A Healthwatch “take” on the 6 April Health and Wellbeing Board

For a useful summary of all the papers that came to the Board and to see the context for these Healthwatch Nottinghamshire questions, please see: www.nottinghamshire.gov.uk/media/112734/mar-2-2016.pdf

This was my last Health and Wellbeing Board before standing down as Chair of Healthwatch Nottinghamshire on April 29^th. Healthwatch must be making a positive contribution to the discussions and decisions that the Board are making because, at the end, there was a spontaneous round of applause. Something is working.

Bassetlaw CCG 5 year plan.

Healthwatch question on prevention: If Bassetlaw’s new models of care in the future are to focus on multi functioning primary care GP centres and integrated neighbourhood community nursing teams, will there be opportunities for them to commission from their budgets local voluntary and community sector preventative services for older and vulnerable people? This is important as voluntary and community sector groups are telling Healthwatch that they are finding it increasingly difficult to fund their preventative work.

Response:  The Chief Officer for the CCG, Phil Mettam, thought that there would be such opportunities.  He gave as an example the current GP commissioning of “social prescriptions” (e.g buying practical help and social support to older people from voluntary bodies) in Bassetlaw.

Update on Sherwood Forest Hospitals Trust merger with NUH

Healthwatch question on risks: Our health experts on the Healthwatch Board say that the national evidence on large hospital trust mergers is equivocal about their success. Some mergers work and improve the situation; but some don’t. The risk is that senior management can get distracted from quality of health care improvement by the shear complexity and time- consuming business of bringing together the many services and organisational cultures involved.

Response:  The two Chief Executives, Peter Herring and Peter Homa, responded by saying that they had also done a great deal of research into Hospital Trust mergers, successful or otherwise. They intend to follow the best practice of successful mergers, to avoid the kinds of risks I cited.  They referred to the earlier successful merger of QMC and City Hospitals in 2006 as a good example of what can be achieved.

Strategic public health framework for Nottinghamshire Healthcare NHS Trust

Healthwatch question on gaps in provision: Are there gaps in provision from the Trust in the provision of mental well-being services for young people before they become so serious that they actually need the help of Children and Adolescent Mental Health Services (CAMHS) or cognitive behaviour therapy as provided by the Trust?

This area of preventative mental well-being has been one of the seven agreed priority actions for the Health and Wellbeing Board. It has also been one of the areas that young people have raised with Healthwatch Nottinghamshire over the last two years.

Response:  Professor Chris Packham, Associate Medical Director at the Trust, in response agreed that there are gaps of service provision in this area, both within the services provided by the Trust and within other public agencies.

We were reminded by the Director of Public Health, Dr Chris Kenny, about the new Nottinghamshire Children and Young People’s Mental Health and Wellbeing Transformation Plan. This had been discussed and supported by the Health and Wellbeing Board in December 2015.

It places a focus on promoting (mental health) resilience, prevention and early intervention for children and young people. One of the examples in the plan is taking what it calls a “whole school and college approach” to promoting emotional health amongst young people. This is something that children and young people tell Healthwatch they would keenly support.

A Healthwatch “Take” on the Health and Wellbeing Board meeting, 3 Feb 2016

For a useful summary of all the papers coming to the Health and Wellbeing Board (HWB) please go to the following link:  http://www.nottinghamshire.gov.uk/media/111920/feb-3-2016.pdf

A pre-meeting of the HWB had been agreed at the previous meeting in December. The issue was whether the Board should give a response to the NCCs budget reduction proposals. This was particularly relevant in the light of the possible social services budget reductions. There was debate between County Councillors as to whether the Board could give such a view. The County Council’s legal advice was that, as the HWB was a Council committee, it would not be possible to give a collective view. However individual organisations on the Board would be able to do so. Both Nottingham North and East CCG and Healthwatch Nottinghamshire had already submitted their views on the negative implications of more social services budget reductions.

Healthwatch made the concluding point that it would be detrimental if this apparent legal and constitutional limitation on HWB powers meant that that it would not be able to make recommendations on future, perhaps controversial, decisions concerning health and social care funding and planning.

