Leading the way - listening to the voices of children and families in Cumbria

Developing a health economy patient experience system

Ross Forbes – iWantGreatCareNicola Jackson, NHS Cumbria Clinical Commissioning Group

Kerry Little – University Hospitals of Morecambe Bay

Overview• Cumbria Context• NHS Cumbria as system architect• Strategic partnerships• System wide approach to patient experience – providers and pathways• Voices of children and young people• iWantGreatCare

Cumbria – county of contrasts• 51% of the population live in rural areas• 20% (107,000) of the population are

aged under 19• 51% of the population live in rural areas• The rural areas of Cumbria encompass

the Lake District National Park and are mainly affluent , as they benefit from tourism

• 10% of rural population are classed as income deprived

• District of Barrow in Furness being the third most deprived area in England

FACTORS AFFECTING EFFECTIVE PARTNERSHIPCumbria covers a vast area. Cumbria County Council therefore has to cover to an area as large as Greater London (1), Hertfordshire (2), Bedfordshire (3), Buckinghamshire (4), almost half of Oxfordshire (5) and Berkshire (6), part of Hampshire (7) and all of Surrey (8), plus parts of Kent (9), Essex (10) and Cambridge (11).

CCGs as System Architects

“Every system is perfectly designed to deliver the results it gets”

We need systems that:

• Maximise value for patients – in terms of outcomes and experience• Maximise value for the NHS – in terms of outcomes and cost• Minimise waste for patients and the NHS – in terms of waiting and

unnecessary duplication / repetition

OverviewExtract from CCG Tender Advert (summer 2012):

The programme which is being developed by the Clinical Commissioning Group aims to gather and act upon information from NHS patients and carers about their experience as health service consumers in order to improve services on the ground and inform future commissioning intentions.

A contractor is required to help develop, establish and run the central component of the Programme for the CCG. In order to fulfil this aim the Cumbria Patient Experience Programme’s Technical Partner will:• Develop guidance and instruments which will then be used to undertake qualitative and quantitative

surveys of patients and carers• Analyse and help disseminate the results of the surveys undertaken• Advise the CCG, Provider Organisations and General Practices on using this information to improve

services

iWantGreatCare appointed as our technical partner in December 2012

Cumbria Health And Care AllianceCumbria’s health and social care network has committed to work towards a fully integrated,

patient-centred system over the next five years.

This is in recognition that:• The current system causes more harm than is acceptable• It costs more money than it is allocated• And there has been a serious loss of public confidence

Partners• NHS Cumbria CCG - North Cumbria University Hospitals Trust• Cumbria County Council - University Hospitals Of Morecambe Bay Trust• Health Watch Cumbria - Cumbria Partnership Foundation Trust• CNT & W Area Team

The Alliance’s programme of work• The facts about our challenge

– A single version of the truth

• Fixing the here and now– Immediate steps to reduce harm (or improve quality), improve financial stability and improve

public confidence

• Our journey for getting better– Transforming the system (patient experience work sits here)

• Getting things done around here– Our behaviours and tools for service improvement

• The engagement campaign– Shared, content, ongoing approach to engaging our public

Progress with patient experienceOur vision is to have a system wide common platform for measuring patient experience (quantitative and qualitative) that allows patients and commissioners to compare how well we are delivering “value” across providers and along pathways.

• UHMBT – iWGC being rolled out across the organisation – 3 sites, all services• CPFT – iWGC roll out for Childrens and Mental Health Services in April, Community Services

from autumn• NCUHT – using Northumbria Trust tools• Cumbria County Council – active consideration of iWGC, agreed in principle for children’s

services• General Practice – iWGC pioneers to start in April• Cumbria Health on Call – starting to implement children’s tools

Supplier partnership with • Protracted procurement to find partner for whole system solution

• iWGC ‘Trip Advisor’ for Health – now market leader

• Large volumes of patient feedback in multiple care settings,multi-channel

• Strong project management approach

• Deep understanding of health and social care

approach• System-wide project team• Standardising questions – long haul!• Standardising metrics and reporting• Producing comparative data • Making it child friendly

iWGC – children and young peopleThe drivers:

• Office of the Children’s Commissioner Report ‘we would like to make a change: Children and young people’s participation in strategic health decision-making’ (March 2013) reports:

– Despite pockets of good practice, nationally, children’s participation in health service planning and participation is varied and patchy

• Ofsted & CQC inspection of safeguarding and looked after children’s services (April 2012)

– Need to listen to the voices of children and young people and use any feedback to change practice and redesign services where appropriate

iWGC – children and young peopleInvolving children and young people:

• Opportunity for all children to take part• Outreach ensuring that all children known about their right to be heard• Simplicity so that children understand the purpose and feel confident about

making contributions• Variety of approaches so that children from all age groups and background

can participate• Outputs and outcomes so that children can see change

iWGC – children and young peopleAim:

To harness high volumes of quantitative and qualitative feedback from children in order to improve the quality of children’s services across the Cumbria care economy

iWGC – children and young peoplePurpose

• To agree an integrated ‘whole-system’ approach for collecting and reporting feedback on children’s services across Cumbria

• To work together to deploy an integrated solution across all services – allowing children of all age groups to provide real time feedback on their care

• To evaluate progress regularly – and identify mechanisms for translating feedback into direct service improvements and patient and public engagement activities

Introducing it to the patients…..• Questionnaires were piloted on the children’s wards, including day care

surgery, assessment unit and children’s outpatients.

• Feedback was taken to the iWGC group and shared with other Trusts.

• Children started to fill in the questionnaires even though they hadn’t been asked to.

What they liked:• Questionnaires were easy to read.• Wording was good and easily understood.• Liked scoring system.• Liked opportunity to add own comments.• Questions were relevant.• Questions were easy to answer.• Giving out the questionnaires was an opportunity for families to discuss any

issues they had on the ward, for example, confidentiality for teenagers/ young people.

Simple, clear and eye-catching.

Go!• The paper questionnaires were launched in January, initially on the wards,

assessment units, day care, and children’s outpatients.

• The Emergency departments followed slightly later in the month.

• Staff have been kept up to date, and give the questionnaires out routinely on discharge.

Little white post boxes.

Collection and posting.• Myself and a colleague collect the questionnaires weekly and they are

posted to iWGC by General Office staff.

• Emergency Departments collect their own.

• Business support Unit staff are also available to collect and post if required.

Teething problems?

How do we monitor feedback?• Feedback is provided monthly.

• The CYP leaders meet weekly and discuss patient experience.

• Results are displayed for staff, patients and parents to see as they enter the Children’s department.

• Monthly comparisons will be available when we have further data.

Open, honest and transparent.

Benefits of iWGC• Gives children, young people and parents and voice.• Empowerment.• Enables the Trust to be open honest and transparent and share information.• Allows the Trust to improve the care it provides through service user feedback.• Feedback is in real time, questionnaires are completed before the family leave.• Use of technology means it is current and appealing to younger service users.• Allows praise to be shared, and induces pride and satisfaction in staff.

Thank you

•Any questions?