Equality delivery system 2 (EDS2) - Erewash CCG | … · Web viewEquality delivery system 2 (EDS2)...

Equality delivery system 2 (EDS2)

Introduction to EDS2 Overview of CCG population information

Overview of CCG health inequalities CCG approach to Equality

Evidence portfolio

Date of publication31.01.17

Introduction to EDS2The Equality Delivery System (EDS) framework was designed by the NHS to support NHS commissioners and providers to meet their duties under the Equality Act. The EDS has four goals, supported by 18 outcomes as detailed in the table (1) below. NHS Erewash CCG have used the EDS as a tool kit to meet the requirements (Public Sector Equality Duty) under the Equality Act 2010 and in discussion with local partners including local populations, review and improve their performance for people with characteristics protected by the Equality Act 2010. Furthermore we have linked the EDS to Human Rights, table 2 lists the Articles.From April 2015, EDS implementation by NHS organisations was made mandatory in the NHS standard contract. In addition, EDS implementation is explicitly cited within the CCG Assurance Framework, and will continue to be a key requirement for the CCGs

1Equality Inclusion and Human Rights (EIHR) Team, November 2015

Article 2 | Right to life

Article 3 | Anti-torture and inhumane treatment

Article 4 | Anti-slavery

Article 5 | Right to liberty and security of the person

Article 6 | Right to a fair trial

Article 7 | Anti-retrospective conviction

Article 8 | Right to private and family life

Article 9 | Right to freedom of thought, conscience and religion

Article 10 | Right to freedom of expression

Article 11 | Right to freedom of assembly and association

Article 12 | Right to marriage

Article 13 | Right to an effective remedy

Article 14 | Anti-discrimination

Article 1 of the First Protocol: Protection of property

Article 2 of the First Protocol: Right to education

Article 3 of the First Protocol: Right to free elections

Table 2 Articles of the European Convention on Human Rights

Map of Erewash CCG region

Overview of Erewash CCG population demographics (Census 2011)2

Equality Inclusion and Human Rights (EIHR) Team, November 2015

Age (years) Derbyshire Overall NHS Erewashn % n %

0 to 4 57339 5.82% 5731 6.09%5 to 14 111313 11.30% 10213 10.86%

15 to 24 120995 12.28% 11849 12.60%25 to 39 177231 17.99% 17704 18.82%40 to 64 342922 34.80% 32473 34.53%65 to 74 93812 9.52% 8620 9.17%

75 and over 81736 8.30% 7460 7.93%Total 985348 100.00% 94050 100.00%

Sex Derbyshire Overall NHS Erewashn % n %

Females 499723 50.72% 47826 50.85%Males 485625 49.28% 46224 49.15%Total 985348 100.00% 94050 100.00%

Disability Derbyshire Overall NHS Erewashn % n %

Day-to-day activities not limited 787765 79.95% 75835 80.63%Day-to-day activities limited a little 103808 10.54% 9773 10.39%

Day-to-day activities limited a lot 93775 9.52% 8442 8.98%Total 985348 100.00% 94050 100.00%

Ethnicity Derbyshire Overall NHS Erewashn % n %

White English/Welsh/Scottish/Northern Irish/British 892743 90.60% 89238 94.88%White Irish 5231 0.53% 484 0.51%

White Gypsy or Irish Traveller 604 0.06% 24 0.03%White Other White 18995 1.93% 1329 1.41%

Mixed/multiple ethnic group White and Black Caribbean 6920 0.70% 673 0.72%Mixed/multiple ethnic group White and Black African 1152 0.12% 63 0.07%

Mixed/multiple ethnic group White and Asian 3726 0.38% 221 0.23%Mixed/multiple ethnic group Other Mixed 2134 0.22% 156 0.17%

Asian/Asian British Indian 14969 1.52% 727 0.77%Asian/Asian British Pakistani 15555 1.58% 80 0.09%

Asian/Asian British Bangladeshi 887 0.09% 20 0.02%Asian/Asian British Chinese 2939 0.30% 208 0.22%

Asian/Asian British Other Asian 5270 0.53% 206 0.22%Black/African/Caribbean/Black British African 4425 0.45% 113 0.12%

Black/African/Caribbean/Black British Caribbean 4508 0.46% 322 0.34%Black/African/Caribbean/Black British Other Black 1067 0.11% 71 0.08%

Other ethnic group Arab 1098 0.11% 27 0.03%Other ethnic group Any other ethnic group 3125 0.32% 88 0.09%

Total 985348 100.00% 94050 100.00%

Religion Derbyshire Overall NHS Erewash3


n % n %Christian 599156 60.81% 52619 55.95%Buddhist 2282 0.23% 180 0.19%

Hindu 3545 0.36% 389 0.41%Jewish 462 0.05% 37 0.04%

Muslim 21144 2.15% 239 0.25%Sikh 11194 1.14% 264 0.28%

Other religion 3747 0.38% 336 0.36%No religion 274909 27.90% 33528 35.65%

Religion not stated 68909 6.99% 6458 6.87%Total 985348 100.00% 94050 100.00%

Marital status Derbyshire Overall NHS Erewashn % n %

Single 249010 30.96% 24987 32.52%Married 394932 49.11% 36006 46.85%

In a registered same-sex civil partnership 1789 0.22% 104 0.14%Separated 19855 2.47% 2038 2.65%

