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Patient and Public Involvement (PPI) Annual Report

09-10

Patient and public involvement annual report

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Contents

16

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26

Welcome....................................................3

Breastfeeding peer support...................31

Introduction...............................................4 Patient and public involvement..............5

Attention Deficit Hyperactivity Disorder (ADHD)...................................32

Get involved, share your views................5

Kirklees Young People’s Survey 2009.....33

Public events...........................................6

Support for parents to improve the health of their families..........................34

Organisational development....................7 Developing engagement methods...........8 Public consultations................................11 A consultation on developing specialist hospital services for mid Yorkshire.........11 Holme Valley Memorial Hospital............12 NHS Constitution..................................13 Social marketing.....................................14

Staying healthy.......................................35 Kirklees Drug and Alcohol Action team.35 Learning Disabilities...............................36 The Learning Disability Direct Enhanced Service..................................................36 It’s My Health Day.................................37 Practice Based Commissioning...............38

Dance Lab: evaluation...........................17

Evaluation Summary of the pain self management service commissioned on behalf of the Three Valleys Commissioning Consortium..................39

Auntie Pam’s: pre-test...........................18

University Health Centre........................40

Obesity in 16-24 year olds: pre-test in halls of residence..................19

North Kirklees Consortium....................41

Obesity in 16-24 years old: evaluation in halls of residence activity...................20

The South Stand Alone Forum..............41

Now we’re cooking: pre-test.................15 Dance Lab: pre-test...............................16

Dewsbury Doctors Consortium (DDC)...41 Volunteering............................................42

Stop smoking support groups: ‘Kick the Habit’ and ‘Time for Me’: pre-test...20

Victoria Medical Centre..........................43

Improving our long term conditions services....................................................22

Pharmaceutical Needs Assessment........44

Projects for 2010/11................................44

NHS Kirklees stroke programme............23

Infection prevention and control...........44

Chronic pain management....................24

Targeted Mental Health in Schools (TaMS)......................................45

Diabetes................................................25 Pilot diabetes Urdu Expert Patient Programme...........................................26 Neurology and Myalgic Encephalopathy (ME)............................27 Women and children’s services..............28 An evaluation into the maternity services available to the people of South Kirklees.......................................28 Infant mortality.....................................30 2

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Patient and public involvement annual report

Single equality scheme..........................45 Reducing children’s and young people’s attendance at accident and emergency............................................45 Specialised commissioning....................45 Involvement of children and young people in new health in schools commissioning model...........................46 Social marketing...................................46


Welcome I would like to welcome you to NHS Kirklees third annual Patient and Public Involvement (PPI) report. We have a new duty to tell you about our engagement and consultation activities which have influenced our decisions about the services we buy (commission) on your behalf. Consultations are described as the act of asking a person for their views on a proposal or issue, before a decision is taken on any changes to services or how they will be delivered. Although we have produced annual reports previously this one is more detailed to show you how we have met the duty set out in the NHS Act 2006. This year has been a busy one for all our staff and we hope that this document captures all the work that has taken place to involve you in what the Primary Care Trust (PCT) is doing. During this year the concept of World Class Commissioning (WCC) has been used to help us deliver an NHS which is

fair, person-centred, effective and safe. WCC was introduced in 2008 to improve the way PCTs commission services and to make sure that there is an improvement in local people’s health and well-being. To improve how we do things and capture our commitment to putting the patient at the centre of everything we do, we have produced a Communications and Engagement Strategy which was published in February. This sets out how we will improve our communication with you and inform and involve you in our plans. We hope that you find this report both interesting and informative. If there are any aspects that you would like to discuss or you want to get involved in the work of the PCT, please contact a member of our Patient and Public Involvement Team, details of which are at the end of the report. Helena Corder. Director of Corporate Services

During this year the concept of World Class Commissioning (WCC) has been used to help us deliver an NHS which is fair, person-centred, effective and safe.

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Introduction Patient and public involvement (PPI) is about working together so that everyone benefits from improved healthcare. It means putting patients at the centre of all we do in the health service. This includes involving patients and the public in: • sharing their ideas and experiences • identifying what they want from services • making sure they understand our plans, and why services need to be changed, so that they know how we make the best of our resources. NHS Kirklees can meet people’s needs better if we listen to what people tell us, instead of relying on existing knowledge and assumptions. We can develop better, more responsive services, if we involve and truly listen to those who are already using services and to those who are not. We have a statutory duty to involve patients and the public whether by consulting or providing information, or in other ways. All services and directorates must make sure that changes in services are commissioned in line with the Health and Social Care Act 2006 (Section 242). This report captures the work done to support the organisation’s delivery of our five year strategic plan.

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Patient and public involvement annual report

We can develop better, more responsive services, if we involve and truly listen to those who are already using services and to those who are not.

Realising our Ambition

Five year Strategic

Plan 2010 - 2015

Revision January 2010

Download the strategic plan here: www.kirklees.nhs.uk/publicinformation/publications/plans/


Patient and public involvement Get involved, share your views NHS Kirklees is working hard to include people in the shaping of local health services. We want to do this because it helps us to make sure we are improving our services in ways that meet your needs. It is really important for us to hear your comments, ideas and suggestions about ways in which we can make services better.

Below are some of the ways that you can let us know about your recent experiences of the NHS.

Get involved, share your views database If you would like to get involved in the development of new and existing services and share your experiences, then join the ‘get involved, share your views’ database. We have more than 200 people on the database who are contacted when an opportunity arises for them to get involved. This can range from being part of a discussion group, completing a questionnaire, joining a service user group and receiving the get involved, share your views newsletter which contains information about up and coming developments. Your NHS… your comments …

Comments card

A comment card means patients can have their say and feed back their views on local health services. The postcards have a freepost address and are available at various community venues or from the NHS Kirklees website www.kirklees.nhs.uk/get-involved Get involved, share your view s

www.kirklees.nhs.u

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During 2009/10, we received 24 cards, of these nine were compliments, seven were general comments, seven were expressing concerns and one was a request for information. All comments received are recorded on a database and fed back to the department / person relating to the comment.

Patient Opinion NHS Kirklees recognises the importance of gathering patient feedback using different channels and, as such, has invested in the provision of this opinion based website. The public can share their thoughts on the health care they have recently received, by contacting Patient Opinion on 0845 113002 or by visiting www.patientopinion.org.uk Patient Opinion is an independently run website service where patients

can see what other people are saying about local health services, helping people to choose the service which is right for them by sharing their stories and helping to improve services by giving their feedback. During 2009/10, 18 comments were posted on the website, nine of these were concerns, eight were compliments and one was a general comment. The comments were about services received at Calderdale and Huddersfield NHS Foundation Trust, Mid Yorkshire Hospitals NHS Trust, a dentist, a

district nurse and hospitals out of the area. Our Patient Advice and Liaison Service (PALS) has had a leading role in responding to all comments and has worked with neighbouring trusts in addressing these. This and other work of the PALS and complaints service can be found in their annual report which is available at: www.kirklees.nhs.uk/ fileadmin/documents/PPI/Annual_ Report_2010/NHS_Kirklees_ Complaints__PALS_and_Claims_ annual_report_2009-10_board.pdf.

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Local Involvement Network (LINk) We have continued to work with the Local Involvement Networks (LINks) which have been set up in all local authorities in England to hold local health and social care services to account. They are independently run and made up of members of the public. We have liaised with the host organisation to inform them of opportunities to get involved in the work of the PCT as well as attending meetings and responding to requests for information. Kirklees LINk produce an annual report of their work and this can be accessed at www.kirkleeslink.cloverleafadvocacy.org.uk.

Readers’ Panel The Kirklees Readers’ Panel is made up of 96 volunteers who read new and updated information produced by NHS Kirklees and Kirklees Council. Members also get the opportunity to meet as a group four times a year, have some lunch and listen to speakers to find out about services and projects in Kirklees for example Selfcare Web Portal and Telehealth, approximately 25 members of the panel usually attend these meetings. As well as this, written information is sent out to members to comment on making sure that documents produced are easy to understand and accessible to everyone. The leaflets considered by the group included ‘Maintaining independence and keeping well’, ‘Why have I been referred urgently to the hospital?’ and ‘Clostridium difficile – information for patients, carers, relatives and visitors’.

Public events We have worked hard in the last 12 months to make sure as many people as possible know about how to get involved and have their say. This has included the annual mailshot to all independent contractors, voluntary and community sector and key partners. The PPI team have also attended 41 events across Kirklees, consisting of giving talks / presentations to groups or being part of a health fair / community event. Some of the events the team has attended this year were:

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• Long term conditions roadshow

• Spring into Action mental health event

• Partnership roadshows • Get Going events

• National Breastfeeding Awareness event

• Darby and Joan

• Belonging to Dewsbury

• Eatwell 4 Life launch

• Parkinson’s Information day

• Kurdish community project events

• Dalton School Parent Group

• Recession event

• Older People’s access to services in the Valleys

• Patient choice roadshow • Dewsbury Pensioners’ Group • Physical sensory impairment event • SureStart one stop shops • Carer’s Week event • Better Future for the Blind event

Patient and public involvement annual report

• Active Citizen event

• Chickenley community campus event • Diabetes UK - Huddersfield voluntary support group presentation • It’s My Health Day - learning disabilities event


Organisational development

Equality and engagement advisory group

PPI toolkit

In response to the increasing number of requests from staff for support to undertake engagement work, an internal advisory group has been established. The group provides specialist support and guidance to staff, undertaking pieces of work that might need the involvement of:

To help staff in involving the public the team developed a PPI toolkit. The aims of the toolkit are to: • provide specific information on working with groups traditionally termed hard to reach; • create awareness of the need for patient and public involvement within our everyday activities; • promote an understanding of the wider issues relating to patient and public involvement;

• PPI

• provide practical guidance to enable staff from across NHS Kirklees to engage patients and the public in how services are planned, developed and delivered; • support work to make services more accessible and appropriate to a wider group of people; • encourage a more pro-active, developmental approach to involving people, including establishing long-term mechanisms for involvement; • acknowledge existing expertise and highlight examples of good practice; and • support the organisation to achieve World Class Commissioning. To raise awareness of the toolkit, we held eight drop-in sessions across the patch for staff to attend and also attended team meetings. Copies were also distributed to teams and all independent contractors.

Training DVD We have been working with NHS Calderdale, Calderdale and Huddersfield Foundation NHS Trust, NHS Wakefield and University of Huddersfield to develop training materials for staff. This has included producing a training DVD, the DVD includes members of the public and staff talking about their experiences of being involved.

• Communications • Equality and diversity • Social marketing • Patient experience The purpose of the group is to: • Actively support the delivery of objectives as set out within the communications and engagement strategy, enabling staff across the PCT to communicate with and engage service users in an appropriate, consistent and timely manner. • Actively support the PCT’s 11 strategic programmes used to direct work towards achieving the organisation’s vision, goals and outcomes. • Make sure staff receive consistent advice and support which in turn will help to promote good practice across the organisation. • In addition to providing support to staff, it is intended that it will also enable the members of the group to share information on the work they are doing and as such reduce duplication and increase efficiency.

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Developing engagement methods We have aimed to test different methods of engaging with the public and these are captured below. Comments Camper Van The Comments Camper Van was an innovative way to capture the opinions of the public. It was a mobile video diary room where the public could go to give their comments on the services commissioned and provided by NHS Kirklees.

