Kingston Clinical Commissioning Group · Patient and public engagement review 2018/19 2 Foreword Welcome to our review of patient and public engagement (PPE) for the period April

Kingston Clinical Commissioning GroupPatient and public engagement review 2018/19

Patient and public engagement review 2018/19

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Foreword Welcome to our review of patient and public engagement (PPE) for the period April 2018 to June 2019. This review sets out some examples of the engagement we have carried out and how the voice of local people, patients and carers shapes our work and impacts on our plans.

This year, health and care partners in Kingston from the NHS, Royal Borough of Kingston upon Thames and the voluntary sector have committed to work together as part of the Kingston local health and care partnership.

Our community engagement outreach programme has continued to go into local communities to speak to people we would not normally hear from, enhanced by our work with Healthwatch as part of the South West London Health and Care Partnership grassroots engagement programme. The rich insight gained from this programme is having a positive impact on our local health and care plan as we set out local commitments to improving health and care across the borough.

Evaluating our PPE is key to ensuring we continue to improve how we engage with our local communities and demonstrate our impact. As in previous years, NHS England assessed PPE as part of their improvement and assessment framework (IAF) for CCGs and we are pleased to maintain our green rating for the second year running, indicating that our PPE is considered “good”.

We would like to thank everyone who has been involved with us during the year, providing the CCG with local insight to inform our plans. We would also like to thank our partner organisations including NHS providers, Kingston Council, Healthwatch Kingston, Kingston Voluntary Action and local voluntary and community organisations. Working together to engage local people has helped us to improve health outcomes and reduce inequalities across the borough.

Dr Naz Javani Jim SmileyChair, Kingston CCG Governing body lay member for patient and public involvement

“ With the help of our friends and partners across health and care services and particularly in the voluntary sector, we have again made huge efforts in the last year to keep local people informed about and engaged in the way local health services are organised and delivered. At the centre of our engagement work during this period has been the local health and care plan – in particular our borough engagement events which brought together old and new partners and representatives of the public around our priorities for future local service delivery. We are grateful to all who gave their time and wisdom in this and the many other engagement events our team has held in this period.”

Jim Smiley


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Highlights of the year

• We visited 26 different groups in our borough.

• We heard from over 750 local people.

• We engaged with over 60 local people who had not been involved in our work before.

• Winter champions gave CCG staff the opportunity to volunteer at local community groups and share winter health messages.

• We maintained our green rating and improved our score for NHS England’s patient and community engagement indicator 2018/19 assessment.


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Contents

Foreword 2

Highlights of the year 3

Introduction 5

Networks and partnerships 6

Working closer together 7

Winter champions 8

Kingston health and care plan (HCP) 9 Using early insight to inform our early thinking 9 Testing early thinking and draft priorities 10 Targeted engagement with groups potentially affected by the health and care plan 12

Listening to and involving our communities 14 Start well 15 Live well 19 Age well 23

Patient engagement in primary care 26

Experts by experience 27

Musculoskeletal (MSK) working group 27 Cancer strategy steering group 27 Non-emergency patient transport procurement 27 Youth Out Loud! 28

Our plans for 2019/20 29

Get in touch 30


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IntroductionPatient and public engagement is at the heart of what we do at Kingston CCG. Working together in a shared office and management structure with Richmond CCG, our engagement team is made up of three staff members, our executive lead is our Director of Corporate Affairs and Governance with PPE as part of their portfolio. We also have a lay member for patient and public involvement on our governing body.

This review provides us with the opportunity to show our responsiveness and accountability to our patients, future patients and local people. During the year, we have reviewed and updated our approach to PPE across the CCG.

Our work this year has been shaped by working closer with our colleagues in CCGs across south west London and consolidating our local partnerships with health and care colleagues across the borough. Our main engagement project for the year has been working with local health and care colleagues to ensure that the voice of local people informs the development of our local health and care plan.

https://www.kingstonccg.nhs.uk/Downloads/Publications%20folder/Patient%20and%20public%20engagement/Our%20approach%20to%20Patient%20and%20Public%20Engagement.pdf


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Networks and partnershipsPrimary care forumThe primary care forum meets quarterly bringing together people with an interest in primary care (PPG members, primary care practitioners and local people). It gives local people an opportunity to get involved in discussions about the commissioning, delivery and quality of local primary care health services. This is one way that we ensure that insight from local people is embedded into our primary care transformation programmes.

