Rehabilitation and Recovery Services for Mental Health in Kirklees – Autumn 2018
NHS Greater Huddersfield and North Kirklees CCGs, who buy (commission) healthcare for local people, want to improve local mental health services. The CCGs worked with Kirklees Council to gather views on:
- The type of Rehabilitation and Recovery services, including supported accommodation, people would like to see (this would include looking at the current service based at Enfield Down); and
- What good community services for mental health could look like, including help to keep people well and the type of support that needs to be in place
Currently Enfield Down based in Honley, provides a service for people who have long term complex mental health needs. In addition there are 43 people who are receiving services in accommodation outside the Kirklees area.
People in the community who require rehabilitation services are supported by ‘Community Mental Health teams’. Many of the people supported this way will also have used specialist hospital inpatient facilities.
Engagement took place between August and October 2018 so that local people could tell us what else we need to do to ensure that we can support people in the local community with complex mental health needs.
In total we received 664 responses, 592 were in response to the survey and 72 views were from other methods. We also received 525 equality monitoring forms. You told us about what good accommodation looks like and what works well in the community and what good looks like. You also gave us ideas where we could improve.
The next steps for the CCGs will be to consider all the views and feedback along with the EQIA to inform the development of options on the future arrangements for services. The engagement report will be received and considered by the CCGs and stakeholders. The report will be received through CCGs governance and once considered a decision will be made on the next steps. The findings were shared at the Health and Scrutiny Panel in December 2018.
Wheelchair Services report on pre-consultation engagement – August 2018
The wheelchair services report on pre-consultation engagement work was carried out by Parents of Children with Additional Needs Making a Difference in Kirklees (PCAN) in conjunction with North Kirklees CCG, Greater Huddersfield CCG, Calderdale CCG, Voluntary Action Calderdale, Community Voices in Kirklees, engagement champions in Calderdale, wheelchair users and their families, schools, community groups and professionals across the district.
This next stage of engagement with people who use wheelchair services, including carers, family and staff was to identify what a good wheelchair service could look like. This engagement followed on from previous engagement with service users in Autumn 2017 where people told us that improvements needed to be made to the current service.
The engagement was co-delivered by CCGs and PCAN and included two stakeholder events in May and July 2018. The engagement took place from 11 May – 20 July 2018 and PCAN used all the information gathered to create a report of findings.
People told us the areas of improvement they would expect to see from the service and identified solutions to inform the service specification. People told us:
- They would like the right, good quality equipment, first time
- Equipment that supports independence and consideration of lifestyle and a wider range of equipment
- 24/7 repair service for all that is responsive and includes same day repair service for complex wheelchair users
- Well trained staff and a clear referral process and information about what to expect, when and how
- Complex service users and children and young people who have changing needs over time getting planned reviews regularly and timely re-assessments
- Timely honest communication, including calling people back, and updates on progress
- Accessible communication – type talk, language interpreters (including staff who can speak different languages) and more use of technology
- Regular clinics in other areas and settings and appointment bookings managed in a timely way
- Fast track appointments for urgent needs
- Holistic approach to providing information for people who use a wheelchair – multiagency approach to creating information to support people
- Personal budgets, equipment and advice on buying equipment independently
- Comprehensive training on the use and maintenance of equipment
- Service users employed in the organisation, look at a the role of the voluntary and community sector in providing non clinical services with a clinical partner
- Develop service user led service evaluation, principles and information and robust monitoring of the service involving service users
- Investment in the service to keep people healthy and well
- Look at areas where people can contribute costs – rental equipment, topping up funding and personal budgets
The CCGs have worked together to understand the findings from all the engagement. This included findings from Healthwatch and previous engagement in Autumn 2017.
Using the information provided the CCGs can now work with the current provider to support service improvements and continue to work together to develop a new service specification.
Work to develop a specification will continue in October at a workshop aimed at service users, carers and families. The purpose of the workshop is to help develop and co-design the service specification.
Following the workshop a service specification will be developed.
Extended access in primary care – Autumn 2017
NHS England provided additional funding to CCGs to improve access to GP services. We wanted to find out your views about how an extended GP service might work and the hours of operation. We used a number of approaches to get feedback including an online survey that was promoted via social media and in local newspapers. We also commissioned a number of community and voluntary groups to to engage with local people on our behalf. We received 506 responses from North Kirklees residents.