Who we consulted It was intended that by using the Comments Camper Van it would help to gain the opinions of those Kirklees residents that are seldom heard and raise the profile of NHS Kirklees. NHS Kirklees took the van to four local events over the summer of 2009. 27 June – ‘Carnival 4 Life’ – Batley, North Kirklees 11 July – ‘Huddersfield Carnival’ – Huddersfield 26 July – ‘Pink Picnic’ – Huddersfield 29 August – ‘Dewsbury-on-Sea’ – Dewsbury Over the course of the four days a total of 111 interviews were carried out, with ages ranging from 12 to 89 years.

Feedback received We gathered a wealth of information and the majority of those interviewed were very satisfied and appreciative of the services they had received, with particular praise going to GPs and nurses. Areas of concern and suggestions for improvement included: provision of comprehensive, free/affordable dental services and the allaying of fears regarding the removal of key local hospital services to Halifax, Wakefield and Pontefract.

Action taken The summary video was shown to the NHS Kirklees Trust Board and is available on our website at the web address detailed below. The company contracted to carry out the interviews compiled a report of the findings and this can also be found at www.kirklees.nhs.uk/get-involved/patientpublic-involvement/ commentscamper-van/

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Patient and public involvement annual report

We asked the . following questions: 1. Have you heard of NHS Kirklees and what does it mean to you? 2. What experiences have you had of NHS Kirklees and its services? 3. What did you think? 4. What worked well? 5. What changes would you want to see and why? (what didn’t work well and what could have been improved?)


Discussion groups - hip replacement What the consultation was about The aim of this project was to gather the experiences of patients who had undergone a hip replacement. Patients were given the opportunity to share their experiences three – six months following the replacement in order to be able to capture their experiences prior to the surgery, the referral, surgery and recovery stages of their journey. This work was used as a pilot study in the area of gathering patient experience.

Who we consulted and methods used Contact was made with Calderdale and Huddersfield Hospitals Foundation Trust and Mid Yorkshire Hospitals Trust to identify patients meeting the set criteria. These included: • Patients to be residents of Kirklees. • Operation to have taken place between January and March 2009, though during the process it became apparent that this would need to be extended in order to get a sufficient number of invitation letters sent out. • Participants were to have had hip replacement only, but no specific emphasis was set on whether this was first or second operation. • Consideration was given to interested patients who speak other languages and it was established that specific discussion groups and/or one to one sessions would be held with help from interpreters. Mid Yorkshire Hospitals posted 51 letters on our behalf and a further 102 were sent by the Calderdale and Huddersfield Hospitals Foundation Trust.

The PPI team produced a postal pack which included a letter inviting patients to attend a discussion group to share their experiences. Those patients that were interested completed a reply slip and forwarded it to the PPI team using a freepost address.

Number of service users involved • Overall, the project saw a good response to the invitation. Many responses were received from those unable to attend. • Those that could not participate fed back their experiences both via telephone and email. • three groups were held - one in Batley (seven patients and two carers attended) and two in Huddersfield (20 people attended with five people being carers/relatives)

the majority indicated that an opportunity to share experiences with others, even if just listening to discussions, was of benefit to those attending

• 17 evaluation forms were received from participants with the majority indicating that an opportunity to share experiences with others, even if just listening to discussions, was of benefit to those attending. For some, there was also an added benefit when a clinician was available to discuss/explain questions arising from the discussions. The discussion groups focused on the patient journey – diagnosis, surgery, discharge and recovery.

Feedback received Overall, participants rated the clinical aspects of the procedure positively, but highlighted several process-related areas that could have been improved. Their journey started via referral from the GP and at this point, participants noted several concerns including lack of information about the referral and the forthcoming process.

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Communication between staff, patients and their carers at the time of referral, whilst at the hospital and at the point of discharge is an important aspect which, when conducted appropriately, leads to an improved experience and positive perception of the service. Thought needs to be given to the patient waiting area in terms of the chairs as these need to be suitable for those with hip problems. Information on the recovery and what patients should avoid in terms of physical movements/exercise would help to prevent complications arising during recovery. Participants rated the preparation for going home positively stating that they had equipment prepared and explanations/demonstrations given to them on, for example, how to approach stairs and get in and out of a vehicle. There was, however, inconsistency amongst the cohort in terms of the help received

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when actually leaving hospital with some not being helped into their vehicle. Gathering patient experience information on hip replacements was an important part of this study. It has, however, also demonstrated that patients do value an opportunity to personally share their experience and find it beneficial to do so in a group with others who used the same service/share the same condition. Given the fact that many of those who have been contacted to participate in these discussion groups might have been experiencing some degree of mobility restrictions, the response rate was very good.

Action taken The work has demonstrated that discussion groups are a valuable method to adopt when gathering data on service areas. It is a process which not only gathers information, but also provides participants with an opportunity to share their experience, voice concerns and ask questions thus benefiting from the process. It has also provided valuable lessons learnt which have been applied in subsequent projects involving discussion groups. A report of the findings was produced and submitted to Calderdale and Huddersfield Hospitals NHS Foundation Trust and Mid Yorkshire Hospitals Trust to help in improvements in patient experience.

Download the hip replacement report here: www.kirklees.nhs.uk/ fileadmin/documents/PPI/Annual_Report_2010/Hip_replacement_-_Final_ report.pdf

Patient and public involvement annual report


Public consultations A consultation on developing specialist hospital services for mid Yorkshire The Mid Yorkshire Hospitals NHS Trust (MYHT) comprises services provided across the following three sites: • Pinderfields Hospital, Wakefield; • Dewsbury District Hospital; • Pontefract General Infirmary (PGI). During the months of August through to the end of October 2009, MYHT, NHS Kirklees and NHS Wakefield District held a public consultation on the proposed development of the following specialist centres: • Neonatal intensive and high dependency care; • Inpatient surgery for children; • Inpatient orthopaedic trauma surgery;

and community pharmacies, and publishing articles in the local press. In order for the public to submit and discuss their views and opinions, each consultation document contained a questionnaire that could be completed and returned to a freepost address, as well as a link to an online questionnaire that could be completed and submitted electronically. The questionnaire wanted to know how the changes would affect the respondent: 1. Will any of the changes we are suggesting affect you in a good or positive way? If yes please explain. 2. Will any of the changes we are suggesting affect you in a bad or negative way? If yes please explain.

• Inpatient surgery for urology and lower gastro-intestinal cancer.

3. What are the most important things we need to consider if these changes to services were to go ahead?

Methods

4. Are there any other comments you would like to make?

The consultation employed a number of different methods for distributing summary material to the general public, patient groups, NHS staff and stakeholders. Methods included delivering summary documents directly to key stakeholder organisations for distribution amongst their members, material distributed in GP surgeries

MYHT, NHS Kirklees and NHS Wakefield District also arranged 31 public meetings held across the region, which attracted 335 attendees. Questions and comments made at the public meetings were transcribed and collated for subsequent analysis.

Download the consultation document here: www.kirklees.nhs.uk/ fileadmin/documents/PPI/Annual_Report_2010/Mid_Yorkshire_-_ Consultation_document.pdf

Feedback The York Health Economics Consortium (YHEC) was commissioned by NHS Wakefield District to analyse responses to the public consultation. The analysis conducted by YHEC was funded by the NHS. However, the analysis was conducted independently of the organisations involved and no attempt was made by any of the stakeholders to influence the content of this report.

Outcome Following the NHS consultation on developing specialist centres for hospital services in mid Yorkshire, NHS Kirklees, NHS Wakefield District and The Mid Yorkshire Hospitals NHS Trust agreed to proceed with the development of dedicated specialist centres for neonatal intensive and high dependency care and for children’s inpatient surgery. These specialist centres will open at the new Wakefield hospital, when it fully opens in 2011. In light of the current economic climate and the financial challenges now facing the NHS nationally, the three NHS trusts decided to put on hold plans to build a new facility for a specialist urology and lower gastro-intestinal cancer surgery centre at Dewsbury and District Hospital. This was a key requirement to support the creation of both this centre and the specialist centre for orthopaedic trauma inpatient surgery in Wakefield, and required substantial additional investment.

Download the YHEC analysis document here: www.kirklees.nhs.uk/ fileadmin/documents/PPI/Annual_Report_2010/Mid_Yorkshire_-_Final_ report.pdf

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Holme Valley Memorial Hospital Holme Valley Memorial Hospital is situated in Holmfirth and has a range of services including minor surgical procedures, physiotherapy and an in-patient ward. We proposed to make improvements to the current buildings and facilities to enable an increase in the range of services provided and improvements in the way in which they were delivered locally. Although we were proposing developments, these proposals were not what would be considered major service change and, as such, this was not a formal consultation process as set out under Section 242 of the NHS Act 2006. However, we still wanted to make sure that as many people as possible could be involved in shaping the new developments and were keen to hear their views.

What we were proposing We were proposing to improve the facilities and range of services available at Holme Valley Memorial Hospital. There were three main options being proposed. In recognition of the history of this site and the high regard that local people have for Holme Valley Memorial Hospital, all of the options put forward would keep the facade of the house at the front of the current hospital building. The war memorial and surrounding gardens would also remain unchanged. We knew this is what local people wanted us to do. Option 1 - We would provide the services in a mostly new building. Option 2 - A combination of new buildings and the refurbishment of old ones. Option 3 - Refurbish most of the existing buildings with a very limited amount of new building.

Who was involved in discussions about the project? The views of local people had already influenced the shape of the proposals, Local Area Committees had debated the range of services that could be offered and local people had attended several meetings where their comments had been listened to by the PCT. We held six drop-in sessions across Holme Valley to give the public the opportunity to view the proposed plans, ask questions and to give their comments. We asked four main questions: 1. Will any of the changes we are suggesting affect you in a good or positive way? If yes please explain 2. Will any of the changes we are suggesting affect you in a bad or negative way? If yes please explain 3. What are the most important things we need to consider if these changes to services were to go ahead? 4. Are there any other comments you would like to make?

Feedback received Twenty-one people attended the drop-in sessions and we had nine completed forms returned. The key questions raised were: • Would there be additional parking spaces? • Would the war memorial gardens be knocked down? • Would there be an A&E service? Download the consultation document here: www.kirklees.nhs. uk/fileadmin/documents/PPI/Annual_ Report_2010/Holme_Valley_ Memorial_Hospital_-_Consultation_ document.pdf

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What happened next? An Outline Business Case was submitted to Yorkshire and Humber Strategic Health Authority for its agreement. If the Outline Business Case demonstrates the viability of the project to the satisfaction of the Strategic Health Authority a procurement exercise will be undertaken to select a development partner for the scheme.

Patient and public involvement annual report


NHS Constitution The NHS Constitution was published on 21 January 2009 and set out a ten year plan to provide the highest quality of care and service for patients in England. The purpose of this was to bring together in one place, what staff, patients and the public expected from the NHS. The NHS Constitution also sets out the responsibilities that patients and the public should uphold to help the NHS work effectively and to make sure that resources are used responsibly. It helps staff, patients and the public work together to make sure that quality NHS services are delivered. NHS Kirklees supported the Department of Health’s consultation on the updated patient rights for the NHS Constitution with staff, members of the public and patients.

