Stakeholder Panel

Stakeholder Panel Event 3 Report 25th July 2014

20.08.14

Integrating Care in Eastern Cheshire


20.08.14

Document Control Sheet Document Title

Stakeholder Panel Event 3 Report – 25th July 2014

Status

Draft 1

Author

Louise Booth - Participate

Team Date

30.07.14 Stakeholder Panel Event 3 Appendices

Supporting Documents

Document History Version

Date

Author

Comments

01

30.7.14

Louise Booth

Insight from event on 25.7.14

02

03.08.14

Helen Bidwell

Executive summary

03

05.08.14

Sheena Hobbs

Edit

04

06.08.14

Helen Bidwell

Final Edit

05

20.08.14

Sheena Hobbs

Final Edit


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Contents 1. Introduction

4

1.1 Event agenda

4

1.2 Stakeholder panel role

5

1.3 Attendance at the event

5

1.4 Other engagement

5

2. Executive Summary

6

2.1 Our approach

6

2.2 Pre and post event questionnaires

6

2.3 Challenges to the system

7

2.4 A proactive care model

8

2.5 In conclusion

9

3. Main Findings

10

3.1 Pre and post event questionnaires

11

3.2 Challenges to the system

16

3.3 A proactive care model

21


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1. Introduction The following report sets out the findings from the third Stakeholder Panel event, held on the 25th July 2014 in Macclesfield. 1.1 Event agenda The full event agenda can be found with the appendices and the outline structure is below:  Welcome  Pre-event questionnaire to capture opinions pre deliberation  Introduction to challenges in the system and the ‘Cranfords’  Real-time scenario acting out a day in the life of the ‘Cranfords’  Feedback from participants, captured by visual minutes illustrator  Facilitated group discussions, data captured on ‘targets’ with highest priorities placed at centre and then working out towards the outer ring  Lunch  Introduction to the proposed care model  Real-time scenario acting out a ‘proactive’ day in the life of the ‘Cranfords’, with the care model and feedback applied  Feedback from participants, captured by visual minutes illustrator  Facilitated group discussions, data captured on ‘scenario print-outs’  Next steps presentation  Questions & Answers  Post-event questionnaire to capture opinions post deliberation  Close Integrating Care in Eastern Cheshire

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The insight from the group discussions has been inputted into coding frames and analysed for frequent common themes. Other comments and the feedback have also been coded. 1.2 Stakeholder Panel Role The role of the Stakeholder Panel is as follows:  Deliberate the issues around proposals to feed into the development of the Care Models  Help to develop plans for engagement and consultation methods to ensure that a broad cross section of the public, staff and stakeholders across Eastern Cheshire are reached  Work with the Caring Together programme office to help formulate solutions for improving health and social care services across Eastern Cheshire  To meet at stakeholder events to help achieve the objectives of the Panel and to subsequently review the event reports as being an accurate reflection of the discussions undertaken. 1.3 Attendance at the Event Nearly 70 people registered for the event and 55 participants actually attended, made up of the following representation:       

19 Professionals 13 Service Users/carers 2 Political 10 Partner Organisations 3 Community Group representation 7 Providers 1 Volunteer

In addition, Local MP Mr David Rutley paid a visit to the event. 1.4 Other Engagement It is envisaged that the Panel will meet for the fourth time in the autumn to assist with the implementation of the Care Models. In addition to the Panel, the process of outreach and targeted engagement, for this phase of the programme, will be complete by mid August 2014. The report from this process will also feed into the care model implementation stage. Integrating Care in Eastern Cheshire

