Evidence shows that when patients, public and healthcare staff work together, it results in better services which lead to better health outcomes. We place patient involvement at the heart of our commissioning and decision making from the very beginning of a project, including analysing and planning, designing pathways, buying services and delivering and improving services.
Throughout this section you will see how our engagement has directly contributed and is supporting the delivery of many of our strategic priority areas and our commissioning intentions, including work undertaken as part of the South West London Health and Care Partnership.
Our current and recent projects include:
Trailblazer: Improving emotional support in Schools for Children & Young people
Background and purpose
Across South West London (SWL) we have a high number of children who are self-harming, and we want both to address and prevent this by developing consistent wellbeing support and early intervention.
We aim to reduce the number of children self-harming in South West London through a 'whole system', multi-agency approach, using health, education and local authority resources to provide support in schools to parents and carers and children and young people.
Wandsworth CCG, as part of the South West London Health and Care Partnership, works closely with a cluster of schools in the borough to introduce enhanced support for emotional wellbeing. Having secured funding to establish an innovative 'trailblazer' programme to pilot new approaches to working with children and young people to support them to develop resilience and to get easy and rapid access to specialist help if they need it.
We have worked to ensure the project is informed by the views and experiences of children, young people, parents and carers, and will continue to be built on this foundation as we take forward this important programme.
Our engagement aimed to seek feedback from children and young people around key areas within individual school audits in order to Influence the development of individual school and cluster action plans and interventions. We plan to continually enhance student voice within schools to support future engagement work and as part of best practice
We delivered engagement workshops with each of the schools in the Merton cluster. We worked with individual schools to understand their channels of communication within school, consent processes, existing mechanisms for engagement and previous engagement around emotional wellbeing and resilience.
Working alongside the emotional wellbeing leads within each school, we drafted a session plan, drawing out key areas from the action plan that children and young people were most able to influence. Once the plan was drafted, we worked with each individual school to tailor; content of the session plan; wording and format for different age ranges and agreed how the session would be delivered to foster collaboration and partnership working.
The agreed session plan covered, student voice, school support, school vision and values and peer support and bullying.
Of the 8 engagement sessions delivered, 2 were with secondary schools and 6 were with primary schools. We spoke with 84 children, within the ages of 6-17years old (year 1- year 12), of mixed genders and mixed ethnicities.
Key messages included;
Generally a good understanding and awareness of mental health and wellbeing amongst young people.
School vision and values – some children were clear on what these are were and had ideas on what else could be included. Some children could not recall the schools vision and values but were happy to share what they thought they should be.
Student voice – Good practice in place for children and young people to be involved, but greater promotion needed and methods reviewed. Students value the opportunity to give their voice and would like to encourage more inclusive methods to collate feedback from a more representative sample of the school and involvement in the action plans
School support – children feel able to speak to some school staff for support but better signposting is needed about who to talk to and the choices available. Students understand the value of confidentiality and this needs to be taken into consideration for support mechanisms for example location of worry boxes.
Resilience and emotional wellbeing - Students had a good understanding of resilience and would like more opportunities to build resilience and improve emotional wellbeing.
Outcomes and next steps
Each school has developed a set of actions which will be taken forward based on feedback and consideration will be taken about how the actions will be appropriately monitored throughout the year. One of the 8 schools have asked an engagement session to be delivered after a years' time, to assess impact.
Actions set by the schools included;
- The school will implement an application form for friendship monitors and recruitment to the posts will be based on skill and who will be suitable for the role.
- A specification will be devised for the school prefect's role, to encourage and facilitate them in having more responsibilities within school.
- All ideas raised in the school council, will be fed back to the whole school during an assembly.
- Have a voting system for major changes in school – allow all children to have a view.
- Implement friendship benches in school.