During the year, the forum looked at pharmacy services, the local implications of the NHS long term plan, the south west London digital service, Doctorlink and most recently the introduction of primary care networks. Local people have the chance to feedback directly to our guest speakers including our Managing Director, the Director of Primary Care and the CEO of the Local Pharmaceutical Committee.

Healthwatch KingstonWe continue to work with and develop our relationship with Healthwatch Kingston which is represented as a non-voting member on the CCG’s governing body and primary care commissioning committee.

Kingston Voluntary Action (KVA)We work closely with our partners in KVA, who represent the community and voluntary sector. The KVA Health and Wellbeing network meets quarterly and is an opportunity for organisations with an interest in health and wellbeing to come together and hear about developments in local work and plans from partners in health and care. This year we presented the health and care plan at the network at key stages in its development to hear from our colleagues in the voluntary and community sector who have a vast knowledge of how local people experience health and care services.


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Working closer togetherKingston CCG has been working as part of the South West London Alliance with our partners Richmond, Sutton, Merton and Wandsworth CCGs for two years now, sharing expertise and making more efficient use of resources.

Kingston and Richmond CCGs have also been working together during this time with shared management, staffing and office arrangements.

Partnership working in KingstonHealth and care organisations in Kingston are working more closely together as the Kingston Health and Care Partnership to look at what’s important for health and care in Kingston, what the challenges are and how, if organisations work more closely together, we can make a difference. The partnership involves:

• Kingston Hospital NHS Foundation Trust

• Your Healthcare Community Interest Company

• South West London and St George’s Mental Health NHS Trust

• Camden and Islington Mental Health NHS Trust

• Kingston GP Alliance / Kingston GPs

• Achieving for Children

• Royal Borough of Kingston upon Thames

• Community pharmacies

• Kingston Voluntary Action (voluntary sector)

• NHS Kingston CCG

• Healthwatch Kingston

Kingston and Richmond communications and engagement groupTo support the work of our local health and care partnership we have set up a professionals’ communications and engagement group across Kingston and Richmond, with representation from our partners in health and care from both the statutory and voluntary sector.

We are working together to develop consistent and best practice engagement and communications across both boroughs where appropriate, for example, our winter communications campaign and health and care plan communications and engagement. Working in this way means we can support each other’s work as well as have a consistent approach to engaging with local people and evaluating our efforts.


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Winter champions

During winter 2018/19, staff had the opportunity to volunteer at local community groups or events to talk to local people and share information about staying healthy during the winter months. This included messages about seeing their local pharmacist if they feel unwell; getting the flu vaccinations and being aware that GP appointments are available 8am – 8pm via their GP practice or NHS 111.

Our focus was to reach out to local groups working with people at risk during winter, this included: 2-3 year olds via groups working with parents; over 65s, carers and people with an underlying health condition such as heart disease, diabetes and chronic obstructive pulmonary disease (COPD). We have showcased examples of our winter champions throughout this report.


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Kingston health and care plan During the year, the focus of our engagement has been to support the development of Kingston’s health and care plan (HCP). The plan describes our vision, priorities and actions to meet the health and care needs of local people and deliver improvements in their health and wellbeing. It is a two-year plan (2019–2021) focusing on the actions which no single organisation could achieve alone. By working together, health, social care and the voluntary sector can deliver quality health and care services that support local people.

Patient and public engagement took place between June 2018 - May 2019 and the following is a snapshot of the engagement which took place. You can read the full report here.

• The engagement was divided up into the following stages:

• Using local insight to inform our early thinking around health and care priorities

• Testing our early thinking and draft priorities to inform the actions and impact to support our health and care priorities

• Targeted engagement with groups potentially affected or involved in actions and impacts identified in our draft health and care

Using local insight to inform our early thinkingWho we askedKingston’s health and care partners considered the views of local people gathered over the last two years to shape our thinking as we developed our early ideas about what the health and care priorities for Kingston would look like. This included hearing from communities and groups who face specific obstacles to getting their voices heard. Between June and October 2018, we shared our initial ideas at events and forums across the borough to hear what local people had to say.

We plotted the groups we wanted to test this with carefully so that we filled any gaps in our previous engagement and could make sure we listened to those most affected by the plan. These included our colleagues in the Kingston Voluntary Action (KVA) health and wellbeing network, people aged over 60 at Staywell, members of the LGBT+ community at Bifest and the LGBT+ Forum, students and people with attention deficit hyperactivity disorder and/or autism at a Fast Minds event.

