Joint Forward Plan Appendix 2

Appendix 2: Joint Forward Plan Engagement Report

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Appendix 2 – Joint Forward Plan Engagement Report ( pdf, 2.85 MB )

Context

In January 2023, the Integrated Care Board (ICB) launched its engagement on the development of the Joint Forward Plan (JFP). The Plan is based on the outcomes and priorities identified in the Integrated Care Strategy, which was developed to cover the whole of the Integrated Care Partnership (ICP). The Joint Forward Plan sets out HOW the NHS intends to deliver the outcomes identified in the strategy.

A considerable amount of insight gathering, and engagement took place to develop the Integrated Care Strategy, and this formed the basis of the approach adopted for the Joint Forward Plan. Rather than starting afresh, the ICB was able to refer to priorities and issues raised previously, seek to build on the insight gathered, and link to existing strategies and plans previously agreed. The Plan seeks to build on existing work and not introduce radical change.

Aim

In December 2022, NHS England published guidance for how ICBs should develop their Joint Forward Plans. This included an expectation that people, and communities should be involved in the development of the Plan and its final draft. The NHS England guidance said that the JFP should build on existing system and Place strategies, in line with the principles of subsidiarity and that ICBs and partners are expected to engage with people for whom they have a responsibility, and anyone else they feel is appropriate. Considering both the guidance and the work that had already taken place three core aims for the engagement activity were identified.

To enable effective and meaningful involvement in the draft JFP in manageable way
To share the JFP approach in an accessible, creative, and inclusive way to encourage interaction and discussion
To ensure all people and communities can comment, either on the sections most important to them or the whole document

These aims then informed the design of the engagement methodology and approach adopted. To reach the greatest number of people, both online and in person discussions were planned. This would enable people to take part in the way most appropriate for them.

An early draft of the Joint Forward plan was developed in partnership with stakeholders, groups, and providers of services. This development work took place collaboratively, considering previous feedback, insight, and coproduction work that had taken place in other engagement activities. This early draft formed the basis for the engagement activity. The ICB commitment to working in partnership with people and communities meant it was important to include people at the development stage of the document and not just once the final document had been produced. It was crucial to provide clear, transparent, and honest information about the purpose, governance, and accountability of the Joint Forward Plan to manage peoples’ expectations of how much can be changed or reflected.

The full draft document, and an executive summary were uploaded to the website so that people could read and comment on the plan in its entirety if they wished, again reinforcing the commitment to transparency and openness to our approach. A short video was also uploaded explaining what the Joint Forward Plan is, and the approach taken, for people who may prefer to hear it explained rather than read it.

Approach

The JFP was developed around a set of areas relating to the life course. These are referred to as the Live Well Domains and are broken down into six sections.

Start Well: Giving children and young people the best start in life.
Feel Well: Supporting the mental wellbeing of our population.
Be Well: Empowering adults to make healthy lifestyle choices.
Stay Well: Supporting adults with health or care concerns to access support and maintain healthy, productive, and fulfilling lives.
Age Well: Supporting people to live safely and independently as they grow older.
Die Well: Giving individuals, nearing end of life, choice around their care

It seemed appropriate to follow the domains format as a structure for the engagement. Using the engagement platform www.LetsTalkSnee.co.uk a series of web pages were developed to define and break down each domain, outlining the key priorities. People and communities were then to asked to comment on the key priorities and outcome measures. They were also invited to rank them in order of priority. Each priority area also had an ‘Ideas’ board where people were able to suggest ideas, leave reflections, or make comments.

Four public meetings were also held to ensure people could discuss the plan face to face. The format of these meetings followed a similar format to that of the ww.LetsTalkSnee.co.uk platform. A broad overview was followed by detailed discussions focused on each domain. Facilitators took notes of the discussion and then uploaded them on to the Lets Talk Snee platform. This maintained transparency and openness about what people were saying and ensured that the ICB would see everything people had said.

Participation

The engagement activity ran from Monday 16th January until Wednesday 22nd February.

There were over 1000 visits to the engagement platform, 340 voted using quick polls, 280 ideas were submitted and there were 330 downloads of the draft document and executive summary.

Approximately 100 people attended an in-person meeting.

