Emma Taylor, senior communications officer, NECS Path to Excellence Transformation Programme – Championing the public during major service change Emma Taylor, senior communications officer, NECS The Path to Excellence NHS equalities legal and policy context for significant service changes relevant to public consultation and engagement Identified groups Equality duties compliance and specific engagement carried out How learning is being used in the next phase

Empowering patients and communities New Care Models: Empowering patients and communities Source: national voices

Case study: Path to excellence NHS public consultation Fifth principle: Voluntary, community, social enterprise and housing as key partners and enablers

The Path to Excellence A five-year transformation of healthcare provision across South Tyneside and Sunderland To secure the future of local NHS services and to identify new and innovative ways of delivering high quality, joined up, sustainable care that will benefit our population both now and in the future The four NHS organisations involved in the partnership are South Tyneside NHS Foundation Trust , City Hospitals Sunderland NHS Foundation Trust , NHS South Tyneside Clinical Commissioning Group , NHS Sunderland Clinical Commissioning Group Called ‘The Path to Excellence’, the public consultation was launched on Wednesday 5 July and ran for 14 and a half weeks until Sunday 15 October Skim over - this overview in presentation

To effectively engage the local population, partners and other stakeholders To give the local population, partners and stakeholders the opportunity to consider and comment on the scenarios for new models of acute care services To use the comments and feedback from the local population, partners and stakeholders to inform consideration by the CCGs and providers on the needs of the population To inform CCG commissioning responsibilities in relation to the services under review and inform providers in the delivery of those services To ensure that the consultation is accessible to local people, patients, partners and key stakeholders, that they are aware of the survey and events and have the opportunity to participate fully, should the wish to do so

Consultation activity Resident street survey 805 interviews Online and paper based consultation survey 496 responses Direct mail patient survey (across three service areas) 324 responses Focus groups 32 groups, 324* participants Public, staff and stakeholder events 19 events, 451** participants Staff Q&A events 12 groups, 174 participants Phone, letter, email submissions 57 submissions Travel and Transport discussion group 1 event, 53 participants Quantitative (Survey) Based Statistical analysis – SPSS Street – statistically representative Online and patient – important views, participative democracy Direct patient – representative views Qualitative (Discussion) Based Fully read and analysed by the team ‘Coded’ into themes Key sentiments * 144 / **141 completed monitoring forms Communications group recommended an integrated mixed methodology of qualitative and quantitative techniques: Public events – launch, formal public discussion and subject specific deliberative events including travel and transport (19 events, 443 attendees) Surveys, focus groups and submissions Consultation survey – on-line and paper – self selecting (496) Residents on street survey – shorter and demographically robust sample of opinion (805) Focus groups targeting equality and protected groups (32 groups, 324 participants) Direct mailings targeting lived experiences of services (141 maternity returns, 81 stroke and 102 for children and young people services) Submissions received from groups, teams and individuals (57) Supported by communications and marketing activity, website, publication scheme, media and social media etc.

Compliance with Equality Act and Public Sector Equality Duty The NHS has a duty to meet its public sector equality duty, as defined by S.149 of the Equality Act 2010   The Equality Act 2010 applies to all organisations that provide a service to the public or a section of the public (service providers). It also applies to anyone who sells goods or provides facilities. It applies to all our services, whether or not a charge is made for them.

Equality Act protects people from discrimination on the basis of a ‘protected characteristic’ disability gender reassignment pregnancy and maternity race religion or belief sex, and sexual orientation marriage and civil partnership (named purposely in the equality act 2010 -linked to the now retired sex discrimination act where people were protected on their marital status) age (under the Equality Act from April 2012 until then The Employment Equality (Age) Regulations 2006 still applied)

Review of compliance with Equality Act Integrated impact assessments (IIAs) were conducted in relation to the future options for each of the three acute services IIAs identified groups which could be vulnerable to the proposals and the aspects of the services which could reduce or deepen health inequalities Appropriate engagement with identified groups who work with people who may face barriers to taking part in this consultation, providing a meaningful opportunity for people who may be more impacted by any potential change to consider and feedback on the various issues and proposed changes As part of NHS Assurance process Worked with Dr Jackie Gray – very comprehensive IIA -

The IIA showed that the proposed changes could have a disproportionate impact on adults resident in South Tyneside and specific vulnerable groups summarised in the table below: Stroke Maternity & Gynae Paediatrics Over 65s “Fertile” groups  - men and women working age Parents and child carers  - men and women working age BME groups- over 50s BME groups  - expectant mothers / new mothers  and partners BME families / parents with young children Disability groups and their carers – over 50s (emotional / mental illness / physical / hearing and sight impairment / speech / cognitive / learning) Expectant women / new mothers and their partners with disabilities (emotional / mental illness / physical / hearing and sight impairment / speech / cognitive / learning) Children, carers and families affected by disabilities (emotional / mental illness / physical / hearing and sight impairment / speech / cognitive / learning) Socio-economically deprived groups  - over 50s Expectant women / new mothers and partners in socio-economically deprived groups Children, Carers, and parents suffering socioeconomic hardship – including children in care   Teenage mothers  - 13-19 year olds Young people – 11-18 year olds All adults Expectant women / new mothers and their partners with problems relating to drug and alcohol misuse  Children,  carers and families affected by substance or alcohol misuse To validate perceived impacts from the IIAs, people from these groups have been engaged and asked about their perception of how any changes to services might have an impact on them, whether this is positive or negative.