- Give students a better understanding of buddy benches – School Council to deliver an assembly and promote its benefits
- In the new academic year, when the new School Council representatives have been chosen, an assembly to highlight the role to the whole school
- 'Something I would Like My Teacher To Know' box / worry boxes provided in every class
We have evaluated all aspects of the engagement process to improve engagement in future. This evaluation has veen shared with schools so through shared learning, consideration can be taken to improve engagement within school.
Our key learning included;
- Better collaboration – Engagement leads to codesign engagement sessions and materials with teachers and students. More direction given on the questions so the right insight can be collected.
- The purpose and value of the session wasn't always clear at the beginning. Towards the end of the engagement activity teachers reported engagement was valuable and gave them a greater understanding of the children's perspective of emotional wellbeing and support available.
- Presence – ensuring those involved are representative and supported to give their feedback.
- We had a good representative sample, however the selection of students who attended the session could have been improved, as there was an emphasis on students who had a strong voice and were members of the school council. Further work could be done to reach the least heard.
- Some younger students could have been involved but needed extra support to join the discussions.
- It would be helpful for teachers to co-lead the session or be present in the room.
- The timeliness of the sessions could have been earlier in the academic year and been aligned with the school audits and not in the exam period. Less pressure on teachers to fit in the sessions.
- Impact – more understanding needed on how we will be monitoring how the feedback has been actioned and the results.
We have shared an evaluation of the project and our key learnings with South West London colleagues, to enhance the engagement work which will be done with all of the cluster schools across South West London.
NHS Wandsworth CCG_Emotional Wellbeing in Schools Workshops Report_Burntwood School.pdf
NHS Wandsworth CCG_Emotional Wellbeing in Schools Workshops Report_Westhill.pdf
NHS Wandsworth CCG_Emotional Wellbeing Workshop Report_Ronald Ross.pdf
Developing our Local Health and Care Plan
Health and care organisations in Wandsworth are working more closely together to make services better connected and more joined up. The NHS, Council, voluntary sector and Healthwatch are developing a Local Health and Care Plan for how this might be achieved.
Work has already been undertaken to look at local population needs; current services and what patients have already told us about what they want from local services. Through this we have developed some high-level areas of focus around the themes of start well, live well and age well.
To develop our ideas, we wanted to bring together local people, frontline staff and key stakeholders (including local councillors and voluntary and community groups) to help us agree priority areas for all the partners to focus on.
recognised that a lot of engagement work had already been undertaken by the NHS
and our partners. We summarised this and presented this, alongside our ideas
and information about our local population, at an accelerated design event in
November 2018. Local partners, Healthwatch and the voluntary and community
sector helped us to design this event - making them as accessible as possible
for a range of stakeholders and knowledge bases.
than 130 people attended the day – including around 50 local people who had
been specifically recruited to represent the diverse community in Wandsworth and
who had never worked with us before. We worked with a specialist organisation
to reach out to a representative cross section of the community using online
advertising and on-street recruitment. As a result we heard from a range of
people we wouldn't ordinarily have reached including from those in deprived
communities, young adults and people from multi-cultural backgrounds.
The event asked people to discuss what surprised them about what they'd heard about living in Wandsworth, what they thought was missing from our ideas and, most importantly, their ideas for how we could take forward the priority areas. This focussed on why the issue is important, what the challenges are, opportunities, solutions and how the change will be made.
Topics discussed included:
- Childhood obesity
- Children and young people's mental health
- Risky behaviours
- Integration of physical and mental health resources
- Health and social care integration
Outcomes and next steps
The energy and enthusiasm in the room generated a lot of feedback and ideas, which will be analysed in a feedback report, to be shared with those who gave up their time and decision makers in 2019.
We will be using the outcomes of the event to form the basis of our Wandsworth Health and Care Plan which will be drafted by March 2019 and be championed by the Health and Wellbeing Board.
But, publishing the plan won’t be the end of the conversation and we want to work together with local people and community organisations to put these plans into action. Further engagement work is planned for 2019/2020.