A full stakeholder mapping exercise was conducted to ensure widespread promotion of the engagement activity and inclusion of diverse groups. The 900 registered members of www.LetsTalkSnee.co.uk; were sent regular newsletters and information about how to take part. It was also promoted through social media, local networks, and forums. A press release was shared widely, and Health Overview and Scrutiny made aware.

Presentations were made at core system meetings or with underrepresented groups. This included Alliance meetings, Patient Participation Groups, learning disability and autism Forums, maternity meetings, mental health forums and many more. Ensuring marginalised groups, or those with particular communication and support needs were able to give their views, specific meetings and groups were identified and attended throughout the engagement period, taking the engagement to people for inclusion.

Results

In Person Meetings

Approximately 100 people attended the events to discuss the draft plan and priorities identified. The events spent time focussing on each
domain with facilitated discussion. Senior system leaders gave presentations about the context and development of the plan, how the priorities were organised and how they would be measured. Each workshop lasted 3 hours to provide time for detailed discussion and reflection.

This enabled a much richer discussion and in-depth evaluation of the priorities proposed. The attendees were able to spend time reflecting on the plan as whole and the interaction between domains. There were discussions about an individual’s ‘health journey’ and how someone may transition through the various priorities and areas of work. The importance of a joined-up system, interoperability and integration between partners was raised repeatedly. There was also significant interest in the how the plan would be delivered and assurance around the monitoring and performance management of the priorities. The importance of the system approach and role of all partners came through strongly.

The specific comments, ideas and priorities raised at these events were noted and uploaded on to the LetsTalkSnee.co.uk platform. They have been incorporated in the results outlined below.

Start Well

Start Well: Maternity and Neo Natal Services

Number of People Engaged on Let’s Talk SNEE:
Total Visits: 315
Informed Visits: 230
Engaged visits 44

Quick Poll Reporting

When asked which action is most important:

42.9% said that joined up care across services was the most important action
28.6% said that Improved access to high quality perinatal mental health care was the most important action
14.3% said that targeted care of women with heightened risk of preterm birth or complex pregnancy was the most important action
14.3% said that workforce was the most important action

When asked which change people would most like to see, 22.2% said:

living conditions promoting health
services trusted to provide tailored care for all
personalised care and support plans
psychological safety

11.1% said positive and memorable experience.

When asked which measure is most important 0 people responded.

When asked if we were on the right track 100% of respondents said yes.

Ideas Board

There were 26 contributions to the ideas board.

These ideas can be put into the following themes:

personalised approach to care – 5 contributions
education and information – 4 contributions
continuity of care – 3 contributions
workforce sustainability – 3 contributions
healthy Lifestyles i.e., drug/alcohol/smoking support – 3 contributions
health Inequalities Race, Ethnicity and Cultural Heritage – 2 contributions
increased involvement from Health Visitors – 2 contributions
social isolation – 2 contributions
support for carers – 1 contribution
access to dentistry – 1 contribution

Quotes

“Every pregnancy should have a named midwife and continuity throughout.”

“Good Stop smoking for families, not just mothers.”

“Choice! Better support for people who chose outside of guidance care.”

“Access to playgroups for people in rural communities”

Start Well: Children and Young Peoples Services

Site visits: 311
Informed visits: 237
Engaged visits: 64

Quick Poll

When asked which action in the Children and Young People’s programme is most important the responses were equally spilt three ways.

33.3% said:

access to standardised care pathway for neurodiverse services
access to excellent mental health, eating disorder and emotional wellbeing services
access to special educational needs and disabilities (SEND) support and therapies promptly

Start Well: Mental Health Services

When asked which mental health measure was the most important to them, 46% said a reduction in waiting times.

15.4% said to each:

reduction in crisis need and admissions
workforce confidently support children, families and young people and sign posting appropriately
reduction in tier 4 admissions

7.7% said effective training available to staff for their specific roles

When asked which change, they would most like to see in mental health 50% of respondents said that they would like to see services and provision wrapped around the individual, the remaining 50% was spilt equally 16.6% wanting to see:

cohesive support to navigate the system
schools and colleges being better supported
being able to make decisions about the support that individuals feel they need

Start Well: Neurodevelopmental services

When asked which neuro development service measure was most important 90% of respondents said that a reduction in waiting times for ASD and ADHD assessments was their priority. The remaining 10% said a consistent reduction in children and young people requiring an assessment for ASD and ADHD was their top priority.