Discussions with local groups took place throughout January 2010 to make sure that the additional proposed constitutions reflected people’s views. NHS Kirklees asked what people’s opinions were regarding: • introducing a new right to access services within maximum waiting times or for the NHS to take all reasonable steps to offer a range of alternative providers if this is not possible; • introducing a new right to an NHS Health Check every five years for those aged 40-74, to come into effect in 2012, and the right to see an alternative provider if you are not offered one by the provider you approach; • the introduction of a number of potential future rights; and • introducing the role of ‘Constitution Champion’ within each NHS Primary Care Trust.

A local process underpinning the work of the Department of Health and Yorkshire and Humberside Strategic Health Authority was established to raise public awareness of this consultation and encourage responses. The following methods were used: • press release • information to staff via staff bulletins • inclusion in voluntary sector publications • inclusion in the PCT’s Get involved, share your views newsletter • presentations / displays and discussions at local groups • public perception survey • staff survey Information gathered through the various methods was collated and submitted to Yorkshire and Humberside Strategic Health Authority.

Download the summary of consultation activities here: . www.kirklees.nhs.uk/fileadmin/documents/PPI/Annual_Report_2010/NHS_ Constitution_-_SHA_response_table.pdf

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Social marketing Health-related social marketing is:

“the systematic application of marketing, alongside other concepts and techniques, to achieve specific behavioural goals, to improve health and to reduce inequalities.”1

Social Marketing helps us understand: • why people behave the way they do • what factors influence that behaviour • if any barriers exist to adopting the desired behaviour • how we remove those barriers and increase incentives to the desired behaviour change Social marketing starts and ends with a focus on the person and what is important to them; it does not approach people in isolation, but considers them in their wider social context. It requires genuine consumer insight, understanding the ‘exchange’, i.e. what is ‘competing’ for attention in people’s lives? It uses whole-systems, holistic and wider determinant thinking so it integrates a clear focus on the individual with the need to address wider influences and inequalities so one size does not fit all. Social marketing is an approach to insight led commissioning, starting with the person, understanding their motivations, needs, barriers and incentives to the particular behaviour change. NHS Kirklees follows the National Social Marketing Centre’s total planning process and all elements of the social marketing project development are documented on a shared database currently known as Accessing Consultation and Engagement (ACE) Database (the database has been developed and will be known as INVOLVE from July 2010).

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French and Blair-Stevens (2007) Big Pocket Guide. London: National Social Marketing Centre.

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Now we’re cooking: pre-test What we did

What was the issue to address?

As part of the women of child bearing age (WOCBA) project, NHS Kirklees consulted with members of the public to determine the best ways in which we could support and educate women with children to cook healthily.

The North Kirklees Annual Health Report (2005) revealed that infant death rates were twice the national average in some areas of Kirklees.

Feedback We found that we needed to help them to develop their cooking skills and raise their confidence in their abilities to provide healthy family food. Budgeting skills, cost effective shopping, advice on weaning, fussy eating and recipe adaptation were also needs that were identified.

A follow up report in January 2008, which analysed the causes of infant mortality, highlighted the following focus areas for NHS Kirklees:

The difference we made? NHS Kirklees piloted a WOCBA family food support service providing practical cookery and food budgeting advice within the family’s home. The pilot targets women living in Dewsbury and is delivered by the charity ‘Action for Children’.

• The need to educate and support women to be healthy before, during and after birth • The need to increase awareness of genetic conditions which may cause infant deaths

A family food support worker works closely with the families to build confidence and skills in cooking and healthy eating. The support worker considers individual family needs and offers solutions to their food challenges. This can include help with weekly budgeting or a cookery session in their own kitchen.

• The need for antenatal care to be accessible and accessed

So far over 40 families have accessed the service and feedback has been very positive.

• For more research to be done and insight gained.

The keys to our success

Chicken

The keys to our success were understanding the wants, needs and beliefs of the target audience. Our consultations with members of the public helped us to determine the type of service that they wanted and were likely to access. The pilot was created from this and has proved very Leek and Leek and potat o soup potato soup successful.

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Dance Lab: pre-test What was the issue to address? To formulate a strand of activity around dance that would raise the physical activity levels of young mid teenage girls in North Kirklees (Batley area) and divert them away from behaviours such as smoking and drinking.

What we did Interviews and focus groups were held with the target audience to establish what type of dance sessions they would be interested in attending.

Feedback • Dance respondents were drawn from Batley and all agreed with the statement ‘There’s nothing to do round here’. • Ideas involving early introduction to different dance styles, with opportunities for participants to have some say over content, as well as something to work towards such as a performance. • The pilot would benefit from being a women-only programme; the invitation to boys was not an essential requirement for the girls’ attendance. • As well as having credibility as a dancer, the tutor needs to be capable of managing a potentially challenging group with skill and care. S/he must also be accessible - someone with whom ‘Batley girls’ can easily identify with. • There is a clear need for taster sessions so that potential participants can ‘try before they buy’ and develop more confidence in the pilot. • Dance was seen as an activity that had more of an aesthetic impact on the body (a better body, more visually pleasing) as opposed to activities with a greater emphasis on fitness/workout. This benefit was in line with most of the young women’s priority aspirations. • The emphasis was to be less on direct health messages (particularly smoking and drinking – reduction of these would be subtle bi-products, being active and having fun were primary objectives). • The pilot would not be seen as NHS branded, consultation suggested this would be too blatant for direct health messages and be off putting.

What happened next? Using the elements described through these topline findings from the pretesting consultation, a pilot project using dance as the draw to engage in physical activity is to be developed. This is to help counteract a decline in long term motivation to be regularly active for teenage girls. The key is to provide taster sessions with opportunities for participant input in the style of music and dance, so that a sense of ownership is created. Current dance classes tend to be very prescriptive and engage few who would just like to have a go.

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Dance Lab: evaluation What was the issue to address? To determine the success or otherwise of the pilot project Dance Lab, run for teenage girls (15-17 years) in Batley. Evaluation will steer the project to a package that can be commissioned by public health to engage and motivate teenage girls in dance as a route into long term physical activity, and that encourages a reduction in harmful health behaviours.

What we did Interviews were held with the teenage girls that had attended the sessions.

Feedback • Marketing support needs to be more permanent posters, or leaflet board, rather than leaflets in hand. Leafleting and posters reached some hardest-to-reach audiences. • Venue seems to be key in establishing credibility and legitimacy, needs to be a currently recognised venue where young girls feel confident and comfortable. • The dance lessons and the relationship with the dance teacher offer a point of clarity and kindness in sometimes quite complex backgrounds. • Appearing in a local showcase was a significant point of motivation and a great marker of achievement for those who took part. • The marketing support elements (t-shirts and water bottles) were highly visible and liked by those who received them. • The main elements of the pilot delivery seem fit for purpose; there is little (in terms of the product) that needs to be changed. • For those who learn, the experience of dancing appears to be delivering some emotional benefits – increased self-esteem and self-confidence. • However, food education levels are still extremely low, diets are very heavy in carbohydrates (almost exclusively so in some cases) and very low in vegetables. • Even without discussing smoking/drinking, some basic food education would be both acceptable and useful.

What happened next? A detailed manifesto for the Dance Lab package was produced in order to develop a specification to commission delivery in other local communities. Discussions have been held with potential providers to deliver in key target areas, with links through local schools, youth services and community bases. Detailed profiles of the elements for marketing, engagement, tutor role and support mechanisms were developed, in order to meet the initial insight findings.

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Auntie Pam’s: pre-test What was the issue to address? The aim of the initial stage, carried out in February 2009, was to identify reasons why some women were not engaging with maternity services. Whereas the purpose of the pre-test was to put forward propositions based on the findings of the initial insight regarding identifying any gaps in service provision – focusing on the women’s needs identified by them to aid in the development of a new service based on the key insight of ‘listen to me and I’ll listen to you’ and understanding the range of issues concerning our target audience.

What we did Discussions with local women took place to identify the type of service which would meet their needs using associated creative materials which the target audience found attractive/resonated with.

Summary of findings Respondents had initially told us that they want to be listened to, and are more likely to get information and support from friends or family than from health professionals who can seem distant, uncaring and formal. The proposition of a ‘salon’ was well received as it met the key needs for neutral and welcoming access to information/services. But more of a ‘drop in’ centre, a place to spend ‘adult/impending parenthood’ time away from ‘the scary medical environment’ was preferred. The idea of a lounging space – ‘somewhere to chill out’ coffee-shop style (but no actual café) – juicy colours, big sofas, warm spaces, warm welcome – very prevalent. Town centre based, easy to access but discreet enough to be private was again confirmed from initial consultation. The name ‘Auntie Pam’s’ was unanimously agreed by the respondents as it is recognised and respected in several cultures and was felt to be identified as someone ‘kind’ and ‘caring’. Building on the initial findings –‘ Show me don’t just tell me”: many women thought that actions spoke

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louder than words – too much written information led to overload and ignoring messages. Women’s real needs and concerns they felt were ignored (where they will live, where they can get financial help, how they can get support with their relationship etc). Emotional support they felt they needed was not from health professionals or leaflets - but from young people (peer supporters) from similar backgrounds who understood their ‘real lives’.

What happened as a result? Auntie Pam’s is a new Dewsbury based project that has been designed for local women by local women based on their opinions, beliefs and what they desire from a service. It is staffed by peer supporters who are trained volunteers with personal experience of pregnancy and parenthood. Each volunteer has had basic brief interventions and communication training. Volunteers are not trained to either give advice on aspects of lifestyle or health issues. They are trained to offer a signposting service that will effectively engage the women with the most appropriate service to meet their individual needs. Auntie Pam’s is not aimed to be a substitute for other services, in particular maternity services, and has not been promoted as such. It has been recognised that all women should be encouraged to access

Patient and public involvement annual report

maternity services as soon as possible once they find out that they are pregnant. For those women who do not engage early with maternity services because they have a range of other priority issues, Auntie Pam’s is a route to support this rather than an alternative. Engagement with local women and clinicians from the Dewsbury area took place with insights informing the process and promotion messages about the service. A report of the findings has been produced and can be accessed at www.kirklees.nhs.uk/ getinvolved. Pregnant women aged 15 – 25 not currently engaged with services were targeted. It was found that by addressing women’s real needs and concerns (where they will live, where they can get financial help, how they can get support with their relationship, etc) women would have increased confidence, motivation and capacity to address health and social lifestyle changes. By engaging with women, peer supporters have been able to support women to engage with maternity services, improving outcomes for mother and baby.


Obesity in 16-24 year olds: pre-test in halls of residence What were the aims?

What were the expected outcomes?

Engaging with students aged 18-24 studying at the University of Huddersfield within Kirklees and living within halls of residence at Storthes Hall that are classed as being overweight or obese (BMI 25+). To pre-test ideas for interventions based on dance and cooking that will influence behaviour change.

Method

The project team used the consultation to discover how likely the students were to engage in regular dance classes and cooking demonstrations. In collecting data based on the students preferences, the interventions would be carried out at the most convenient time, place and cost to them.

Sixty questionnaires were completed via a door-to-door survey and 40 via a postal survey.