Update on Progress by Healthwatch Nottinghamshire

Our update report received a good response. Positive comments were made on the work over the last year on the renal patients experience on the transport service and our choice of optician services for the Question of the Month. Two of the GP members expressed concerns about the statistical validity of some of our findings on the quality of GP services in terms of numbers of responses. A useful suggestion was made that Healthwatch could also use the findings from GPs’ and other survey feedback. This we will take on. We need to remember, however, that the experiences that Healthwatch gathers from patients is primarily qualitative rather than quantitative in nature.

Mental Health Crisis Concordat

This concordat across Nottinghamshire’s agencies concerned with mental health services has reduced the urgency of Healthwatch looking further into local crisis services. At least for the moment. Yesterday’s (15 Feb) announcement of the government’s response to the major report on inadequacies in England’s mental health services, I think, reinforces the position we have taken.

Key questions from Healthwatch were:

1. Did the new 111 mental health pilot service described in the Concordat require people phoning in for help to be already known to mental health services. If this were the case, it wouldn’t help large numbers of people in distress.

Answer: The pilot 111 line will take calls from all people. This is good news.

• One of the risks that the paper identifies is the current demand on psychiatric beds, issues around hospital discharges, and having to use beds outside of Nottinghamshire. What is happening to address this?

Answer: Nottinghamshire NHS Healthcare Trust is currently undertaking an audit on delayed discharge, bed capacity and the use of out of county psychiatric beds.

Tackling Winter Pressures in our Hospitals

Nine out of ten patients are seen and treated in A & E within the four hour national target. This is apparently a higher standard than in any other major western nation. This is the positive backdrop to the serious problem of hospitals struggling every year to meet winter demand from patients. This is a problem that increases year on year and, last year, was the worst ever.

What triggers the problem is winter’s cold conditions and flu bugs, particularly on our growing population of over 75 year olds. They are most at risk of developing respiratory and related conditions. Between December and February the huge volume of admission numbers means many hospitals simply run out of available beds.

As a result patients wait on trolleys in hospital corridors or in ambulances for a bed to become available, and in other hospital departments planned operations have to be postponed. The worst such situations are called “major incidents” where patients are moved to neighbouring hospitals and others are discharged early to free up beds. Last winter about 20 of England’s 160 acute trusts declared such “major incidents”.

What’s to be done? The problem appears in A &E but the solutions lie in the wider health and social care system. The way the NHS funds hospitals does not help. Hospitals are paid according to how many patients they see and treat, not how many patients they and community services prevent from being admitted in the first place. This perverse incentive is made worse by downward funding pressures on hospitals with the result that 90% of NHS Trust hospitals are now predicting budget deficits.

To reduce demand there has to be to be a sea change in the way that health and social care services are organised in the community – between GP and primary care services, hospital services, NHS 111 and the ambulance service. In addition all of us, and by that I mean family members together with health and social care services, voluntary and charitable groups, need to help prevent unnecessary emergency hospital admissions.  We can do this by getting smarter and earlier at recognising and responding to the needs of elderly frail people. At the other end of the problem – the bed capacity of hospitals – there needs to be better management of staffing resources, care and beds.  We need improved hospital discharge practice with social care and the voluntary sector with a view to freeing up beds and reducing urgent readmissions.

A Healthwatch “Take” on the Health and Wellbeing Meeting of 3 June 2015

There is a good summary of all the papers coming to this Board that can be found at the following link:
http://www.healthwatchnottinghamshire.co.uk/?p=2646

The Health and Wellbeing Board (HWB) is a large meeting with an average of 23 members attending, often 7 or so staff attending to give papers, a number of visitors – because it’s open to the public, and sometimes the press attend. In this case the Evening Post journalist did actually pick up on one of the Board papers on the poor record in Nottinghamshire on women breastfeeding.  It was featured in a good article in the Post the following day.

But today there was generally a bit more of a buzz in the air at the Board. Perhaps it was a bit of post peer challenge Summer feel creeping in?

Most of the papers were concerned with children and young people’s health.  This demonstrates that it’s not just adult and older people’s health and social care matters that come to the HWB!

Huge changes are afoot in the way children’s health services are organised. I’m sure that most people are not aware that health visiting, school nursing and family nurses are moving across, or have already moved, to Public Health that now sits in the Local Authorities across England. So health visiting and all that goes with it (now known as the “Healthy Child Programme”) now sits locally with the Nottinghamshire County Council or Nottingham City Council. They’re no longer managed or funded within the NHS.