“ Most of my support comes from neighbours, we all look after each other, I live in a very friendly area. I am too shy to go to day centres, so I would welcome an alternative with fewer people. I knit baby clothes and take them to Kingston Hospital and that makes me feel useful.”

participant at Staywell event

What did we find out?Local people welcomed us working together. They told us it was difficult to navigate the health and care system and that it was often left to older and disabled people to do this alone.

What did we do?We used the feedback we received from local people to refine our early ideas into a set of draft priorities.


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Testing early thinking and draft priorities Who we asked In November 2018, we held an engagement event for local people, health and care staff and representatives from community organisations. We talked about the kinds of things no single organisation can achieve alone like combating childhood obesity and supporting people with diabetes. Discussions were centred on whether we are focusing on the right areas for Kingston, and how to ensure the action we take has maximum impact for local people.

We wanted to hear from people we hadn’t heard from before and used a recruitment agency to find a roughly accurate demographic reflection of our local population. There was a great energy and passion in the room and it was clear that local people wanted to support us in our plans to work together.

What did we find out? The conversations we had suggested that local people welcome health and care working closer together, and the introduction of social prescribing through Connected Kingston. They would like to see more work in preventing ill health and improved IT systems to improve communication between agencies.

We made a film which captured the feeling of the day.

“I felt there was a genuine interest from key individuals, driving this initiative.”member of the public

“ With all the good ideas and suggestions, the systems would greatly improve standards and speed things up for people who need help and support as well.”

frontline healthcare worker

The illustration below captures the key themes from the event.


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The following provides an overview of what we knew at this stage of the process from talking to local people at community events and from the feedback from the event.

Start well

We talked to parents, children and young people and people who work with young people. They told us about their concerns for the mental health resilience of Kingston’s young people; difficulties in accessing SEND services and how we could work closer together to give people the best start in life.

“ There is a lack of communication between services. It makes it difficult to keep up. My child has complex needs and uses several different services and hospitals for treatment, but files and notes aren’t shared. When I ask about a new therapy or service, people always talk about their budgets. I don’t care which budget it comes from, my child just needs the service! It can take ages to sort out sometimes.”

Parent at a SEND Family Voices event

Live well

Working age adults told us they would like to see health and care services making better use of technology to make services reliable, easy to use and joined up. Many talked about using community hubs to build links across generations to support each other.

“ My elderly mother and I have been trying to support my sister through her 3rd or 4th mental health crisis. My sister is reluctant to seek help because of the stigma as she doesn’t want people at work to know she isn’t coping. She mostly relies on her church for support which is great for her, but they don’t have the training. It shouldn’t be this hard.”

Person at a neurodiversity event

Age well

Older people told us that as they age, people need reliable community services and help with accessing them and that tackling isolation and loneliness should be an area of focus. They also told us they would welcome more formal ways of planning the last years of their lives.

“ I try to talk to my children about my end of life care, but they get very upset. I wish I knew who to talk to about it.”

Staywell event, New Malden


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Targeted engagement with groups potentially affected by the health and care planIn March 2019, a mix of health and care professionals from the NHS, council, voluntary and community sector, and Healthwatch came together to build on what we had heard from local people so that we could agree the key actions and anticipated impacts to support our health and care priorities. These were then collected into a discussion document to support our next stage of engagement.

During May 2019, we used the discussion document to sense check the health and care plan (HCP) proposals with targeted groups in start well, live well and age well who may be affected by or involved in this work. There was also an online survey hosted on the council’s website providing an opportunity for the wider population to contribute. This work was led by Kingston’s health and care partnership communications and engagement group who used a range of channels including local networks, websites, social media, and staff and stakeholder communications to promote the opportunity to comment on the discussion document.

Who we spoke to? Nearly 200 local people and health and care professionals directly engaged with our HCP proposals during May either in discussion groups and forums, by completing the survey or in writing: with a further 450 accessing the document through the council’s consultation portal. These included people who do not speak English as a first language with Learn English at Home (LEAH), young people at Youth Out Loud! and the Children in Care Council, people with mental health conditions at the Mind Kingston drop in café, older people from the Tamil community at the elders’ empowerment group and people working with children with SEND. It was not possible to have discussions with all the groups we wanted to, so we ensured that key groups were sent the HCP discussion document with an invite to provide feedback.