What were the results? From the initial survey 40 students expressed an interest in dance activities, of these 20 were also interested in cooking activities. An additional 20 students expressed an interest in cooking activities only. The students enjoyed the dance taster sessions held in the two weeks prior to fresher’s week. The type of dance they were interested in varied, but the general feeling was that easy dance moves to popular music were the most popular. Early evenings were the most popular time. Following the cooking demonstrations, students enjoyed the sessions and favoured early evening as their preferred time. The students were interested in actively participating in the demonstrations by helping in preparing the food to be cooked. They were also interested in learning how to cook traditional recipes such as those enjoyed at home.

What were the outcomes? As a result of the consultation the project team acted on feedback and dance classes were arranged on a regular basis twice a week. Cooking demonstrations became cooking classes with students encouraged to prepare the food to be cooked. Traditional recipes were demonstrated with the recipes available on the web site to download. The recipes were formulated using healthy food choices as an alternative to unhealthy high fat content. The dance and cooking classes were promoted by flyers/ posters and plasma screens. In addition facebook was used as a reminder as was text messaging. Block reps were used to distribute the flyers/posters as a way of using peer pressure to influence attendance at the events.

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Obesity in 16-24 years old: evaluation in halls of residence activity What were the aims? This consultation assessed the impact of dance and cooking classes carried out at the halls of residence, as well as exploring the feasibility of the interventions being sustained throughout the remainder of the academic year.

What were the expected outcomes? The outcomes would inform the project team about the level of student engagement with the interventions as well as how much the students enjoyed taking part. Results would also assess the likelihood of further student engagement that would impact on the interventions becoming self funding and sustaining.

Methods Eighty on-line surveys and a further 40 telephone questionnaires were completed.

dance classes enjoyed the experience. The tutor commissioned was very popular and students informed the interviewer that they had attended more classes as a result of attending the taster sessions. The reason why they were less inclined to continue attending was given as a lack of time. The students that were interviewed having attended the cooking classes enjoyed the experience, but would have liked to have been shown how to prepare and cook more ambitious recipes. The reason students gave for not attending future classes was lack of time.

What were the results?

What were the actual outcomes?

The response to the online survey was poor. As a result the students were contacted by telephone to gauge their response to the online survey. Students that attended the

The outcomes of the consultation support the initial insight conducted in 2008 when students told us that they have very little time and lead hectic lives. In view of the poor

uptake for the dance and cooking classes it would not be feasible to sustain them in their present format. Kirklees Active Leisure were keen to explore the possibility of conducting focus groups to assess how to further enhance engagement with university students for interventions based on dance activities. The project team will support this piece of work by making their communication channels available to Kirklees Active Leisure. The management team of the halls of residence is to be offered support to carry forward cooking activities based on a ‘Come Dine with Me’ style of challenge. The project team will offer communication channels and might be able to offer incentives for students to take part. Simple and more ambitious recipes are available on the web site to download.

Stop smoking support groups: ‘Kick the Habit’ and ‘Time for Me’: pre-test What was the issue to address? The Department of Health has targets to reduce smoking rates in the UK, especially among routine and manual workers (R&M). While local smoking rates are reducing, successful quits among routine and manual workers are difficult to achieve and research has shown they find it harder to stop and are less likely to access support.

Purpose

Methods

Phase 1 aim

To make sure that routine and manual workers were involved in the review and re-design of stop smoking services across Kirklees to make sure they appeal to the target group both in terms of promotion and content.

We conducted focus groups with both male and female target groups. These were carried out with people who lived in Batley and Newsome, between 20 and 40 years, who smoked 20 or more cigarettes a day and were interested in stopping smoking.

To test and develop, with the target audience, the proposed service design and promotion to inform the development and implementation of the pilot programmes planned (to reduce smoking rates of R & M workers in the Batley and Huddersfield South areas)

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Key findings - changes to service provision Men told us that smoking is part of their group culture and an opportunity to relax, de-stress and chat with friends. We found that a barrier in attempts to stop smoking was that they thought they would be excluded from ‘the gang’. When asked what stop smoking support they would like, men commented as follows: • That it doesn’t feel like ‘Alcoholics Anonymous’! • There is humour • Information giving • Opportunity to get fit • Guidance on how to deal with their anger and frustration Women said that smoking provided much needed ‘me time’, an opportunity to leave worries behind and relax and enjoy some space. When asked what stop smoking support they would like, women commented as follows: • A chatty, friendly advisor who they can relate to • A chance to meet others who have been through the service (an ex-smoker) • To be able to relax • To get some ‘me time’ • They don’t want to put on weight • Guidance on how to cope with stress without smoking

The keys to our success

To gain feedback from routine and manual workers (men and women) from a real life stop smoking group with some of the enhanced elements (e.g. guest speaker) and tweaked promotional materials.

Working with the target audience to provide a service that fits their needs and developing promotional materials that appeal will give the pilot groups their best possible chance of success. By tailoring the service and redesigning elements to suit the differing needs of men and women, we are offering more patient choice. It has also provided an alternative from the generic one size fits all approach.

Key findings • There was overall support for the proposals of the sessions. • They liked the idea of a closed group with the same people attending every week and especially welcomed the idea of guest speakers on particular weeks as this would encourage them not to miss a week. • All agreed that the personality of the advisor is crucial; that they must be engaging but serious; approachable and nonthreatening.

Action taken In Kirklees, Newsome and Batley have high smoking prevalence rates and are areas of high routine and manual worker occupancy. These localities were chosen as pilot sites for the new ‘Kick the Habit’ and ‘Time for Me’ support groups.

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Specialists providing stop smoking support were joined by fitness, stress management and nutrition advisors to help participants address the issues that were raised during the insight work.

The groups started in the pilot sites in January 2010; ‘Kick the Habit’ in Newsome and ‘Time for Me’ in Batley. An evaluation company has been commissioned to independently review every aspect of the work. Learning from these pilots will be incorporated into service design and, if successful, will provide a service model to roll out across other locations in Kirklees. This process will make sure that the views and recommendations from service users are taken into account throughout the 12 month period and fed into the subsequent groups rather than waiting for a final report at the end of this time.

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We designed single sex groups to reflect the differing needs of men and women. The groups run for seven weeks with the same people throughout to help a group identity to form and support to develop. Ex-smokers who have quit through attending stop smoking support groups were recruited to act as meet and greeters to ease first attendance and share their experiences.

What next?

Tim

Both sexes were well aware of the health issues and found reminders of these and cigarette pictures in advertising for stop smoking services effective in raising awareness of this. They did not want to be preached to, but having an ex-smoker; someone who had been through the experience, at a group was welcomed.

Phase 2 objective

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Long term conditions services Improving our long term conditions services What was the issue to address? The long term conditions (LTC) programme needed strong and robust primary care clinical leadership and effective joint commissioning plans to be developed by Health Improvement Teams (HITs). This was to make sure the services delivered to people are safe, effective and of excellent quality. We therefore needed the support of clinicians, clinical leads, programme managers and engagement with the public to achieve this.

What we did • Reduced the reliance on secondary care services and increased the provision of care in primary, community and home environments through the re-design and development of intermediate care services. • Embedded into our local health and social care community an effective, systematic approach to the care and management of patients with long term conditions. • Met the individual requirements of people with long term conditions through high quality personalised care which offers choice and services commissioned to meet individual needs.

The difference we made • Reduced reliance on emergency services. • People feel more supported and in control of their condition. • People are able to manage their condition and medication more effectively. • Care closer to home when needed. • Improved access to specialist services. • More choice of when and where people can receive their care. • Improved skills in the community workforce.

The keys to our success • Engaging with patients, the public and carers through a patient reference group, events and questionnaires. • Ongoing partnership working with Kirklees Council. • Raising awareness of services within the community for people with long term conditions. • Promoting community services to clinicians and health professionals in primary and secondary care including local authority staff via LTC road shows.

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NHS Kirklees stroke programme What was the issue to address? NHS Kirklees conducted stroke discussion groups to give people who had had a stroke in the last two years the opportunity to share what they had experienced in order to understand better from a real person’s perspective ‘what it is like to experience a stroke and to live with stroke in Kirklees’. Two discussion groups were held and 35 people attended, the groups explored the following themes:

What was your life like before you had your stroke? This was intended to explore people’s perceptions of stroke before - did they understand what a stroke was, what the causes of stroke were, who it affected? Also, before stroke, what did they enjoy doing and what were the things they took for granted?

How did stroke affect you? This was to provide the opportunity for people to talk about the circumstances surrounding the stroke, exploring how stroke was detected? How did they or others feel and respond.

What is it like for you now living with a stroke? This theme was to help in developing an understanding of what life is like now (since the stroke) for them and their carers and families. The groups explored how relationships had changed, what daily life was like, what they enjoyed and what was difficult.

What would have helped to make your experiences easier? This theme was acknowledging that people had or were learning to live with the effects of stroke and explores what would have made this easier, what would really make a difference to them and their life and about anything that would make their goals more easily achievable.

Feedback The discussion groups told us that: • They did not have a real understanding of what stroke was, what the signs and symptoms were or the devastation stroke could cause. • They experienced anxiety and stress, loss of confidence and feelings of isolation. • They felt vulnerable and were in constant fear of another stroke. • They felt guilty about how their illness was affecting their family. • They wanted more emotional and family support following stroke around how they could adjust to living with stroke. • They wanted more meaningful information that was relevant to their situation. • They wanted to be able to access support networks where they could meet people with similar experiences.

The difference we made? Through working with Kirklees Council we introduced an information, advice and support service dedicated to stroke. The service provides advice to individuals and families on the physical and psychological effects of a stroke and information on organisations and local sources of support. In the last seven months, the service has received a total of 184 referrals from stroke wards, community rehabilitation teams, social care, individuals and other health professionals.

We have established stroke drop-in groups to support stroke survivor’s recovery. The groups focus on helping people to get better and preventing further strokes. We recruited stroke skilled health trainers to help address lifestyle issues and promote healthier living.

The keys to our success • Engaging with patient, public and carers through stroke discussion groups • Ongoing partnership working with Kirklees Council • Raising awareness of signs and symptoms of stroke within the community • Collaborative working between primary, secondary and tertiary care to provide links across all sectors.

What next? We will be continuing and evaluating the effectiveness of the advice and support service. We will be working with the drop-in support groups to find out what useful information we can provide to others suffering from stroke and to find out how the service can be improved. We will be targeting areas in Kirklees where the risk of stroke is high and aim to provide high quality stroke services for all which will reduce disability and save lives.

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Chronic pain management Background Chronic pain has a severe impact on many peoples’ lives - nearly one in seven people experience chronic pain in the UK, with 20% of those having suffered for more than 20 years.2 In Kirklees, one in three people are affected by pain problems, including backache.3 As a result, NHS Kirklees working with key partner organisations, has made chronic pain a key health priority.

Purpose To make sure that service users were involved in the review and re-design of chronic pain services across Kirklees and to establish a mechanism for continuous participation in the work.

Methods

• Clarify service users’ views of changes required to chronic pain services to meet their needs.

• Provide comprehensive programme, rather than just one or two sessions.

In total, over 70 service users were involved in discussion groups.

