Previous projects and consultations

People with learning disabilities often have difficulty in recognising illness, communicating their needs and using health services.

The County Durham CCGs worked in partnership with Durham County Council and Healthwatch County Durham to better understand the problems experienced by people with learning disabilities at their annual health checks.

The aim of the work was to encourage more people with learning disabilities to attend free annual health-checks.

Healthwatch County Durham (HWCD) spoke to 100 people with a learning disability and discovered there was a problem with the invitation letter.

Durham County Council’s People’s Parliament developed an ‘easy invite’ that was sent to all people with a learning disability in County Durham. The aim was for the letter to be an easy reading format so people can read it unaided and so reduce anxiety around annual health checks.

The aim of the letter was to encourage more people with a learning disability to be on their GP learning disability register. Registration also means more help is available to them.

Following the Healthwatch County Durham recommendations, Shinwell Medical Group are piloting health checks in a community setting. People aged 14 and over who have been assessed as having moderate, severe or profound learning disabilities, or people with a mild learning disability who have other complex health needs, are entitled to the free health check.

The Annual Health Check is also a chance for the person to get used to going to their GP practice and encourage patients to feel more comfortable about seeing their GP at other times.

Health checks involve a general physical examination, including:

• checking their weight, heart rate,
• blood pressure and taking blood and urine samples;
• asking questions about their lifestyle and mental health;
• a check for epilepsy;
• a check on their prescribed medication;
• a check on whether any chronic illnesses, such as asthma or diabetes, are being well managed;
• a review of any arrangements with other health professionals, such as physiotherapists, speech therapists, dieticians or other specialists.

It is also a good time to check they are up to date with immunisations, the flu vaccine and any screening tests for cancer.

Care Navigation is the next step to appropriately managing the demand on our primary care services and is in line with the ambitions set out in the GP Forward View (2016).

Using the wealth of knowledge and experience that exists within the wider Primary Care Staff teams and reception teams, we are ensuring patients receive the right care from the right person at the right time.

To help lead and steer this project, a DDES project team was set up with representatives from GP practices across County Durham. These members helped to drive the development of the programme forward as well as identify the training providers who would deliver the practical as well as ‘soft’ skills needed.

Conversations were held with administrative staff through Collaborative group sessions to ensure their queries and concerns could be recorded and addressed throughout their development. Regular updates were also taken to the Council of Members for both CCGs in County Durham. Presentations about Care Navigation were provided to all of the CCG Patient Reference Groups (PRG) and the Area Action Partnerships.

The information and comments received through this process helped to inform and shape the production of a Frequently Asked Questions (FAQs) and briefing document to go complement the wider public roll-out of the programme. Our Patient Representatives have also met with us separately to strengthen this FAQ document and to also discuss what ‘Care Navigation’ means to them.

Bringing together staff from primary care (clinical and non-clinical), associated organisations and partners Citizens Advice Bureau (CAB), Pharmacy, Public Health and many others) and our PRGs we held two workshops. These partners helped identify and develop the priority areas to be included in the first year and how they could be effectively be implemented locally. Further engagement work will now be undertaken for future developments.

More information on Care Navigation

Community Services are local services eg: district nurses, physiotherapy, diabetes services etc. These services were review during September 2017 and involved patients and NHS staff. The aim of this was to understand how care in the future could be improved to meet patients’ needs. The engagement targeted Patients, their carers, GPs, Practice nurses, a wide range of community services staff (Community nurses, District nurses, Vulnerable Adults Wrap Around Service etc).

The CCGs, Community Services staff and practice nurses worked together to reach individual teams across their local area. The engagement also benefitted from the support of Community Services staff who spoke directly with their patients and gathered the views of friends, relatives and family carers.

The summary engagement report was also published on the CCGs’ websites as part of the regular updates about the progress of this project. The same report was also fed into the County Durham Integration Steering Board as part of the work that is being developed to help shape future Health and Social Care services.

In early 2018, Dementia Services were reviewed by the CCG and included feedback from patients, carers and their families.

