Ready to engage?

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Commissioning for People a patient and public
engagement resource
Ready to engage?
Whats this?
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Youve chosen to start engaging
Click on a level of engagement on the left to
begin
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Whats with the Cow?
The Newham Engagement Cow is an easy way of
remembering that Engagement should be
Blue-Sky there are no limits to your joint
creativity
Best Value giving patients more for less
Friendly a smile can do more than you think!
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Youve chosen to find out more
Good idea, lets begin
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What is Patient and Public Engagement?
Patient and Public Engagement (PPE) is a way
of 1. reviewing existing services for quality
and fit 2. assessing need to narrow down the
options 3. developing plans which meet local
priorities 4. localising procurement decision
making processes 5. managing demand by asking
what works 6. achieving continuous improvement
through feedback
Commissioning for People
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Commissioning for People
How does this work with commissioning?
Engagement enables the Commissioning Cycle by
1. Reviewing existing services for quality and fit
2. Assessing need to narrow down the options
6. Achieving continuous improvement through
feedback
3. Developing plans which meet local priorities
5. Managing demand by asking what works
4. Localising procurement decision making
processes
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• Commissioning for People
• What are the levels of engagement?
• Inform
• You offer to provide information in an accessible
  and open manner, but no influence over decision
  making, in fact the decisions may already have
  been made and you should state this.
• Consult
• You are asking a question. It may help you think
  about what the public considers important, which
  may be very different to what the needs of the
  service may be.
• You should tell the people who you spoke to what
  you did with that which they told you.

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• Commissioning for People
• Levels of engagement
• Collaborate
• You offer to work together, not necessarily as
  equals. However, as a group with common purpose.
  When changes occur they take place after open
  discussion, but perhaps not agreement.
• You may agree to disagree, however the promise is
  to engage regularly and with a view to developing
  an effective and enduring relationship.
• Partner
• You offer to work as an equal. Your relationship
  means you are working to achieve agreed goals
  based on recognition of each others special
  expertise and insight.
• Meetings and discussions are regular and open.
  Your promise is to enable shared decision making.

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Youve chosen a level of involvement
You chose to inform Now choose a stage of the
cycle
Plan
Monitor
Engage
Your contract with the public You will provide
information about your chosen stage in an
accessible and open manner. You offer no
influence over decision making, in fact the
decisions may already have been made and you
should state this.
Procure
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Youve chosen a level of involvement
You chose to consult Now choose a stage of the
cycle
Plan
Monitor
Engage
Your contract with the public You are asking a
question. It may help you think about what the
public considers important, which may be very
different to what you had considered
important. You should tell the people who you
spoke to what you did with that which they told
you.
Procure
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Youve chosen a level of involvement
You chose to collaborate Now choose a stage of
the cycle
Plan
Monitor
Engage
Your contract with the public You offer to work
together, not necessarily as equals. However, as
a group with common purpose. When changes occur
they take place after open discussion, but
perhaps not agreement. You may agree to
disagree, however the promise is to engage
regularly and with a view to developing an
effective and enduring relationship.
Procure
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Youve chosen a level of involvement
You chose to partner Now choose a stage of the
cycle
Plan
Monitor
Engage
Your contract with the public You offer to work
as an equal. Your relationship means you are
working to achieve agreed goals based on
recognition of each others special expertise and
insight. Meetings and discussions are regular
and open. Your promise is to enable shared
decision making.
Procure
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A Newham Example!
The Let's do something stage
You've chosen inform plan Case Study gt Big
Values Mini Jamboree The Trust had decided on a
set of values for how it would work, the acronym
being 'CLEAR' Caring, Learning,Encouragement,
Accountability and Respect. However, there was a
need to inform people in the community to
demonstrate how we wanted to work. Tasked with
this, the PPI team came up with the Big Values
Mini Jamboree. The aim was to draw out the
alignment, ownership and trust of local people
with the Trusts' new values and describe a
planned process of sustainable constructive
engagement. The event has created lasting
relationships and was a promising start to a
renewed commitment to working more closely with
the community.
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A Newham Example!
