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Your Care, Your Future

We are committed to making sure that the people of west Hertfordshire have access to the best possible health and social care services now and in the future.

So that we cater for a changing population with more complex health and care needs and to live within our financial means we need to transform the way that we deliver health and social care locally.

Your Care, Your Future looks at how best to provide health and social care services to respond to these challenges and make sure that local people receive the right care, at the right time and in the right place.

This reflects the national picture and challenges described by the NHS Five Year Forward View.

Our Your Care, Your Future plans feed into the sustainability and transformation plan for Hertfordshire and west Essex, called A Healthier Future

The organisations involved in delivering Your Care, Your Future alongside Herts Valleys CCG are:

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Developing hospital services

Developing hospital services

Developing community services

Developing community services

Vision, strategy and case for change

Vision, strategy and case for change

Examples of 'you said, we did'  

You said

We did

You said (again)

What difference did it make?

Patients and residents wanted the refresh of the strategic outline case (SOC) for hospital redevelopment to be comprehensive and to re-evaluate options relating to a new build hospital on a new site (even though those options had been discounted by the SOC submitted in 2017).

 

To view the full engagement report here

 

We carried out a more detailed refresh than NHSE/I had asked us to.

 

The refresh full retested the original SOC by looking again at various options, including building a new main A&E hospital on a new site, which formed part of an initial longlist. We analysed these options based on factors such as affordability and deliverability.

 

We carried out an extensive programme of communications and engagement to inform the refresh. This explained the process we were following.

As part of the public engagement patients shared their views. This told us:

·       Easy access to hospital facilities (including parking provision at Watford) remains important for residents.

·       Any hospital development must be able to meet future demands arising from new homes being built in west Herts.

·       Enthusiasm in some areas of west Herts (especially in Dacorum and in St Albans to a lesser extent) for a new centrally located hospital.  In other areas there was broad support for development scheme proposed in 2017 SOC.

·       Agreement from all sides that current condition of Watford General Hospital site is unsatisfactory. 

·       Having looked at and costed all options we concluded that redeveloping Watford as the main A&E hospital remained the only viable option within financial parameters.  

·       The refreshed SOC put forward a proposal to prioritise investment at WGH as this would have greatest beneficial impact overall for patients. We are aiming to make Watford look and feel like a new hospital within available finances.

·       Improved visitor parking at WGH will be the first development to take place on the site.

·       HVCCG and West Herts Hospitals NHS Trust have committed to work with the local councils and local transport providers to explore whether improvements can be made to public and community transport access to our hospitals.

·       The plan for WGH leaves space to create new buildings in future years should population growth create additional demand. 

·       We secured funding from the government based on the redevelopment plans we put forward in the SOC.

 

Some patient focussed information and communication is not written for a public audience and is not easy to understand.

We developed our reader panel to review all patient focussed information to ensure it is fit for purpose:

 

 

 

All patient / public focussed information is reviewed by the reader panel to check for easy read, plain English and clear.  This has included consultation material, patient letters, changes to service provider and medication.

Example

Information on over the counter medicines, shortages and stockpiling medication was shared with the reader panel to review

·       Change wording of community pharmacy  which is not recognised by the public to local chemist

·       Change positioning of information to ensure key messages  to increase impact

·       Increase font size for easier read and correction of  typos and grammar

 

·       Information amended according to feedback

·       Helping to ensure that any patient / public facing information is clear, non-ambiguous and easy to read

Practices and their patient groups highlighted the need for additional funding to support their group activities

Working with patients, Healthwatch Hertfordshire, lead GP,  practice managers and our patient group network we have agreed an incentive scheme to encourage development of groups with a payment to support activities

·       Include patient group members in assessment process

·       Provide clarity on whether the funding has to be used for patient group activities

·       Provide guidance on how to develop patient groups

·       Incentive scheme amended in line with feedback

Patients who have been involved in service redesign, procurements and other CCG activities have suggested lessons could be learnt from their experience of involvement

We have set up a focus group in 2020 with patient representatives and staff to review how we recruit and support patient volunteers– to learn from your experience and make improvements where necessary.

 

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Our PPI committee and local patient groups raised concern about lack of engagement with younger people as future users of the NHS

We have worked with our primary care nursing team and West Herts College to develop a session for their health and social care students. This includes an introduction to the NHS, information on local services, getting the students to think about their experiences and what good communication looks like

Feedback from the students following the sessions are here

·       Raised awareness with young people  of local health services

·       Session structure revised in accordance with feedback

Concern that provider services were not aware of what is expected from them in terms of patient participation when changes are proposed

Working with colleagues, NHS England and our patient and public involvement committee information on to be added to new contracts for 2020 to provide guidance.

Information to be added to 2020 shared with PPI committee for comment

·       Ensure early patient involvement  and communication when any changes are being proposed

Clear information on two week wait cancer referrals is needed to raise awareness of the importance of attending the appointment, an early diagnosis and treatment

Working with the lead Macmillan nurse,  patient information on initial referral by a GP on urgent two week wait pathway was drafted.

 

A focus group of public, experts by experience, carers and health professionals reviewed the information

·       Ideally leaflet should be printed in colour but equally clear if printed in black and white

·       Consider A5 booklet

·       Too much repetition

·       Use ‘gentle’ words with more consistent approach (questions/answers)

·       Change ‘prioritise’ to ‘very important’

·       Title too long, too many capitals: delete ‘suspected cancer’

·       Clarity that ‘other support’ can be accessed and useful within 2 week wait

·       Confirmed that ‘can I bring someone with me’ section is useful but could be shortened

·       Consider using FAQ approach to the information

·       Use ‘successful’ rather than ‘effective

·       Consider using symptoms / questions reminder box

·       Some disagreement re the use of the diagram – get rid of it or make bigger and put on A5 back page

 

·       The leaflet was amended based on all the feedback and distributed to GP practices in West Herts to give to patients

Following a brief introduction to GP group consultations  patient group network members requested a more detailed session to include GPs, practice managers and patients

On 18 July a co-creation event was included  nearly 50 primary care clinicians, GP practice staff and patients from local patient participation groups  to learn about group consultations and set a shared ambition for the benefits that could be realised by their introduction  in 18 months’ time.

In response to the question,

“In 18 months’ time, when group consultations are up and running, what will be different for….”

 

Discussions at the meeting summarised a co-created ambition, incorporating the feedback themes and produced a narrative to underpin the change that needed to be put into place to support the introduction of GP group consultations.

 

More detailed notes of the discussions are here

 

 

Information on the group consultations was shared with GP practices and practice patient groups.

 

Dr Jon Landy, Consultant Gastroenterologist at West Herts Hospitals NHS Trust asked for comments on proposed research project into bowel cancer testing

Information was sent widely through our patient networks and comments were invited on:

1.      If patients supported the study, felt it was important and had potential to enhance patient experience

2.      If there were aspects they felt should be changed so that it was better from a patient viewpoint

3.      Suggestions to improve the patient information sheet (PIS) that would make information more accessible to patients

Patients fed back to Dr Landy, with a number of suggestions based on the questions posed

·       The feedback suggested that the study was reasonable regarding patient experience and no changes were necessary to study procedures that were set out to minimise any discomfort or risk to participants

·       the protocol would not be shared with patients as it was considered too technical but the patient information sheet was useful

·       Descriptions and explanations of polyps and colonoscopy  were added to the PIS

 To view more information  here

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