Two items really stood out at this Board meeting. Cllr Henry Wheeler of Gedling Council described how Gedling had become the first Council in the County to become “breastfeeding friendly” with all staff trained and all buildings having places for women to breastfeed. The council has also encouraged dozens of businesses like Asda and Sainsbury’s and local cafes to sign up to the scheme. Nottinghamshire lags behind the rest of the country with only 68% of women breastfeeding their babies.

The second item was a great bit of work, close to Healthwatch’s heart, initiated by Public Health on “How Young People Friendly Are Our health Services?” – Nottinghamshire Mystery Shopper report. Public Health had recruited 20 young people aged 14-19 in 2014 to visit GP Practices, Contraception services, and Pharmacies to assess for their youth friendliness on information, responsiveness and accessibility, but not treatment as such. A host of recommendations has come out of this mystery shopper exercise.  The Board was impressed with the work and supported the recommendations.

Becky Whittaker, Healthwatch Nottinghamshire’s Children and Young people worker, will be liaising closely with the young people involved and the Young People’s Health Steering Group that will be taking this work forward.

Healthwatch made the following points across all the papers presented:

• We supported the children and young people mystery shopper exercise and the recommendations coming out of it.
• On the role of the Public health Committee we asked for clarification about what issues came to the HWB and what to the Public Health Committee to ensure there’s no duplication or confusion between the two.
• Regarding the report on how the Better Care Fund (BCF) for Nottinghamshire (£59 million) was progressing, we asked what the relationship was between new integrated schemes for older people funded by the BCF and similar such schemes funded by other sources of money (eg CCG or LA). i.e how joined up is the planning for such services?
• Given that three streams of community health services for children and young people are being integrated under the Integrated Commissioning Hub ( which is not a well-known body to people outside the system, but clearly an increasingly important commissioning body) we asked how the Hub was managed and how it was quality assured.
• In the Chair’s report there was mention of the Department of Health £55 million fund for housing initiatives for homeless people. We suggested that, given Nottinghamshire had cut Supporting People funding to direct access homelessness hostels across the County last year, and that this had been a HWB issue, this was an opportunity to attract additional funding in.

More to do on NHS and Social Care Complaints

One of the most powerful yet challenging ways to improve the quality of health and social care services is for the public to be able to feedback when the service is going well and when it is not.

Here’s a recent example of this in action where a complaint contributed to an improvement.  Healthwatch Nottinghamshire received a couple of comments from patients who were unhappy with the delay in making GP appointments and with the booking system. In response to this, and other feedback the practice had received, the practice extended the online service to enable cancellation of appointments and to order repeat prescriptions.

It’s not always so positive. Services responding to complaints may get defensive or sometimes focus down too much on the individual concerned. They then risk missing the feedback on how the wider health and social care system might be improved.

According to a recent Parliamentary report from the Health Committee, there’s not enough of this sort of learning from complaints happening in the NHS.  It recommended that the NHS moves “to a culture which welcomes complaints as a way of improving services”.

The problem that’s been identified by almost everybody who looks into this, is that services very easily become defensive when a complaint is made.  It’s then difficult for the service to listen to, and then learn from, the complaint. It becomes a vicious circle, with service users then feeling vulnerable and not able to complain. The word itself, “complaint”, has a negative ring to it.  Perhaps another phrase is needed.

Healthwatch England’s survey on complaints in health and social care services draws two conclusions: either the whole complaints system in England should be restructured, or the current system requires much improvement.

Going down the improvement route, it recommends that it should be made easier to complain for the patient or service user and also for the “worried bystander” as well. Advice and advocacy help should be more readily available.  Staff should encourage feedback, and respond positively when they get it.  The response to complaints should be compassionate and timely, acknowledging the person’s experience, outlining the next steps and, where appropriate, giving an apology.  Complaints can be stressful for staff too and they also need supporting.

Concerns and complaints are an important source of information for improving services. They should not be wasted.

