The joint Patient and Public Forum was held on Monday 19 August 2019 to discuss the proposal for Croydon CCG to potentially merge into a single South West London CCG with Croydon residents.
The NHS Long Term Plan is an ambitious plan to support organisations who manage local health, social care, community and voluntary sector services come together to improve the health and well-being for residents. As well as helping us to better support people to stay well and manage their health better, this will also help us to get the best value for patients and taxpayers.
The CCGs in southwest London have already been working together for over a year, and in line with the NHS Long Term Plan want to reduce duplication so that more can be invested in front line services.
Thirty-five participants attended the Forum. They were from a range of community and voluntary sector organisations and Patient Participation Groups as well as residents with an interest in health and care services.
This conversation continued as part of the table discussions. Themes for these discussions are presented below.
Question and Answer session
Panel: Matthew Kershaw, Mike Sexton, Elaine Clancy (Joint Chief Nurse) Agnelo Fernandes (NHS Croydon CCG Clinical Chair) and Nnenna Osuji (Deputy Chief Executive and Medical Director)
After the presentations a question and answer session was held so that the participants had an opportunity to find out more about the proposals and comment on what they had heard.
Question: You've said that by going into a wider organisation, you will be able to better support primary care. How? SWL is very centralised, GPs are very localised.
Answer: (MS) Working with SWL is, in part, about protecting management costs in Croydon. If we have make the savings we need to just in Croydon it would be more severe. By working with SWL we can pool governance and other functions to protect roles.
There are also aspects of primary care IT and estates where skills are needed beyond Croydon; by working together we can accelerate development.
(MK) Most decisions that directly affect patients won't be taken at SWL level. If we took 20% of management costs out of every CCG, it would potentially leave some CCGs unable to function. If we do it together we can get the best use out of management spend that we've got.
Question: You said that most people's patient experience wouldn't be affected – what will be affected? How can we be sure decisions at SWL will be made in the interests of the people of Croydon?
Answer: (MS) The CCG's current Governing Body holds a clinical majority and this will be preserved at SWL and in Croydon local committees.
(MK) – We hope the estates situation will improve as we have an overview of the total building stock across SWL. With workforce, be it clinical or managerial, all the CCGs have similar challenges and shortages so we can look how we solve those issues together. We'll also look at more specialised commissioning, where some services will need to be done at SWL level, some at London.
Question: We've been talking about mergers. Is there going to be a merger or a collaboration between CCG/CHS?
Answer: (MK) It's definitely not a merger between CCG/CHS - legislation doesn't allow it. We can align, make decisions together and work more closely together. There is a proposed merger between SWL CCGs.
Question: With the reduction in management costs, can we expect a positive impact on the number and quality of frontline staff delivering services?
Answer: (MS) Croydon health budget is not being cut. We're working to retain local control of that budget. Our management costs are being cut – our £8m budget is being reduced by £1.6m. This change should not impact frontline services, rather we need to make sure that the positive impact we've been having continues.
(NO) We've referred already to working to reduce duplication. We're trying to do better, and also do better things. For example, we've changed our Quality Committee to bring clinical and managerial staff together to solve issues.
Question: How are you going to let residents know what's going on in the future? I only knew about this because I'm on the CCG mailing list.
Answer: (NO) It's a relevant question to ask the group – how do we best stay in contact with the many different organisations in Croydon?
(Participant): I can't remember last time I had something from then, there's never been a major engagement in my experience from SWL. What are their plans? How can we get involved? How engage with us to engage with other people?
(AF) Healthwatch is representing patient engagement. There will be a number of groups represented at SWL level.
Question: Where are the ordinary people represented at SWL level?
Answer: (MK) Most of the work we need to do is not done at SWL level. Having Croydon representation is important – but it's not where the decisions are made. SWL will be more of an information exchange. We want to base engagement at the hyper local level here in Croydon.
Question: It feels like if we have a borough-based group, every member will be representing a group - how do they engage? How are we going to resource this? If there's no support there's a risk it will fade away. I'm also worried that this group will be told about things and told to endorse them, rather than using it for real engagement.
Answer: (MS) SWL Healthwatches have been involved in the development of this initial suggestion for a structure. It's up to us to decide an engagement structure that works for us. We might want to do things differently locally.