Divorced or formerly in a same-sex civil partnership 77609 9.65% 8054 10.48%Widowed or surviving partner 61038 7.59% 5657 7.36%

Total 804233 100.00% 76846 100.00%

The Census demographics highlighted above demonstrate the difference in the local community that the CCG serves and Derbyshire as a whole.The 2011 Census collected information across 6 of the 9 protected characteristics, of those included the CCGs local population is generally representative of Derbyshire. There are some differences in relation to Race where the CCGs local geography has a lower representation of people identifying with an Asian or Asian (Mixed) heritage.Of the 3 protected characteristics not covered by the 2011 Census, the CCG is working with partner stakeholder agencies such as Public Health and Local authorities to understand those communities within the CCGs geographical area.


Overview of CCG health inequalitiesAs a ‘vanguard’ Multi-specialty Community Provider (MCP), Wellbeing Erewash is spearheading new care models. Partners in the MCP are Erewash CCG, Derbyshire Community Health Services NHS Foundation Trust, Derbyshire Health United, Derbyshire Healthcare NHS Foundation Trust and Erewash Health.

The MCP Value Proposition (2015) contained detailed information which shows Erewash as a borough with inequity across the area and pressure on services; demonstrated by waiting times in A&E as well as for planned care. Whilst some progress has been made in addressing health issues, there are still a number of areas where people in Erewash have a lower health status than in comparable areas.

Erewash MCP is about a core fundamental transformation with the public sector empowering people to gain the support they need in their community, to enable them, their family and their community to lead healthier and prosperous lives.The Wellbeing Erewash (MCP) vision is for thriving communities within Erewash, where people feel confident and supported to choose a healthier lifestyle, stay well, and know how to get help and support when needed.Our mission is to develop Thriving, Capable, and Healthier Communities.The CCG’s aim is to deliver better care, better health, and better value for the population by:

Building community support, rather than health and social care services Building resilience in our services and in communities Not just bringing the workforce together, but changing how we work together, what we deliver for people and what the people deliver for themselves

So that in 2020 Erewash will be characterised by: Strong inclusive communities A shared ethos between the people in the community and their trusted professional staff of self-care and shared decision making Responsive and accessible support services Integrated services that wrap around people, their family and carers, reducing the need for bed-based care

The model is based on the principle of shifting care into the lower tiers of care; thereby better meeting the needs of people. There is emphasis on prevention and early intervention which puts individuals at the centre of decisions about their care, truly transforming community and primary care services with integrated local provision of services.

The CCG is determined to make a reality the aspiration that all patients are fully involved in decisions about their own care and treatment so that the principle of shared decision-making - “no decision about me, without me”- becomes the norm.


Erewash CCGs Approach to equalityErewash CCG is committed to design and implement policies, procedures and commission services that meet the diverse needs of our local population and workforce, ensuring that none are placed at a disadvantage over others. The CCG takes into account current UK legislative requirements and best practice These include the Equality Act 2010, Human Rights Act 1998, Gender Recognition Act 2004, the NHS Constitution and guidelines on best practice from the Equality and Human Rights Commission and the Department of Health.The CCG commits to promote Equality, Inclusion and Human Rights (EIHR) to ensure that the CCG’s activities ensure no-one receives less favourable treatment due to their personal circumstances. This includes, but is not limited to, the protected characteristics of their age, disability, sex (gender), gender reassignment, sexual orientation, marriage and civil partnership, race, religion or belief, pregnancy and maternity status.The CCG commits to ensure that when making decisions, appropriate and proportionate consideration is given to; gender identity, socio-economic status, immigration status and the principles of Human Rights in the Human Rights Act 1998.In carrying out its functions, Erewas CCG is committed to having due regard to the Public Sector Equality Duty of the Equality Act 2010. This applies to all the activities for which the CCG is responsible, whether internal or where services are commissioned on its behalf, including policy development and review.

At the heart of this commitment is the requirement placed on ALL staff to ensure that robust and proportionate Equality Analysis and Due Regard is taken around any decision which the CCG takes and can be effectively demonstrated.This is a Legal requirement, enshrined in:

The Equality Act 2010 (Public Sector Equality Duty, s149) The Human Rights Act 1998. The NHS Constitution. Health and Social Care Act 2012 (Section 14)

In order to meet these requirements, the CCG ensures that before making any decision it has proportionately considered the following:

1. Who will be affected by the decision?a. Current / prospective / future service usersb. Families, carers and dependantsc. Staff

2. Is the information available comprehensive or will more research be needed to gain a complete understanding of the affects?

3. What will the impact(s) be?a. Will it be positive or negative?b. Are some groups affected differently than others?c. Is action required to ensure an equitable outcome?