Prevention is better than cure – that is, when it’s available

87 year old Ben is living alone and he’s beginning to let things go. He needs help with his housework, the garden is growing wild and there’s little sign of safety or security about the house. There’s no family nearby, the neighbours are not very neighbourly and he’s not eligible for social care help yet because he can manage his own personal care.
But then Ben has a bad fall. From having no services at all from the State, suddenly Ben is pitched into high cost hospital admission followed by intensive social and health care support at home.

“Prevention is better than cure”. What this would mean for Ben is that if he’d had that little bit of help “upstream” the need for high dependency, and costly, help “downstream” might never have happened.

Last year’s NHS England report, “A Call to Action” agrees.  It says that the NHS must place greater emphasis on keeping people healthy and in “preventing rather than treating illness”. The government is saying the same about social care.  The 2014 Care Act includes a new prevention duty for local authorities.

This is looking optimistic for thousands of people who are in Ben’s situation, but how realistic is it? Across the country grant aid to voluntary groups, for example, to help with housework, befriending, keeping the garden orderly and making the house safer, is under pressure. These service do cost some money, though miniscule amounts as compared to “downstream” health and social care.  It seems likely that this bit of the Care Act may remain as well-intentioned but ultimately hot air.

One alternative scenario to this bleak picture of insufficient funding is in the development of self-help and self-care. Examples of this would be Ben helped to learn how to lead a more healthy lifestyle, or relatives or neighbours popping in to prevent him neglecting himself. This is all well and good if you actually have any family living nearby, or if you have the financial means or strength of mind to take some control of your life. But people like Ben are not so fortunate.

In the absence of any new government money coming in to Ben’s world, another route we might follow lies in encouraging people to take on more active roles in their neighbourhoods as volunteers. Sometimes called “the Big Society”, this looks like a good idea.

But the question Ben’s neighbours ask is, why them? What they see is the voluntary sector struggling to maintain such services whilst the bigger picture is one of growing inequality. This can undermine the motivation to be helpful to others and, without that motivation, the “Big Society” idea will continue to struggle to get off the ground. With Britain’s top executives now being paid 130 times as much as their average employee the Big Society solution right now feels like a non-starter. I fear we will continue to be pulling people like Ben out of the river “downstream”.

Why Transformation Matters: One Patient’s Experience

A recent Patient Opinion entry from a woman in Nottinghamshire gives us a good, if painful, indicator of where there needs to be system changes across health and social care (sometimes called “whole system change” in the jargon). The entry is titled “Patients needs not being met and very poor experience”, I advise that you view it before you read any further.

The daughter’s experience was one of a seemingly never-ending series of things going wrong in the care of her mother with dementia.  It deserves an analysis of what would have to change in the future to achieve a better service.

At a local level what’s called “whole system change” in the NHS and social care is something that NHS England now expects local transformation bodies to take responsibility for. In Nottinghamshire there are three planning areas for these “transformation programmes” now underway:

• “The Bassetlaw Integrated Care Board -covering Bassetlaw CCG area;
• “The Better Together Transformation Programme” – covering the mid Nottinghamshire CCGs area;
• “The South Nottinghamshire Transformation Board” – covering the South Nottinghamshire CCGs area (now including Nottingham City)

Each of these bodies have the challenging job of “fundamentally reshaping the health and social care system over the next 5 years”. As I suggested in an earlier blog this can be seen as essentially a local response to a national problem of: (a) an increasing budget hole in NHS resources in the face of increasing health demand whilst, at the same time, children and adults social care budgets are being been reduced by Councils, and (b) needing a new initiative (after decades of patchy and relatively unsuccessful initiatives) to remedy the lack of joined-up services both within the NHS and between health and social care.

This patient story identifies at least seven areas I can identify which a successful transformation programme will need to tackle and resolve if patients and service users are to experience a better health and social care system. There may well be other areas I’ve missed

1. Achieving Patient-centred care

The first observation is that this woman and her daughter have experienced poor care practice in a NHS Trust in-patient rehabilitation hospital for older people and also from the same Trust’s specialist mental health and treatment team. This may well have been a one-off occurrence. But the fact that it happened means that one of the transformation challenges is to create a health service that is increasingly “patient-centred” across all its services and with all staff. There is still much to be done.