When asked which change, they would most like to see in neurodevelopmental services 33% of people said improved outcomes and impact, 33% said broader range of interventions available to address gaps, 16.7% said families confidently navigation the neurodevelopmental pathway and 16.7% said effective change in the support received by families.

Start Well: Special Education Needs and Disabilities (SEND) Therapies

100% of respondents said that a reduction in SEND therapies waiting time was important to them.

When asked what change to SEND therapies was most important to them 40% of respondents said the wider children’s workforce should be empowered to make effective decisions, the remain 60% was spilt equally between the following 3 areas of change:

20% being informed of decisions in a clear and timely way
20% parents and carers being supported with information and resources
20% therapeutic needs being identified in a timely manner

Start Well: Asthma

When asked which asthma measure was most important to them 50% of respondents said reduction in emergency hospital admissions and 50 % said regular reviews on condition, medication, and education.

100% of respondents said that the most important change in asthma services would be for families building knowledge and confidence in supporting individuals with asthma.

Start Well: Diabetes

When asked which diabetes measure was most important to them 80% of respondents said building on existing relationships within the ICS and 20% said engagement in developing technical support.

66% of respondents felt that it was important that Children and young people were involved in codesigning future diabetes services, particularly non-attenders. The remaining 34% did not feel that this was an important change.

Start Well: Epilepsy

When asked what change to epilepsy services they would like to see 50% said a clear pathway with support and resources readily available, 25% said access to a specialist epilepsy nurse or community paediatrician 25% said training and support.

When asked if we are on the right track with the Children and Young People Services Plan 75% of respondents said yes and 25% said definitely not.

Ideas board

There were 43 contributions to the ideas board.

They can be put into the following themes:

prevention, Health education and information
multi agency working
workforce sustainability, education, training, and retention
diagnosis
personalisation
mental Health
healthy Behaviours inc. sexual health, obesity, diet, exercise
funding
access
transitions from children and young people’s services to adult services

Feel Well

Feel Well: Mental Health including Suicide Prevention

Site visits: 297
Informed visits: 228
Engaged visits: 57

Quick Poll responses

When asked which action they felt was the most important to them 44% said best quality integrated services, 33% said prompt access to mental health support, 11% said resilient and inclusive communities and 11% said resilience and maintenance of good mental and physical health.

When asked which measure, they felt was most important to them 60% said that a continued expansion of non-clinical voluntary sector services, 20 % said increase in coverage of 24/7crisis teams and support and 20% said fewer hospital admissions for mental health conditions.

When asked which change, they would most like to see in mental health services 28% of respondents said improved wellbeing levels, 14% said
improved access to wellbeing advice, 14% said improved access to psychological therapies, 14% said more people moving to recovery following access to psychological therapies, 14% said improved wellbeing levels.

100% of the respondents to the question “Are we on the right track?” said “not really”.

Ideas board

There were 37 contributions to the ideas board. These can be grouped into the following themes:

personalisation and reasonable adjustments
access
organisational Accountability
workforce welfare
multi agency working (including role for VCSE)
men’s mental health
eating disorders
community development
crisis intervention (including MH expertise in A&E)
broader determinants of health i.e., finances, housing, social isolation.

Feel Well: Trauma and abuse

There were three ideas added to the ideas board:

bereavement and trauma
refugees and asylum seekers
long term trauma and abuse – working with victims of childhood abuse

Feel Well: Addiction

100% of respondents said that “Avoidance or reduction of alcohol and drug related harm” was the most important action.

100% of respondents said that “an increase in successful completion of alcohol or drug treatment” was the most important measure.

Ideas Board

There were 2 contributions to the ideas board:

education around the dangers of vaping for young people
greater awareness at primary care re: addiction to prescribed medication

Be Well

Be Well: Dental and Oral Health

Site Visits: 245
Informed visits: 187
Engaged Visits: 12

100% of respondents felt that “access to high quality oral health care” was the most important action.