4. If there is a negative impact, can this be mitigated?a. If so, what action is needed and is this proportionate?b. If not, why is this not possible

Historically, many NHS and public organisations have used an Equality Impact Assessment form (EIA) to facilitate this process. With the introduction of the Equality Act 2010, an EIA form (while providing structure) proved inadequate to demonstrate the level of evidence required to meet the new legislative requirements in having Due Regard. It is important to remember that this is about far more than the need to assess policies. A range of decisions can have an impact and if this is not identified in advance an inequality may be produced or sustained and the CCG placed at risk of challenge from the local community they serve.

The CCG has published on its website a summary of its activities around Equality Inclusion and Human Rights annually both around its Equality Objectives annually in October and its activities against the NHS Equality Delivery System 2 (EDS2) annually in January. The twin overviews showcase the CCGs work and approach to deliver the best possible outcomes for all local residents including those vulnerable groups who have historically experienced inequalities in healthcare.

Procurement


Erewash CCG procurement service is provided by Arden & GEM CSU and works to ensure that in Designing and Procuring services, the CCG ensures that services are delivered inclusively and in line with the Public Sector Equality Duty. A key goal in doing so is to ensure that equality of access is provided to all patients and that services deliver equality of outcome. With the move towards Co Commissioning of GP Practice services with NHS England the CCG has a further role in using the procurement process to enhance services and ensure equality of access / outcome for all patients.Each aspect of the procurement activity includes embedded EIHR considerations (where relevant) and includes comprehensive EIHR-related tender questions in both Pre-Qualifying Questionnaire (PQQ) and Invite to Tender (ITT) stages.

HR (including workforce information)

Erewash CCG has strongly committed to embedding Equality Inclusion and Human Rights across the organisation to ensure that the experience of staff is a positive one and that they feel supported and engaged.The CCG is supported with specialist HR expertise from Arden & GEM Commissioning Support Unit (CSU) which covers all aspects of HR activity including key areas where embedded EIHR considerations are necessary for the CCG to demonstrate the value its workforce provides. Through this collaboration with CSU specialist colleagues (from both HR and EIHR), Erewash CCG is successfully maintaining its status as a Two Ticks for Disability employer. As well as Mindful Employer and Time to Change standards, representing the CCGs commitment to having a represented and supportive workforce.All HR policy development and the recruitment, selection and appointment processes are fully assessed for their EIHR considerations to ensure a proactive approach is taken.

In terms of Erewash CCGs workforce demographics (at December 2016), the CCG employs 27WTE (whole-time equivalent) staff, given this small number of people it is not possible for the CCG to produce detailed staff profiles without identifying individuals. The CCG is committed to ensuring the working environment is inclusive and appropriate support is provided to any member of the organisation that may require it.In addition to this, the CCG have commissioned Arden&GEM Commissioning Support Unit (AGEM CSU) to provide an annual HR Dashboard. This dashboard (a redacted example of which is included in the document library) is used to monitor the diversity of the CCG’s workforce and other agreed KPIs.


Equality Delivery System 2 (EDS2)Evidence Portfolio

1. Better health outcomesThe NHS should achieve improvements in patient health, patient safety and public health for all, based on comprehensive evidence of needs and results1.1 Services are commissioned, procured, designed and delivered to meet the health needs of local communitiesHow does the CCG design/procure/commission services which are appropriate to its local population? Please give examples

Protected characteristics

Equality objective Human Rights Evidence(What has actually been done/achieved?)

Impact Grading[May

2017]

Age Disability Gender Pregnancy

and Maternity Ethnicity

• Objective 1: To develop an enhanced understanding of the experiences of children and young families in health care and use this understanding to influence effective and inclusive commissioning of services for this section of the local community.

• Objective 2: To further enhance the working relationship with local seldom heard groups in order to engage and include these groups as a core part of the design and delivery of services.

• Objective 3: To further support the work on integration of care focused on Frail and Older people, identifying the experiences of patients and their carers, providing support and information including those in care homes (which links to CCG priority 5)

• Objective 4: To embed consideration for the needs of carers in the work to support people with long term conditions.





Considerations for Human Rights are embedded into the planning and delivery of services by the CCG. This is especially important since its area of work includes mental health services and regular use of the Deprivation of Liberty Standards (DOLS) and other actions which impact on an individual’s Human Rights.

1) Commissioning Intentions

This document outlines the CCGs strategic direction for 2016/17 demonstrating how the CCG will commission, procure, design and deliver services to meet the health needs of local communities.

Erewash CCG recognises that the key health inequalities in its population relate to the differing experiences of those from different economic backgrounds.

The core shift from the previous year has been to move resources from in/out patient hospital based care to primary and community services, with more integrated services. This will ensure that such services are local, relevant and accessible to the Erewash population.

Having passed over responsibility for Emergency and Non-emergency ambulance services the CCG is currently in transition towards the Community focused MSP Vanguard model. Nonetheless the CCG has continued to work with providers and the voluntary sector to ensure that key needs of the Erewash population are met.