2. Upholding Carers’ rights

The daughter’s account of her meetings with health staff suggests that there was a lack of consideration of her as a carer – that is, her insights, knowledge and advice about her mother’s needs and personal likes and dislikes. On occasion there is bound to be a conflict of interest between carer and the cared-for person e.g where financial interests clash, or where there are relationship difficulties. But the new NHS Constitution aims to place patients and carers at the centre of decisions that affect them and the patient. The daughter in this case describes how, at the multi-disciplinary meeting, “Noone …. would listen to what we were saying …. I felt I was not listened to and it broke my heart”.

3. Improving Hospital discharge

There is a question about how well hospitals achieve appropriate discharge arrangements, sometimes a complicated and a multi-agency process. In this Patient Opinion posting the daughter was told that the mother may have been discharged to a rehabilitation unit that had insufficient specialist dementia staff. Perhaps the right unit had had no beds at the time. One of the key challenges facing all transformation bodies is working out how to bring hospital systems closer to community health and social care systems to prevent patients falling through the net. Or, as the daughter says in the posting – “No wonder she is so bad as she has been moved 4 times in 10 weeks”.

4. Effective transfer of some hospital functions to community health

Transformation bodies have to consider how and where hospital functions can be more sensibly and economically provided for by in the community by the health service. In this case the daughter’s experience was one where she felt that the specialist hospital based ward provided the best patient-centred care her mother experienced. This is one of the mental health services for older people wards that is currently being consulted on for closure with proposed replacement by community based specialist staff. This demonstrates how careful transformation planning has to be to ensure that patients and carers’ needs are met in an equivalent and satisfactory way by community services designed to replace hospital services.

5. Better health and social care Information systems

In the social services department responsible in this case for the mental health assessment of her mother the daughter was not able to find out who had been allocated to do this work. She describes having to call 5 different offices before she was told that no social worker had yet been allocated. Improved information systems will be a vital part of any “fundamental reshaping of the health and social care system over the next 5 years”. This includes better information about the range of services available to service users and carers. In this case the daughter was asked by the ward staff to “go and look at residential homes”. How was she to do that? “We knew nothing and were just given a booklet!”

6. Complicated complaints systems

If the daughter had chosen to complain about what happened, rather than post her dissatisfaction on Patient Opinion, she might have had to simultaneously complain to Nottingham University Hospitals Trust, Nottinghamshire Healthcare Trust and Nottinghamshire County Council. Going through one complaint process is burdensome and stressful enough for most service users. To have to navigate up to three in this instance would put off all but the most strong-willed of us.

Healthwatch England have recently identified a staggering 75 types of organisations in England having a role in complaints handling and support, from councils and CCGs locally to national regulators. The Parliamentary and Health Service Ombudsman has agreed with Healthwatch England “that the current complaints system is too complex”. Both are now working with the Department of Health to simplify and reform the complaints systems.

7. Mental ill-health services as a “Cinderella” service?

The Secretary of State for Care and Support, MP Norman Lamb, recently lamented that: “It’s a bit of a cliché to say that mental health is the Cinderella service of the NHS but it’s essentially true”. In this posting the daughter reflected on how poor her mother’s care had been as compared to her father-in-law’s experience of physical ill-health services in the NHS. This is how she described it: “It just seems (in our case anyway) that mental health is not important.  My father-in-law who recently passed away had a physical health problem and has had the best of care in comparison.  It really is so unfair”

What next?

The three transformation boards in Nottinghamshire and Nottingham would do well to have a close look at this Patient Opinion posting.  As the transformational plans begin to develop over the year ahead, they could be tested in terms of their ability to tackle the sorts of issues highlighted by the plight of the daughter and mother in this case. Getting mental health services right for older people is, after all, probably the most challenging of needs to the way health and social care services are organised.

The good news is that the Trust concerned is now looking into where things have gone wrong in their services for this particular family. Patient Opinion as a patient feedback system has proven effective. The three transformation bodies in Nottinghamshire and Nottingham, charged with this most difficult task of directing whole system change, are working hard to begin to address the big issues such as these.

If any readers have experiences of the health and social care system – both successes and/or weaknesses – within older people mental health services, we would be very interested in hearing your story at Healthwatch Nottinghamshire. Get in touch by visiting www.healthwatchnottinghamshire.co.uk or by phone on 0115 963 5179.