100% of respondents felt that “few children with decaying, missing and filled teeth” was the most important measure.

100% of respondents said that “improved access to NHS dentistry” was the most important change that they wanted to see.

Ideas Board

There were 15 ideas on the ideas board, These can be grouped into the following themes:

prevention, health education, information
access
poor patient experience
address Health inequalities for marginalised groups

Be Well: Eye Health

Site visits: 235
Informed Visits: 179
Engaged Visits: 4

Quick Polls

There were no contributions to the quick polls.

Ideas Board

There were 2 contributions to the ideas board:

what can be learned from other providers
diabetes and eye care have to work hand in hand

Be Well: Healthy Behaviours

Site visits: 283
Informed Visits: 212
Engaged Visits: 31

Quick Poll

When asked which action they felt was the most important 28% said feeling more socially connected, 28% said living in a clean and sustainable environment, 14% said support to be physically active, 14% said opportunities to connect, learn and take notice and the remaining 14% said support to make healthier food and drink choices.

50% of respondents said that “increased healthy lifestyle and reducing the social gradient” was the most important measure. 16.7% of respondents said, “reduction in adults classified as overweight or obese,” 16.7% of respondents said, “reduction in over weigh and obesity in reception and year 6 children” and the reaming 16.7% said “increase in the number of people taking part in recommended levels of physical activity”.

33.3% of respondents said that “reduction in people feeling lonely” was the change they would most like to see, 33.3% said “more use of outdoor space for exercise and health,” 16.7% said “people having as much social contact as they feel that they need” and 16.7% said “fewer people feeling low satisfaction and high anxiety.”

Ideas board

There were 26 contributions to the ideas board.

They can be grouped together into the following themes:

broader determinants of health
collaborative working across organisations, especially schools
effective use of existing community assets
workforce sustainability and wellbeing, including volunteers
access, particularly hours and transport
prevention, health education and information
right to clean air

Be Well: Personalised Care

Site visits: 253
Informed visits: 193
Engaged visits: 12

100% of respondents felt that “working as a system to deliver personalised care” was the most important action.

100% of respondents felt that “personalised approached embedded across the system by 2028” was the most important measure.

Ideas Board

There were 10 contributions to the ideas board:

access
reasonable adjustments
digitalisation
carers
prevention, health education and information

Be Well: Women’s Health

Site visits: 242
Informed visits: 184
Engaged visits: 5

Quick polls

50% of respondents said that they felt that “understanding women’s health inequalities” was the most important action and 50% said that they felt that “development of a program of analytics”.

100% of respondents said that they felt that “reduction in inequalities” was the most important measure.

100% of respondents say that “women feel listened to and have a voice regarding their health and care.

Ideas Board

There were no contributions to the ideas board.

Stay Well

Stay Well: Cancer

Site Visits: 262
Informed Visits: 198
Engaged Visits: 14

Quick Polls

50% of respondents said that “prevention” was the most important action and 50% said that “improved access and early diagnosis” is the most important action.

100% of respondents said that “increased positive responses to the national cancer experience survey” is the most important measure.

Ideas board

There were 7 contributions to the ideas board. These can be grouped into the following themes:

proactive screening
improved aftercare
better links between specialist services and primary care
personalised Care and reasonable adjustments
access

Stay Well: Cardio Vascular Disease

Site Visits: 246
Informed Visits: 187
Engaged Visits: 13

Quick Poll

75% of respondents said that “those with CVD have the right treatment and support “was the most important action and 25% of respondents said that “those with CVD receive the right treatment and support”.

75% of respondents said that “5% reduction in deaths from CVD” was the most important measure. 25% said that “5% reduction in acute admissions” was the most important measure.

50% of respondents said that “more people having lipids managed with statins” was the change they most wanted to see. 50% said that “more people with high blood pressure having it managed”.

Ideas Board

There was 1 contribution to the ideas board.

Where are the benefits of good care and diagnosis of cardiomyopathy considered?

Stay Well: Diabetes

Site visits: 240
Informed visits: 185
Engaged visits: 10

Quick poll responses

100% of respondents said that “access to the best possible care and support to live with the condition” is the most important action.