These included carers organisations, groups and organisations working with children and young people, people with long term conditions and diabetes, older people and organisations involved in the wider Kingston borough partnership.

What did we find out? We heard that people were supportive of the health and care plan and of us working closer together to deliver health and care across the borough and that they wanted us to build on the community initiatives already present in the borough. There were several areas that needed further clarification and more information, some of which are outside of the remit of the plan.

People wanted to see more specific detail around the actions and impacts included in the discussion document. These included more emphasis on the first 1000 days, more specific actions connecting the priority around carers to the carers strategy, greater detail around how we will support people who already have a long-term condition, how we make sure children and young people’s voices are heard in their education, health and care plan assessments and more concrete examples of how we will support older people.

What did we do? Health and care partners have considered the key themes from the feedback provided to inform the final version of the health and care plan. The following changes have been made to the plan in response to this feedback.


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Changes made to the plan in response to the feedback

You said › We didIt was clear from talking to carers that they need appropriate support. They asked for more detail about what actions would be taken to achieve this priority.

›Agreed. The plan now includes more actions to support this priority including connecting with the carers strategy.

Can the document define what benefit there is to carers once they have been recognised as carers?

›There are additional actions to address this including implementing Kingston’s carers strategy.

Good Food Group is an action within Start well, perhaps this is something that could be addressed across the life course. The Food Poverty Action plan was developed in 2018 and highlights vulnerable groups who are experiencing food insecurity in Kingston. Supporting the implementation of Good Food Group (across the life-course) would support these vulnerable groups, tackle inequalities and food poverty through people powered change.

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Agreed. Food insecurity will feature in prevention, across the life-course.

Children and young people told us that they would value some education around how to look after their own mental health and how to support their friends if they are having difficulties.

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The plan now includes actions to address this including working with young people to design and develop peer lead services to reduce involvement in risk taking behaviours and the emotional wellbeing programme in schools.

We had lots of positive feedback on the Daily Mile though some thought it might be ambitious to implement in all schools in the borough.

›Noted. We will work with schools to overcome barriers where possible to implementing this initiative.

People asked for more emotional support groups for people with mental health problems by expanding IAPT (psychological therapies) particularly for those who have been living with long-term conditions for a long time.

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There is an action in the plan to expand IAPT to include people with long-term conditions and older people.

People asked for more detail in the plan about how we will ensure housing is appropriate such as building sheltered housing. ›

The plan includes an intent to improve local sheltered accommodation provision and housing support for older vulnerable people.

Suggestion that we divide the priority around living the last years of life well and ending well into two to allow for each aspect to be given sufficient attention.

›This priority has been revised to include a specific action around planning for the last years of life.

End of life care should be discussed openly and frankly – the plan should talk about death and dying rather than ends and ending.

›The actions have been revised to reflect this.

Once the HCP has been agreed patient and public engagement will move to a more targeted approach; working with people with lived experience to deliver the actions and ensure outcomes for local people are met.


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Listening to and working with our communitiesWe continue to visit community groups and organisations to listen to people about their experiences of local services, to give them the opportunity to shape future services. Through our outreach we have had meaningful conversations with local people who do not always feel their voice is heard, or who face specific barriers to being involved in our work.

When considering the priority groups for our community outreach we use insight from equality and health inequality impact assessments and data from our borough’s Joint Strategic Needs Assessment (JSNA) particularly around health inequalities.

During the year, we attended 26 different groups and spoke to more than 750 different people. We used these opportunities to find out more about how seldom heard groups experience our services and what they view as most important for us to focus on for local health and care.

We have also worked with local people to ensure they had the opportunity to help shape wider south west London commissioning programmes where we are working with our neighbouring CCGs in south west London.

This section provides some examples across the life stages of how we have engaged with local people to inform local projects such as the health and care plan and how local people can participate and inform south west London programmes.


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Start well in Kingston

Youth Conversation – Chessington Community College The Chessington youth conversation was initiated by our colleagues in the Royal Borough of Kingston. Along with Achieving for Children, they had surveyed young people across the south of the borough to find out about the issues that were important to them. The main issues the young people wanted to talk about were health, antisocial behaviour and transport. We were invited with colleagues from Transport for London and the Metropolitan Police to hear what the young people had to tell us.

We heard from 36 young people from Chessington Community College and Hollyfield School speaking to them in small groups.