Question: I'm aware that the majority of people in this room are older than the average – are you looking at a social media strategy to engage with younger people?
Answer: (AF) Yes – that came out the HCP event.
(MK) We trying to engage a wider range of people all the time. We're testing moving the trust board to the evening at the Council in order to give people who work during the day a chance to engage with us.
Comment: Would this be a good time to review the number of groups – there could be duplication, not all of them might be having a positive impact. I'm concerned about proposals for more and more groups. This is an opportunity to stop and think about what Croydon needs. I'm also aware that not all Croydon communities are well represented at today's meeting.
Question: The NHS Long Term Plan was partly about social prescribing. What is the status of this in Croydon?
Answer: (AF) There is lots going on throughout the borough, helping to address local issues and supporting local people.
Question: Can people only access social prescribing in their area? Can people access services outside of their network? Do people have to be referred by their GP?
Answer: (AF) The model we have is about empowerment, you can just turn up to the exercise class etc.
GPs in the north of the borough all have the same website, all linked to same social prescribing website, the plan is to share this format to the rest of the borough to localise
Question: I've tried to set up a patient participation group up in my local GP practice but they didn't want to get involved; they just wanted to send emails to patients who've signed up. If every GP practice had a group – it would be easier to get views.
Answer: (MS) Experience of GPs not wanting to know is a common experience – PPG coverage is patchy.
Table top discussions
After the question and answer session participants discussed the following areas:
- Are we right in thinking you want us to focus on improving how we engage with people in primary care, secondary care?
- How can we best do that? Where do we need to invest?
- How will you know engagement is happening?
- How can we shift the focus to improving quality (making services better – shift to listening and doing)
During the discussions the following themes emerged:
Making engagement meaningful: Participants felt that it was important for any engagement, either at local or southwest London level had to have a purpose and boundaries. The importance of an open and honest dialogue with all participants knowing how, when and on what basis they were engaging.
Engagement must always be timely: Many participants spoke of experiences where they had been part of groups which were presented with options which had already been, in effect, decided. People need to understand the framework and boundaries to their engagement, what are they being asked to do and at what stage at the being involved. A clear and transparent set of guidelines need to be the building blocks of any Patient Reference Groups, or similar.
Respecting engagement: Residents who choose to engage with the CCG and Croydon Health Services do so to help support and improve local health and care services. Their time, energy and commitment should be respected. This includes organisations committing to listening to patient and public representatives and working in a transparent way.
Ensuring representative engagement: While there were some concerns raised about the establishment of a borough based Community Reference Groups, in terms of its influence, it is important to ensure that representatives are reflective of local populations in terms of age, gender, ethnicity, for example. Careful consideration needs to be given to how people and/or organisations are recruited and supported. There must also be a system in place to ensure that representatives are plugged into local networks to develop a way for them to listen to local peoples experiences and feedback to bring to the group and also as a way that they can feedback to local communities on areas of work. Healthwatch Croydon would be well positioned to support with this.
Engagement within Primary Care: Many of the participants are members of their GP Practice's Patient Participation Group and do a significant amount of work to support practices, patients and local communities. By, for example, running health based activities and carer support groups, supporting flu vaccination uptake and ensuring that patient's views are represented on decisions which impact on the running of a Practice.
Participants discussed how they felt that the CCG had not provided enough support to develop PPG's local, this included support to Practices to develop PPG's.
The CCG engagement team are committed to working with the Croydon PPG Network in developing engagement processes for Primary Care Networks.
Broadening engagement to seldom heard populations: Many of the participants were people who take an active interest in the work of the CCG and Croydon Health Services and already work with us on commissioning programmes. People were aware that in order to encourage groups or individuals who do not traditionally engage to get involved much more work needs to be done in the community. For example, within schools, colleges and workplaces. Some existing patient representatives generously offered to support the CCG to reach out to seldom heard groups.
Resourcing for Engagement: Patient and Public engagement is a core principle of the NHS Constitution and should be sufficiently resourced so that it can be effective and influential.
A key theme which ran throughout was that patients and the public must be active participants in building future engagement and involvement structures both locally and at southwest London level.