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2. Executive Summary A total of fifty-five participants attended the third Stakeholder Panel event held on the 25th July 2014 in Macclesfield. This executive summary highlights key findings from the day’s deliberations. A full set of findings is in Section 3. 2.1 Our approach The days deliberations followed a set agenda, incorporating the use of pre and post event questionnaires, real time scenario’s acting out ‘a day in the life of the Cranfords’, facilitated group discussions, prioritizing, minutes, captured by a visual minutes illustrator and Question and Answer sessions. 2.2 Pre and post event questionnaires  As a result of their attendance, participants were well informed, leaving the event with an enhanced understanding of Caring Together and how they aim to provide care in the future. The majority felt they knew a lot or a great deal (86% of 47 participants post, compared to 44% of 54 participants pre event).  Overall the participants feel that much needs to be done to help and support people so that they can adopt an enhanced self-care approach, with the majority of participants either agreeing or strongly agreeing that people need help and support to look after themselves (93% of 54 participants pre event and 94% of 47 participants post event).  Participants feel that facilities such as A&E would be used less for minor ailments, if people were trained on how to care for themselves. Both pre and post event, the majority of participants either agreed or strongly agreed that people would use A&E less if they were trained on how to better care for themselves (81% of 54 participants pre event and 83% of 47 participants post event).  It was felt that technology is very important but it should not be solely relied upon, especially for older people who may struggle to use it. There was an uplift in agreement that technology is important when people look after themselves if used properly, post event (75% of 47 participants post event compared to 56% of 54 participants pre event).


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 The findings post event infer that overall there was agreement with the approach Caring Together is taking to improve care across Eastern Cheshire (average rating of 8 out of 10, on a scale of 1 -10 where 10 is strongly agree).  The majority of participants came to the event to find out what is happening locally to health and social care services (46% of 54 participants). When all participants were asked if the event had met with their expectations for the day 80% either strongly agreed or agreed (out of 46 participants).

2.3 Challenges to the system A scenario where a family has a stressful day that ended in crisis was acted out. Scene breaks were included where participants fed back challenges to the system. This feedback was captured in visual minutes.  A number of ‘obstacles’ or ‘challenges’ to the system were discussed. The top three priorities identified were: o Information sharing/joined up working o Proactive information, signpost services o Early intervention to avert crisis.  Whilst still deemed important to mention, comments made at the bottom of the spectrum were: o Need care co-ordinator at EVERY GP o Involve community / voluntary services o Regular home visits / care would help.


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2.4 A proactive care model  A scenario showing a typical day where there is a proactive future model of care was acted out. Feedback was captured through visual minutes during scene breaks:

 Participants were asked if there was anything they think should be taken into account when taking Caring Together forward. The top three comments were: o Care co-ordinators need to be adequately trained o Training needed on new systems / processes o Joined up working is essential.  Again, whilst still deemed important to mention, comments made at the bottom of the spectrum were: o Reduce jargon – it can cause anxiety o What is the referral process to care co-ordinator? o Need an effective review process in place.


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2.5 In conclusion In conclusion, the insight contained within this report should be used to further develop and refine the future Model of Care. It is clear that the way in which the care model was explained – by acting out scenarios and through deliberative discussion – increased participants’ level of understanding around Caring Together, what the future model of care could look like and how an individual might interact correctly with this new system. To be successful, the Caring Together team should continue to communicate what the future model might look like, and how citizens and staff in Eastern Cheshire should interact with and access this new, proactive system of care. The Stakeholder Panel should be reconvened to further develop Caring Together and help ensure widespread engagement of staff and service users. It is envisaged that the Panel will meet again in the autumn to assist with the implementation of the Care Models.


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3. Main Findings The main findings from the pre and post event questionnaires, group exercises, feedback converted to Visual Minutes and other comments are outlined on the following pages. The raw data from the activities has been inputted into coding frames so that the frequency of common themes can be drawn out. The raw data is included in the Report Appendices. The main findings contain the following:  Pre and post event questionnaire charts demonstrating a direct comparison in findings before and after deliberation  Visual minutes detailing feedback from participants in relation to the scenarios of care that were acted out, which demonstrated a day without proactive care solutions and a day when a proactive care model has been applied  Group discussion feedback detailing: o Suggestions for solutions and interventions to create a more responsive and proactive system of care that is joined up o Potential obstacles to implementing the proposed model of care and further steps that could be taken  Other comments received through the comments cards. The insight from the activities outlined above is reported on the following pages.


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3.1.