We talked to dementia patients and carers at local dementia arts projects, memory cafés, dementia cafés, relevant groups involved with Beamish museum, the Alzheimer’s’ Society and others.

An online version of the survey was developed to make it easier for relatives and family carers to respond. The survey was also sent to local patient groups, health networks, Durham Dementia Action Alliance (DDAA) and the Area Action Partnerships across the County.

A summary engagement report was made available to groups who had participated and through the DDAA network. The report outlines the outcomes of the discussions and how these have been included in the decision-making process. The comments and suggestions showed what type of support and personal outcomes were most important for people. This information was given to the Commissioning Team to help with their decisions.

Five health commissioners across Durham and Teesside are working together to re- procure the Direct Access to Adult Hearing Services for Age Related Hearing Loss – Audiology Services and we would like your views to help us do that.

Background

The impact of hearing loss in adults can be immense both at a personal and a societal level leading to social isolation, depression, loss of independence and employment challenges.

Assessing the needs of patients with hearing difficulty and developing an individual management plan which provides appropriate interventions can reduce isolation, facilitate continued integration with society and promote independent living.

The ageing population means that demand for both hearing assessment and treatment services is likely to rise substantially over the coming years. However, a significant proportion of this client group will have straightforward hearing loss that does not require referral for an Ear, Nose, and Throat (ENT) out-patient appointment prior to assessment.  These patients would benefit from direct access to adult hearing care services with a referral being made directly from their General Practitioner (GP) enabling timely diagnosis and treatment.

One in six people in the UK has some form of hearing loss. Most are elderly people who are gradually losing their hearing as part of the ageing process, with more than 70% of over 70 year-olds and 40% of over 50 year-olds having some form of hearing loss.

The aim of the service is to provide a comprehensive, patient-centred, direct access adult hearing service for age-related hearing loss in line with national guidance and local requirements.

Why does it need to change?

It is recognised that continued increases in activity are not financially sustainable and other contracting models and financial payment methods should be explored to offer CCGs increased levels of sustainability within financially pressured times. Alternative models have therefore been considered and we would like your views to help us make sure the new service works well for you.

Stakeholder Briefing

Summary Engagement Report

The period of engagement is now complete. Please read the Audiology Engagement Report

How you can get involved (the engagement period is complete and the survey is now closed)

A period of 8 weeks public engagement will begin on Monday 14th May 2018 until Friday 6th July 2018. We will be gathering the views of service users and local stakeholders about their experience of the current service and seeking suggestions on how to improve a future service.

You can get involved by completing an online questionnaire

If you have any queries or require assistance completing the online survey, please contact the Communications and Engagement team on 01642 745 401 / 0191 374 2795 or at NECSU.engagement@nhs.net

Following a period of engagement and review, in October 2018, a procurement process was undertaken to procure a Direct Access Adult Hearing Service. The procurement has been extended to allow for further work to be undertaken and we expect the new service to be in place on 1st September 2019.

During March and April 2018 we engaged with local people about proposals for a new mental health service model called Increasing Access to Psychological Therapies (IAPT).

This piece of work was taking  place across five CCGs.  In County Durham we held  two open public sessions at the end of March so that patients, public and other interested parties to hear from the County Durham project lead about the background of the IAPT work and the intentions for the new mode. The proposed new IAPT model is targeting how the CCGs can provide new elements of support (a well-being offer and specific support for people with a long term conditions) and  achieve the national patient access target of 25%.

A series of targeted sessions were also held with a range of groups such as chronic pain patients, individuals with Learning Disabilities, substance misuse groups and individuals with hearing loss and deafness. Working with Investing in Children, we made sure that young people had the chance to contribute directly too. We explored people’s views regarding access, the range of support to be provided and any potential barriers preventing full participation in their full course of treatment. As an alternative, the opportunity to contribute through an online survey was also offered across the five CCGs.

The full report can be found here

Engagement began in late April 2018 with children, young people and their parents/ carers and involved schools to find out about their experiences of accessing Children’s Therapy services (0-19 years) and the way they are delivered.