Activity to engage with identified groups An asset based approach engaging with third sector and interest groups in South Tyneside and Sunderland who support people who may face barriers to taking part in the consultation. This offer included:  Online and telephone support on how to run an effective focus group with stakeholders/service users, plus later additional facilitated sessions by the partnership Free Webinar online training session, including practical tips on how to run an effective focus group Focus group toolkit – discussion guide and tools, includes Easy Read versions Payment of £100 plus reasonable event expenses Requirements: Provide a short output report of each focus group feedback Request data monitoring information from participants and provide that data back Where groups indicated an interest to be involved and did not have the capacity to deliver a session with service users, these were facilitated by the partnership with the support of the third sector organisations. Those groups which were unable to deliver a focus group due to no uptake, challenges bringing service users together or concerns about consultation fatigue, distributed surveys to clients and staff and/or sent in an organisational response to the consultation.

Activity to engage with identified groups Mapping activity: cross-checking groups with those highlighted in IIAs ensured that any gaps could be identified and additional work carried out to engage and consult or seek an organisational response Feedback and dialogue captured, analysed and included in the final feedback report Equalities data monitoring of the key characteristics of participants to ensure we were hearing from key groups in alignment with IIA ( not mandatory for people to complete and return this information after taking part in a focus group) Ensures that the NHS meets its equality duties as well as its statutory duties to involve and consult   and this lead to the programme team responding to further interest as well as undertaking additional work to contact and encourage groups to take part and run focus group sessions or send an organisational response to the consultation. NECS staff delivering sessions

Review of activity to engage with identified groups Over 80 groups in South Tyneside and Sunderland invited to run focus groups 32 focus groups, events or one to one work with service users 20 local organisations delivered focus groups involving (but not limited to): BME women, mothers and refugee and asylum seekers, ESL people who are deaf or with hearing impairment people who are visually impaired/Blind/sight loss or partially sighted young people, including young carers and teenagers accessing mental health services older people, older people with a disability, family, carers socio-economically deprived groups – and food banks people with a disability including people with a learning disability and their carers mothers including new mothers and mothers with children under two years 324 people shared their views / 144 monitoring forms and this lead to the programme team responding to further interest as well as undertaking additional work to contact and encourage groups to take part and run focus group sessions or send an organisational response to the consultation. Published on 5th December for period of consideration until 8th January Two public events Two staff events Promotional activity Provided an opportunity in-line with best practice for ‘sense check’ of what was heard during the consultation process.

We would like to thank community and voluntary group partners for their very important work reaching into those communities

Key learning from phase one Working with partner organisations in the third sector has been a positive experience A commitment to continue to build upon the relationships that have been established In early 2018 a review of the equality engagement activity and processes to inform an updated equality delivery strategy for the programme and to underpin the updated communications and engagement strategy for the next phase During informal discussions with third sector partners this was welcomed and early developments included: Support from Sunderland People First (learning disability) to develop a protocol for easy read documentation Inclusion of HealthNet (CVS umbrella organisations) in a new Stakeholder Advisory Panel Key learning from phase one includes: nextresponse to feedback that the third sector feel the NHS only engages with them in order to ‘tick a box’. Start to engage as early as possible Be flexible and build relationships - genuine engagement takes time and effort Pick up the phone – talking with people helps to maximise involvement Partnership with TCI Co-production – what do we mean? Designing services in partnership to meet needs Be clear about academic evidence base and

Questions and feedback 1.What did you think was positive about the case study (reaching people with protected characteristics?) 2. What could you suggest the NHS did differently in the future? 3. What other ways can you suggest the NHS reaches specific groups and in particular those with protected characteristics? 4. How can we encourage people to get involved and fill out equality monitoring? Key learning from phase one includes: nextresponse to feedback that the third sector feel the NHS only engages with them in order to ‘tick a box’. Start to engage as early as possible Be flexible and build relationships - genuine engagement takes time and effort Pick up the phone – talking with people helps to maximise involvement Partnership with TCI Co-production – what do we mean? Designing services in partnership to meet needs Be clear about academic evidence base and

Thank you