Levers for Change

1
Levers for Change

• 1st May Taunton Racecourse
• Event Evaluation

2
Contents

• This document is designed to be read on screen
• Programme for the day slide 3
• What you thought of the presentations slide 4
• What you said about the day slide 5
• What you said were the best things about the
  day slides 6 7
• What you didnt like about the day slide 8
• The outcomes you would like to see as a result of
  the day slides 9, 10 11
• Locality discussions slides 12 - 23

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Programme for the day

• 9.30 Registration and Refreshments
• 10.00 Welcome
• Judy Walker, Director of Operations, Stroke
  Association
• 10.15 World Class Commissioning, Dr Steve Feast,
  Department of Health
• 10.30 Doing your local leadership differently
  Professor Steve Onyett, South West Development
  Centre
• 11.15 Refreshment break
• 11.30 Putting People First, Pam Richards, South
  West Personalisation Coordinator
• 11.50 Doing commissioning locally, Jan Evans,
  Commissioning Manager, Wiltshire 12.15 The
  Richard and Judy ShowThe views of service users
  and carers,
• South West Alliance of Neurological
  Organisations
• 1.00 Locality Discussion
• 1.15 Lunch and exhibition
• 2.00 A model for a network, Lynne Barr, North
  East Long Term Conditions Team
• 2.30 Locality discussion
• 3.00 Final Comments and Close

4
What you thought of the presentations
5
What you said about the day

• Has today helped you with what you need or want
  to do as part of your work or involvement?

6
What you said were the best things about the day

• Hearing the views of service users and carers in
  the Richard and Judy show, invaluable
  information and great to get their perspective
  (x22)
• Service user and carer involvement in the day
  (x2)
• Willingness to challenge current thinking
• Local leadership presentation, Inspirational
  leadership talk (x3)
• Good programme, varied speakers, good venue
• Time out to focus on these issues
• Very inspiring lectures
• Network model (x3)
• Inspiring to think that one can get a successful
  network running with no funding initially
• Networking (x5)
• Information on the exhibition stands
• Meeting people, meeting people from other
  organisations in the SW
• Sitting at a Wiltshire table so that we could
  apply the bigger picture to our own patch

7
What you said were the best things about the day

• Well structured with useful consistency of themes
• Good balance, wide ranging
• A thoughtful overview of key issues
• Gaining ideas about how to change service at all
  levels
• Good relationships
• Opportunity to meet with other care providers
  from different backgrounds, carers and
  associations
• Awareness of who is doing what, or not
• Great mix of people on the tables
• Opportunity to dedicate physical and head time to
  considering commissioning- how in my job I
  influence and am affected by it
• Good venue, lunch directions etc.
• Chocolates! Lunch!

8
What you didnt like about the day

• Prof Onyetts talk was too short ! (x4)
• Too much PowerPoint, you can not listen and read
  at the same time
• The leadership stuff ego fuelled and lacked
  structure, all theory , no practical application
• Speakers rushed as the timescales were too tight,
  this ate into the time for networking too (x2)
• The partnership talk didnt add anything to the
  info I already had
• Network discussion too late in the day, no time
  for questions
• Network discussion was tricky to hold on tables
  with very small geographical representation,
  might have been better to hold a plenary
  discussion
• Presented network model doesnt reflect the local
  situation (x2)
• The DVD should have been there in person,
  patronising and too long and didnt work
  properly, too much jargon, needed examples to
  explain the ideas (x3)
• Some sheets of blank paper for notes would have
  been useful (x2)
• Too much sat listening, other delivery styles
  needed, chance to move around and get to know who
  else was there needs to be built in to the day
• Got very cold with excessive air con in the
  morning, later resolved
• Venues should have accessible dedicated disabled
  parking bays
• Buildings should be completely compliant with DDA
  I.e. provision of WCs for disabled

9
The outcomes you would like to see as a result of
the day

• This process is a whole system change I hope it
  moves forward involving every agency
• People just to get on with it and not be
  tokenistic or waste money
• Further NSF implementation, more focus on
  neurological conditions(x2) and reporting
  information back to delegates
• Joined up thinking resulting in across-the-board
  communication and coordination (x2)
• More productive partnership working, closer
  working between health and social care locally
• (x3)
• Implementation of key points made, such as health
  professional responding to the need to improve
  communication and coordination
• Investment in delivering services for people
  living with long term neurological conditions in
  the community
• Feedback from services users experiences of
  personalisation
• More time to discuss future proposed plans
• A cradle-to-grave pathway for cerebral palsy
  within a general neurology pathway

10
The outcomes you would like to see as a result of
the day

• Further events giving examples of good practice
• Follow up groups assessment staff to be
  included especially in further events
• Time to work on the big picture as well as
  meeting clinical needs
• Valuing the work of frontline clinicians to a
  greater degree leading to cascading of leadership
  roles and empowering individuals
• More services, improvement in access to services
• Better publicity and information about different
  conditions
• Services developing in Wiltshire
• Engagement of patients in developing stroke
  services in Gloucestershire
• Return to patient centred care
• Promotion of appropriate service provision
• Increased connections between professionals
  across health and social care
• More volunteers supported to engage in
  co-production
• Improved commissioning of services that allows
  frontline staff to really meet the needs of
  service users and not be restricted by protocols
  and funding
• Patient related outcomes that are measurable and
  real and make real changes for people and their
  carers
• Patient reported outcome measures for each
  specific neurological condition

