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

2. 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

3. 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Existing guidance now outdated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)

4. 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.

5. 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

6. 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

7. 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 s
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

8. 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!

9. 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?)

10. 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

11. 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

12. Involvement Hub

13. Involvement Hub Public participation resources produced by NHS England

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

15. Equality & Health Inequalities Hub

16. Person centred care resources

17. Insight
Resources

18. 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

19. 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

20. 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

21. 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.

22. 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!

23. Close Thank you! To follow: Slides Summary of agreed points/actions
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