The Let's do something stage
You've chosen inform procure Example gt Open
House at the Clinic Procurement is expecting to
implement government reforms of key services in
the coming year, however there is a low level of
public awareness about the approaching
changes. After consulting the PPI team, they
work in partnership with existing services to
present an informative half day open house for
staff as well as patients. On Thursdays, the
clinic runs for a half day, the latter half of
the day from 12.30pm onwards is allocated for an
open house event. Three parts of the Multi
Disciplinary Team are each allocated a task, one
team sets up computer displays using videos from
the Dipex website of patient experiences. Another
creates a multimedia time line showing the
current service arrangement and the planned
changes and a third team is tasked with publicity
and incentives to identify patients interested in
participating in the procurement process.
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A Newham Example!
The Let's do something stage
You've chosen inform monitor Case Study gt
Radiology and Open Systems The Radiology team has
a regular flow of patients and regular monitoring
had identified that these patients would really
appreciate some information about what they are
about to go through, but weren't sure what to do
and so we went along and had a chat. We
suggested opening up the system, presenting what
happens in picture and leaflet format, especially
as some people may not have English as a first
language, exactly where people could get accurate
information and at the same time what was
happening when they went through an MRI scanner
or an X-ray machine. The team is now putting
pictures on the wall and using comment cards. It
will also signpost people to community support
and assess what patients think about their
service. However, you could use a presentation
at a community forum, a community centre event or
the Trusts health pages in Newham magazine to
help people get the information they need.
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A Newham Example!
The Let's do something stage
You've chosen inform monitor Example gt A
Patient Charter When listening to users' stories,
service teams were hearing a message about a
lack of clarity of information. Patients were
saying that they weren't sure what they should
expect from the service. This made decision
making difficult for all and patients felt
unclear about when they were entitled to ask for
a need to be met, or not. As a proactive
responsive service, the team felt they needed to
come up with a solution. They came up with a
Patient's Charter, describing the desirable and
essential outcomes of a hospital experience.
Every patient was given a copy and an explanation
using their preferred means of communication. The
resulting service recorded higher levels of
satisfaction and a higher quality of
relationships and communication between staff and
patients.
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A Newham Example!
The Let's do something stage
You've chosen consult plan Example gt Learning
Difficulties and Primary Care Complaints data
was showing a pattern of poor experience amongst
people with learning difficulties. The PCT
organised a Focus Group in partnership with three
major local Learning Difficulties
charities. Data from the Newham Health Debate,
Complaints, and the Local Focus Group led to NHS
Newham including a specialist Learning
Difficulties service line in the Service
Specification for a new Health Centre. At the
time of the Newham Health Debate, 73 of people
questioned said that they believed their input
would be influential in shaping health services,
and in a later survey by Ipsos-MORI, the public
put NHS Newham first in London on listening to
local people and improving services.
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The Let's do something stage

• You've chosen consult plan
• Case Study gt Calderstones' Discussion Groups
• Calderstones NHS Trust is a specialist learning
  disabilities trust in North West England
• It provides long-stay services that include a
  range of medium-secure places for offenders
• with learning disabilities and others with
  similar needs. During a choice consultation a
• series of discussion groups to support planned
  improvements to services were set up for clients
  facilitated by a facilitator.
• The following changes have resulted in
  information provision
• a clients monthly brief to develop better
  communication with patients during the change
• a relatives newsletter to create a link between
  the hospital and the public
• a revised version of our services to you" on
  DVD
• a day service information and awareness sessions
  for clients.

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The Let's do something stage
You've chosen consult procure Case Study gt
Helston Birthing Unit Focus Groups We consulted
two focus groups with young mothers. Fifteen
mothers took part in the groups. We provided a
crèche to support the first group of mothers.
These mothers were part of a peer support group
to help them back into education. Two of the
mothers were living in hostel accommodation. This
group explored what is important to young mothers
in low-tech birthing facilities In the
procurement phase the mothers said they valued
more personal care, local midwives and a
home-from-home environment. However, the changes
mothers said they needed focussed on practical
things, so in the new build we agreed to
install a water-birth facility ensure there was
plentiful parking and enable mothers to have
more control of lighting in the birth environment
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The Let's do something stage
You've chosen consult procure Example gt
Helping People Make Informed Choices Patient
choice was about to arrive in GP surgeries.