2) Voluntary Sector Projects

The following projects show examples of the CCG funding small projects to address particular issues in the community in line with its Commissioning intentions. Within the evidence folder are a range of projects from 2016 and 2017. Examples are shown below:

Bright Street Laundry Carers Hardship grant Dinners 4U Home Comforts Team Project Community Concern Erewash (CCE) Winter Survival

Scheme Supporting parents in Borrowash and Draycot Befriending lunch club Befriending at home Sitting services Shopping services Befriending sensory scheme – for sight and hearing

impaired people

A key example of a targeted project is the Links VCS BME

1) Commissioning Intentions

I. The CCG will have a renewed focus on improving the health of the population and reducing pressure on services by:

II. reducing obesity (especially in school age children)

III. reducing smoking (especially in pregnant women)

IV. reducing alcohol consumption (especially by teenagers)

2) Voluntary Sector projects

Bright Street Laundry

Funding was provided by the CCG initially as a capital investment to replace a very old and unreliable large washing machine and several irons. In the last year the funding has been provided through the discretionary voluntary sector funds to support the running and extension of the service

Set up as a Community Interest Company, Bright Street Project is a Laundry Project which is available for anyone across Erewash. Profits from commercial sales are driven back into the project to keep costs affordable to those who are elderly / terminally ill / have a long term illness.

By enhancing this facility the CCG has safeguarded it and improved outcomes for the


Mental Health Project.

As part of the on-going commitment to address the equality agenda in mental health, Hardwick Clinical Commissioning Group agreed to commission Links CVS (on behalf of the Derbyshire CCGs) to run a mental health community scheme to improve the mental health of Black and Minority Ethnic (BME) people in Derbyshire. This will be done through engaging BME community groups to enhance access to support provisions for members of the diverse BME communities by building bridges and removing barriers. These barriers include not knowing how the system works, the availability of types of mental health care services, how to access such provisions, lack of culturally appropriate information, as well as the language barriers for those who are not proficient in the English language. Links CVS will be the co-ordinating body for this new contract with the active involvement of BME groups to deliver the service at relevant community venues.

Not knowing the availability of full range of mental health care services could have major adverse impacts on the mental wellbeing for many BME people who are at risk. The scheme will provide initial contact and signposting service to mainstream service provisions for BME people with reference to mental health support. It will connect BME communities with the mainstream mental health provisions in Derbyshire.

Participating BME groups will provide weekly drop-in or telephone line support sessions that are culturally appropriate to members of their communities at relevant community venues. The need for this scheme has been established through consultations with BME organisations and members of their respective communities. The main aims of the scheme are:

Provide support for mental wellbeing of BME communities; Early referrals to mental health services for BME people to

prevent deterioration of mental health;

The CCG also funds a range of other voluntary sector groups as shown on the table in the evidence portfolio. Each group contributes to improving outcomes for the Erewash population by supplementing NHS services.

During 2016 the CCG in company with the other Derbyshire CCGs carried out a full review of the voluntary sector funding with the local authority.

MCP Vanguard –

The CCG is working to pilot a new integrated care model, known as MCP. Further detail can be found by following this link.

As a result of this scheme a number of key projects have emerged.

Brilliant Erewash – this is an ‘Art of Being Brilliant’ programme commissioned by public health and Wellbeing Erewash to work with all year 7 pupils across the six secondary schools in Erewash. It aims to build self esteem, confidence and resilience

Person Centred Approaches - this project aims to change the way services have conversations with people, focusing on what is strong rather than just what is wrong.

Women and Alcohol – this project focuses on how we work with women in Erewash to reduce alcohol related illness and admission to

above group.

Dinners 4U

Provides a funded food delivery service for older / disabled people to ensure they receive hot meals. As a result more patients are able to remain in their own home and be at less risk of hospital admission. It also enables volunteers to engage with isolated people and raise concerns and put them in touch with appropriate support such as befriending and shopping services.

Home Comforts Team Project

Funding was awarded to contribute towards the purchase of equipment and running costs for our Home Comforts Team (HCT) who support elderly and vulnerable residents in Erewash to remain living independently at home.

MCP Vanguard Projects

These projects are focused to supporting key targets for the CCG in improving outcomes for the population it serves. These link to the CCG’s Commissioning intentions and priorities.


http://www.erewashccg.nhs.uk/news/2015/transforming-care-in-erewash-interview/

hospital.

Move More Erewash- this project looks at how we increase physical activity throughout Erewash.

Quality for Health – this is a quality accreditation scheme for voluntary sector groups in Erewash. It supports them to work with us.

Community Links project – this project finds ways of enabling people to know more about what services/groups are on offer in the area and was the main discussion for the afternoon at the conferences.

Move More Erewash- this project looks at how we increase physical activity throughout Erewash and particularly at increasing physical activity across our local workforces..

Quality for Health –. This package is the only quality assurance system in the country designed to support the voluntary, community and social enterprise (VCSE) sector to demonstrate the outcomes of their health services through rigorous external assessment. It is a vital tool in supporting those organisations to deliver local health services for local communities.