Self care

Key findings - changes to service provision

It was agreed to identify service users who experience chronic pain by inviting individuals from the NHS Kirklees Patient & Public Involvement (PPI) database and via identified services (Better Health at Work, health trainers, Expert Patient Programme support groups) that have contact with individuals suffering from chronic pain.

Primary care

Two phases of engagement were planned and delivered jointly between Public Health and the PPI team:

• Improved GP understanding of chronic pain services and self care programmes

Phase 1 objectives • Understand to what extent chronic pain affects individuals’ day to day life, including physical health/ daily functioning and emotional well-being. • Identify service user experience of NHS and non NHS services in relation to chronic pain and to what extent the services made a difference for their pain management. • Understand the extent that service users self manage their chronic pain condition.

• More immediate action for relevant assessments/ investigations. • Being able to see the right person at the right time • More links between services • Improve waiting times for referral to physiotherapy

• More continuity of care with each service having an understanding about other services that can provide help

Hospital • Treat the person as a whole with a full assessment. • Similar service provision across south & north Kirklees. • Better patient information.

• Self care as a key part of managing pain • Regular access to self care resources and programmes including complimentary therapy.

Phase 2 objective To gain feedback from service users about each step of the proposed pain care pathway in order to help shape future chronic pain services. Twenty six service users were involved in this discussion group. Key findings – views of proposed care pathway There was overall support for the proposals. Service users particularly liked the patient centred approach using an holistic health needs assessment with additional support via health trainers. Service users agreed that the following issues would need to be addressed through the chronic care pathway: • Improved access to primary care - referral to specialist services

• Improve access to physiotherapy and occupational therapy.

• All GPs referring patients consistently for self care advice and support

• Reduce waiting times to pain clinics.

• Improved medicine management • Rapid access to physiotherapy and specialist services

The British Pain Society and Royal College of General Practitioners “A practical guide to the provision of chronic pain services for adults in primary care” p6-7. Chronic Pain Society: October 2004 3 NHS Kirklees & Kirklees Council. “Current Living in Kirklees survey” 2008 2

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• Development of patient held records • Improved self care advice/support from specialist services

Action taken The valuable feedback from service users has been shared with service providers and commissioners at a range of forums including, Commissioning College, GP Consortia and acute trust providing specialist pain services. The key themes have been reported back to the Pain Health Improvement Team (HIT) and these findings have formed part of the decision making

around reviewing service provision and development of a Kirklees chronic pain care pathway.

case for service redesign linked to a wider musculo-skeletal service review.

In addition, the pilot pain management service commissioned on behalf of the Three Valleys Commissioning consortium, has been positively evaluated and will inform the production of a service specification for the proposed Kirklees chronic pain care pathway, including the needs of service users. The next step is to agree a business

The intention is to link with existing patient support groups e.g. Expert Patients Programme (EPP) support groups, to make sure there is ongoing involvement of people living with Chronic pain and to provide feedback about how the chronic pain care pathway is operating.

Download the summary of key themes here: . www.kirklees.nhs.uk/fileadmin/documents/PPI/Annual_Report_2010/ Chronic_Pain_-_Report.pdf

Diabetes The diabetes service was undergoing a review to make sure that it met the needs of patients. As part of this review, two service user reference groups were set up – one for north Kirklees and one for south Kirklees. These groups are looking at issues relating to improving diabetes services. We considered various methods of recruiting members to this group and achieved this through networking with existing organisations as well as publicity via services. The groups are meeting bimonthly and continue to help in the development of services.

Do you or someone you care for have diabetes?

If you have diabetes, or care for someo ne with diabetes, and would like to infl uence diabetes care for adults in Kirklee s, please join our group. We are committed to involving patients and carers in planning diabetes services and are seeking interested and motivated people with diabetes (both Type 1 and 2) to join a reference group to look at issues relating to improving diabetes services. The group will meet initially in January 2009 to consider how diabetes services are provided. They will then decide how they want to work with NHS Kirklees and the diabetes team to influence and shape services within Kirklees.

If you are interested in joining our group, please contact: Ann Wood on 01924 351469 or ann.wood@kirklees.nhs.uk

Kirklees

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Pilot diabetes Urdu Expert Patient Programme What was the issue to address? A health needs assessment conducted in the Birkby and Fartown area of the Huddersfield North locality identified a high prevalence of diabetes among the South Asian community. Further work with people from this community and local health care professionals identified a lack of understanding about diabetes prevention, management and the services available to support self care.

Feedback The initiative identified that more support to increase understanding of diabetes and what people can do to improve their health was needed.

Action taken A bespoke diabetes education programme was developed to engage and empower people from the South Asian community. The aim of the education course was to equip people living with or, caring for someone with diabetes with self management skills and to make healthier lifestyle choices. ‘Partnerships for Wellbeing’ (PFW), an organisation specialising in self management training, was commissioned to design and deliver an innovative ten-week diabetes-specific, Expert Patient Programme (EPP). This programme was facilitated in Urdu - the most commonly used South Asian language, within this community. The programme was designed in collaboration with local clinicians and community representatives. The course was targeted at South Asian women with diabetes or, caring for someone with diabetes. Twenty-six women enrolled and completed the course, (100% completion and retention rate). The group composed almost equally of carers and people with diabetes. The age group ranged from eighteen to eighty years. Twelve of the women also had additional long-term health conditions. The demand and interest for the course proved to be high and a waiting list was generated for future courses.

The difference we made? The evaluation of the project identified the following: • Increased understanding of diabetes and how to improve their health • Improved confidence to make lifestyle changes • Quite a few participants reported weight loss and improved blood glucose readings.

The keys to our success These were as follows: • Delivering the course in Urdu which meant that people were able to participate actively rather than through translators • Adapting the course to meet cultural and faith needs i.e. delivering the course to ladies only • Partnership working with other health care professionals • Significant levels of community engagement in promoting the course. Download the pilot report here: . What next? www.kirklees.nhs.uk/fileadmin/ documents/PPI/Annual_ We are taking the learning from this course and piloting further diabetes Report_2010/Urdu_EPP_-_Pilot_ Expert Patients Programmes in other areas in Kirklees where there is high Report.pdf diabetes prevalence among the South Asian community.

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Neurology and Myalgic Encephalopathy (ME) Background The Neurology HIT lead has established an effective working relationship with local patient groups (via a local charity called The Nerve Centre) and clinicians (via the Health Improvement Team - HIT). Together we have designed clinical pathways for:

You said “We know we’d benefit from the Leeds based weekly group therapy sessions but the travelling is very tiring. So, we either don’t attend or if we go, the benefit is practically wiped out due to the resulting fatigue.”

We did Organised for the staff providing the therapy to travel to Huddersfield and conduct the sessions locally. All suitable patients were able attend.

• Parkinson’s Disease (PD)

What were the keys to your success?

• Epilepsy

• Arranging for the sessions to be hosted by a local charity based at The Nerve Centre, in town.

• Myalgic Encephalopathy (ME) These were agreed by all parties and present NHS Kirklees with no significant additional cost – they just articulate the national requirements already in place with guidance on how these can be implemented locally. They also explain the expectation that patients agree to undertake self management of their disease, with support from clinicians and other healthcare staff, as required - a concept that has taken time and negotiation to embed within the PPI group who formed a neurology reference group supported by Kirklees Local Involvement Network. Neurology includes myalgic encephalomyelitis (ME) patients, who suffer extreme fatigue just dealing with daily living. In response to feedback, a valued group therapy service was provided locally for ME patients – The Road Less Travelled.

• The hire cost paid by NHS Kirklees was managed within the allocated budget • There was full attendance throughout the course sessions • The patient evaluation was excellent • The Leeds staff feedback was that it was successful, though travelling time affected other work

What are you doing next? • Produce a business case for continuing the local service. • Canvass local PCTs to join in providing this closer to home service.

We’ll keep in touch after the course, because everyone lives locally.

I would never have finished the course if I’d had to travel to Leeds.

I couldn’t complete the course at Leeds due to the travelling and I think this has held up my progress. Quotes from patients

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Women and children’s services An evaluation into the maternity services available to the people of South Kirklees Background During 2008, NHS Kirklees did a consultation into maternity services in North Kirklees, partly in response to the relatively high infant mortality rate in the area. Following this consultation, NHS Kirklees developed The Healthy Pregnancy and Maternity Services Strategy. The purpose of this strategy was to outline the goals for realising the shared vision between pregnant women and practitioners, and to describe the outcomes that put women and their families at the centre of a healthy pregnancy. The national context for the project is set out by the Department of Health’s 2007 Maternity Matters report, which outlines that; “the priority for modern maternity services is to provide high quality, safe and accessible services that are both women focussed and familycentred. Pregnancy and birth should be as safe and satisfying as possible for both mother and baby and support new parents to have a confident start to family life”. The document also highlights that; “future maternity services must be planned to address current challenges including outcomes for more vulnerable and disadvantaged families”.

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With both the national and local picture in mind, NHS Kirklees decided to do a consultation into the services available to women in South Kirklees.

Objectives The overall objective was to undertake a service evaluation of the maternity services available to women in South Kirklees, by consultation with health care professionals (midwives and health visitors) and women of the area. Specifically, evaluation was required with regards to the following areas:

Informed and choices 1. How well informed pregnant women feel throughout their pregnancy.

5. The extent to which they feel prepared for the birth – in terms of labour preferences and what to expect. 6. The extent to which the services had helped to prepare them for the first few weeks of motherhood.

Vulnerable groups 7. The extent to which the services are provided to and accessed by vulnerable groups.

2. The extent to which they felt they are able to make informed choices about the nature of the services they receive.

Engaged

3. Whether they feel suitably informed about how to have a healthy and happy pregnancy, both in terms of positive choices (e.g. healthy diet) and negative choices (e.g. smoking during pregnancy).

Education and parent craft

4. Whether they feel the information they received is delivered in an appropriate way (personal consultation from a professional versus information overload by leaflet).

Patient and public involvement annual report

8. The extent to which they engaged with the services overall. 9. Views on parent craft classes – what were the motivations for attending, and to what extent did they fulfil their needs? For those who did not attend – what were the reasons for not doing so?


Health care professionals Their perspective on the issues above, plus: 10. The extent to which workloads compromise the quality of the service they feel able to offer (e.g. suitable appointment lengths, an early enough booking in appointment, discussion rather than leaflet provision)? 11. The extent to which they believe that women are provided with an appropriate level of service in order to begin parenting from a solid start point?

Methodology and sample

What were the results?

The consultation required a qualitative, face to face approach. Fieldwork took place throughout April and May 2009. All fieldwork was recorded and transcribed. The sample comprised two main audiences:

In general, the women of South Kirklees were satisfied that they received a good maternity service. Women were physically engaging with the services – the vast majority attend all their appointments. Women who were engaged emotionally with the services were more likely to have better outcomes.

• Women (pregnant or baby under four months) – 36 women took part in focus groups and 10 participated in interviews. • Health Care Professionals – eight interviews were held with health care professionals.

What are the actual outcomes? The report has been shared with strategic managers of the service providers and this is being used with midwifery teams to challenge and change practice.

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Infant mortality Background A previous audit in North Kirklees identified above average rates of infant mortality and also highlighted that locally, the impact of consanguinity (cousin to cousin marriage) needs to be widely understood in contributing to congenital abnormalities in children of such relationships. NHS Kirklees public health team planned to present information on cousin to cousin marriage and its effects on families to those targeted communities identified by the North Kirklees audit.