The engagement was predominantly aimed at families with children / young people with complex needs such as special educational needs and disabilities (SEND) and those with Education Health Care Plans (EHCPs) as well as involving those without complex needs.

The discussions helped us to understand what would work best for children’s complex needs, what is important to them and when they need therapy services. We wanted to find out:

• What do parent and carers think their children’s needs are?
• What is required to keep them safe and be able to achieve in the school day?
• From a health perspective what do they want from each service?

We spoke to children, young people and their parents/ carers through the therapy services and those attending groups such as the Investing in Children eXtreme group. Links with established groups such as health networks and the Making Changes Together Conference in May 2018.

The period of engagement is now complete. Please see final Summary Engagement Report below.

Engagement Feedback Report

 As part of the review into the Mental Health Crisis Service and Home Treatment, engagement was an integral part of this process. The conversations with patients and carers focused on understanding their experiences.

An online survey was created along with a paper version and this was shared widely via groups and social media. The team went along to meetings such as the County wide mental health forum, Cree Groups and also Home Group Happy clubs for people to experience physical activity.

All key points were gathered, including 26 surveys. These findings will be included into a wider report which also covers feedback from Mental Health Crisis Service staff and service managers, GPs and other professional groups.

The feedback will be shared via groups we worked with and those who took the time to give their views and experiences.

In line with guidance from NICE in November 2017, County Durham patients were transferred to local community-based services to receive their routine monitoring appointments. To help this

transition, we worked closely with County Durham and Darlington Foundation Trust (CDDFT) to talk directly to these patients. We did this by visiting the Ophthalmology clinics in Darlington.

These conversations helped to understand patients’ concerns. They were kept informed about accessibility of services now and in the future, whom to contact if they had a query and confirmation that they would still receive good clinical care closer to home.

What is the consultation?

NHS England launched a public consultation on 20 December 2017 in relation to reducing prescribing of over-the-counter (OTC) medicines for minor, short-term health concerns which could save the NHS millions of pounds a year and encourage more people to self-care.

How can I get involved?

You can see the full consultation document

You can respond to the consultation by using the online web-form

Alternatively, written responses can be submitted to england.medicines@nhs.net

When does the consultation close?

The NHS England national consultation will close on Wednesday 14 March 2018.

More local information:

Over-the-Counter-Medicines-NHS-England-Consultation—Summary-sheet

Easy Read Version

Our Consultation and Local Health Services From 1st April 2017

In 2016  we consulted with you on the future of urgent care services in your area. We received a total of 2,771 survey responses, and engaged with a further 1,202 people of which 257 were at events and a further 380 at Supermarkets.

The consultation is now closed and the DDES CCG Urgent Care Consultation Report is available.

The CCG’s Governing Body convened in public on 13th September 2016 to make a formal decision on a future model for urgent care services, read about the changes to urgent care services following the Urgent Care Consultation Outcome. We presented a number of options and you told us that you wanted greater access to urgent care services

Urgent Care Consultation Outcome

We have listened to what you told us and from 1st April the way you access your health care will change.

Urgent Care Pocket Guide

We have worked with our patient groups on a quick guide to urgent care services. A pocket guide and information card to all patients in the DDES area that will help you understand the improvements to urgent care services that started on April 1st 2017. This will provide patients with the information of where to go when they are poorly.

Look out for this guide coming through your letter box in March. If in doubt call NHS 111 and ‘talk before you walk’. You can also download a PDF version of the DDES Urgent Care Pocket Guide.

DDES Urgent Care Pocket Guide

Useful Documents

DDES Communications Strategy

DDES Engagement Strategy

Urgent Care Communications and Engagement Plan

Since the implementation of the Primary Care Services (PCS) in Durham Dales, Easington and Sedgefield (DDES), data shows that these services were not being utilised in the expected way. The public were asked if they were aware of the current services, how they used them and involved them in the future development of these services. An Engagement plan was designed to ensure that all groups were reached.

Lead staff from the CCG met with rural Dales councillors in December 2017 where they were updated on the current use of the service. They were asked to share groups with the engagement team that they felt were a priority. These groups were added to the engagement plan.