Erewash Voluntary Sector Forum – this forum brings together voluntary sector groups to influence the way services are commissioned and to promote the work of the sector.

Erewash Development Workers network – this is a network for all people delivering front-line services in the Erewash area to learn about what is available and to promote their projects throughout the network.

Community Links project – We are now working to introduce a new role of ‘community wellbeing links’. These will be volunteers who work with members of the public to help connect people to groups and assets. Their main role will be to communicate with individual citizens, asking what is important to them and what they need and considering how best it can be provided.

GP On Day services This project aims to give increase access to primary care by increasing the number of On the Day appointment, and reducing A&E attendence

Community GP - The expected benefits of this role are improved quality and patient experience and a reduction in hospital attendances and admissions, by effectively managing and supporting patients in the community. The Community GP has a specific focus on care home residents and the frail and elderly at home

Acute Home Visiting Service - The overall aim of the service is to provide capacity within primary care via an externally delivered home visiting service. The aim is to test whether a same-day acute visit will benefit patients by reducing A&E attendances, potentially avoidable admissions and reducing pressure on primary care

CCG Engagement projects by theme


The CCG recognizes that engaging effectively with the population it serves is key to ensuring that services are truly commissioned, procured, designed and delivered to meet the health needs of local communities. The evidence portfolio includes a document showing these by theme (protected characteristic)

This shows engagement on current services with the following groups: Carers

o End of Life Careo Dementia

Young People Older People People with dementia and their carers Patients with a Learning Disability

1.2 Individual people's health needs are assessed and met in appropriate and effective waysHow does the CCG ensure individual health needs are met effectively? Please give examples



Impact Grading[May

2017]


and Maternity





Article 2 | Right to lifeArticle 3 | Anti-torture and inhumane treatmentArticle 8 | Right to private and family lifeArticle 14 | Anti-discrimination

In line with the CCG’s Commissioning intentions outlined in 1.1 the CCG continues to work towards ensuring every individuals needs are met. In moving to a community based treatment programme the CCG is making services more local and accessible.

By funding the additional support programmes listed in 1.1 the CCG uses its discretionary funding to fill gaps that statutory services can’t fill.

Additional support for carers is vital both to their wellbeing and that of the patient they support. By providing additional support the CCG supports ensures that patients can remain in their homes for treatment in community.

Health Inequalities for patients with a Learning Disability.

Recent research has shown that obesity levels are higher amongst patients with a learning disability than the rest of the population.

To address this, the CCG is working with Public Health and other agencies to identify a campaign and other solutions to improve the effectiveness of campaigns to reduce obesity levels for this group. Further progression will be reported subsequently during 2017.

Learning Disability Partnership GroupThe CCG attends this groups’ meetings regularly and the information provided by the group has been instrumental in influencing the commissioning of the recent core podiatry contract for Derbyshire.

Further information can be found by clicking here

Commissioning Intentions

This programme has had a significant impact in reducing hospital admissions with patients treated in the community instead. This will be expanded and ultimately improve quality of care and increase financial efficiency (allowing better use of money spent).

Learning Disability Meeting

This meeting marks a commitment by those agencies involved to reduce obesity levels among patients with a learning disability.

1.3 Transitions from one service to another, for people on care pathways, are made smoothly with everyone well-informed11


https://www.derbyshire.gov.uk/social_health/adult_care_and_wellbeing/disability_support/learning_disabilities/partnership_board/default.asp

How does the CCG ensure patients and carers are well-informed when moving between services/care pathways? Please give examplesProtected

characteristicsEquality objective Human Rights Evidence

(What has actually been done/achieved?)Impact Grading

[May 2017]


and Maternity

In addition the CCG has worked closely with the third sector and patients to ensure that consideration for carers is embedded into its work.





Article 2 | Right to lifeArticle 3 | Anti-torture and inhumane treatmentArticle 8 | Right to private and family lifeArticle 14 | Anti-discrimination

The CCG recognises that services will only be fully effective if patients are as informed and involved as possible in their care. With the changes currently occurring in the NHS it is vital that patients are kept clearly informed by the Commissioner.

The CCG is strongly committed to engaging and involving all local communities to ensure their needs are understood and met by services.

Within the portfolio, a range of engagement reports illustrate how the CCG has engaged successfully with the community it serves.

In particular the Erewash Youth Forum has seen a traditionally seldom heard group provide views and feedback on services.

The CCG uses a mix of engagement events and other routes to ensure that patients are engaged and aware of services:

As the CCG’s Commissioning intentions evolve and more patients receive their treatment in the community the CCG will carry out further work to ensure that patients are clear as to what is happening and that this is a service enhancement not a reduction.

The CCG’s have developed, implemented and measures a strategy for Public and Patient Engagement and Patient experience together with a delivery plan and a quarterly reporting process. The strategy details the aims and objectives of engagement and involvement and the delivery plan identifies how and where this is happening. The reports assure the CCG and the population of what is happening. The engagement plan shows how the CCG has planned its engagement for 2016 and ensured that despite the changes patients are kept informed.