Care homes should be a bit more open

CARE homes have got a bad press. When the subject comes up, there’s a common response:

“I’m not putting my mum or dad in any home.”

The scandals of a small minority of homes have unfairly given the impression that the majority are of questionable quality. It overlays another commonly-held image, of older people sitting in their lounge rows, with little going on outside of mealtimes and bedtime.

Nevertheless, the demand for care home places continues to grow. The number of older people in care homes with nursing increased from 2006-13 by 22 per cent. Here in Nottinghamshire, we can expect our “oldest of the old” – people over 85 – to double in number over the next 16 years.

Where are “they” going to be living? Many of us will happily be staying at home, but what of those who will need 24-hour care? Care homes will remain an important and growing part of the range of care options. They need a better press.

National Care Home Open Day in June was a good start. A quarter of Nottinghamshire’s 293 care homes opened their doors to the public. I visited one in Arnold where “activity care staff” described how the home welcomed neighbourly contact with residents and emphasised helping residents having a life outside the home.

Care homes could go further in encouraging every day to be, in a sense, an open day. Friends, relatives and neighbours should feel able to drop in, an approach that many homes already have.

This should not be a charter for anyone to invade residents’ privacy but opening the doors of care homes helps residents feel part of their neighbourhood.

The second way of reassuring the public is for there to be a concerted effort to improve the weaker care homes. These homes – perhaps nationally up to 18 per cent of the total – are known to the Care Quality Commission which inspects them.

These proprietors and managers need to be helped to change their ways of providing care. If they cannot, they should be eased out of the sector – but with the residents being able to stay where they are wherever possible.

Healthwatch England’s Annual Report: Implications for Healthwatch Nottinghamshire

Healthwatch England’s first Annual Report to Parliament 

What are its key points; what are the implications for Healthwatch Nottinghamshire

1    What does the report cover

Healthwatch England (HWE) presents an overview of the current state of health and social care in England. To do this it commissioned research which included a survey of 2000+ people and a face to face deliberative event.  The aim was to dig a bit deeper into what people really felt about the care they receive and how things actually are on the ground.

The weaknesses and failures in care identified here and elsewhere have led HWE to conclude that what is needed is a consumer rights approach to improving social and health care. It identifies 8 consumer rights it considers as key to ensuring that improvements happens (see below).

The report also covers the budget cuts facing social care services and future budget pressures within the NHS.

It celebrates the progress made in developing Local Healthwatch as a “network speaking with one voice”.

2   What did the HWE/MORI research identify

• 1 in 3 of us report experiencing or knowing someone who has experienced abuse, neglect or malpractice whilst being care for.
• More than half of us experienced poor care in the last three years but didn’t report it because we didn’t trust the system to act.
• An overwhelming 94 per cent of us think the nation’s health and social care service need improvement.
• There is something of a contradiction in this particular finding because, at the same time as they are saying the above, 72% of the public surveyed are saying they get good quality care. The report concludes that despite the apparent high satisfaction levels, this is not supported by the more in-depth comments of consumers of services, describing this finding as a “paper veneer of satisfaction”.
• 23% say that professionals aren’t really interested in what they have to say or do not actively listen to their views of those of their loved ones.
• 61% did not feel they had a clear way of providing feedback on a service.  Where concerns are raised, many people are not confident that action would be taken.

3     The Health and Social Care Funding Challenge

The report describes the financial pressures facing health and social care. Local Authorities responsible for social care have had their budgets reduced by 30% between 2010 and 2014. For the NHS, it has been suggested that due to an increasing dependent population and increased cost of treatment, around £20 billion of efficiency savings are needed between 2011 and 2014 to make healthcare sustainable in the future.  This has been described as the future “budget–hole” in the HHS.

4     Taking a Consumer Rights Approach

Anna Bradley, Chair of HWE, describes this approach as:

“Just seeing ourselves as having rights changes the game.  It gets us thinking differently, asking different types of questions and helps us demand the standard of treatment and care we deserve”.