What did we ask? We were very much led by the young people. They wanted to talk to us about mental health, healthy eating and their ideas about fitness initiatives that could improve their experience of living in Kingston as well as their health. We also tested the draft health and care priorities.

What did we find out? Many said that exam pressure impacted on their mental and physical health and that they had sacrificed leisure time to study. They felt under pressure to succeed from both parents and schools.

They told us that it could be difficult to know how to speak with professionals who could help because they did not have the right vocabulary and worried that their parents would be upset that they weren’t happy.

Some children told us that many of the initiatives they saw for extra curricula activities cost money and that could be a barrier to getting fit.

What did we do? This insight has fed into our local health and care plan which includes actions such as the Daily Mile in schools, a free and inclusive way to make sure all children are being taught about how to fit in small amounts of exercise into each day.

We are working with local schools and colleagues across south west London to find out more about the language young people use when they speak about mental health with a view to this feeding into teachers, doctors, nurses and other professionals who have contact with children and young people.

We are working with parents, teachers and children and young people to raise awareness of mental health conditions and mental health first aid so that low level interventions are available and children and young people can take responsibility for their own mental wellbeing.


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Winter champions helping young people to start well

Vicky Fraser, our designated nurse for looked after children met with a group of young people who are part of the Children in Care council. Vicky said:

“The Children in Care Council is a fantastic initiative, which is led by a group of young people who represent the looked-after population in both Kingston and Richmond. They were really interested to hear about what they can do to look after themselves, such as keeping a well-stocked medicine cabinet and visiting a pharmacist for minor illnesses, instead of waiting for a GP appointment.”

“It is important to empower young people to look after themselves, directing them to our experienced community pharmacists and NHS111 instead of A&E for non- life threatening ailments. We also explained that sometimes small lifestyle changes such as walking instead of taking the bus, can make a big difference to health and your quality of life.”

Vicky found that many of the young people welcomed the use of technology in healthcare and they were looking forward to the NHS app being launched. The young people had used the NHS111 app to help them make decisions about whether they needed to see a doctor, but they sometimes found it difficult to understand the language used on the app.


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Start well in south west LondonChildren and young people – from addressing self-harm to developing emotional resilience We know that across south west London (SWL) we have a high number of children who self-harm and we want to both address and prevent this by developing consistent wellbeing support and early intervention.

We aim to reduce the number of children who self-harm in south west London through a ‘whole system’ multi-agency approach using health, education and local authority partners and carers as well as children and young people. For more information read the full engagement report.

How have we involved children, young people, parents and carers?During 2018 we engaged children, young people, parents and carers as well as teachers and schools to examine the root causes of self-harm and poor emotional wellbeing and to test potential solutions. We met with children across south west London and ran eight meetings. Over 1200 people responded to our online survey.

The surveys were promoted in six south west London boroughs. The response rate varied significantly between the boroughs for each of the three surveys.

Children and young people

Parents and carers

Teachers Total

Croydon 28 32 1 61

Kingston 56 109 19 184

Merton 109 77 70 256

Richmond 128 341 20 485

Sutton 14 21 66 101

Wandsworth 43 21 18 82

Other 41 41 1 83


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How have we responded so far?• We have narrowed down our long-list of possible interventions to a shorter list that

children, young people, parents, carers and teachers told us would work for them.

• We have developed a diverse model of support that is based outside of a medical environment – in schools – and that includes one-to-one and group sessions for children and young people, online self-help and counselling, an online directory of services and education/training programmes for parents and teachers.

• We have established a cluster of schools in Kingston that is working with us and with other health agencies and higher education partners to introduce enhanced support for young people’s emotional wellbeing.

• All partners have signed up to some core principles for involvement to make sure that involving children, young people, parents and carers is truly everyone’s business.

• We have started to involve young people in designing and procuring new services we introduce as part of this programme, for example, the Wandsworth Youth Council and a school student council have recently taken part in deliberations to inform the selection of the provider of a new online counselling service for young people.

What happens next? We will continue to involve children and young people, parents and carers and teachers. The involvement of children and young people will be critical as we put our plans into practice and we have developed a framework for involvement to make sure that at every opportunity we act to ensure the voice of children, young people, parents and carers is built into our work – in needs assessment, in service design, in service delivery, in monitoring the quality of the services we provide and in our assurance processes.