However with low levels of health literacy, the
question was not, would people use our service,
but how can we make sure people exercise choice
so that it is not made for them. The
commissioning team set out to consult on and
discover two things, what were the barriers to
making informed choices and what were the most
important things for people when they made those
choices? They attended public meetings and
public events and came up with a patient criteria
for choice, during the procurement the top issues
were not clinical outcomes or star ratings, but
accessibility, cleanliness and respect and
dignity. Consequently the team began to put
information into GP surgeries which allowed
patients to make choices based on their ideas.
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The Let's do something stage
You've chosen consult monitor Case Study gt
Dartford Paediatric Physiotherapy Group Ongoing
monitoring of the Dartford, Gravesham and Swanley
Primary Care Trust had identified a staffing
crisis in the Paediatric Physiotherapy
Department. Services for 240 children receiving
physiotherapy were at risk. We involved parents
in a consultation. We explained the staff
shortages and the need for re-design, discussing
aims, admission conditions and structure. Two
outcomes were that we decided that parents would
work with their child during group sessions so
that they could develop their skills and use them
at home. Now that parents are involved, the
groups are developing all the time with new
ideas. These include a group meeting in the
holidays and Saturdays so dads can be more
involved. We work with eight children in one
session, compared with one child earlier. We have
a partnership with the voluntary sector.
Recently the group organised a day for the
mothers. They did this with the local college
where the students learn massage and reflexology.
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The Let's do something stage
You've chosen collaborate plan Case Study gt
Sussex Cancer Care Welcome Evenings At Sussex
Cancer Care Centre, we carried out a
collaborative mapping exercise of radiotherapy
services with Seaford Cancer Support Group.
Patients said they were unaware of the behind
the scenes activity in the unit. We agreed to
set up welcome evenings for new patients and
guests. Staff explain what will happen before and
during treatment and we then have a tour of the
department and demonstration. The local support
group answer questions too. We provide
refreshments and try to create an atmosphere
where patients and their guests can be open and
ask questions to enable continuous feedback so
that planned future developments are patient
centred. Feedback from patients and guests has
been consistently good. I cant say Im looking
forward to the treatment, but I know now that I
can cope OK. My wife and I would like to
express our appreciation we left the evening
with the utmost confidence in a dedicated,
professional team and the availability of the
latest technology.
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The Let's do something stage
You've chosen collaborate plan Case Study gt
Cherrydown Patient Stories Cherrydown Ward in
Basildon Mental Health Unit is part of South
Essex Partnership NHS Trust. This is a mental
health and learning disability trust that
provides care for elderly patients who are
mentally ill with conditions such as
Alzheimers. The ward support workers sit down
with the patients and collect stories of
important life events, family photographs and
anecdotes. Our staff and carers have reported
that as a result of this, patients become people
again. The whole experience has had a huge
effect on staff morale. All staff are involved in
the project. Collecting the stories is a very
intimate and personal process that has had some
startling effects. Patients stories are now
included in the care planning process from the
start.
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A Newham Example!
The Let's do something stage
You've chosen collaborate procure Example gt
the Newham Health Debate Newham ran a broad-based
listening campaign called the Newham Health
Debate designed to embed patient and public views
in the Commissioning and Procurement of a new
GP-led Health Centre and an Additional GP
Practice in an 'under doctored' area. The
public said that they wanted services that
respected and responded to them as individuals.
To further localise the data about these
experiences the PCT wrote to approximately 4000
households in an 'under doctored' area to seek
their views on what additional services should be
offered from the new Practice and when the
additional opening hours should be. This was
followed up with a Focus Group and collaboration
with the Patient Experience Working Group, which
resulted in Continuity of Care being given
additional weighting in the tender evaluation for
the new GP Practice. The procurements for the
GP-Led Health Centre and the additional GP
Practice were subject to formal tendering and
with further involvement of Patient
Representatives. The newly commissioned provider
is now under contract to engage and respond to
the patient experience as part of the new
contract.