Targeted areas

Methods used

Birkby, Fartown, Thornton Lodge, Lockwood and in North of Kirklees Batley, Dewsbury, Saville Town were targeted due to the high Pakistani/ Muslim population resident in those areas.

Prior to delivering genetic awareness sessions in the community, key Asian Kirklees community members, such as children centre workers, voluntary workers, local authority staff from Children and Young People Services (ChYPS), community health staff and three Imams from the local hospitals were invited to a number of meetings to gain their views on how best to target the community to deliver messages regarding consanguinity and its potential impact on infant mortality.

Aim • To raise the profile of cousin to cousin marriage and its impact on infant mortality by communicating with partners and the public, particularly in those Asian communities with higher rates of infant mortality. • Engage communities and involve users in service developments and to educate families with regard to the health implications of consanguinity. • These families will be empowered to make informed choices with regards to marriages and planning their families. • To provide good communication routes and work with families and other professionals to achieve improved health outcomes for children and families.

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Advice was sought from these key personnel about how best to deliver the factual information about recessive inheritance in the most sensitive and culturally appropriate way, taking into account the religious and cultural perspectives. Semi-structured interviews were used in small focus groups (4 people at most) to elicit the above information and advice.

Results The results of these discussions informed the way the genetic awareness sessions were delivered and the most appropriate venues. Information gathered also contributed to informing the content of graphics to demonstrate recessive inheritance and also a small wallet type reminder card which was developed in order to

Patient and public involvement annual report

remind communities to think about the issues. This information was then fed back for approval through the infant mortality communications sub-group which is a multi professional, multi agency group set up to look at best practice for communicating with hard to reach groups.

Outcomes These consultations changed the initial plans for delivering the sessions. The venues were changed to access those people attending English For Speakers of Other Languages (ESOL) classes in the targeted areas. Also the findings influenced our choice of using an experienced interpreter who understood recessive inheritance as well as confirming that appropriate graphical material was needed. We also made sure that we were very clear that cousin to cousin marriage in itself is not the cause of infant mortality. The sessions were about providing information so people could make informed choices. Statistics were also included as the focus groups requested that there were factual information regarding numbers affected in the education sessions. This was not originally planned as we thought it would complicate proceedings.


Breastfeeding peer support What was the issue to address? Breast milk is the ideal food for a baby. It is nutritionally balanced, with the perfect amount of proteins, carbohydrates, fats, vitamins and iron to help the baby grow. It contains antibodies that help to protect the baby from infection and it changes to suit the different needs of the baby as it grows. Exclusive breastfeeding is recommended for the first six months of an infant’s life, as it provides all the baby’s nutritional need. Statistics show that more than 70% of new mums in Kirklees breastfeed their babies at birth. However, by six weeks only 35% of mothers are still exclusively breastfeeding. Evidence shows that mother to mother support is the most effective way of supporting breastfeeding mums to continue to do so. Breastfeeding is a skill that needs to be learnt by both mother and baby.

Feedback Feedback received from mothers attending the Baby Bistro identified that mothers would like the tools to be able to share their experiences of breastfeeding and support other mums to continue to do so.

What we did We provided ten weeks of two and a half hour training courses for mums who have breast fed their babies. This was to develop the knowledge and skills that are needed to share their experiences of breastfeeding and to support other mums to continue to breastfeed.

The difference we made? NHS Kirklees public health have trained 37 mothers as breastfeeding peer supporters so far. Research shows that mums relate better to other mums who have breast fed rather than professionals. Breastfeeding peer supporters also provide this support to expectant mums who would like to breastfeed.

The keys to our success Breastfeeding peer supporters have usually experienced difficulties themselves with breastfeeding and are eager to share these experiences to help other mothers overcome the

same problems. Mothers relate to them very well. Breastfeeding peer supporters have forged good links with professionals such as midwives, health visitors and Sure Start Children’s Centres. This means that they can communicate the issues received by mothers who breastfeed to professionals to make sure that they receive appropriate guidance and training. Crèche facilities are provided for breastfeeding peer supporters who attend the training sessions.

breastfeeding peer support groups. Breastfeeding peer supporters are meeting with pregnant ladies at parent-craft classes and links have been made with the Child Care Co-ordinator at Royds Hall High School which we are progressing to improve the service even further. In addition to the above, one-toone peer support work is now taking place on the wards at Mid Yorkshire Hospitals NHS Trust with new mothers.

What happened next? Our Breastfeeding peer support training is now a rolling programme. We are liaising with City and Guilds accredited body to develop the training as an accredited course. We are continuing to work in partnership with Sure Start Thornhill, Golcar, Cowersley & Milnsbridge, Gomersal & Littletown, Dewsbury Moor & Scout Hill, Huddersfield Central, Savile Town and Chickenley & Earlsheaton Children’s Centres in facilitating baby bistros –

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Attention Deficit Hyperactivity Disorder (ADHD) ADHD has increasingly been recognised in Kirklees over the recent years but due to current National Institute of Clinical Excellence (NICE) guidance the service has been re-designed with the involvement of children, young people and their families. The redesigned service now meets NICE guidance and ensures collaboration and integration among agencies to provide comprehensive services that take into consideration a wide range of personal, social and educational factors for children and young people.

What we did A wide range of consultation events were organised which involved contacting all parents/carers of current service users to inform them of the proposed plans and invite their involvement in re-designing the service. Postal questionnaires were sent to all the families, one for parents and one for children and young people. Other consultation events were organised including telephone interviews, online feedback, discussion groups, face to face interviews and SMS messaging. This resulted in a parent/carer reference group being established and a young person’s advisory panel who were influential in telling us what was important to them from an ADHD service. The involvement of children, young people and families has helped us to design a truly child and family centred service.

What parents/carers want Parents and carers in Kirklees told us they wanted: • Outstanding communication about their child’s condition with well-timed and understandable information • Swift and easy access to the services including specialist child and adolescent mental health services (CAMHS) when required • Support, practical advice and reassurance, including information about sleeping difficulties, diet and lifestyle, and promoting self esteem

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• Co-ordinated and organised care with continuity for the child and family • The right treatment and the best outcomes • A community service delivered in community locations • An out of hours contact number for crisis times, particularly covering weekends • Clarity about the roles and responsibilities of the different team members and agencies involved. • Parents, children and young people, where appropriate, want to have their own hand held records and family care plans. • A range of parenting support/ training including information on practical advice and coping strategies • A weekly parenting drop-in to provide the extra support, including parenting support when things are difficult.

What children and young people want Children and young people with ADHD in Kirklees wanted: • Their views about ADHD and the treatment options to be taken into account • Community service to be delivered closer to home in child friendly environments, including school, but not at Glen Acre House. • School staff to have training on how to support pupils with ADHD • To have contact with the community service about

Patient and public involvement annual report

appointments etc. via SMS text or email with reminders about appointments • Follow up or contact sessions to be carried out over the phone, where appropriate • Understanding and acceptance from other children in school about ADHD and the impact on themselves and others.

What happened next? We have designed the new ADHD service to include the things children, young people and families told us they wanted. We developed our service specification so that; • Services are delivered close to home in local children’s centres. • A range of parenting programmes will be offered to all parents and carers. • A training programme will be rolled out so that schools and others will be more informed and able to manage children and young people with ADHD. • A weekly drop-in will be held twice a week for families needing crisis support. • Appointments will be co-ordinated around the lives of children and young people. Download the questionnaires here: . www.kirklees.nhs.uk/fileadmin/ documents/PPI/Annual_ Report_2010/ADHD_ questionnaire_-_Parent_or_carer.pdf www.kirklees.nhs.uk/fileadmin/ documents/PPI/Annual_ Report_2010/ADHD_ questionnaire_-_CYP.pdf


Kirklees Young People’s Survey 2009 Background NHS Kirklees, Kirklees Council and West Yorkshire Police have worked in partnership to develop a young people’s survey (YPS) for 2009 and future years. This survey brings together the previous year 9 young people’s health survey carried out by NHS Kirklees every two years; the year 9 physical activity survey carried out by Kirklees Council’s Culture & Leisure service every two years; some questions from the ‘Tell Us’ survey (a statutory annual survey of year 6, 8 and 10 pupils carried out by the Department for Children, Schools and Families); and questions to inform the work of West Yorkshire Police. By working in partnership we were able to make sure the survey is not duplicated; we obtain a single source of intelligence that can be shared across partners consistently in commissioning and developing service actions; we benefit from cost savings; and provide better value for money.

Aims and objectives The overall aim of the partnership survey is to gather comprehensive data on health, lifestyle and perceptions of the local area from year 9 pupils across Kirklees.

The objectives of the YPS were: • to increase understanding of the needs, behaviours and views of young people to inform commissioning and service provision; • to compare the views of young people with the adult (18+) population, look at trends over time and explore demographic differences in the behaviour and views of young people;

• to update intelligence about young people to inform key strategic documents including the Joint Strategic Needs Assessment (JSNA), the children’s plan and the community cohesion strategy.

• Fewer pupils have tried illegal drugs • Fewer pupils have had sexual intercourse • Fewer pupils are concerned over their appearance. - BUT more this year have an issue with body size

Method • Swift Research Ltd was commissioned to print questionnaires; carry out data input and analysis; and produce reports and other outputs specified by the YPS project board. • 26 out of 27 schools in Kirklees agreed to participate in the YPS. • Questionnaires were distributed by school nurses to 26 schools across Kirklees. • The questionnaires were filled in by year 9 pupils under exam conditions for confidentiality and consistency. School nurses were on hand for any questions. • The total survey sample is 4041 year 9 pupils.

Overview of key findings – has the 2009 picture changed? • Generally, findings are very positive, with many key indicators having improved compared to previous years • Good levels of health • More pupils eating breakfast and consistent levels of eating five or more fruit and vegetables • A higher proportion happy with their weight • Fewer pupils having tried smoking and fewer starting under 10 years • Fewer pupils having tried alcohol and fewer drinking regularly. - BUT regular drinkers are more likely to get drunk

• More pupils are confident in their appearance. - BUT more want to change their looks • Fewer pupils bullied / bullying - Poor satisfaction with local area - Poor satisfaction with local activities

What happened next? Whilst the results for Kirklees overall from the YPS are generally positive there are some important differences and areas of concern at the level of localities and individual schools. There are also some key distinctions between demographic groups which need more exploration. School nurses will work with individual school head teachers to identify issues and areas for action at school level, supported by the healthy schools team and other relevant services. Locality and Kirklees-wide issues identified in the YPS will be shared with all services, teams and individuals in NHS Kirklees, council and police involved in commissioning or providing services for children and young people. Download the young people’s survey here: www.kirklees.nhs.uk/ fileadmin/documents/PPI/Annual_ Report_2010/Kirklees_Young_ People_s_Survey_2009_-_Executive_ summary_report.pdf

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Support for parents to improve the health of their families What were the aims? To explore how parents from disadvantaged communities throughout Kirklees perceive and understand their role in improving the health of their families.

What were the expected outcomes? • A clear understanding of parent’s perceptions of their role and responsibilities in improving their family’s health. • An understanding of why parents are not seeking out and taking advantage of the parenting support programmes currently available.