You can watch the Wandsworth Local Health and Care Plan deliberative event film here:
Information about the local health and care plan event has been published on the South West London Website, click the link to view the report here.
Falls Prevention Service redesign
Falls in Wandsworth have been rising despite many developments in service delivery over recent years. Falls happen for many reasons and so all services need to have an awareness of these factors e.g. medication, frailty, environment and musculoskeletal difficulties.
A review and redesign was initiated to address the needs of the population and improve the prevention strategy for falls across Wandsworth.
Engagement work aimed to seek views about why people felt falls were a problem, what they felt were the causes, what they thought about our ideas and how they had been affected by falls.
The PPI team and the GP Lead worked with the falls commissioning team to undertake engagement work with local people, which took place between May and October 2018.
Activity included a falls questionnaire being placed in Wandsworth GP Surgeries and being made available online, as part of the Productive PPI and white board project. The questionnaire had the potential to cover a broad area of the community with relatively quick feedback. We also shared the survey with those we undertook face-to-face engagement with. This included community organisations helping older people - an age group where falls most frequently happened.
We were keen to get as broad a view as possible on the redesign and the perspective the public had on falls. Looking at the data available of the age range for the greatest number of falls, we approached and gave presentations to Wandsworth Older People's Forum and Katherine Low Settlement and discussed the key issues with them to seek their feedback. The presentation introduced the draft redesign for the service and the patient journey most appropriate for their needs. We also spoke to Healthwatch.
To ensure that there were views from minority and hard to reach groups, we also presented to Thinking Partners at the CCG, a group made up of voluntary sector representatives including learning disabilities, LGBTQ, autism, mental health, faith community groups, sensory impaired and many others.
Through the questionnaires, we received around 50 responses. Early themes from the face-to-face feedback and questionnaires included areas such as frailty, poorly maintained pavements, losing confidence following a fall and inappropriate hospital discharges. People were pleased about moving exercise programmes into the community and joining these up with social opportunities. It was felt that this would incentivise more people to come along.
In general, there seemed to be a low awareness of the 'falls service' unless they had a fall and been referred.
Outcomes and next steps
The issues of loneliness and social isolation that have been raised have been heard and are being considered further. This is through the introduction of community exercise programmes which will also support social interaction.
We have spoken to the council with regards to the maintenance of pavements and they have suggested that there is planned investment.
South West London Diabetes Programmme
Wandsworth CCG created a questionnaire for patients to give their thoughts on their diabetes care. The questionnaire was aimed at patients with Type 2 diabetes and those who completed the questionnaire, did so whilst attending an appointment at their GP surgeries.
The aim of the questions was to find out more detail regarding how many patients have attended structured education, if they are supported to control their treatment targets, the frequency they receive care at the surgery and what their preference of treatment venue would be.
The outcomes of this project have initiated discussions at a south west London level around improving diabetes services.
Over 30 patients completed the questionnaires over a six-week period starting in June 2018 across multiple GP surgeries. The questionnaire asked people, since being diagnosed, whether they had attended a diabetes education course, had care planning, contact with clinicians and where people would prefer to receive their care.
More than 50% of patients surveyed reported that they have attended structured education since their initial diagnosis. This highlighted that the current way data is being captured does not present an accurate picture of the volume of patients attending structured education.
On average 75% of the patients that were surveyed reported to have made a plan to support at least one of the three treatment targets (blood pressure, cholesterol and HbA1C (long term glucose average).
Although a small sample size, one cause for concern is that 25% of the patients surveyed reported to not have a plan to support any of the three treatment targets.
Most people are visiting their GP every 3-6 months for their diabetes. Those who visit the surgery more frequently have plans made for their treatment targets rather than those who attend only for their annual review. This may indicate that patients who attend more regularly need more support than just their annual reviews.
Patients who have attended structured education, tend to have appointments less frequently - either once or twice a year. Patients who have not attended structured education tend to have more frequent visits, either going on a regular basis or at least every 3-6 months.