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The Let's do something stage
You've chosen collaborate monitor Case Study
gt Brent Learning Disabilities Service
Standards Valuing People, sets a target for a
multiagency quality assurance framework for
learning disability services. In Brent, we set
up a group of 15 people with Learning
Disabilities. We covered the subject of Whats
important about services? looking at buildings,
staff, things to do and food and drink. This
generated standards that defined expectations.
The board agreed these standards the PCT uses
them to monitor the performance of services. The
Group consisted of people with learning
disabilities who had ideas about how services
should change. The communication difficulties
meant sessions were recorded visually by
plotting on a map of Brent the services people
used using photos to identify the members of
the group recording the minutes of each
meeting in easy-to-read format with pictures
and symbols and producing a video about the
groups work for those who do not read.
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The Let's do something stage

• You've chosen collaborate monitor
• Case Study gt Hull East Riding Stroke Service
  Open Meetings
• A local stroke survivor group, Strokewatch, was
  lobbying for resources for stroke services.
  Members of the group were given an open
  invitation to all meetings across the acute and
  community service and invited to open discussions
  about the services development.
• These service users now collaborate to
  continuously monitor and influence the way stroke
  services are developed. Working together in this
  way has resulted in many achievements
• The staff feel supported by representatives from
  the local stroke survivor group, who are
• watching and influencing the services growth and
  development.
• Health records are given to all stroke patients
  and their families as they come through the unit
• Members attend to share experiences as stroke
  survivors or carers with professionals. They
• tell the professionals about the things that they
  would like them to do or not do.
• Provides a continuing source of feedback to
  improve staff morale.
• Working together to further develop the role of
  family support organisers.

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The Let's do something stage
You've chosen partner plan Case Study gt East
Somerset's Time to Talk Group At a conference an
ex-patient told us, Nurses dont talk to
patients. so we asked him to help us do
something about it! We set up a partnership group
including staff, users and our ex-patient. The
groups task was to review how nurses gained
information about patients needs and concerns
and plan for the introduction of a new system
with good records of that information. We
introduced a daily assessment for nurses to carry
out. This encouraged patients to express their
needs and concerns. We highlighted four main
categories as a basis for assessing emotional
wellbeing. The patients themselves had identified
these categories. How do I feel and what is
happening to me here in hospital? What is
likely to happen to me in the future? What
problems might I or my family have when I leave
hospital? All patients on the test wards have
the opportunity to talk with a nurse to identify
their emotional needs, we will be rolling this
out across the Trust and the results have been
excellent.
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The Let's do something stage
You've chosen partner procure Case Study gt
The Eccles Parish Surgery Working Group When two
doctors who ran a branch surgery in Eccles
announced their retirement, we proposed to close
it as other practices nearby agreed to take on
this small group of patients. The residents of
Eccles were shocked, and over 60 people contacted
PALS about this. PALS passed this on to our
Director of Commissioning and Partnership
Development Manager, who accepted an invitation
to attend a meeting set up by Eccles Parish
Council. After hearing residents views at the
meeting, we set up a partnership working group to
decide the best way forward for the Eccles
surgery. The group included a council
representative, a representative from the
residents association, a Councillor and staff.
It was agreed that this group would decide the
future of GP services for the residents of
Eccles. At the time of writing, the process is
not yet complete, but Maidstone Weald Primary
Care Trust is planning to continue to procure GP
services to Eccles branch surgery for the
foreseeable future, and people in the village are
very happy with this.
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The Let's do something stage
You've chosen partner monitor Case Study gt
Manchester Cheshire Cardiac Network
Video Patients waiting for cardiology procedures
are often cared for on general medical wards and
hospital staff may not have the background
knowledge to tell patients what is going to
happen. I said to the sister on the ward
whats happening tomorrow?, but she wasnt sure
at all. No-one told me what to expect when I
came over to have the angioplasty done there
was not talk of it at all... Nursing staff
reported that one patient was so anxious he
refused treatment at the tertiary centre because
he didnt know what he was there for. To prevent
patients feeling anxious, The network decided to
produce a video to provide accessible, accurate
information for patients who are being treated
for acute coronary syndrome. A partnership of
users and staff agreed the content for the video
and the objectives of the project. The producer
of the video was a member of the cardiac
networks patient and professional partnership
group who had undergone coronary-artery bypass
surgery some years before. Patient-led research
is now planned to assess whether the video has
helped to reduce anxiety in this group of
patients.