Most people were supportive of the idea of providing early morning, late evening and weekend appointments. They felt there were a range of benefits, especially for those who work full-time. For routine appointments, Monday to Friday 6.30pm to 8.00pm; Saturday 8.00am – 8.00pm; and Sunday 8.00am to 1.00pm were most popular. People also told us that for urgent appointments they were more willing to travel further and be seen by someone other than their own GP.
We used this feedback to develop a service specification for the GP Extended Access Service and to inform the way we promote opening hours to patients. When developing the new service we took into consideration the following key themes from the engagement:
- A central location
- Disabled Access
- Good car parking facilities
- Public transport access by bus and train
- Access to a pharmacy nearby
- Communications campaign to raise awareness of the evening and weekend appointments and how to book them
Health care in care homes – Autumn 2017
We looked at how the health services that older people receive in care homes could be improved. We used two surveys: one for GP practices and one for care home residents, staff, carers, relatives and the public. We worked closely with Healthwatch Kirklees who visited 12 care homes to talk to residents, carers and staff and encourage the completion of a survey. They also developed an animation to explain proposed changes, which can be viewed here.We received around 250 completed surveys.
There was overwhelming support for the proposal to introduce regular health and wellbeing reviews in care homes. There were mixed views on the use of digital technology (telehealth) and while some could see the potential benefits there was concern as to how it would work in reality. Care home staff liked the idea of having one GP practice per care home as they felt it would improve support, quality and continuity of care. However, some residents recognised this would mean changing their regular GP and had concerns about this approach.
Overall the engagement feedback supported the CCG proposals and provided reassurance around the model. However, the comments helped us to refine and improve our approach in respect of a number of elements. For example, the mixed views relating to the use of telehealth means that we now plan to provide GPs and care home staff with access to clinical records to support them in decision-making when using digital tools. In addition, weekly visits to the care home will now be a key part of the new service and we have further developed the way in which practices will be aligned to homes.
Health optimisation – Spring 2017
North Kirklees and Greater Huddersfield CCGs agreed to scope the introduction of a health optimisation programme that would include new criteria asking patients with a BMI over 30 to lose weight and smokers to quit before undergoing non-urgent elective surgery. To support this engagement work we recruited 13 community and voluntary sector representatives to have conversations within their communities. In addition, a task and finish group was set up and included five lay representatives from a range of voluntary and community organisations. We received responses from 584 people.
Most people we spoke to were supportive of encouraging people to give up smoking or lose weight prior to a routine operation. Although it was felt that these decisions should be made by the consultant on a case by case basis and that people should be provided with realistic weight loss goals. Views on how much time people should be given to achieve these goals ranged from two weeks to 12 months. For smoking this ranged from six weeks to six months.
Initially the CCGs agreed to develop a programme asking people to lose weight/quit smoking before their surgery. However, after further engagement with clinicians and elected representatives, the decision was taken not to progress with the original programme but instead to:
- Review/amend clinical policies to make sure they are in line with NICE guidance in respect of smoking and weight loss
- Ensure that GPs and hospital doctors talk to patients about the risks of smoking and being overweight
- Improve CCG signposting of healthy living information and local support services
- CCG to produce its own guidance leaflets for patients and use key national campaigns during the year to highlight healthy living e.g. Stoptober and Change4Life
Wheelchair services engagement – Spring 2017
The current provider in partnership with NHS North Kirklees, Greater Huddersfield and Calderdale CCGs and Healthwatch engaged with service users. This was as a direct result of a number of issues raised by service users, carers and families. We wrote to all services users who had used the service in the last two years and circulated a survey to key stakeholders.
From the 287 responses received, people told us that there were a number of improvements needed to ensure the current service meets the needs of all service users. For children and young people, carers and families and service users whose needs change over time, timely access, good information and communication were the most reported improvements required. For people who had used the service less frequently the service received more positive feedback.
In conjunction with the service provider, a range of areas for immediate improvement have been identified alongside additional funding to support this work. The CCGs will also use the feedback to help inform the engagement process as we move to develop a new service specification.