As expected, most patients (87.5%) chose that they wanted to receive their care at the GP surgery.
you said, we did page to see how feedback influenced our plans.
Winter and Pharmacy campaign
In order to reduce the pressure on A&E during the winter months, we have worked with local people to develop a campaign to encourage patients with minor illnesses to visit their local pharmacist. We wrote a survey which was sent to our 3000 people’s panel members to find out insight about their use of pharmacy services. We specifically wanted to find out
• Level of awareness around what services that pharmacists provide
• Level of awareness around which ailments that pharmacists treat
• What would encourage people to use pharmacists more often
• How people locate their nearest pharmacy
The results were very helpful and helped shape our campaign. We developed an infographic which illustrates what we found out and how this influenced our work. This has been shared with our panel and via social media.
Click the link to view the
You can click on the Knowing your pharmacy.pdf
Currently, planned and emergency ophthalmology services are provided by Moorfields Eye Hospital. Although patient experience is excellent, to support care closer to home and to increase access in the community for those with minor eye conditions, the CCG is undertaking a procurement across Merton and Wandsworth. This will provide a community ophthalmology service to complement emergency services at Moorfields.
From our equalities analysis, it highlighted that those most likely to be using this service were older people and those from BAME backgrounds – so we aimed to target these groups through our engagement work. To inform the service specification, a focus group was held with Wandsworth Vision in October 2018, drawing together 13 diverse people with lived-experience of visual impairments. We also discussed proposals with our Thinking Partners Group and sought their feedback.
Those we spoke to were asked about their eye conditions, where they went in their local community for eye care, how they currently access eye care services, what changes they would like to see and their thoughts on our proposals to introduce a community ophthalmology service.
Patients felt that they were not given the correct information about their eye-health with some receiving inappropriate treatment. Patients highlighted that due to the work happening in the ophthalmology ward at St Georges Hospital, they have had to attend different locations for their various eye conditions.
In some cases, appointment letters sent out are unreadable for those who have visual impairments – more needs to be done to adapt and use other forms of communication. Often, patients struggle to access some buildings due to disability and their visual issues. More support is required to adjust these services. Those who attended also reported issues with patient transport.
As part of the procurement process, we have supported patient representatives to be involved in the panel to select a provider to run the new community ophthalmology service.
you said, we did page to see how feedback influenced the final service.
Macmillan Primary Care Nursing Project – Cancer Care Review Focus Group
Listening to patients and ensuring their experience and views help to shape the project's outputs has been key to the Macmillan Primary Care Nursing project from the beginning. Whilst it is well documented that patients' experience a high level of unmet need following the end of their main hospital treatment and that there is a gap in the supportive care and cancer expertise available in primary care, the project team identified that to their knowledge no attempts had been made to find out from patient what their experience of a cancer care review was like. As our patient partner put it: 'how do we know that patients find them helpful?'. Attempting to answer this question formed the basis for a focus group, with the expectation that the results would inform the education and influencing strategy for the project.
You can read the report here: Macmillan Primary Care Nursing Project Focus Group Report
The Junction - improving primary care services
New national standards have been introduced which mean that all treatment centres offering urgent care services, if they meet the requirements, will be renamed Urgent Treatment Centres. As part of this we have been involving local people, patients and the public in a review of the
walk-in centre at the Junction Health Centre.
We visited the Junction along with our colleagues from Wandsworth Healthwatch to find out patients views of the Junction Health Centre. We also sent surveys and information leaflets to local groups, businesses and voluntary sector organisations in the area.
Of those people currently using the walk-in centre we found that:
• More than 50% of people aren't from Wandsworth
• 35% are registered with a Wandsworth GP
• A quarter of people aren't registered with a GP anywhere
The most common reason patients use walk-in services is because they can't get a GP appointment.
The walk-in centre on the site will not meet these requirements and generally only treats patients with primary care needs.