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A Newham Example!
The Let's do something stage
You've chosen partner monitor Example gt
Children and Young Peoples Services Children and
young people's services were being told by the
Newham Youth Parliament that young people
experience poor customer care and do not always
feel confident that their health information will
be treated with confidentiality. In response to
this, Children and Young People's Services
planned a service review and consultation
exercise involving 70 primary school and
secondary school representatives, 49 youth
project representatives, 53 children's rights
representatives, 25 young mayor and youth council
representatives and representatives from parents
and carers groups. Feedback informed priorities
for the coming year as part of the annual
planning cycle, and a summary of the most
important issues for children and young people
appeared on the London Borough of Newham
website. Outcomes have included the
establishment of a Young People's Board,
monitoring the adoption of the You're Welcome
standards, with young people as mystery shoppers
working in full partnership with children's and
young people's services.
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• help? help part 1
• Hullo. To begin (to press the first button) you
  need to ask yourself some screening questions.
  So, to determine the level of involvement you can
  achieve (inform, consult, collaborate or partner)
  you might ask
• Have any decisions already been made about this
  piece of work?
• Is this an open question or are there
  constraints which mean we are limited in what
  options or ideas we agree?
• Do I need help to answer the questions from a
  colleague?
• What engagement skills can I bring in from the
  organisation?
• Proceed to help part 2 gt

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help? help part 2 ? Stuck? Use the five senses
approach Now, the next bit is your theme, there
are lots of case studies and examples here, but
lets take a new one. Lets imagine that you work
in reception and you want to do some ppe-ing but
you dont know where to start. Ask yourself what
your best ever, ever experience of being received
at a reception desk was like. Got it? Okay, now
think about what you smelt - what you touched -
what you heard - what you saw - what you tasted,
okay, maybe not tasted, but all of the rest, you
get the idea. Now try to make this happen in
your service. Good stuff, now ask how can you
make the same thing happen to every single person
who comes looking for your help.
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help? help part 3 You want more help? Well you
could call the Patient and Public Involvement
team. However, its not like Ghostbusters, we
wont arrive in a hearse with an emergency siren
wearing boiler suits. Itll be quieter. However,
there are a load of ways in which you can help
yourself. There are things you can use to kick
start the process of thinking about what you want
such as your comment cards, the national survey,
and you dont have to launch into a huge,
ambitious project either. You might decide you
just want to get someone from estates along to
paint one of your doors a bluer shade of
green. ?
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pictures for evidence Why? We think multimedia
evidence is very important. It allows the viewer
to take a deeper look at how and what happened.
Multimedia evidence for World Class Commissioning
is a powerful way of illustrating competency 3
and it serves as a useful record of your past
work. Proceed to look at all the nice pictures gtgt
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were out there! Every year NHS Newham involves
thousands of local people in fun and engaging
activities designed to support local influence
over NHS services. More nice pictures gtgt
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a learning organisation The team has organised
Patient and Public Involvement seminars with
academic and public sector speakers, from
Pembroke College, the Mary Seacole Research
Centre and the LSE to the Department of
Health. More nice pictures gtgt
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In recent years weve built partnerships with
local and national agencies from the Radha
Krishna Temple and the Hong Kong Hospital
Authority, to Erewash PCT and The Health
Foundation. More nice pictures gtgt
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About this resource This tool kit, was produced
by the Newham Patient and Public Involvement team
with borrowings from the following 1. Getting
Over the Wall, How the NHS is improving the
Patients Experience DH, October 2004 2. Now I
feel tall, What a patient led NHS feels like.
DH, December 2005 3. Results from a programme of
consultation to develop a patient experience
statement, Final report by Opinion Leader
Research for the DH, November 2003 4. Creating a
Patient-led NHS, Delivering the NHS Improvement
Plan DH, March 2005 If you find this useful, or
youd like us to include examples of changes
youve implemented in future editions of this
resource, then call us on 020 8271 1416 or
email ian.mcdowell_at_newhampct.nhs.uk shahid.sardar
_at_newhampct.nhs.uk