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Pre and Post Event Questionnaires

Participants were asked to answer the following questions at the start of the event before they had deliberated in groups and at the end of the event, once they had discussed how a proactive care model could operate. The aim of the questionnaires is to ascertain if there is any knowledge transfer or shift in opinion as a result of the day’s deliberations. The findings are anonymous and aggregated. Please note, not all participants chose to complete the questionnaires. Of the following statements which one best describes how much you know about the way Caring Together is aiming to provide care in the future? 7%

Options

I know nothing

0%

48%

I know a little

15%

33%

I know a lot

Pre %

60%

Post %

11%

I know a great deal

26% 0%

Number of responses Sample Base: Pre 54 responses and Post 47 responses


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To what extent do you agree or disagree people need help and support to care for themselves across Eastern Cheshire? 6% 4%

Strongly disagree

0% 0%

Options

Disagree

Pre %

2% 2%

Neither agree nor disagree

Post %

37%

Agree

45% 56% 49%

Strongly agree 0% 0%

I don't know

0%

Number of responses

Sample Base: Pre 54 responses and Post 47 responses

Options

To what extent do you agree or disagree that people would use A&E less if they were trained on how to better care for themselves? Strongly disagree

2% 0%

Disagree

2% 0%

Pre % 13% 13%


Post %

Agree

35%

Strongly agree

34%

49% 46%

2% 4%

I don't know 0%

Number of responses

Sample Base: Pre 54 responses and Post 47 responses Integrating Care in Eastern Cheshire

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Options

How important a role do you feel the use of technology has in helping people to look after themselves? I don't know

0% 0%

Should not be used at all

0% 0%

Pre%

2% 0%

Post%

Not important at all

No more important than any other type of support

15%

26% 59%

Important if used properly

72%

13% 13%

Essential on all levels 0%

Number of responses

Sample Base: Pre 54 responses and Post 46 responses Overall, how much do you agree with the approach Caring Together is taking to improve care across Eastern Cheshire?

Average Rating

(1= strongly disagree, 10=strongly agree

7.5 Pre 8.0

1.0

3.0

5.0

7.0

Post

9.0

Average response Sample Base: Pre 51 responses and Post 45 responses Integrating Care in Eastern Cheshire

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And what do you expect to get from today's event?

Nothing

0%

To meet people from the NHS and Council

0%

Options

Pre%

To meet other people and discuss changes to services

30%

To have my say about any proposed changes to services

24%

To find out more about what is happening to health and social care services locally

46%

0%

Number of responses

Sample Base: Pre 54 responses To what extent do you agree or disagree that we have met your expectations for today?

Strongly disagree

4%

Options

Disagree

0%


15%

Agree

50%

Strongly agree

Post %

30%

I don't know

0% 0%

Number of responses

Sample Base: Post 46 responses Integrating Care in Eastern Cheshire

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In summary, the findings from the pre and post event questionnaires infer that:  Post deliberation, the majority of participants’ felt that they knew a lot or a great deal about the way Caring Together is aiming to provide care in the future (86% of 47 participants compared to 44% of 54 participants pre event). This finding infers the participants were well informed as a result of the event and left with an enhanced understanding of Caring Together’s aims  Both pre and post event, the majority of participants either agreed or strongly agreed that people need help and support to look after themselves (93% of 54 participants pre event and 94% of 47 participants post event). This infers that overall the participants feel that much needs to be done to help and support people so that they can adopt an enhanced self-care approach  Again both pre and post event, the majority of participants either agreed or strongly agreed that people would use A&E less if they were trained on how to better care for themselves (81% of 54 participants pre event and 83% of 47 participants post event). This infers that overall the participants feel that facilities such as A&E would be used less for minor ailments, if people were trained on how to care for themselves  In terms of the perceived importance of technology when people look after themselves; there was an uplift in agreement that technology is important if used properly post event (75% of 47 participants post event compared to 56% of 54 participants pre event). This finding reflects feedback from the group discussions, where it was felt that technology is very important but it should not be solely relied upon especially for older people who may struggle to use it  The findings post event infer that overall there was agreement with the approach Caring Together is taking to improve care across Eastern Cheshire (average rating of 8 out of 10, on a scale of 1 -10 where 10 is strongly agree)  The majority of participants came to the event to find out what is happening locally to health and social care services (46% of 54 participants). When all participants were asked if the event had met with their expectations for the day 80% either strongly agreed or agreed (out of 46 participants).