Based on this national guidance and best practice about giving patients continuity of care, we think access and services need to change.
We are therefore proposing to use the capacity in the current walk-in service to increase the number of appointments available through the GP hub service. We feel this will improve care for patients, for several reasons including reduced waiting times and access to care records.
We tested our approach to patient and public engagement with
the PPIRG ahead of starting engagement on the Junction and made changes to the plan as a result including suggestions of groups to engage with and greater clarity on access to the GP Hub on the site.
The engagement activity we have undertaken to-date includes:
sending targeted communications out via post and email to local voluntary, community and voluntary sector organisations to inform people about the project and invite feedback via focus groups in the community and online or freepost return paper copy of our questionnaire.
setting up a pop up informtion stall within the Junction Health Centre waiting area with leaflets, questionaires and a feedback post box.
presenting on the project proposals and gathering feedback and insights at our patient group meetings including those in the three localities in Wandsworth, the Patient Public Involvement Reference Group and Thinking Partners.
publishing a page on our website summarising the project with a link to the questionnaire and ways to feedback and inform the plans.
contacting local businesses and the train station management team to ensure they are aware of the project and changes planned.
visiting local groups located in the area surrounding the Junction Health Centre inviting feedback and discussing the plans with local people.
collaborating with Wandsworth Healthwatch to collect patient feedback via survey in the Junction Health Centre waiting area.
We undertook a mid-point review of feedback received and the response rate during this project. As a result, we changed our engagement approach from focus groups to conducting telephone interviews and on the street engagement with local businesses. It is hoped that this will encourage a greater response from communities identified through our equalities analysis.
An engagement report will be produced and published here outlining reccomendations and key themes. This will be used to plan our next phase of communications and will infomr our final decion making.
You can read our patient and public engagement plan and approach
Co-design of Wandsworth Children’s Mental Health Services Map
Wandsworth is now three years into its ambitious transformation of services for children with emotional and mental health needs, on route to increasing treatment by 35 per cent by 2021.
The new young-person friendly map of services was commissioned by Wandsworth CCG and created by staff and young people from Participation People, who run Wandsworth’s Youth Council and mental health champions scheme in schools. You can access the map here:
Your Wellbeing Map for Young People.
The young leaders did a great job jargon-busting NHS language into straight forward descriptions, changing ‘Tier 2 Early Intervention’ into ‘Getting Help’.
Services in Wandsworth now provide support and treatment to over 2000 young people per year, mainly swiftly and in easy to access community locations. This includes teams of mental health clinicians in the youth schools, the youth offending service and children’s services within Wandsworth Council. NHS leaders are currently working with Wandsworth schools and youth providers to roll out whole-school programmes that will promote emotional wellbeing and help identify mental health at the earliest stage.
Involving young people in the procurement of an online counselling service for schools in south west London
What we did
We held a demonstration and focus group at Southfields Academy in February 2019 to involve school children in the selection of a provider for online counselling services for schools in south west London. We partnered with the Southfields Academy School Council and the Wandsworth Youth Council to recruit interested young people to the session.
Purpose of the engagement
Presentations were made by potential providers of online counselling services and we asked the young people for their views on the sites look, feel, language, icons, navigation, anonymity and whether they would recommend to a friend or use the sites themselves.
We gave the young people the opportunity to ask questions about the service and to understand how the site would work in practice.
Who we spoke to
We involved 10 young people aged 11-17 in the discussions. The group were very engaged in the process and produced a vast amount of insightful feedback, which will be incorporated into the decision making process as part of the procurement and into future development of the service and site.
We received thanks for allowing the student council to be a part of this process.
They told us:
“It’s great for their confidence, leadership and other transferable skills and will look great on future CVs and personal statements. They’d be delighted to be part of any future sessions.”
