PPG Network practically in the future.

 

The PPG Network are currently developing a work plan to hold regular patient information sessions across the Borough on topics relevant to Croydon's neighbourhoods and population groups. The Engagement Manager s offering support to help set up the events.

 

 

SERVICE SPECIFIC
Muscular Skeletal (Physiotherapy)    
Patients wait too long for an appointment with a Physiotherapist which might make their condition worse while they are waiting

Since 2016 the CCG have been working with Patient Representatives, Clinicians and service providers to provide the local NHS muscular skeletal service (MSK) in a way that better meets the need of Croydon residents.

In the summer of 2018 the CCG procured and introduced an Integrated Physiotherapy Service in Croydon.  The service began in December 2018.

The service will be assessed against its ability to deliver:

  • shorter waiting times for an appointment with a physiotherapist and a greater choice of locations across the borough
  • telephone assessments, advice and guidance within two days of all referrals

online advice from a physiotherapist to work best with Croydon residents' busy lives

The patient representatives who were part of the procurement panel will be invited to be involved in the on-going quality monitoring of the new service to make sure it delivers an excellent service for Croydon residents.
IAPT (Talking Therapies Service) ​ ​
People do not know what IAPT is or what it does

 The CCG Engagement team worked with local residents from BME Communities and groups of older people (65+) to try to find out why they were under represented as service users. Most of the people we spoke had never heard of IAPT and did not know it did.

 

The people we spoke to suggested a lot of possible different names and agreed on Talking Therapies. South London and Maudsley NHS Trust (SLaM), who provide the service agreed and since Spring 2018 it has been officially named – Croydon Talking Therapies.

 

In November and December 2018 the CCG undertook targeted insight work with men (aged 18-30 and 31-50) to help us to know how better to target working age men to raise their awareness of the service. As a result of what they said we have:

 

  • Started an Instagram campaign to raise awareness among young men (under 40). 
  • Planned to replicate this campaign to target other appropriate groups. 
  • Completely redesigned images and messaging to make it clearer what Talking Therapies is and how it can help local people
  • Targeted advertising at East Croydon station, a major transport interchange in Croydon.
Further insight work will be undertaken to make sure that the messaging is relevant to target groups who would benefit from the service but who are not currently accessing the service.
The Talking Therapy service must be culturally appropriate – one size does not fit all.   

The Engagement team ran a number of focus groups with people from BME communities. The feedback was that for some cultures mental health issues were not discussed and there is a very big stigma amongst families and communities in admitting people may need support.

 

SLaM are very committed to ensuring that the Talking Therapy service is accessible to all Croydon residents. They are working across communities and undertaking significant outreach work to make talking about mental health issues part of everyday conversation in schools, workplaces and families. This work includes talking to faith groups and people who have influence in their communities to help them support individuals.

This work is on-going and SLaM and the CCG are working on a joint action plan to address this, and other, issues which may act as a barrier to Croydon residents accessing the service.
Croydon Wheelchair service ​ ​
The waiting list for assessment and repairs is much too long

The CCG reviewed its current wheelchair service in late 2017. As part of this review they spoke to the Wheelchair service user group who were very concerned about how long people had to wait to get a wheelchair initially and the long wait times for repairs once people had a chair.

 

As a result of this review the CCG transferred commissioning responsibility of the wheelchair service, including repairs, under s75 to Croydon Council and they are providing it in-house through Croydon Equipment Services (CES) who are affiliated to Croydon Council. Additional resourcing was awarded to reduce the waiting list.

 

CES became the service provider in October 2018. The additional resources has reduced the waiting list and helped to clear the backlog of patients waiting for repairs.

CES and the CCG worked closely with the wheelchair service user group during the service transfer. The group will also have oversight of the monthly plan to improve the service.
It's very difficult to contact the service because of very limited opening hours for the telephone service Since October 2018 the telephone opening lines have been extended from 1 hour a day (under the previous contract) to 9am to 5pm every working day.The wheelchair service user group will monitor the availability of customer service personnel and report back to CES quarterly.