100% of respondents said that “improved access to glucose monitoring and fewer people of minority ethnic origin developing type 2 diabetes” is the most important measure.

Ideas Board

There were 6 contributions to the ideas board:

promote the importance of regular health checks
improved awareness of the impact of diabetes on physical health and emotional wellbeing
early intervention of Type 2 diabetes
prevention
impact of diabetes on mental health must be given consideration

Stay Well: Elective Care

Site visits: 239
Informed visits: 182
Engaged visits: 4

Quick poll responses

100% of respondents said that “best experience of care” is the most important action.

100% of respondents said that no difference in waiting time between all population groups is the most important measure.

100% of respondents said that “elimination of 18 month waits from referral to treatment” is the most important change.

Ideas board

There were no contributions to the ideas board.

Stay Well: Learning Disabilities and Autism

Site visits: 249
Informed visits: 191
Engaged visits: 19

Quick poll responses

40% of respondents said that that most important action was” provision of services to keep people healthy in the community”, 20% said “Good quality integrated care”, 20% said “action taken to address causes of morbidity and preventable deaths” and 20% “importance of understanding the needs of people with a learning disability was the most important”.

66.7% of respondents said that “learning from the LeDeR reviews” was the most important measure, 33.3% said that “All care education and treatment reviews =” was the most important measure.

100% of respondents felt that it was important that “the wait from referral to first appointment is no longer than 18 weeks” for people see4king an autism diagnosis.

Ideas Board

There were 16 contributions to the ideas board. These can be grouped into the following themes:

access
children and young people’s SEND
reasonable adjustments and personalisation, including communication needs
transitions
workforce sustainability, retention, and education

Stay Well: Long Covid

Site visits: 231
Informed visits: 178
Engaged visits: 2

Quick poll responses

There were no contributions made to the quick polls.

Ideas board

There were 2 contributions to the ideas board.

The importance of data collection and utilisation
The impact on Children and Young People. Must link into education 2settings to offer support.

Stay Well: ME and Chronic Fatigue Syndrome

Site visits: 255
Informed visits: 187
Engaged visits: 15

Quick Poll responses

100% of respondents said that “high quality care and reduced health inequalities” is the most important action.

66% said that “increase in the number of people diagnosed within 3 months” is the most important measure. 33% of respondents said that “establishing an e-learning training programme” is the most important measure.

50% of respondents said that “60% of patient reporting improved outcomes” was the most important change to them and 50% said “increase in patients/carers reporting satisfaction and confidence in their care plan”.

Ideas Board

There were 2 contributions to the ideas board:

do not lose all of the good work that has been done in development of the ME/CFS pathway
promotion of people’s experience surveys to gather better data

Stay Well: Neurorehabilitation Services

Site Visits: 233
Informed Visits: 179
Engaged Visits: 4

Quick poll responses

There were no contributions to the quick polls.

Ideas board

Parkinson’s UK have been advising on development of services and patient experience, if we get it right for them then we get it right for everyone.
the actions set out in this plan are vague and not SMART

Stay Well: Primary Care

Site Visits: 255
Informed Visits: 195
Engaged Visits: 12

Quick poll responses

50% of respondents said that “effective embedding of prevention programme” is the most important measure, 25% of respondents said, “Less people needing unplanned care and support” and 25% said “safe and sustainable workload”.

50% of respondents said that it is important for “every practice having digital booking system by April 2024” 50% said it is not important.

Ideas Board

There were 16 ideas added to the ideas board. They can be grouped into the following themes:

digital – maximise potential and be mindful of limitations
workforce sustainability
prevention, health education and information
access
communication

Stay Well: Respiratory Services

Site visits: 248
Informed visits: 189
Engaged visits: 3

Quick poll responses

100% of respondents said that “early diagnosis” is the most important action. 100% of respondents said that “improved access to pulmonary rehab” is the most important measure.

Ideas Board

There were no contributions to the ideas board.

Stay Well: Stroke and Stroke Rehab

Site visits: 232
Informed Visits: 177
Engaged visits: 2

Quick poll respondents

There were no responses to the quick polls.

Ideas board

There was one contribution to the ideas board:

early supported discharge, what happens after the 6 weeks support?

