Elizabeth Manero, Director

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EFFECTIVE, INCLUSIVE,STAKEHOLDER ENGAGEMENT IN
DEVELOPING POLYCLINICS

• Elizabeth Manero, Director
• Health Link

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Background to Health Link

• Not for profit social enterprise
• Set up Jan. 2004
• Strengthening public influence on health through
  PPI
• Involving public in
• Patients Choice
• Choose Book
• Health libraries
• Mental health in libraries
• Health Homelessness

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Three New Drivers

• Revised Legislation
• Our NHS Our Future (Darzi)
• Stubborn Health Inequalities

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1. REVISED LEGISLATION

• The Involvement Duty
• S. 242 involvement of patients and public (by
  consultation/information/otherwise) in
• (a) Planning service provision
• (b) Developing considering
• service change proposals
• (c) Decisions affecting
• service operation

• Only if Impact on
• Manner of Delivery
• or
• Range of services

S.242 Health Act 2006 as am.
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The Consultation Duty

• Duty to undertake public consultation on major
  change proposals with relevant local authority
  Overview Scrutiny Committees
• OSCs right to refer S of S
• proposals not in the interest of the health
  service in the area or
• consultations of inadequate length/content of
• S of S may seek advice from Independent
  Reconfiguration Panel
• S of S can make decision or order more
  consultation

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2. OUR NHS OUR FUTURE

• Stakeholder engagement redefined

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• Patients

Politicians
Clinicians
Managers
BEFORE
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PATIENTS
POLITICIANS
SOLUTIONS
CLINICIANS
MANAGERS
AFTER
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3. WORSENING HEALTH INEQUALITIES

• Black African women including refugees asylum
  seekers are 7 times more likely to die in
  childbirth than White women
• People with Mental Health problems are more than
  twice as likely to get strokes and coronary heart
  disease before 55 and less likely to survive 5
  years
• Sorting out services for most people first and
  making them fit marginalised groups after, does
  not work
• Inequalities in involvement exacerbate
  inequalities in health

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A Case Study

• Health Links outreach consultation with
  traditionally under represented groups on
  Healthcare for London for the London PCTs
• Contacted 36 groups across 18 boroughs
• Met 317 people
• Explained the elements of the Framework
• Invited views and ideas
• Invited views on the process

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The Objectives

• To seek the views of traditionally under
  represented groups at risk of health
  inequalities, on the change plans for London,
  including polyclinics.
• To test out the assumption that they might be
  disadvantaged by the proposals if not implemented
  with regard to health inequalities
• To engage them so that they would have faith in
  the process and be willing to engage in the
  future

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The Process

• Developed list of target groups
• Made contact with relevant organisations
• Procured 36 meetings over 12 weeks
• Used a range of accessible materials
• Paid goodwill payment of 200 to each group
• Obtained their feedback on the process
• Fed back our record of input to groups
• Produced Framework of Needs from input

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Identifying Finding Target Groups

• Consider statutory equality groups
• e.g. disability, gender (inc reassigned) race,
  religion/belief, sexual orientation,
• Use National criteria
• e.g. older people
• Use Local criteria
• e.g. local BME communities
• Map your local Community Connections
• e.g. religion or belief groups

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284 identified themselves as..

• 13 Offenders
• 82 Older People
• 16 Frail living alone
• 41 Physical disability
• 7 Prisoners
• 10 Refugee/asylum sks
• 177Religion/belief
• 30 Care Home residents
• 18 Sensory impaired
• 11 Travellers
• 168Women
• 19 Young People

• 46 Alcohol/drug dep.
• 121 BME
• 17 Carers
• 19 Children
• 8 Children special needs
• 23 Dementia
• 14 HIV Positive
• 11 Homeless
• 11 Hospice patients
• 30 Learning disability
• 92 Long Term Conditions
• 32 Mental Health (in/out)

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The Outcome -Content

• Active detailed feedback
• As many questions as answers
• Clear needs emerged
• Assumption about disadvantage borne out
• Many comments on quality of care
• Framework of Needs produced

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Summary Outcome on Polyclinics

• In favour because Better access more
  accountable GPs
• In opposition because Possible loss of access to
  own GP or greater travel time
• Reservations because Doubts about transport,
  location in practice funding
• GPs and Polyclinics all should at least be
  networked to one
• Patients should decide, not GPs.

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I think the idea is wonderful but we are losing
sight of the rapport that we have built up with
our GPs.
My GP is at the end of the road. I cant walk
far would not want to take a taxi.
POLYCLINICS
What about elderly disabled who are not able
to get there? They would prefer to stay with
their local clinic.
It would be easy to go there like a big Blue
Water
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The Outcome - Process

• 187 written evaluation forms completed
• 95 willing to be engaged in the future
• 98 found the meeting objective clear
• 88 felt given enough information
• 90 found easy to participate

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Key Success Factors

• Use intermediaries
• Pay organisations for their time
• Go to participants
• No presentations -conversation not dissertation
• Written materials in Plain English
• Ethical considerations
• Let them set the agenda too
• No input is irrelevant
• Quick record of their input for verification
• Keep in touch to show their influence

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Pitfalls

• Complexity break into bearable chunks
• Lack of time minimum 2 hours
• Disagreement record all views
• Disinterest make it real with personalised
  examples
• Expectations raised not met - get high level
  commitment first and convert input to NHS speak

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The Darzi Pledges

• Change will always be to patients benefit
• Change will be clinically driven
• All change will be locally-led
• You will be involved
• You will see the difference first

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Polyclinics the Pledges

• Patients Benefit what cannot be proved in
  advance must be monitored after.
• Clinically driven - Patients at the same table
  with clinicians, inc. GPs as clinicians not
  business men.
• Locally-led timely, socially inclusive
  process involving all local community
• Involved - patients must be involved in
  design/monitoring as experts by experience
• See the difference first good, inclusive
  communication on transition.

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Its all about knowledge....

• The knowledge on which decisions are taken
  already determines the rules direction of
  decisions.
• Knowledge is not neutral but reflects the values
  of those who have control of production of
  knowledge.
• Authentic participation therefore demands early
  involvement in setting the questions developing
  the answers to inform how decisions are
  formulated.'
• Involving deprived communities in improving the
  quality of primary care services does
  participatory action research work? Cawston et al
  BMC HSR 2007