As part of the engagement, Investing in Children (IiC) held three agenda days in the DDES area to engage with young people to gather feedback on how they would respond to common health problems, where they would go and what services they would use.

A survey was developed with the support of members of Patient Reference Groups to ensure the questions were clear and in plain English.

A two pronged approach to engagement was used:

1. Patients who had used the PCS told us about their experience, they suggested how to improve the service, and if there was only one site in their area, how far they were prepared to drive to get there.
2. We visited sites out of the DDES area such as Houghton and Hartlepool Primary Care Centre, Darlington Memorial Hospital and University Hospital of North Durham. At each of these sites we spoke to patients who were using these services.

We asked them if they were aware of their local services, if they weren’t we explained they could call NHS111 to get an appointment on the same day if it was urgent

PCS Engagement Report

PCS Business Case

All of this intelligence was gathered through Survey monkey and a report was written for the Health and Wellbeing Overview and Scrutiny Committee informing them of patients’ views and how to further develop this service.

A consultation was carried out around this work in November 2018 until January 2019.

County Durham and Darlington Clinical Commissioning Groups (CCGs) and County Durham and Darlington Foundation Trust have reviewed community provision for stroke.

The review looked at the current pathway which includes the specialist stroke rehabilitation provision at Bishop Auckland Hospital, as well as rehabilitation provision outside the hospital in the community.

The engagement activity ran from Thursday 4 October 2018 until Friday 30 November 2018.

The CCGs heard from patients who have experienced a stroke and / or their families/carers and gave views of their experience of the rehabilitation services.

How to get involved

We asked patients to get involved by completing a survey

We asked organisations/groups if they had any forthcoming meetings, which would include stroke patients, families/carers, to gather views and discuss the review.

This will help the CCGs provide a service that delivers care closer to home where possible, and more continuity of care.

Please find below the stakeholder briefing, which provides background and further information on this review.

Stroke Resumed consultation stakeholder briefing

Please click here to see the full engagement report and findings.

The CCG worked in partnership with Healthwatch. Patient interactions around stroke services took place over August, September and October 2017. The aim of the engagement was to understand what services and information patients received on discharge from hospital.

Healthwatch organised one- to -one appointment sessions across Barnard Castle, Stanhope, Chester le Street, Stanley, Peterlee and Tudhoe.

The Engagement Teams of Durham Dales, Easington and Sedgefield and North Durham CCGs attended stroke groups to have face- to -face conversations with stroke survivors.

Packs including a letter, a questionnaire and a freepost envelope were sent to patients via their GP practice. The questionnaire was also available on line via Survey Monkey, which closed on October 12^th 2017.

The questionnaire and the above appointment sessions were communicated via our social media platforms and Healthwatch. A total of 155 patients and/or carers responded to the survey.

The full engagement findings were written into a report by Healthwatch and the CCG detailing recommendations for the future service. All of these recommendations were accepted by the CCG Executives and are being implemented in the service from March 2018.

Patients who were involved in the engagement were sent a thank you letter and a short explanation of the results of their feedback. They were also given the option to have a full report sent out to their home address.

The full Healthwatch and CCG report is available: Research into patient access to stroke support services in County Durham

Consultations stood down due to unprecedented demand on hospital services

HEALTH officials have announced they are to stand down plans for two public consultations due to unprecedented demand for inpatient beds.

NHS Durham Dales, Easington and Sedgefield, NHS Darlington and NHS North Durham Clinical Commissioning Groups (CCGs) have taken the decision to withdraw proposals for both Ward-6 in-patient rehabilitation services and stroke rehabilitation at Bishop Auckland Hospital (BAH).

The consultations, which proposed moving stroke rehabilitation services from BAH to the University Hospital of North Durham (UHND) and re-purposing Ward-6 as a dedicated rehabilitation facility for patients will cease with immediate effect.

Dr Neil O’Brien, accountable officer for the CCGs, said: “Despite the clinical proposals presented for both Ward 6 and stroke rehabilitation being valid, the level of service demand has far exceeded expectations and these need to be taken into account.