Methods used Eighty people took part in focus groups with a further 40 being interviewed as part of this work.

What are the results? The findings from this initiative indicate that parents living in the more socially deprived areas of Kirklees have few, if any, personal aspirations. Parents have many concerns, but their family’s health is not usually a major one.

What are the actual outcomes? An interest group representing a range of services has been convened to examine the findings, understand the implications for their service and agree action to take forward.

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Staying healthy Kirklees Drug and Alcohol Action team What was the issue to address? Alcohol misuse and associated problems are a significant issue in Kirklees where over a third of Kirklees adults drink at levels that are placing their health at risk.

Rationale Discussion groups were held with service users from KAAS (Kirklees Alcohol Advisory Service), approximate numbers 40 in Huddersfield, 15 in Batley. We asked them what they wanted from a new alcohol treatment service before going out to tender for the service. Responses were used as part of forming the questions to potential providers as part of the tender exercise.

What we did Colleagues from the commissioning and public health directorates worked closely together to secure neighbourhood renewal funding that went on to fund two specialist alcohol workers and an alcohol nurse. The funding also supported the Kirklees Partnership to develop the Kirklees alcohol strategy (2007 – 2010).

The difference we made? One of the aims of the Kirklees alcohol strategy was to develop comprehensive alcohol treatment services in Kirklees. Funding was secured through NHS Kirklees and Kirklees Council and a tender exercise began in early 2009 to find a supplier for the service. The tender was supported by colleagues from NHS Kirklees, Kirklees Council and The Kirklees Partnership and a collaboration between Lifeline Kirklees and Community Links were awarded the contract. After consultation with service users, On TRAK (Treatment:Recovery: Alcohol:Kirklees) was chosen as the new name for the service. The service, which has new premises in both Huddersfield and Dewsbury, was operational on the 1 October 2009 and was officially launched by the Mayor of Kirklees in January 2010.

The keys to our success Our successes were due to the support of the Kirklees Partnership Local Public Service Board (LSPB) and close partnership working with dedicated colleagues who were keen to secure the very best alcohol treatment service for the people of Kirklees within the resources that were available. A great deal of interest was generated both locally and nationally by different suppliers who were keen to help in the provision of the new service. Upon securing the contract, Lifeline Kirklees and Community Links worked very hard to renovate the new premises and get the service up and running in time.

What next? The Kirklees Partnership’s alcohol strategy is due to be refreshed during 2010 which will set our direction for future developments. The Drug and Alcohol Action Team are currently looking at ways to reduce alcohol related hospital admissions.

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Learning disabilities The Learning Disability Direct Enhanced Service What was the issue to address? The learning disabled population told us that they wanted good access to GP services to support their health needs. They also wanted GPs to better understand their problems and how they can help them overcome these. This project focused on improving the health and wellbeing of people with learning disabilities within Kirklees across primary care services. This included the implementation of a Learning Disability Direct Enhanced Service (DES).

What we did NHS Kirklees worked in partnership with GPs, specialist health and social care staff, people with learning disabilities and their families and carers to develop a framework to implement and deliver the learning disability DES. The main objectives of the project were to design a universal level of support for people with learning disabilities which would compliment and enhance the whole system of service delivery, increase the prioritisation of learning disabilities within primary and acute services, facilitate, promote and motivate learning disabled individuals to access appropriate services to meet their needs and to develop and evaluate an effective toolkit to support those changes.

The difference we made? The group developed a range of innovative, joined up solutions, including the development of supportive resources, including practice based training sessions. Individuals with learning disabilities were supported to deliver awareness training to practice staff, which proved to be an extremely valuable exercise. Training CDs were developed in conjunction with specialist learning disability (LD) services and the local medical committee (LMC). The aim of this was to increase awareness of learning disabilities, communication requirements and safeguarding issues. NHS Kirklees facilitated the development and implementation of LD registers within primary care, the setting of new standards and the monitoring, evaluation and ongoing audit of the project. The intention was that all resources produced should be sustainable, user-friendly, owned by partners, and effective in reducing health inequalities.

The keys to our success The production of all the resources within the toolkit was the result of true partnership working. All stakeholders were involved in launching the resources via an event called ‘It’s My Health Day’. This was followed by a further series of professional training days. NHS Kirklees, in partnership with GPs, launched the learning disability DES during 2008/09. Take up of this proved incredibly successful and for 2009/10 targets have been developed.

What next? In partnership with service users, families, carers and health and social care staff, NHS Kirklees is designing a communications pack specifically for GP practices. This is being introduced to remove barriers for those who find communication difficult. Through working with GPs there will be an annual audit of both the learning disability registers and annual health checks. This is to make sure there is a high standard of service.

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It’s My Health Day It’s My Health Day was an interactive event for people with learning disabilities, their carers and professionals from across Kirklees, Calderdale and Wakefield. The event was organised jointly by NHS and local authorities in the area so that people with learning disabilities, their families, and carers could experience the wide-range of services available to them and give them the chance to provide feedback on the services offered. Amongst an array of interactive attractions, people were able to peddle themselves a smoothie, take part in pilates and dancercise, find out about health and wellbeing services available and tell us their thoughts in a Big Brother diary room. Not only did the event attract over 150 people, but it proved what could be achieved when working together as the event was supported by all three PCTs, all three local authorities and South West Yorkshire Partnership Foundation Trust.

Two key themes that emerged from the event were: 1. Access to dental treatment for people with learning disabilities - length of wait, finding a community dentist and hospital stays for routine dental treatment. 2. Podiatry – service delivery for individuals with learning disabilities particularly improving communication. All the views given at the event will help to inform future planning and delivery of services as we strive to deliver first class health opportunities for people with learning disabilities across our region.

It’s my health day 11th February 2010 The Village Hotel Capitol Boulevard West,Tingley, Leeds LS27 0TS (just off junction 28 of the M62 on the A650)

Programme 10am

Come and let us know who you are at the sign in desk.

There will be lots of stalls, lots of information and the chance to take part in fun activities such as:

Wii

Exercise

Look after

For people with learnin g disabilities and their carers and families living in Kirk lees, Calderdale and Wakefield

Big Bro th diary ro er om

your heart Beer G oggle G ame -making Smoothie s

Pilate

Win a prize

12pm

12.15pm 3pm

Dance

Speech by Chairman of NHS Kirklees, Rob Napier Lunch

Close

Thank you for coming, have a safe journey home.

NHS Kirklees, NHS Calderdale, NHS Wakefield District and South West

Yorkshire Partnership NHS Foundation Trust

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Practice Based Commissioning Practice-based commissioning (PBC) is about empowering GPs and other clinicians such as nurses, pharmacists and allied health professionals to shape the health and healthcare of local populations. Working in partnership with their PCT, GPs can create a more in-depth understanding of the long-term health needs of the local community, and plan and deliver services to better address these specific needs. The NHS Next Stage Review concluded that practice-based commissioning (PBC) has a pivotal role to play in empowering clinicians to shape the health and healthcare of local populations.

The local structure for PBC is as follows: Commissioning Consortia (CC) North Kirklees CC

Dewsbury Doctors CC

Huddersfield’s CC

Three Valleys. CC

23 practices

4 practices

25 practices

10 practices

Slaithwaite Health Centre

Newsome Surgery

University Practice. Huddersfield

The Paddock Surgery

Dr Fox & . Dr Stringer Practice Cleckheaton

Liversedge Health Centre

Stand alone PBC Practices Oaklands . Health Centre. Holmfirth

New Brewery Lane Surgery Thornhill

Thornhill

The following are some examples of work carried out in seeking patient/ public views and how this has impacted on changes in services brought about through Practice Based Commissioning.

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Elmwood . Health Centre. Holmfirth


Evaluation Summary of the pain self management service commissioned on behalf of the Three Valleys Commissioning Consortium Background This service provides a personcentred, patient-led health needs assessment to reduce distress and disability due to long term pain and enable patients to self manage more confidently. The service was introduced in October 2008 and has provided a valued patient-centred resource that addresses most patients’ needs, improves self confidence to self manage and reduces health care use in both primary and secondary care. It appears to have helped GPs become more confident to manage some subsequent patients.

Patient background Data was gathered from 106 patients with an age range of 25 91 years; average 53 yrs. 75% of referrals were women and pain duration ranged from three months to 68 years with an average of 10.6 years. 26% of patients smoked and experienced greater duration of pain than non smokers. 70% of working age men and 55% of women were not in work.

Patient needs and choices The patient identified needs were to improve fitness, mobility and balance, pain relief, reduce side effects of medication and understand more about long term pain. Patients chose from a range of options and services available to address their priorities, which were written information on how to manage their condition, advice and support form the physiotherapist and referral to PALS to sustain physical function improvements, see the health trainer for self management skills and specialist GP

for medicine management. There was little patient choice for hospital service referral or for psychology/ talking therapy.

Service outcome and satisfaction Patients were seen for an average of 4.1 appointments within 16 weeks before discharge and all patients were seen within four weeks of opt in. 92% of patients were satisfied with the service and 88% had increased understanding of their condition and how to manage it. Patients valued all aspects of the service, with 95% finding the doctor helpful to very helpful, 82% for physiotherapist, 78% health trainer and the written resources 84% very helpful to helpful. Common themes from comments and qualitative interviews were the quality of advice and expertise, the interest and understanding the team had of patients’ problems, the time given and the recommended self management materials. Main areas for improvement were a more central location. All patients at formal discharge are given a setback plan and offered open access for severe setback for a 12 month period. To date no patient has contacted the service for either telephone advice or consultation.

Problems with the service Problems raised were around patient access geographically, cancellations at short notice and the complexity of some patient’s life situations or other health conditions e.g. emergence of other conditions, thus staying within the service for periods greater than six months. Obtaining patient outcome data in the short and long term has been a challenge with 30% data completion for some aspects of the evaluation.

Summary Improvements to gain more patient and service outcome data have been implemented. Service changes need to focus on increasing the physical rehabilitation and self management of the long term pain sufferers. The evaluation of the pilot pain management service, supports the NHS Kirklees pain health improvement team patient/users engagement process which highlighted the need for more access to self management and physiotherapy, in addition to pain clinic type resources. The findings from the pilot, will inform the production of a service specification for the proposed Kirklees chronic pain care pathway, including the needs of service users.

GP view of service and skills A GP questionnaire revealed that the service addressed patient goals of pain symptom control and self management skills. GPs realised their lack of skills in this area and found the Pain Self Management (PSM) service helped increase their confidence by 44% to manage similar patients in the future.

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University Health Centre The centre carried out the following engagement work to gather views from patients. Health needs assessment The practice decided to undertake a health needs assessment as part of its commissioning plan for 2009/10 with the intention of utilising the results to tailor services to be commissioned/enhanced during the practice’s short, medium and long term planning. The survey was done during the weeks of 4, 11 and 18 January 2010 and was available for patients to pick up and complete at the main reception desk – the reception team invited patients to participate wherever possible. 107 were completed. Full results of the study can be found at www.kirklees.nhs.uk/ getinvolved

Alcohol audit The University Health Centre has a bespoke population in that it is atypical to that of a normal GP practice. This factor brings with it many challenges in providing appropriate/relevant healthcare for the student population with the following issues in particular being worthy of note: • Being inexperienced users the student population are often high consulters and can tend to utilise A&E services inappropriately. • There is an increased workload associated with contraceptive and sexual health • There is a heavy public health/educational role to bridge regarding healthy lifestyle choices which include diet/alcohol consumption/ smoking/drug use etc. • Mental health issues are rife amongst this cohort of patients who are in a transitional stage of their lives and often experience difficulty adjusting to their new environment with the many challenges that face them.