The CCG’s work with the mental health Innovation project is a good example of how working with clients has changed service provision

Through effective engagement the CCG can be confident that the population it serves is engaged in the decision process. In particular this ensures that where changes are made to services and pathways those patients using them are informed and able to make choices on their care.

The CCG’s work with the Youth Forum is strong evidence, illustrating how the Commissioner can work inclusively with a seldom heard group.

1.4 When people use NHS services their safety is prioritised and they are free from mistakes, mistreatment and abuse12


How does the CCG ensure patient safety is a priority and ensure patients are free from mistakes/mistreatment/abuse? Please give examplesProtected



[May 2017]

Age Disability Gender



Article 2 | Right to life Article 3 | Anti-torture and inhumane treatmentArticle 8 | Right to private and family lifeArticle 9 | Right to freedom of thought, conscience and religionArticle 14 | Anti-discrimination

The CCG is strongly committed to ensuring patient safety and takes a range of measures to ensure this is the case for services delivered on its behalf.

Care Home inspections

The CCG has worked with NHS Hardwick CCG to develop an enhanced Care Home inspection regime to respond both to emerging issues and to ensure that the CCG can be assured of the quality of care and patient safety in Care homes.

The evidence portfolio shows a record of the inspections undertaken, a sample monitoring form and a guide to choosing care homes for patients and their families.

Contract Quality Schedules

In addition, the CCG works with and utilises quality schedule and exception reporting to ensure that where a provider delivers a service on its behalf that service can demonstrate patient safety as a key priority, and that patients are free from mistakes/mistreatment/abuse. As the CCG is currently not a lead commissioner for any specific large contract, it works closely with its Derbyshire CCG partners to ensure that services safeguard and meet the needs of patients in the Erewash area.

By working with Hardwick CCG to carry out additional non-statutory inspections and setting up an enhanced review scheme the CCG is in a strong position to maximise patient safety and ensure that the possibility of events such as Winterbourne are reduced as much as possible.

By working with Lead Commissioners, the CCG uses Quality Schedules to ensure patient safety since they set out the standards and require the provider to report any areas of concern which they are contractually required to work with the Commissioner to resolve. This is especially important around the 9 protected groups since some groups have additional needs.

1.5 Screening, vaccination and other health promotion services reach and benefit all local communitiesHow does the CCG work in partnership to support health promotion in its local communities? Please give examples



Impact Grading[May 2017]

This section is not completed by CCGs since this is a public health function.


2. Improved patient access and experienceThe NHS should improve accessibility and information, delivering the right services that are targeted, useful and useable in order to improve patient experience2.1 People, carers and communities can readily access hospital, community health or primary care services and should not be denied access on unreasonable groundsHow does the CCG ensure all people can access healthcare services where no one is discriminated against and denied access on unreasonable grounds? Please give examples



Impact Grading[May

2017]


and Maternity









Considerations for Human Rights are embedded into the planning and delivery of services by the CCG. This is especially important since its area of work includes mental health services and regular use of the DOLS and other actions which impact on an individual’s Human Rights.

The CCG regards ready and equitable access to services to be at the core of Commissioning. It has made a strong commitment to ensure that all patients can readily access services and that where possible the needs of all are met.

The CCG works with provider organisations to ensure that services provided on the CCG’s behalf are fully accessible to all including the protected groups. Should any issues emerge, providers are required to report these and agree an action plan response.

The CCG’s work during 2015/16 with Airedale Tele Health has seen medical support provided to patients in care homes remotely, ensuring they do not have to attend surgery and reducing the requirement for home visits while maintaining quality of care.

The commissioning of a range of Voluntary sector contracts and Capital grants allows the CCG to tackle so long standing problems and complementing NHS services. This is fully in line with the CCG’s Commissioning intentions and is vital in supporting patients to be cared for in community rather than in hospital, (which has traditionally seen Erewash residents travel to Derby or Nottingham for care.)

Improving outcomes for children and young families is key since this group has been identified as a key target for work by public health. By engaging effectively with this population and commissioning specific support projects from the voluntary sector the CCG can understand their needs and target resources effectively.

The CCG’s work to Dementia proof health services has also been key since this group has historically been less able to access services. The CCG is now working with and challenging services to ensure that they are inclusive of this group of patients.

Airedale Tele Health

Care home residents have been able to access qualified medical support quickly improving access to healthcare for a group that has traditionally seen some inequalities in access.

Voluntary sector funding

Effective funding of the voluntary sector sees NHS work complemented and the following groups benefiting.

Carerso Supported and engaged,

thus able to support those they are caring for

Children and Parentso Additional targeted support

Frail and elderlyo Support to meet their needs

and allow them to receive care in the community and remain in their own home.

o Increased / maintained independence

Dementia proofing

Help for those with dementia to continue to live in their own home for longer.

To support Carers. To provide volunteering

opportunities.14


An example of where the CCG has engaged with patients to ensure that a service is accessible to all is Podiatry. Within the evidence portfolio are the results of a survey carried out around a range of access related issues for the service.