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3.2.

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Challenges to the system

A scenario was acted out where a family has a stressful day that ended in crisis. It demonstrated the following people and situations:  An overburdened carer, with his own health problems and no respite.  An older women with dementia who was not getting the professional support she needed.  A middle aged businessman who was ignoring his diabetes, which led to a diabetic episode which could have been avoided.  A middle aged woman who was being stretched on all sides, which led to her taking her two year old son to A&E as she couldn’t see her GP.  And a GP who was overworked, time poor and unable to easily share information with other professionals. During this scenario, there were scene breaks where the participants fed back and this was captured in the visual minutes below.


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The table below demonstrates the findings from the group discussions, where feedback was placed on targets with the top priorities at the centre and with lower priorities working out towards the outer ring (ring 4).

Caring Together – EXERCISE 1 Where were the Obstacles? Total

Main Themes 1 2 3 4 5 6 7 8 9 10 11 12

Centre

Ring 1

Ring 2

Ring 3

Ring 4

Information sharing/joined up working Proactive information, signpost services Early intervention to avert crisis Need a single point of access/central co-ordinator Preventative education Support, respect & assess carer More use of Telecare would help GPs need to engage, be proactive* Patient centred, empower/holistic approach Need care co-ordinator at EVERY GP Involve community/voluntary services Regular Home visits/care would help

No 22 19 16 14 13 10 10 10 8 8 6 6

% 14% 12% 10% 9% 8% 6% 6% 6% 5% 5% 4% 4%

No 7 1 0 5 3 2 1 3 3 2 1 1

% 21% 3% 0% 15% 9% 6% 3% 9% 9% 6% 3% 3%

No 4 3 7 3 0 3 3 1 1 0 3 0

% 13% 10% 23% 10% 0% 10% 10% 3% 3% 0% 10% 0%

No 2 5 3 4 3 3 1 3 0 1 0 2

% 6% 16% 10% 13% 10% 10% 3% 10% 0% 3% 0% 6%

No 5 7 2 1 5 2 4 1 3 3 0 2

% 14% 19% 5% 3% 14% 5% 11% 3% 8% 8% 0% 5%

No 4 3 4 1 2 0 1 0 1 2 2 1

% 17% 13% 17% 4% 8% 0% 4% 0% 4% 8% 8% 4%

Other

24

15%

7

21%

3

10%

6

19%

5

14%

3

13%

All respondents answering question(multi-coded question)


34

30

31

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37

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EXAMPLES OF COMMENTS 1. Information/Joined Up Working (22 comments)  “Sharing of information – would the ambulance service have info regarding the household they were attending -if not they should have. Maybe a patient passport- make this a requirement for particularly vulnerable.”  “Make sure that information and issues are recorded well so that anyone accessing them will understand and support well.” 2. Proactive information, signposting Services (19 comments)  “Services are out there people need to be aware they are there - publicise something people will read and direct to a HUB or info library.”  “Increase awareness for both professionals and public as to what is available and how!!” 3. Early Intervention to avert Crisis (16 comments)  “Provision and early intervention to be part of the professional training.” 4. Single point of access/Central care co-ordinator (14 comments)  “The central point of contact does not have to be a GP or high level health worker more paid posts should be recruited as "buddies" as a single point of contact for the families.” 5. Preventative Education (13 comments)  “Health education, including caring strategies from school onwards - personal responsibility.” 6. Support, respect & assess carer (10 comments)  “Carer assessment required to enable carer to continue role - support networks.”  “Co-ordinate the availability of doctors within a surgery to give better 7 day care.”