Method The re-audit was undertaken during the summer/autumn of 2009. Patients attending for routine clinics who fell into the category of having registered with the practice during the previous year and having filled out the alcohol questionnaire at the time of registering were asked if they would kindly complete a second audit. 117 patients agreed to participate. A report of the findings was prepared and this can be found at www.kirklees.nhs.uk/fileadmin/documents/PPI/Annual_Report_2010/ University_Health_Centre_-_Alcohol_audit.pdf

Future action At practice level we are now going to try to speak to the same people (or if they are on placement years etc. and therefore not available, recruit third year students for the survey) to ascertain their drinking trends in the final year of studying, i.e. when the novelty of it might have worn off, the pressure of workload may be impacting and they may be a little more constrained financially – we are looking forward to seeing the results. We are hopeful that their drinking behaviour is not setting a habit for life, but rather is simply a transitional part of their lifestyle, i.e. the student experience.

Patient feedback Suggestion trees have been used previously where a large cardboard tree was put on a notice board and patients were invited to write their suggestions on the tree. Feedback received showed that patients would like the service to run throughout the year and not just during term times. This resulted in the development of successful business cases for increased physiotherapy and psychotherapy sessions.

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North Kirklees Consortium NKCC have recognised the importance of involving the public as and when appropriate with commissioning decisions and their intention according to their commissioning plan.

Proposals • To establish a development plan to map out requirements and intentions to improve patient and public involvement. • To develop greater understanding of PPI measures already in place at practice level throughout the consortium. • To take active measures to promote greater awareness of PBC and the consortium. • When commissioning new services and/or influencing service redesign fully take into account how these are informed by local knowledge and service user opinion. • To work alongside the PPI team to test out locality approach to inform the continuing work of the consortium. • Consideration to be given to other options to engage with PPI e.g. public event/utilisation of software tools/ links with more community forums/ agencies.

Phlebotomy patient satisfaction questionnaire Aims and objectives To establish patient satisfaction with the phlebotomy service offered by various providers

Methodology Patients who attended for bloods taking were given a questionnaire. Time frame was 1-5 February 2010.

Results 1534 bloods were taken over the five day period, a total of 1426 questionnaires were handed out with 1031 returned – this equates to a 72% return rate.

Dewsbury Doctors Consortium (DDC) DDC, in putting together their commissioning plan for 2010/2011 have included a section purely for patient and public involvement. Recognising how the patient is central to the commissioning cycle. Their commissioning plan includes: • Developing a greater understanding of what methods are best to use to engage with patients and the public. • Working together with patients and their families and carers to identify the right levels of care, in the right location. • In February they implemented a facilitated peer review programme of clinicians to share experience, pathways and identify better services for patients.

The South Stand Alone Forum A group of like minded Stand Alone Practices, working together for the benefit of the patients. Oaklands Health Centre

The results were very positive and showed that the majority of patients:

Slaithwaite Health Centre

• Had to wait less than two days for an appointment

Elmwood Practice

• Found it easy to make an appointment

Newsome Practice

• Were offered a choice of provider and chose their own GP

University Practice

• Were seen within 15 minutes of their appointment time

The above practices came together in 2009 to look at how good and effective patient services that reduce wait times and provide local care can be shared. In June 2010 they had both an ophthalmology service and an ENT service approved for further roll out to more patients. These provide a multi disciplinary service to patients with minimum wait times.

• Were very satisfied with their visit

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Volunteering NHS Kirklees is committed to involving volunteers in its work to enhance the work of the organisation. In NHS Kirklees a volunteer is a person who makes a commitment to support the work of staff in order to improve and enhance the provision of services. We have 104 volunteers on the books and 37 volunteers who are not currently volunteering, but have done so this year.

Why include volunteers? There are many reasons to involve volunteers. These include: • Volunteers can bring a different perspective to our work, often one that reflects the views of the local community • They can bring credibility to an organisation – giving their time for free suggests that the work must be of value • Volunteers can help to extend services we currently offer • Volunteers can bring a fresh approach which includes diversity of knowledge and experience

Volunteering opportunities The people that volunteer for NHS Kirklees are given the opportunity to take part in a wide range of activities, such as: • Expert Patient Programme (EPP) tutor • Readers’ Panel - is made up of 96 volunteers who read new and updated information making sure that documents produced by NHS Kirklees and Kirklees Council are easy to understand and accessible to everyone. • Breastfeeding peer supporters – local mums who have breastfed their own children are now supporting other mums who want advice about feeding their baby naturally. • Pregnancy peer supports – Helping young mums to access the right sort of pre and post pregnancy support. • Holme Valley Memorial Hospital volunteers

Breastfeeding peer supporters

• Healthy eating food volunteers • Smoking cessation volunteers • Research projects • Volunteer policy reviewers • Maternity service liaison committee

On-going support NHS Kirklees values the work that volunteers do and as a thank you we hold regular events throughout the year. This year we held a volunteer’s picnic and the EPP volunteer tutors were treated to a wonderful barge trip and meal as a way of saying thank you for all the work they have done over the year.

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Victoria Medical Centre On the 1 April 2010 Malling Health Ltd became the new service provider for the Victoria Medical Centre in Dewsbury.

Malling Health Ltd were awarded the contract after an in-depth and robust procurement process. The selection panel consisted of members of the public, patient and public involvement team, local doctors, public health and employees of NHS Kirklees. The staff at Victoria Medical Centre will remain and services which are currently provided will continue. Patients will automatically transfer across to the new providers so there will not be any disruption to the patient. Malling Health Ltd will be working closely with the existing staff, the patients groups and NHS Kirklees to develop an extensive range of high quality patient services at Victoria Medical Centre.

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Projects for 2010/11 Pharmaceutical Needs Assessment NHS Kirklees has a statutory duty to develop and publish by 1st February 2011 a Pharmaceutical Needs Assessment (PNA) that reflects local health needs. This work will be lead by the Pharmaceutical Needs Assessment Project group and contain representatives of community pharmacy contractors, practice based commissioners and public health. Mapping of existing pharmaceutical provision against future need will support this assessment to develop our services and plan for the years ahead.

The objectives of this PNA are: • To have a clear picture of the current services provided by community pharmacies. • To be able to plan for future services to be delivered by community pharmacies. • To make sure that any gaps in service provision are adequately addressed. • To make sure that community pharmacies are utilised as a means of reducing health inequalities. We are currently developing our PNA and have just undertaken a pre-consultation exercise to gain patients’ views on current pharmaceutical provision within each locality and future services they might want to have available.The information gathered is now being used to develop a draft PNA. We are planning to consult on the draft PNA with the public and key stakeholders during August and September 2010.

Infection prevention and control The infection prevention and control (IPC) team at NHS Kirklees have already carried out a program of awareness raising for staff members on the importance and best practice of hand hygiene. The team will be looking to raise awareness and involve patients and the public in the monitoring of hand hygiene compliance by healthcare professionals in accordance with criterion 3 of the Code of Practice for the prevention and control of healthcare associated infections. A patient questionnaire will be developed to evaluate the following: • Public awareness of the infection prevention and control team. • Public awareness of how concerns can be raised regarding hand hygiene and other infection related issues. • Public perception of general standards of infection control by health professionals. The questionnaire will also aim to be designed in a way as to inform participants about good practice for hand hygiene. It is planned to distribute this through GP and dental practices as well as being available at local community events. The questionnaire is planned to be a continuous and ongoing method of evaluation for the IP&C team. More work in the form of events coinciding with the infection control week in late October 2010 are also planned to raise public awareness of the work that the team does and how the public can raise concerns around this topic.

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Targeted Mental Health in Schools (TaMS) NHS Kirklees has been granted £250k to run a pilot project, Targeted Mental Health in Schools (TaMS). The project is looking at three high schools and the 12 feeder schools, the high schools are Colne Valley, Royds and Batley Girls – these were all highlighted in the JSNA as having issues with mental health. The project will be aiming to change the school culture towards mental health in these schools and the support provided to young people and parents. Throughout the project children, young people and their parents will be involved.

Single equality scheme Between August – October 2010, we will be consulting with the public and key stakeholders on our draft single equality scheme 2010 - 2013. This will replace and update our previous scheme (2007-2009) and will aim to demonstrate our commitment to delivering our legal duties in this area and also pave the way for changes in legislation and responsibilities, which are anticipated in the near future.

Reducing children’s and young people’s attendance at accident and emergency Practice Based Commissioning (PBC) and internal partners are planning engagement work around the unnecessary admissions of children and young people. The work will take place over the summer holiday and we will be talking to children, young people, their parents and staff to gather information.

Specialised commissioning Specialised services are those services provided in relatively few specialist centres to catchment populations of more than one million people. These services are not provided by every hospital, and tend to be found in larger hospitals based in big towns and cities. Through the Yorkshire and the Humber Specialised Commissioning Group (SCG), we have agreed to prioritise the commissioning of those specialised services where it is judged that the most gain can be delivered against the headings of: • Price control

• Service model redesign

• Activity control

• Driving up service standards

• Better contract terms and conditions The SCG has identified service areas where a review of models of provision or increased capacity is required. It is recognised that major service change might be required as a result of these reviews, which might significantly affect the provider landscape. These include: • Obesity surgery

• Neurosurgery and long term neurological conditions

• Cancer services • Cardiac services • Children’s services • Fertility services

• Specialist mental health services • Vascular surgery

• Renal services

To develop the draft scheme we have built on the feedback we received from our first equality scheme and have made sure that we have listened to the views of a range of different individuals, organisations and members of our staff.

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Involvement of children and young people in new health in schools commissioning model From September 2009 the Department of Health (DH) and the Department for Children Schools and Families launched an enhancement model for health and wellbeing in schools or clusters, moving schools from achievement of national healthy schools standards to a commissioning based approach. The Enhancement model focuses on identifying health needs and seeks to achieve better health outcomes for children and young people. Enhancement sets out how individual schools or clusters will identify priorities locally through the JSNA, LAA, other relevant local level data and national priorities for children and young people. The work is commencing with a pilot which will include modeling an approach to ensure the involvement of children and young people at each stage of the process is actively embedded.

Social marketing Building on the work that has taken place to present, the following work is planned for 2010 – 2011: • Evaluation of Stop smoking support groups: ‘Kick the Habit’ and ‘Time for Me’ • Evaluation of women of childbearing age (WOCBA) social marketing projects - Auntie Pam’s and ‘Now we’re cooking’.

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If you are interested in getting involved in the work of NHS Kirklees or would like to share your views on local health services, please contact our Patient and Public Involvement Team on: Tel: 01484 464024 / 464025 Email: ppi@kirklees.nhs.uk NHS Kirklees Broad Lea House Bradley Business Park Dyson Wood Way Bradley Huddersfield HD2 1GZ

Reference: KW3672 Date of publication: Jun 10 Š Kirklees Primary Care Trust

www.kirklees.nhs.uk

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