“We all need to stop acting like grateful patients and care users, and start to see ourselves as savvy consumers, insisting on our right to safe, dignified and high quality care”

Accordingly HWE has been working with the public to develop a new framework of rights for health and social care.  These are based on widely established UN consumer rights.

5   HWE’s Proposed Eight Core Consumer Rights

HWE is seeking to develop the thinking on these rights. (I’ve given some illustrative practice examples from the report.) :

·   The right to essential services: we all have the right to a set of basic and essential treatment and care services at a defined standard.

e.g  If you are a resident in a care home, you have a right to be adequately fed and given help with eating at mealtimes;

·   The right to access: we all have the right to access services on an equal basis with others, when we need them and in a way that works for us and our families.

e.g  If you need to use a health service the health professional should not deny you access, provide you with a lower quality service or discriminate against you because you are disabled or because of your age, religion, ethnicity, sexuality or gender;

·   The right to a safe, dignified and quality service: we all have the right to high quality, safe services that treat us all with dignity, compassion and respect.

e.g  If you have a learning disability and are undergoing surgery, you should expect the specialist to talk to you (if you want them to) about it.  They should tell you what the benefits might be and any possible side effects.  They should do this using language you will understand.  They should not withhold any information if you want to know more.

 ·   The right to information and education: we all have the right to information and education about how to take care of ourselves and what we are entitled to within the health and social care system.

e.g  If the NHS collects any confidential information about you, it should be kept safe and secure.  You should be told how information about you might be used and you should be able to request that your confidential information is not used beyond your own care and treatment.

 ·   The right to choose: we all have the right to choose from a range of high quality services, products and providers within health and social care.

e.g  If your council has said that you are eligible for social care, you should be given the option of choosing different ways of being supported in your own home, rather than being pressured to go into a residential care home.

The right to be listened to: we all have the right to have our concerns and views listened to and acted upon. We have the right to be supported in taking action if we are not satisfied with the service we have received.

e.g  If you suspect someone is being mistreated in a residential home where your sister lives, you should be able to register your concerns and have them investigated appropriately.  You should not have to worry that your sister’s care will in any way altered as a result of yur complaint.

 ·   The right to be involved: we are equal partners in determining our own health and wellbeing. We have the right to be involved in decisions that affect our lives and those affecting services in our local community.

e.g  If you are at the end of your life, your family and your doctors should listen to your wishes and make sure you have the support and care you need to die at home if you want to.

 ·   The right to live in a healthy environment: we all have the right to live in an environment that promotes positive health and wellbeing.

e.g   If you are a child carer, your council should make sure you have the opportunities to have a break from your caring responsibilities, have fun and socialise with other children of your own age.

 

Some implications for Healthwatch Nottinghamshire

There are a lot of sets of “rights” out there.

The citizen “Rights” area may be becoming a crowded place. This is acknowledged on p. 32 of the HWE report. I have summarised below some of the other sets of “rights” and/or standards that may be competing for “space”.

Adult Social Care – works to the DOH nationally prescribed Outcomes Framework with 4    categories:

• Enhance the quality of life for people with care and support needs
• Delay and reduce the need for care and support
• Ensure that people have a positive experience of care and support
• Safeguard adults whose circumstances make them vulnerable and protect them from avoidable harm

Each of these categories have specific outcomes.

Think Local, Act Personal (2011 – Social Care Sector, LGA, CQC, Vol sector, DH etc agreement on personalisation) contains 6 principles regarded as essential for “personalisation” of services.

The NHS Constitution – has some 29 rights under the 7 headings of:

• Access to services
• Quality of care and environment
• Nationally approved treatments, drugs and programmes
• Respect, consent and confidentiality
• Informed choice
• Involvement in your healthcare and in the NHS
• Complaints and redress

2013 CQC Inspection regime – now has 5 main questions or “expected standards” designed to be complementary to the DOH’s Outcomes Frameworks for the NHS, social care and public health. The 5 expected standards are:

1. Are they (services) safe?  – People are protected from physical, psychological, or emotional harm

2. Are they doing the things they should be doing? – people’s needs are being met and their care is in line with nationally recognised guidelines and quality standards.

3. Are they caring? – people are treated with compassion, respect and dignity and care is tailored to their needs.

4. Do they change to meet people’s needs – people get the treatment and care at the right time, without excessive delay, and that they are listened to in a way that responds to their needs and concerns.