11
The outcomes you would like to see as a result of
the day

• A regional neuro network for commissioners
• The creation of a sub regional or regional
  network (x2)
• A network for Wiltshire that we define for
  ourselves
• Beginning of the process of networking to aid our
  development of the coordination of these new
  developments for patient input
• Network developed in Plymouth and Cornwall
• A network that works!
• Development of a Devon network
• A good network of neuro colleagues across health,
  social care and voluntary sector so we can share
  best practice
• Action!

12
Locality discussions each table was asked to
think about the following questions

• Who are your local leaders?
• Is there a local vision for future services?
• Is there a local plan for achieving this vision?
• Are the voluntary sector, service users and
  carers involved in developing and implementing
  this plan? E.g. via surveys, consultations, as
  board members, in references groups, as service
  providers
• Do you need help to engage with the voluntary
  sector, service users and carers?
• Network - Good idea or not?
• If yes, should the network be regional, sub
  regional or local?
• Where will the leadership come from?
• Where will the funding come from?
• Who should be involved?
• Would YOU like to be involved? If yes, your name
  please
• Suggest a name for the network

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Locality discussions Table 1

• Who are the local leaders?
• Medical and social, including clinicians,
  physiotherapists, OTs, professionals and others
  with special interests, GPs, pharmacists,
  mobility professionals, social care staff and
  family counselling services.
• Some of the above will be non-professional, third
  sector and the group felt that there would need
  to be nomination of network leads and effective
  communication channels in all directions.
• Local vision
• It was felt that there was vision impairment
  and that it was not whole, with patchy levels of
  service. It was agreed that small, local
  hospitals offer good value
• Local plan
• Planning is at varying stages of development,
  mostly at the early. The group felt that there
  was a lack of things being joined up and that
  baseline assessments would be helpful in
  determining a starting point.
• Voluntary sector, service user involvement etc
• Not always the case with specialist services and
  levels of support for personalisation
  insufficient to enable people to make informed
  choices - and considered patchy. There are good
  examples but not for neurology as a whole. A
  participant who had a long term condition noted
  that he was involved in training some
  professionals, which was good for him and for
  those being trained. Fifty-percent of the
  consultants with whom he had worked had not seen
  PD patients during training.
• Help needed engaging with voluntary sector,
  service users and carers?
• Yes!

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Locality discussions Table 1

• Network discussion
• Networks are a good idea.
• Networks should be at regional, sub regional and
  local level
• Leadership should come from within from each
  according to their abilities Should be a doing
  network and not a steering group, involved in
• Development, Dialogue, Sharing, Supporting
• Emphasising excellence through sharing
• Everyone needs to recognise that mistakes can be
  made and learned from 
• There are various possibilities for funding,
  which does not always have to be new
• Expenses and accommodation need to be covered
• Identify needs and then seek to identify
  potential sources

15
Locality discussions Table 2

• Local leaders names given
• Very new local vision, Neuro Specialist Team set
  up in N Somerset
• Pathways being slowly formulated
• Voluntary sector, service users and carers
  involved in acute service, and BNSSG (?)
• Evaluations being done
• Headway are good, but not good in S Glos, loss of
  partnership board in S Glos
• MS centre Nailsea and Warminster
• Vassal Centre
• Spinal injury centre in Salisbury but services
  not readily available on discharge
• Consultation with all conditions not good,
  tokenism and box ticking
• PCTs and Acute Trust do not work together in
  BNSSG
• Problem with sharing the community work money
• Works well in BaNES
• Friction in N Somerset
• Lack of patient choice on discharge hospitals
  are making the decisions
• Carers are the unsung heroes
• Fire-fighting all the time which blocks the good
  ideas
• Lack of money and resources
• How creative can you be?

16
Locality discussions Table 2

• Network is a good idea, should be sub regional
• Leadership should come from the PCT with the
  support of the SHA
• Funding should come from the SHA
• All groups should be included, plus local forum
• MDTs/clinical groups should be local forum
  otherwise network is too big
• University and SWMPO (?)
• Suggested name Neurosouthwest

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Locality discussions Table 3

• Local Leadership
• Via the SHA 
• Frontline service staff need to be more engaged
  in leadership as collaborators rather than
  followers 
• South Petherton Hospital and Bridgewater Health
  Campus developments achieved via leadership
  through an inclusive approach
• NSF Implementation Plan 
• Role for vol orgs re hard to reach groups but
  must be credible as gateway/conduit to service
  users/carers
• LINks role needs developing re LTNC groups/focus
•  Specialist Nurses much valued by service users
  and as well as direct service providers also act
  as a point of leadership for their specialist
  area
• Regional Network
•  We thought it would be a good thing and were for
  it!
•  Who would initiate SHA?/Specialised
  Commissioning?/SWANO?