The procurement process is on-going, with a decision expected shortly – heavily influenced by the feedback from the focus group. We will be returning to members of the School Council and Wandsworth Youth Council to inform them of the procurement outcome and, once the service is live, to find out how to make the service as young people friendly as possible and how young people in their networks are finding the new service.
Young People's Mental Health: Youth Climate Report
We commissioned Participation People to find out Young People's views, thoughts and feelings to help improve mental health services in Wandsworth. We wanted to know what is working, what is not working and where the gaps are. Sixty four interviews were conducted with young people, parents and professionals to inform an improvement plan published in our Youth Climate Report. This is an assessment and audit tool of an organisations ability to utilise Youth Voice to improve service outcomes. The findings inform our Local Transformation Plan for Wandsworth.
The Young People generated three key reccomendations:
1. Sharing is caring
2. Involve us
3. Youth proof everything
You can read more in the report
Young People's Mental Health Youth Climate Report 2018
We also created a Wandsworth Young People's Mental Health and Emotional Wellbeing Plan of Action Road Map to 2020:
South West London Grassroots programme
NHS England provided a grant to the south west London collaborative commissioning team in March 2016, to run a programme of engagement, extending reach into seldom heard communities. With the success of the 2016/17 project, the grassroots funding was extended into 2017/18.
The project worked with Healthwatch organisations across south west London and provided small grants to local grassroots groups to run events/activities enjoyable to their population. We attended these sessions to speak to people about their experiences of local services.
By providing a pot of money to local Healthwatch organisations, we were not only able to capitalise on the extensive community connections that they had developed with local grassroots organisations, but we were also able to strengthen our own relationship with them as key stakeholders in health and care.
In Wandsworth, through the grass roots engagement programme, we spoke to more than 140 people between August 2017 and September 2018. We visited nine different organisations who work with local people and families who:
- Have mental health issues
- Are from different races and religions
- Have a learning disability
- Have had or have supported someone with cancer
- Are refugees
We asked local people about their experiences of health and care in Wandsworth. They spoke to us about issues ranging from how to make the best use of social media, right through to how to improve mental health services.
To support us to reach these diverse communities we developed easy read questions to support discussions with learning disability groups. Other sessions ranged from formal forum meetings to community fun days.
Feedback from each session was captured and shared with commissioners and providers, the organisers of the events and with Healthwatch Wandsworth – to enable it to inform local developments.
Feedback was used to enhance local plans as well as informing and shaping plans on a pan south west London and Surrey Downs basis. A "you said, we did" report is currently being drafted to demonstrate what has been done because of the feedback and we will be sharing this widely with those we spoke to, as well as linking to this on our website. You can read the "you said, we did" report from 2016/17 on the south west London website.
As part of our commissioning planning cycle, every year we seek the views of local people, partners and stakeholders to inform our commissioning intentions.
The aim is to ensure as many local people and key service users are aware of our proposed plans and that they have an opportunity to provide feedback to commissioners to inform our activity for the coming year.
Between August and October 2018, we held five focus groups with local voluntary and community organisations. Through this work we captured the views of the following groups of people:
People who self-identify as LGBTQ+,
People disabled by sensory, perceptual, physical and emotional processing difficulties (Learning Disabled)
People who care for others whether paid or unpaid
People who identify as Black and Minority Ethnicity
The focus groups gave information about the CCG and local plans before asking people what was already working well with local services and what could be improved. Key feedback received centred around the following broad themes: workforce, the integration of health and social care, primary care, urgent and emergency care, social isolation, carers support, adult mental health and services for those with learning disabilities, care planned in advance (such as outpatient's appointments), and patient information.
Feedback captured has been collated into a report which has been shared with the commissioning team to help determine our commissioning priorities for 2019/20 and to develop our Local Health and Care Plan. Local people we spoke to have already received a copy of the feedback report and we have also published a
you said, we did report outlining exactly how feedback has influenced our commissioning activity.
You can read the Commissioning Intentions report here:
Commissioning intentions key themes feedback report 2018