For example:

• We are making sure that when we sign a contract with a service that will be working with us, they also commit to involving children, young people, parents are carers in developing and improving their services.

• We have been meeting with groups of young people from schools across south west London including Tolworth Girls’ school to discuss the language they use when de-scribing mental health to inform a language guide for professionals and to test some campaign materials with them for a new online counselling service.


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Live well in Kingston

Kingston Churches Action on Homelessness (KCAH) focus group Who did we ask?Kingston Churches Action on Homelessness (KCAH) organised a focus group of ten people who were both homeless and had mental health conditions.

What did we ask?We asked them about how they experienced local health care services and what barriers they may have to accessing health care. Homeless people experience significant health inequalities and it is vital we address this.


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What did we find out?We found out that some people couldn’t afford to call to book an appointment and that online booking is not useful for people who do not have a smartphone. It can be difficult to get to a practice when people don’t always stay in the same location and don’t have money to use public transport. This also caused problems because they didn’t know which practice to register with. Participants also said that ‘most GP’ practices ask for identification, including address, which was impossible to provide. Some resorted to using A&E departments because of these barriers.

Participants also said that they wished they could have longer appointments and that health care professionals took a more personal interest in their wellbeing.

“ When I visit the GP, they just give me something which covers up the reason why I am there.”

None of the attendees felt that they are treated differently by their GPs because they were homeless, however one reported that when they used accident and emergency treatment for diabetes, they were ‘kicked out’ as soon as they were treated.

“ I am a regular at the hospital, I find that my issues aren’t discussed and they always ask me to leave because they don’t have enough beds.”

Many in the group commented that they would prefer more individual support as a lot of the support on offer was in groups. They felt that it would be more meaningful if it was personalised as they felt under pressure and awkward speaking about personal and emotional experiences in groups.

“ You have to be mentally ill, have an addiction and looked after wellbeing to stay at the YMCA. It must be extreme otherwise they don’t listen. The YMCA didn’t want to house me.”

What did we do?Homelessness has been highlighted as an area to address in the health and care plan. We will be carrying out further engagement with people who are homeless or who have insecure housing. Our primary care team is also focusing on improving health outcomes for people without a home.


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Winter champions helping adults to live well

Mal Assi is a contract support officer in the CCG and built on her existing voluntary work this winter to help get important health messages out to her local community at the local gurdwara (Sikh place of worship).

Mal said: “I already volunteer at my local gurdwara, Sri Guru Sabha Gurdwara in Hounslow, and I wanted to offer winter health messages at the weekly wellbeing stall that is held there every Sunday. The stall provides information on various health conditions and is run by a team of volunteers. I wanted to make sure that members of my community knew what to do to stay well this winter, including having the flu vaccine.”

Mal found that the community at her gurdwara used the stall a lot as the first port of call for signposting advice. Many used their local pharmacy after talking to people on the stall.


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Live well in south west London

Diabetes in primary care Our south west London diabetes team invited stakeholders from across the local health and care partnership to discuss how we can improve our primary care for people with diabetes.

Who did we ask? We ran a workshop for people with diabetes, practice nurses, community nurses, GPs, commissioners and public health consultants. We also produced a survey which was distributed across Croydon, Merton, Richmond, Sutton and Wandsworth using our networks and social media channels.

What did we ask?We focused on three key areas - care planning, working together and using the whole team.

What did we find out?Patients felt that we could use more innovative ways of identifying and engaging with people with diabetes. For instance, using community and religious groups to talk to people about recognising causes and symptoms of diabetes as well as potential screening opportunities including NHS health checks, in mental health settings and the national diabetes prevention programme.

People with diabetes told us that they wanted to be a part of their care planning and that a collaborative approach worked better for them. They asked that consultants are well prepared with their latest blood test results rather than wasting time in appointments waiting for results to come through. They also asked for easier access to specialist advice and for all staff to receive specialist training. They noted that it was important for people with diabetes to look after their mental health but that this was rarely recognised.

You can read more about this project on the NHS South West London website.

What did we do?• We applied for funding from NHS England and were awarded £565,000 to spend

on testing a patient-centred approach to care planning. This is initially being tested in about 20 GP practices across south west London and if successful, it will be expanded to further practices.

• We are developing a funding proposal for the next wave of the treatment and care funding programme announced with the NHS long term plan and will include funding to introduce more multi-disciplinary team working in virtual clinics.