There is a focus on engagement with people with a learning disability, their carers and professional workers as a review of previous engagement work showed this group were identified as having limited involvement in the past reviews. Additionally, previous concerns have been raised about their experiences of the core podiatry services following the previous commissioning process four years earlier.

The development of services through MCP Vanguard, integrated services such as On Day Services has improved access for all especially those with long term conditions and health needs who can now get to see their regular GP more easily.

To raise awareness of dementia and how as a community, we can help to better support those with dementia and their carers.

To raise awareness of support services and partner organisations to clients and their Carers

A key priority for the CCG is that patients can access quality services in the community – local to them. By supporting regular GP access these patients can now be seen more easily by their GP rather than being required to travel to other locations.

2.2 People are informed and supported to be as involved as they wish to be in decisions about their careHow does the CCG ensure that people are at the centre of the decisions about their care? Please give examples



Impact Grading[May

2017]


and Maternity



• Objective 3: To further support the work on integration of care focused on Frail and Older people, identifying the experiences of patients and their carers, providing support and

Article 8 | Right to private and family lifeArticle 9 | Right to freedom of thought, conscience and religionArticle 14 | Anti-discrimination

The CCG has put a key focus to engagement and empowerment of the Erewash population to ensure that patients are in a position to genuinely make decisions about their care.

Examples of the work include:

Development of engagement opportunitiesAs of the end of September 2016, the CCG had completed over 162 engagement activities involving 5414 people. Activities include patient stories, stakeholder events, discussion groups, email consultations, public events, surveys, case-study evaluations and interviews. Each engagement relates to at least two or more strategic priorities because it is focused on the MCP and the End of Life care Project. Strategic priority 6 (supporting people with Long Term Conditions) has featured frequently in engagement activities. During the last quarter there has been an increase in activities engaging with mental health service users, this is related to the success of the Mental Health Innovations programme which now has over 60 trained mental health first aiders. Engagement and information events hosted

MCP work has focused on identifying key peoples and groups in the community who can support personal and community resilience. They are now represented on many of the CCG committees including the MCP groups.

Workstreams for the MCP focus on building resilience in young people. The Art of Being Brilliant supports young people to build self-esteem.

Timebank has been established in Erewash as a means of encouraging and supporting informal volunteering. This enables people who need help to access it from the bank and, for people who have time and skills to give, they can support people in their community.


information including those in care homes (which links to CCG priority 5)


as part of this programme have seen a high attendance rate. The last quarter saw the increase in citizen and patient representatives on the various CCG committees and groups, mainly as part of the MCP delivery.When looking at Themes, the most frequent over the last 12 months are;

end of life care, commissioning decisions, support for carers, access to services, equality and diversity.

This matches the key aims and themes of the engagement and experienced activity planned and delivered during the time period which included the;

carers consultation, young people’s forums, consultation on commissioning intentions and MCP engagement through the voluntary sector organisations.

When looking at the Client Group for the engagement activities, most of the activities were inclusive of all age ranges and did not target specific client groups with the exception of the Youth Forum which is a group regularly attended by the CCG to look at young people’s experiences.

The Ripplez project

As part of the Ripplez project to support young mums a series of workshops were held to develop their skills and confidence and support them to influence the commissioning of health care. The workshops were held each week at the Children’s Centre and took the format of art and craft sessions and discussion groups. Young parents build models of their experiences including comment trees, confidence cards and experience boxes all designed to enable them to talk freely about their health and care needs and experiences.

Erewash Youth Forum – Engagement on Delivering Commissioning Intentions 2016/17

Through the MCP links and relationships have been built with many organisations who support people through health and social crisis such as housing and job support. This enables us to identify and influence their health needs

The Ripplez project has empowered young mums and also created a group who can work with the CCG to influence Commissioning decisions putting patients at the heart of decision making.

Erewash Youth Forum by working closely with this forum the CCG is in position to engage this traditionally seldom heard group and ensure their views are included in planning and designing health care.


2.3 People report positive experiences of the NHSHow does the CCG engage and involve people to listen to their views of the NHS? Please give examples



Impact Grading[May

2017]


and Maternity









Considerations for Human Rights are embedded into the planning and delivery of services by the CCG. This is especially important since its area of work includes mental health services and regular use of the DOLS and other actions which impact on an individual’s Human Rights.

The CCG recognises that part of the assurance that services are meeting the needs of patients is provided through feedback.

The CCG are pleased to see that patients are reporting positive experiences. The feedback received from engagement indicates that patients value the CCG’s commitment to seek their views especially when the CCG’s responses are provided through feedback from events.

The CCG’s Annual Engagement Reports (2015, 2016)

This report included within CCG’s evidence portfolio provides a summary of all the engagement undertaken through the year and the feedback received.