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7. More use of Telecare (10 comments)  “24 hour monitoring centre (exists) - community alarms and telecare sensors (exist).” 8. GPs need to engage/be proactive (8 comments)  “GP's need to watch their workload and ensure they can readily deal with patient calls.”  “They must become involved with their own community and its social aids.”  “Responsibility must be picked up by GPs for problems which need a solution to be found.” 9. Patient centred, empower/holistic approach (8 comments)  “Focus on the individual - led by them ensure they are listened to - concerns are managed.” 10. Need care co-ordinator at every GP (8 comments)  “When phoning a doctors surgery you should be able to be put through to a professional person who can access your records and have time to listen.” 11. Involve Community/voluntary services (6 comments)  “Role of the voluntary organisations providing knowledge and power.” 12. Regular Home visit/care would help (6 comments)  “Care at home in emergency for the cared for must be brought into place - if for instance the carer had a fall or illness.” OTHER COMMENTS  Accountability across caring together both individuals and corporate.  Replicating what’s great in services - get feedback from patients with good experience to see why.  NHS Direct being more helpful to manage the situation with effective results.  Better quality for the disabled - mental health. Integrating Care in Eastern Cheshire

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 A&E needs to be in Knutsford and Congleton to filter more serious cases into the main A&E at Macclesfield or elsewhere.  Support hard working staff professionals and others - to do the work for which they are trained and experienced in. Don't block their reputation and work.  Family Advocate.  Dentist analogy.  No diagnosis needed.  7 day and 24 hour access.  Access to the right level of professionalism.  What if the couple don't want help we cannot do it ourselves.  Jargon!!!  System - once you’re in the system - gets better - minimise time - patient/person into the system.  Talk to people.  Is it a crisis? Clarify - need help to clarify!


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3.3.

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The proactive care model

In the afternoon, a scenario was acted out which demonstrated a proactive model of care proposed by Caring Together. This included the carer and his wife being supported by a dedicated care coordinator, who could access their care plan through a tablet or other hand held device. All professionals involved in their care could also access the plan. Proactive measures were put in place, such as:    

support from the Alzheimer’s Society; visits to a memory clinic and day centre; the installation of a community alarm system linked to watches worn by the couple; undertaking a falls exercise programme.

In addition, the middle aged businessman controlled his diabetes through an app and had attended an education programme. The middle aged woman used a central online hub for advice on how to care for her sick son. Again at scene breaks the participants fed back their thoughts and these were captured in the visual minutes below.


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Scene Summary Scene 4 Scene 1  Edward and Elsie have a review visit  Edward falls but can get into an booked in with their care co-ordinator upright position Scene 3  They have been identified as needing help  He uses his watch to alert the  The care co-ordinator tells Edward and through ‘Risk Stratification’ Community Alarm Team Elsie that they have one care plan,  They have been left a leaflet with  He video calls them through the TV which can be seen by all professionals questions to ask  The doctor assesses him and refers to involved in their care  Liz is aware that they have the review visit his crisis plan  She is reviewing this in real time booked in  An ambulance is called electronically  Elsie has attended a memory clinic  They have been contacted by the Alzheimer’s Society Scene 5 Scene 2  Elsie has also attended a day centre a  The Community Alarm Team call John  Liz is using www.caringtogether.info as few times  He calls the care co-ordinator a hub to find advice  They have a ‘call system’ in their house  She informs them Edward will go to an  She is redirected to NHS Choices with alarm watches that alert the assessment centre  She is given advice to take Bryn to the Community Alarm Team  They will get short term care for Elsie pharmacy  The GP has visited them  Edward will be given information on  John is managing his diabetes through  Edward has attended a Falls Clinic and what happens next an app given an exercise programme  The Falls Team will make a further  John has also attended a diabetes home visit education programme  The care co-ordinator will also visit


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The table below summarises the feedback from the group discussions as per the scene summary on the previous page.

Caring Together – EXERCISE 2 Comments on the Caring Together Care Model Scenario Total

Main Themes 1 =2 =2 =4 =4 =4 =7 =8 9 10 11 =12 =12 14 15

Scene 1

Scene 2

Scene 3

Scene 4

Scene 5

Care co-ordinators need to be adequately trained Training needed on new systems/processes Joined up working is essential Scarce resources need to be used effectively Support needed 24/7 – what is back up plan? IT has a role, but there are many pitfalls Train, support & involve carer & wider family Role of voluntary/community/neighbourhood What happens to patient if carer in hospital? Proactive information, signposting services Local services/home care very important Education & courses helps prevent admissions Reduce jargon – it can cause anxiety What is referral process to care co-ordinator? Need an effective review process in place