5. Are they well led? – There is effective leadership and governance. Open, fair and transparent culture.

In addition the government is committed to drawing up a set of “fundamental standards of care” that will sit within the legal requirements of providers of health and social care, focusing on the very basics of care

So what are the Issues for Us:

Taken as a whole, the DH social care outcomes framework, the NHS Constitution and CQC standards, and others, almost certainly cover the proposed HWE eight core consumer rights

Is there a danger that the HWE core consumer rights model might replicate what already exists in different statutory bodies?  How are we to avoid an overlap with parallel approaches being operated by health and social care commissioners and providers?

Some may question the idea of there being a “right” to a choice of services in health and social care analogous to a choice of goods in the consumer market place.

Also – can you have “Rights” without “Responsibilities”? The HWE annual report acknowledges that people using health and social care services also have “responsibilities” (as an accompaniment of “rights”) acting as good citizens. So should it be, for example, a responsibility of the citizen to safeguard their own health as far as possible? Should it be one of the roles of Healthwatch to develop a complementary set of responsibilities sitting alongside the set of rights?

Healthwatch Nottinghamshire is going to need to maintain a watching brief on how HWE proceeds with the further development of practice with the consumer rights approach, perhaps monitoring our local issues recording and practice in the light of it.

 

 

Health and Wellbeing Board 5th June

Health and Wellbeing Board: 5^th June 2013

It is encouraging that the leaders of Nottinghamshire’s health and social care services are in tune with the national vision for co-ordinated care for all as outlined in the recent national publication ‘Integrated Care and Support – Our Shared Vision’* Almost all of the papers to this month’s Health and Wellbeing Board had a common theme – the improvement of services for patients, carers and service users through better integration of health and social care.  So much so, that at the end of the meeting, when the priorities for the next Health and Wellbeing Strategy for Nottinghamshire was discussed, there was unanimous support for Integration being one of the key priorities.

We had a presentation about the blueprint for the Mid Notts Transformation Programme.   Integration is the key theme for the changes that need to happen and the blueprint is the vision for how health and social care services will look across Mansfield and Ashfield and Newark and Sherwood over the next 3-5 years.  A Citizen Board is already meeting to give a patient/carer/service user viewpoint to the Transformation and to help to plan the wider involvement of local people in developing the initiatives outlined in the plan. Healthwatch will be offering support to the partners to ensure that local people have a real opportunity to contribute and have their say.

A similar initiative to promote integration of services for frail older people is underway in the South of the County, including Nottingham City.  The Strategy and Implementation Group for Nottingham South (SIGNS) has developed a shared set of principles and a shared campaign to improve care for frail older people in the area.  There are three themes to the campaign – Support to Thrive, Choose to Admit and Transfer to Assess and the partners will be developing their proposals under these headings.    This was followed by a presentation about loneliness amongst older people and the impact this has on their health and wellbeing.  Age UK is co-ordinating a national campaign to end loneliness and the Health and Wellbeing Board was asked to support the roll out of the campaign in Nottinghamshire.  This will involve mapping loneliness and implementing a range of initiatives to combat loneliness.  The involvement of older people will be an important element of both these pieces of work and Healthwatch will be supporting this where possible.

Children and young people with disabilities and/or special educational needs were the topic of the next item.  This included an update about the findings of the needs assessment carried out in 2012 and the development of integrated commissioning for children and young people with disabilities and/or special educational needs.  The need for integration and co-ordination of health and social care for this group of children and young people was brought to life by a presentation from a parent who highlighted the number of agencies involved in her daughter’s care and the amount of time spent in attending appointments and co-ordinating the various care and support services.  The Health and Wellbeing Board agreed to sign up to the Disabled Children’s Charter for Health and Wellbeing Boards.

Finally the Board discussed the plan for the development of the Health and Wellbeing Strategy for 2014-17.  The draft strategy will be consulted on over the summer so that it can be considered at the Health and Wellbeing Board in September.

If you would like to view any of the papers from this Health and Wellbeing Board, these are available at http://www.nottinghamshire.gov.uk/dms/Meetings.aspx.

Claire Grainger
Chief Executive