• We have promoted the use of e-learning resources via primary care teams and visits to locality meetings.

• We held training sessions for healthcare assistants in footcare for people with diabetes to support both our test bed and our diabetes foot care projects.


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Age well in Kingston

Staywell – exercise and lunchWho did we ask? Staywell, a local charity for older people ran an exercise programme and lunch for almost 40 people aged over 60 most of whom lived in sheltered accommodation in the borough. We joined them for lunch to hear what they had to say on a small group and one-to-one basis.

What did we ask? We asked them what they thought of our draft health and care plan priorities for age well.

Jo Austin PPE Manager speaking to attendees at the Staywell eat and speak event.


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What did we find out? We found there was a lot of support for people having the choice to live at home as independently as possible and that loneliness and isolation was the main thing that put people off doing so.

“ As you get really old and you can’t get out of the house, you get lonely. We’d all like to stay in our own home but we don’t want to be left alone.”

Many commended community initiatives that got them out of the house and valued a range of options rather than a one size fits all approach.

“ Most of my support comes from neighbours, we all look after each other. I live in a very friendly area. I am too shy to go to day centres, so I would welcome an alternative with fewer people. I knit baby clothes and take them to Kingston Hospital and that makes me feel useful.”

People welcomed collaboration between health and care. Some people had found it difficult in the past to work out how everything sits together and felt it shouldn’t be their responsibility to work it out. They noted that services could be disjointed if, for instance, you had been in hospital in another borough.

This group were very keen to discuss end of life care. They felt that it was something older people think about a lot but don’t know how to share their thoughts with friends and family. They felt people shrugged off the conversation because it was too gloomy and felt worried it would make their children feel upset. They liked the idea of a more formal way of planning.

All attendees believed better support for carers was essential. They recognised the pressure carers were under and felt that respite care and GP practices flagging that the patient has a carer in their patient record were two initiatives they thought would make a difference.

What did we do? This rich feedback was used to refine and shape the local health and care plan priorities and actions.


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Winter champions helping people to age well

Tonia Michaelides, our Managing Director, visited Raleigh House, a day centre run by local charity Staywell, in New Malden, to support with a bingo session.

Although Tonia and Sergio didn’t win bingo, it was a good opportunity for Tonia to hear how the centre is a lifeline to the people who use it. Sergio explained how much he enjoys the camaraderie and atmosphere; there is always lots of laughter and fun.

Tonia said: “It was great to leave the office and go and see some of the fantastic work that is happening at Raleigh House. I enjoyed meeting the people who use the day centre and finding out more about the activities that take place. I talked to people about our winter campaign and the importance of getting a flu jab. It was a brilliant day, enjoyed by everyone involved.”


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Patient engagement in primary carePatient participation groupsWe work with some local patient groups in GP practices through our primary care forum. This is also an opportunity for members to network and share information and ideas about their work. We are keen to work with practices and PPGs to develop the network idea further to empower PPGs so that they can provide effective engagement assurance at a practice level.

Across the borough, PPGs are working with their GP practices to identify how improvements can be made to benefit patients. Many of our practices have patient participation groups (PPG) looking to support their practices in practical ways. Merritt Medical Centre in Chessington has been looking at how they can improve patient’s health awareness by running information events and activities.

During PPG awareness week 2018, the PPG arranged a range of health-related activities including:

• Coffee mornings where a small team of volunteers made hot drinks for people in the waiting rooms and asked them if they had feedback on how the practice was run

• A men’s health session run by a urologist from St George’s Hospital NHS Foundation Trust

• Nutrition session provided by a local resident

• Defibrillator training, run by a paramedic

• Mental health first aid for new mums

• Lunchtime walks to get people moving

The events were well attended and some have carried on running throughout the year. The group is planning even more sessions during 2019.

The PPG has also been working with clinicians about women’s health, including running “Mummy MOTs” and being involved in a menopause research project.

“ Our PPG works really well because everyone does the bits they enjoy and no one is left with jobs they don’t fancy doing. I feel like we’ve really contributed to our local community and it’s a great opportunity to get to know people in your local area too.”

Maureen Hayes, Merritt Medical Centre PPG member


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Experts by experiencePlanning and commissioning services is a key function of the CCG, and it is essential that we put patients’ views at the centre of these decisions. We do this by working with patients with lived experience of the services under consideration.

