Statutory guidance – the refresh of ‘Transforming Participation in Health and Care’ Afternoon Workshop 19 January 2017

Transforming Participation workshop agenda 1400 Welcome and table top introductions 1410 Background to refreshing Transforming Participation 1420 Involvement Hub and existing resources 1430 Group discussion 1 – must do’s 1500 Super-fast feedback 1510 Move tables; quick introductions: Group discussion 2 – other issues 1540 Walk round: what’s missing? Any other comments? 1550 Next steps 1600 Close

Why is a ‘refresh’ needed? Existing guidance now outdated - New developments, new resources in place e.g. NHS England patient and public participation policy and arrangements Recognition that CCGs’ legal duties are separate – but linked (patients with high levels of skill, knowledge and confidence to take control of their own health and wellbeing are more likely to participate in engagement activities and vice versa)

CCGs’ legal duties Section 14Z2 – Duty to make arrangements for public involvement and consultation in commissioning – equivalent to NHS England’s Section 13Q duty Section 14U - Duty to promote involvement of each patient and their carers and representatives (if any), in decisions which relate to: (a) the prevention or diagnosis of illness in the patients, or (b) their care or treatment.

Current NHS England CCGs Transforming Participation in Health and Care (Statutory Guidance), Sep 2013 Patient and Public Participation Policy Statement of Arrangements and Guidance for Patient and Public Participation in Commissioning 5 Frameworks for Participation in Direct Commissioning Equalities and Health Inequalities Analysis Involvement Hub Equality and Health Inequalities Hub Insight and Feedback Web Pages Integrated Personal Commissioning Web Pages Person Centred Care Web Pages

High level project plan Jul – Oct 16 Nov 16 Dec 16 Jan 17 Feb 17 Mar 17 Post-Apr 17 Scoping; governance; research user needs Reference group input Communications and engagement Approvals and publication Implementation and assurance Commissioning Cttee – 29 Mar; publication 31 Mar Corporate Exec – 23 Feb

Engagement on the refresh of ‘Transforming Participation’ Relevant insight: Network survey, Involvement Hub scoping, feedback on NHS England policy Olivia Butterworth blog – NHS England website Newsletters/bulletins Targeted e-mails Awareness-raising eg Healthwatch STPs event, CCG Annual Report roadshows Meetings e.g. London CCGs network, Strategic Partners, NAPP, NHS England Patient and Public Participation Oversight Group Webinar - 12 December 2016 Inclusion health workshop to focus on reaching ‘seldom heard’ groups – 20 January 2017

Feedback on Refresh of Transforming Participation in Health and Care Format and style of current document is generally popular Don’t duplicate Need clarity on NHS England’s role in assuring PPP in CCGs How to involve people in difficult decisions Clarity on lay involvement in governance and decision making and requirements around transparency of decision making Don’t lose the Principles of Participation Include something on place based involvement (rather than organisation based) - STPs!

Feedback on Refresh of Transforming Participation in Health and Care Be clear about how it relates to other guidance (eg STP engaging communities guide) Should be clear about how it applies to different levels of commissioning delegation Highlight the benefits of involvement Use case studies (but be clear about themes rather than suggesting that examples are all replicable) Should draw out link between involvement duties and equalities/health inequalities duties Request for clear guidance on how patients and the public should be involved in CCGs (eg PPGs? Patient Reference Group?)

Proposals: what’s going to be kept and what’s new… Not ‘like for like’ replacement but retaining what people have told us is most useful Core sets of statutory guidance simple, short and visually appealing – documents Core guidance supplemented by web-based resources – keeping it live (no major refresh should be required in future) Easy navigation to relevant resources ‘What good looks like’, sharing existing good practice across the system; making it practical and realistic Unambiguous – providing clarity on issues requested e.g. devolution Making the case for participation – messages from influencers; evidence base to persuade senior leaders of the benefits Stronger focus on equality and health inequalities Follow up/evaluation/assurance

Proposed Future NHS England CCGs REVISED Transforming Participation in Health and Care (Statutory Guidance) Equalities and Health Inequalities Analysis Patient and Public Participation Policy (expanded to include NHS England’s internal arrangements) 5 Frameworks for Participation in Direct Commissioning Involvement Hub Equality and Health Inequalities Hub Insight & Feedback Web Pages Integrated Personal Commissioning Web Pages Person Centred Care Web Pages

Involvement Hub

Involvement Hub Public participation resources produced by NHS England

Links to non-NHS England public participation resources Involvement Hub Links to non-NHS England public participation resources

Equality & Health Inequalities Hub

Person centred care resources

Insight Resources

Public involvement guidance – proposed ‘must do’s’ Constitution/arrangements/policy * Minimum of two lay members on the governing body – CCGs; NEDs – NHS England Board CCG Commissioning plans / NHS England business plan * Annual reporting on participation – follow existing guidance – including measuring/evaluating impact * Ensure that involvement in commissioning decisions is ‘fair and proportionate’ * Robust assessment and assurance processes Use existing insight, including feedback from staff as users of NHS services and members of communities, to inform participation approaches

Public involvement guidance – proposed ‘must do’s’ Enable people to easily access key involvement information. This should be through a range of mechanisms including the organisation’s website: Involvement opportunities, including formal roles and consultations Links to Healthwatch and other relevant organisations Making complaints Information on population health needs and health inequalities – and how these are being addressed Demonstrably value involvement e.g. through payment Provide information and training to staff to effectively engage with patients and the public Hold providers to account on patient and public involvement Prioritise involvement by those who experience the greatest health needs and who are ‘seldom heard’ – using appropriate routes, including through voluntary and community sector partners

Individual involvement guidance – proposed ‘must do’s’ Identifying the people who need most support to manage their own wellbeing (PAM) Every person with a LTC should be offered a personalised care & support plan (PCSP) Shared decision-making Services are commissioned in a way that support patients’ right to make choices Personal Health Budgets (PHB) for people with LTCs Integrated Personalised Commissioning (IPC) as part of the core service offer People with learning disabilities should be offered an annual health check and accessible, personalised care plan Patients with communications needs should have those needs identified and met (Accessible Information Standard) Social prescribing as part of the core service offer Commissioning of appropriate patient education resources e.g. Expert Patient Programme

Using insight – proposed ‘must do’s’ Be aware of the information about services that is available through national surveys and feedback mechanisms; Use it to identify priorities and inform commissioning decisions during service reviews and changes; Follow good practice on when and how to commission local insight to supplement this information; Be aware of the limitations of each insight tool and, ideally, use them in combination; Use insight techniques to identify areas where mainstream services do not meet the needs of people with particular characteristics or conditions, taking action to address health inequalities.

Questions/issues 1. Language and framing: 1. Must do vs should do 2. Person Centred Care vs Individual Participation 3. ‘Transforming’ 4. ‘Participation’ vs ‘Involvement’ 2. Guidance only goes so far… what other levers/actions are required to bring about change? 3. Assurance: how will we know this guidance has had an impact? Existing mechanisms: CCG Improvement & Assessment Framework, OSCs, major service reconfiguration scrutiny by NHS England and DH. What more is needed? 4. Making the case for participation – securing buy-in from leaders. Where is the best practice/evidence – case studies, research, etc? 5. Resources gaps and who is best placed to fill them 6. Equality and health inequalities: what are the enablers to participation for all (public and individual) 7. Other – open discussion; you decide!

Close Thank you! To follow: Slides Summary of agreed points/actions Please contact us: england.nhs.participation@nhs.net Tel: 0113 - 825 0861 Thank you!