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Locality discussions Table 4

• Local leaders  named The LIT is a big group
  that meets quarterly and includes service users,
  carers, there is managerial representation, neuro
  services clinicians, Headway, MS, MND, PSP,
  Huntingdons, PD, CP etc. There are also disease
  specific sub groups.  They are looking to
  restructure as the group is too big
• The local vision for future serviceThere is a
  recognition that neuro is under resourced, a
  cinderella serviceThere is a realisation they
  need to involve the local authority and
  personalisationThe third sector has been vital
  in keeping everything going
• As the plan is pan Dorset there have to be
  different models of delivery as some is rural and
  some urban
• The planLooking at different models as the LIT
  too big - may be senior strategic commissioning
  managers feeding in to relevant sub Groups that
  feed into LIT.  Chairs of the sub Groups the
  LIT.  Each sub group to be condition specific to
  see where they are with the NSF.  Will be firming
  up TORs to ensure all groups are the
  same. There are programme leads, one of which
  is LTC.  They are 'bunching up' groups of
  conditions with groups involving contract
  managers, local authority etc to look at
  commonalities and tie into the NSF. 

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Locality discussions Table 4

• Is the VCS involved They are actively engaging
  with everyone to write a service specification.
   Patients are to be involved in the writing of
  the commissioning spec.  They are feeding in what
  they want so they feel involved and
  valued!! They feel the are working well with
  the VCS etc but there is always room for
  improvement!
• Network
• When we discussed the Network idea we did not
  get very far as Dorset feels it really does not
  fit in the region very easily and they work
  closely with Hampshire in the South East. Their
  commissioners feed in to Southampton, there is no
  specialist unit in the county so they work with
  them.They feel any network should be local as
  any bigger gets too big and cumbersome.

20
Locality discussions Table 5

• Local leaders are health and social care teams in
  each locality. Names given
• No local vision yet meeting being held on
  15/05/09
• Voluntary sector and services users and carers
  are involved, but also need well-publicised
  contact at Wiltshire Council
• Do not need any help to engage with the voluntary
  sector
• Networks are a good idea, but capacity is a big
  issue. We all have existing networks
• Within Wilts/Swindon, a neuro sub-group is being
  considered
• This would bring health and social care planning
  together and would look at the big picture
• Could SWANO be developed into a network? Or could
  it support a Wiltshire network?

21
Locality discussions Table 6

• Leadership
• Lack of link with people working on the frontline
  and commissioners
• No integrated records between health,
  intermediate car
• Review by PCT but did not involve frontline
  staff, public invited, but no feedback
• Lack of coordination between acute and primary
  Care Services Improvement Partnership no sharing
  of information so communication is difficult
• MND coordination driven by MND association
• Review of stroke services involved service users
  and carers and voluntary organisation
• Need to avoid tokenism
• Changes recently introduced need to bed down
  before further action is taken
• Network good idea, either at PCT level, or north
  and south of the region, regionally to influence
  future commissioning
• Network would give the opportunity for local
  bottom up approach there has been a user
  engagement event for a neurological review, but
  need to include clinicians perspective. We are
  all leaders but needs coordination
• PCTS/PCOs will be future commissioners so align
  in some way for future funding

22
Locality discussions Table 7

• Ensure region meet specialist needs
• Joint transition group in Torbay
• Only professionals working in joint services know
  their leaders (or providers)
• But external organisations find it difficult to
  find out who to approach, have to enquire and may
  get passed around
• Difficulty with cross PCT work
• There is some vision and there are some plans
• Larger representative groups have specialist
  commissioning but the commissioning is the
  difficult part of planning and providing services
• Torbay has projects in attempt to join up
  planning
• Devon is still subject to reorganisation/ vacant
  posts/ funding problems etc.
• Finance battles between health and social
  services are less in Torbay
• No involvement of services users and carers yet.
  Parkinsons, service users involved in the
  recruitment of specialist nurses
• Devon re establishing itself to involve service
  users again after a review, now on the agenda
• Concern about voluntary organisations creating
  specialist posts which are time limited. PCTs
  have to have commitment to continue funding
  posts, no guarantees in place.
• People need training and devlopment to be
  consulted/ engaged, to make views valid to the
  process. There are professional users who are
  consulted too regularly. PCTs go to clinicians
  for people to approach may not have necessary
  experiences about services that are, or should
  be, available
• What needs to be commissioned nationally and
  those locally is an issue. Both should exist

23
Locality discussions Table 7

• Network is a problem current groups exist, not
  covering all south west, or only certain
  conditions, needs to be all inclusive
• Lots of good work overlaps, perhaps needs to be
  local, feeding into sub regional then regional
• Local people should be used with regional
  representatives at regional level
• Time is limited, problem with time being
  allocated
• Education and connexions need to be included
• People should be nominated by their organisation
  to demonstrate commitment .
• People should identify key players in the region
  otherwise it will be the usual professionals. May
  need core membership, but bring in others as
  planning needs arise
• Suggested name SW Neuro-alliance Network (SW NAN)