Kingston and Richmond musculoskeletal (MSK) working groupWe have an expert by experience on our local musculoskeletal (MSK) working group involved in developing an integrated model of care for Kingston and Richmond. The expert’s involvement has informed a series of information workshops for patients and they also attend the sessions to welcome participants and provide a link between patients and those delivering the sessions.

Kingston and Richmond cancer strategy steering groupOne of the aims of our cancer strategy is improving patient experience and support for families and carers affected by cancer. Our experts by experience have helped shape and inform the local strategy; sense checked a new patient leaflet and other communications materials, provided a patient perspective at meetings across south west London, as well as speaking at PPG sessions. Having people with lived experience of cancer helps us to keep the patient at the centre of our plans.

“I have been involved with Richmond CCG for five years. I am passionate about improving the experience of those affected with cancer whether it be through achieving earlier diagnosis or living with and beyond cancer. My views and contributions are always treated respectfully by both the clinical and commissioning members of the advisory group and I’ve been able to engage with other people affected by cancer in our community to feedback their views and experiences. I am particularly pleased that these experiences, and my own, have had a real influence on the services available to those who have finished their hospital treatment for cancer and been discharged back into the community.”

Bonnie Green, member of our cancer strategy advisory group

Non-emergency patient transport procurement (NEPT) Non-emergency patient transport is for patients who are medically unfit to be transported by conventional means, such as their own car or public transport, to move them between their home to somewhere they need to be to receive medical treatment or assessment, such as a health centre.

During the period, we worked with Richmond CCG, Your Healthcare CIC and Hounslow and Richmond Community Healthcare NHS Trust to procure a new service across both boroughs. We wanted to make sure that the new contract met patients’ needs therefore as part of the tendering process we involved an expert by experience who was also a carer to help us evaluate the bids. The expert helped to draft the questions around patient experience and customer satisfaction and took part in the evaluation of bids.

“ Our expert by experience who worked with us to evaluate the bids was both a service user and a carer and offered us a very helpful user perspective when we were evaluating the bids before, during and at the end of the process.”

Christopher Waters, Contract Manager


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Youth Out Loud! Youth Out Loud! was launched in April 2019 for 13-17 year olds, facilitated by Healthwatch Kingston and Richmond, to improve local health and care services for young people living in both boroughs. It is supported by the CCGs and councils in Kingston and Richmond and Achieving for Children.

The group has already visited Kingston Hospital and will continue to review services and issues that matter to young people. The group will help provide the young people’s voice in our plans for young people over the coming years.

They held a special workshop to discuss our local health and care plan and provided us with invaluable insight into how life is for young people living in the borough and how we should prioritise services on offer to them.


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Our plans for 2019/20Working closer togetherOver the next 12 months we will seek out further opportunities to refine and improve our PPE activities through joint working and sharing best practice with our colleagues in the CCGs across south west London and with our health and care partners within the borough.

Continuous improvementFrom NHS England’s Patient and Community Engagement Indicator 2018/19 assessment, we can see that feedback and evaluation is an area we can improve and this will be a focus for us during the next 12 months. We will continue to support colleagues to understand the role of PPE in commissioning and the importance of evidencing the impact PPE has on the CCG’s work. We will continue to work with senior management and governing body members to support them in their role in seeking assurance and championing PPE in the CCG’s work.

Local health and care plansWe will support the involvement of experts by experience in the programmes of work to achieve our health and care plan priorities. Working with health and care professionals across our local health and care partnership.

Primary care During the summer, we want to build a picture of PPGs in the borough to understand how they are organised, their role in practices and the types of activities they are involved in. This will help us to share good practice and identify what support practices and the newly formed primary care networks (PCNs) may need to support PPGs in the future.

We will work with our primary care team to support our newly formed local PCNs. This could include providing information and advice on how to work not just with their patient populations but also to engage with their local communities to ensure local people can help shape and inform the work of the PCNs.


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Get in touchIf you would like to find out more about the CCG’s patient and public engagement you can contact the PPE team on:

Telephone: 020 3941 9917

Email: [email protected]

Website: www.kingstonccg.nhs.uk

Twitter @KingstonCCG

Facebook www.facebook.com/KingstonNHS

http://www.twitter.com/@NHSRichmondCCG

http://www.facebook.com/RichmondCCG

Kingston Clinical Commissioning Group · Patient and public engagement review 2018/19 2 Foreword Welcome to our review of patient and public engagement (PPE) for the period April

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