“We have further reviewed the demand and complexity of patients and as a result a decision has been made to withdraw the proposals.

“Due to unprecedented pressure being placed on the system in recent months, we felt that the proposed model of care would not be deliverable at this time.”

The move comes after seeking public views on both stroke rehabilitation and Ward-6 inpatient rehabilitation, during the initial consultation period which restarted on January 14 following the need to pause in November 2019 due to the general election.

“The CCGs listened very carefully to public opinion during the early consultation period and we, alongside County Durham and Darlington Foundation Trust, are fully committed to the long term future of BAH,” added Dr O’Brien.

“There is agreement that additional therapy support is required for both stroke rehabilitation and Ward-6. Significant improvements are being made to the community element of the stroke pathway and we are committed to further investment in hospital based services.

“Specifically there will be dedicated therapy provision made for stroke services on both BAH and UHND sites and in addition resources will be made available on Ward-6 for an enhanced level of therapy.”

The local NHS will continue to review services across County Durham and Darlington to ensure high quality services are available to all, whilst ensuring where possible care is delivered close to home.

In 2016  we consulted with you on the future of urgent care services in your area. We received a total of 2,771 survey responses, and engaged with a further 1,202 people of which 257 were at events and a further 380 at Supermarkets.

DDES CCG Urgent Care Consultation Report

Urgent Care Consultation Outcome

The CCG’s Governing Body convened in public on 13th September 2016 to make a formal decision on a future model for urgent care services, read about the changes to urgent care services following the Urgent Care Consultation Outcome. We presented a number of options and you told us that you wanted greater access to urgent care services

We have listened to what you told us and from 1st April the way you access your health care will change.

Urgent Care Pocket Guide

We have worked with our patient groups on a quick guide to urgent care services. A pocket guide and information card to all patients in the DDES area that will help you understand the improvements to urgent care services that started on April 1st 2017. This will provide patients with the information of where to go when they are poorly.

Look out for this guide coming through your letter box in March. If in doubt call NHS 111 and ‘talk before you walk’. You can also download a PDF version of the DDES Urgent Care Pocket Guide.

DDES Urgent Care Pocket Guide

Consultations stood down due to unprecedented demand on hospital services

HEALTH officials have announced they are to stand down plans for two public consultations due to unprecedented demand for inpatient beds.

NHS Durham Dales, Easington and Sedgefield, NHS Darlington and NHS North Durham Clinical Commissioning Groups (CCGs) have taken the decision to withdraw proposals for both Ward-6 in-patient rehabilitation services and stroke rehabilitation at Bishop Auckland Hospital (BAH).

The consultations, which proposed moving stroke rehabilitation services from BAH to the University Hospital of North Durham (UHND) and re-purposing Ward-6 as a dedicated rehabilitation facility for patients will cease with immediate effect.

Dr Neil O’Brien, accountable officer for the CCGs, said: “Despite the clinical proposals presented for both Ward 6 and stroke rehabilitation being valid, the level of service demand has far exceeded expectations and these need to be taken into account.

“We have further reviewed the demand and complexity of patients and as a result a decision has been made to withdraw the proposals.

“Due to unprecedented pressure being placed on the system in recent months, we felt that the proposed model of care would not be deliverable at this time.”

The move comes after seeking public views on both stroke rehabilitation and Ward-6 inpatient rehabilitation, during the initial consultation period which restarted on January 14 following the need to pause in November 2019 due to the general election.

“The CCGs listened very carefully to public opinion during the early consultation period and we, alongside County Durham and Darlington Foundation Trust, are fully committed to the long term future of BAH,” added Dr O’Brien.

“There is agreement that additional therapy support is required for both stroke rehabilitation and Ward-6. Significant improvements are being made to the community element of the stroke pathway and we are committed to further investment in hospital based services.

“Specifically there will be dedicated therapy provision made for stroke services on both BAH and UHND sites and in addition resources will be made available on Ward-6 for an enhanced level of therapy.”

The local NHS will continue to review services across County Durham and Darlington to ensure high quality services are available to all, whilst ensuring where possible care is delivered close to home.