Key points raised at the September 2016 stakeholder meeting included:

Access to GP appointments for carers Implementing on day services Access to services out of hours Understanding where to go, who to see Supporting people to be more informed Developing personal resilience

At the meeting, the group received a more detailed summary of the work already completed for Multi Community specialist providers (MCP)s in Erewash. There have been some very positive outcomes from this approach to working with Stakeholders with the following comments made:

The events were rated very positively by stakeholders attending

Debate was meaningful and “on task” The process of building knowledge and information in

steps together with updates on key local and national information ensured discussions were relevant and well informed.

Confidence levels in the stakeholders were higher as they were able to demonstrate understanding of the topics discussed.

Relationships were strengthened between stakeholders and the CCG as no one held all the information. Everyone was an “expert”

As illustrated in previous sections extensive engagement with

The impact of positive experiences is most clearly shown in the outcome reports, showing the success achieved by the CCG funded third sector projects.

These projects support vulnerable groups such as carers and the frail and elderly to remain in their homes and allow the CCG’s flagship project to increasingly treat patients in the community rather than hospital to succeed by filling in areas that are not possible for the NHS.

The following outcomes have been fed back to the CCG as a result of the CCG’s voluntary sector funding over the last 2 years.

Reduction in presentations at A&E for slips, trips and falls

Residents accessing services previously unknown to them

Residents living independently in their own homes for longer

Reduced professional carer input Isolation and anxiety reduced Health Visitor intervention earlier 49% of people in Erewash able to

die in their place of choice compared to 18% - 35% nationally

Improved bereavement support for families

More appropriate use of local services

Increased employability of volunteers

This shows the positive impact on patients and Erewash residents through these projects.

With the key focus on the move to an MCP model the CCG has engaged closely with local people, the voluntary sector and stakeholders around this important project. As a result, the CCG can be assured that the views of Erewash residents have been considered as much as possible in decisions made.


the voluntary sector has helped the CCG in shaping services and gaining feedback on current and future projects. The feedback received has illustrated the value of the funded projects to patients.

Projects by Theme: The CCG’s engagement with a range of groups can be seen summarised here by Protected Characteristic.

Patient and Public Experience, Engagement & Involvement report Q2

This report illustrates the key engagement undertaken and comments raised – these are now focused around our commissioning intentions and delivery of the engagement strategy. Over the quarter July to September 2016 we have worked with in excess of 137 people in 14 different formal consultation, engagement and feedback work. Activities have focused on the following:

Reviewing patient and carers experience of End of Life Care (EOLC)

Citizen representatives in the Health as a Social Movement project

Citizen and Lay representatives involved in the review of the Equality and Diversity scheme objectives and evidence for the CCG

Review of communications with Heathwatch Derbyshire in the light of the 360 analysis and the changing landscape presented by the MCP and Sustainability and Transformation Plan

Patient engagement in the review and re-commissioning of the Podiatry contract for Derbyshire

Increased activity with people with learning disabilities Completion of a social capital survey

July - S

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Oct - D

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Jan - March

2014

Apr - Ju

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July - S

ept 2014

Oct - D

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Jan - March

2015

Apr - Ju

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July - S

ept 2015

Oct - D

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Jan - March

2016

Apr - Ju

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July - S

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10

20

30

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Engagement and Involvement - Number of Activities

This has seen a range of feedback produced which has been used to shape future decision making.

It is pleasing to report that the CCG’s decision to fund a range of 3rd sector organisations has delivered positive outcomes for patients.

There has been significant development within infrastructure to support the delivery of the engagement agenda especially for the Vanguard (MCP) delivery. These include:

Database of all engagement and partnership working and action plans supporting the quarterly reporting process

Commitment to the Health and Wellbeing Partnership in Erewash

Development of Stakeholder Forums PPG Networks Erewash Healthy Voices consultation

group Development of Community Maps Development of Engagement Maps Development of work streams with

young people Development of networks and

working arrangements with the voluntary and third sector organisations including identifying the five key stakeholders

Social capital survey for Erewash

2.4 People's complaints about services are handled respectfully and efficiently18


How does the CCG handle and monitor complaints ensuring action is taken? Please give examplesProtected



[May 2017]

Age Disability Gender





Considerations for Human Rights are embedded into the planning and delivery of services by the CCG. This is especially important since its area of work includes mental health services and regular use of DOLS and other actions which impact on an individual’s Human Rights.

The CCG recognises that part of the assurance that services are meeting the needs of patients is provided through feedback.

The CCG has reviewed its complaints reports (2015 and 2016) (included in the portfolio of evidence and works to address patient concerns and lessons learned.

The CCG also works with the organisations it commissions to address concerns raised by patients to ensure that where possible lessons learned are actioned as quickly as possible.

This year (2016) all complaints received related to Continuing Healthcare Services (CHC).

In general CCGs receive a numerically small number of complaints and these primarily focus around funding decisions and quality of care.

As a result of complaints / concerns / comments received the following actions were taken in relation to Continuing Healthcare Services (CHC)

Key learning points being:

CHC Service To review their decision to not

routinely send out outcome letters when there has been no change in funding.

Retrospect Review Service (RRS) To ensure checklists are completed

periodically where claims span a number of years.

To ensure un-assessed periods of care identified are placed back into the retrospective process.


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