No 17 12 12 11 11 11 10 10 9 7 6 4 4 3 2

% 13% 9% 9% 8% 8% 8% 7% 7% 7% 5% 4% 3% 3% 2% 1%

No 4 1 0 3 0 0 3 0 4 3 1 0 1 1 1

% 9% 21% 6% 15% 9% 6% 3% 3% 9% 3% 0% 3% 3% 6% 9%

No 1 3 1 0 0 2 0 2 0 2 0 1 0 2 0

% 8% 23% 8% 0% 0% 15% 0% 15% 0% 15% 0% 8% 0% 15% 0%

No 7 3 10 2 6 3 3 4 1 1 2 1 1 0 1

% 15% 7% 22% 4% 14% 7% 7% 9% 2% 2% 4% 2% 2% 0% 2%

No 2 3 0 3 3 3 2 1 0 0 0 1 2 0 0

% 8% 13% 0% 13% 13% 13% 8% 4% 0% 0% 0% 4% 8% 0% 0%

No 2 2 1 2 0 3 0 2 4 0 2 0 0 0 0

% 9% 9% 5% 9% 0% 14% 0% 9% 18% 0% 9% 0% 0% 0% 0%

Other

11

8%

0

0%

0

0%

2

4%

4

17%

4

18%

All respondents answering question (multi-coded question)


19

13

46

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24

22


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EXAMPLES OF COMMENTS 1. Care co-ordinators need to be adequately trained (17 comments) “Ensure care co-ordinator can signpost:- looking after accident/social - arranging visits/domestic - repair light bulb. Appropriate to needs and check needs are met.” “In reality how quickly can a care co-ordinator react!” 2. Training needed on new systems/processes (12 comments) “When will all pertinent information be given to families/carers? Who will do it? How will they be trained?” “Will the system make allowance for people unwilling/unable to use technology.” 3. Joined up working is essential (12 comments) “Professional territories and differing understanding could be a barrier STILL!” 4. Scarce resources need to be used effectively (11 comments) “Pro-active co-ordination is a wonderful idea if it is financed adequately for the required level of resource.” 5. Support needed 24/7, what is back up plan? (11 comments) “Fall - how will it work to phone the co-ordinator out of hours.” 6. IT has a role, but there are many pitfalls (11 comments) “Need glasses to read the community alarm watch.” “Skyping adds in an extra unnecessary level of complication.” 7. Train, support and involve carer and wider family (10 comments) “From Liz's perspective the GP is stonewalling, she is not getting the support she needs or her mother in law needs. She also has a lack of sleep to add into the equation which will make her less rational and more in need of support. A telephone call can make a big difference” 8. Role of voluntary/community/neighbourhood services (10 comments) “Should there be some system that really vulnerable people living alone, are phoned to see if they are alright? Neighbours to keep an eye!”


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9. What happens to patient if carer in hospital? (9 comments) “What happens to Elsie when Edward is injured wasn't discussed with care coordinator.” 10.Proactive information, signposting services (7 comments) “A to Z guide of community care services should be available again.” 11.Local services/home care very important (6 comments) “We need public day assessments and respite in the local area, so that in an emergency someone already attending local day care can have short term overnight respite in a familiar place with people they know.” 12.Education & Courses help prevent admissions (4 comments) “Training sessions - for candidates – prevention, healthy eating etc.” 13.Reduce jargon – it can cause anxiety (4 comments) “Risk Stratification - change name - Risk Profiling.” 14.What is referral process to care co-ordinator (3 comments) “What about the people not in the top percentage of risk strategy - can a neighbour nominate/raise concerns to the health/social care system” 15.Need an effective review process in place (2 comments) “Care co-ordinator - sequential calendar, next appointment.” OTHER COMMENTS  Will care co-ordinators be available.  Need to have a plan for pets.  Discharge - co-ordination for the care plan.  Care Plan not necessary here in crisis but useful for more general day-to-day consideration with care/health professionals.  Who will look after the cat if they both have to be admitted to hospital?  Re-assisted dying before any legislation is put in place we must have full and adequate accountable safeguards in place and fully working.  From commissioning needs to look at options?  Need a proper system to deliver this and take account of company priorities.  More than just older people living alone - key safe should be fitted in all homes.


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