Stay Well: Urgent and emergency care, including community

Site visits: 238
Informed visits: 182
Engaged visits: 8

Quick poll responses

75% of respondents said that “treatment by the right person in the right place” is the most important action. 25% of respondents said that “those on the emergency or urgent care pathway or managed in the right place and by the right people”

100% of respondents said that “increased capacity and quality of mental health care in emergency care” is the most important measure.

50% of respondents said that “an integrated single point of access model” is the most important change and 50% said “improvement in timing and quality of ambulance response, including handovers” is the most important change.

Ideas Board

There were 2 contributions to the ideas board:

more support in the community for people who do not need to be in hospital – use of digital
prevention, education, and information to stop people becoming ill

Age Well

Aging well programme

Site Visits: 277
Informed visits: 215
Engaged visits: 47

Quick Poll responses

75% of respondents said that “enabling aging population to live healthy lives for longer in their preferred place of residence” is the most important actin. 25% said Increase referrals into strength and balance programmes”

50% of people said the “fewer emergency admissions due to falls” is the most important measure, 30% said “increased disability free life expectancy at age 65 by 2028”, 10% said “reduced rates of frailty by 2028” and the remaining 10% said “more carers identified and supported”

33.3% of respondents said “yes” the plan is on the right track, 33% said “no opinion” and 33.3% said “not really”.

Ideas Board

There were 18 contributions to the ideas board. These can be grouped into the following themes:

system working
prevention, health education and information
health Inequalities – rurality
community connections
access – transport
carers
workforce – incl. volunteers

Age Well: Carers

Site visits: 298
Engaged visits: 218
Informed visits: 32

Quick poll responses

37.5% of respondents said that “easily accessible information and young carers having same status as adult carers” is the most important action. 37.5% of people said that “improved health and wellbeing for carers” is the most important and 25% said that “carers influencing systems and services.

57% of respondents said that the most important change is “carers feel recognised and supported”, 29% said “improved signposting to carers’ assessments” 14% said “improved access to information is the most important change.

Ideas Board responses

There were 13 responses to the ideas board. These can be grouped into the following themes:

access to services and assessments
support
education, information
data
respite

Age Well: Dementia

Site visits: 264
Informed visits: 201
Engaged visits: 18

Quick poll responses

43% of respondents said the most important action is “everyone with dementia and their families feel understood and able to access support”

14% said “training and expertise”, 14% said “all people with dementia receive support to reduce risk and manage crisis”, 14% said “access to the right information at the right time” and 14% said “timely diagnosis and support”

71% said “enhanced integrated models of care” is the most important measure”, 23% said “reduction in emergency admissions and delayed discharges”.

50% of respondents said that “development of wider support to build dementia friendly communities” is the most important change and 50% said “improved pathways to formal assessment, care and support”.

Ideas Board responses

There were 2 contributions to the ideas board:

better review post diagnosis
counselling and support for families and carers

Die Well

Site visits: 290
Informed visits: 225
Engaged visits: 49

Quick poll responses

53% of respondents said that “timely identification of those approaching end of life” is the most important action. 33% said that “eliciting recording and support of people’s care preferences, ensuring these are accessible across the system” and 13% said “equitable treatment, as individuals, of those who are at end of life”.

45% of respondents said that “measurement of the extent care is coordinated around people’s priorities” is the most important measure, 45% said “measurement of dignity and symptom control” and 9% said “patient carer survey”

When asked if we are on track 71% of respondents said yes, 14% said “no opinion” and 14% said “no”

Ideas Board responses

There were 29 contributions to the ideas board. These can be grouped into the following themes:

early identification
personalisation
workforce sustainability and training
normalising conversations about death
health education and information
carers and families

Die Well: What should be the number 2 priority for SNEE ICB in the next 5 years?

Site visits: 438
Informed visits: 346
Engaged visitors: 97

There were 89 contributions to the ideas board for the number 1 priority for the ICB. These can be grouped into the following themes:

health inequalities
mental health and emotional wellbeing
workforce sustainability, retention, training, welfare
prevention, health education and information
access
personalisation and reasonable adjustments
children and young people’s services – SEND
digital, including data
primary Care

Conclusion

We could also see that this process will be the foundation for so many other pieces of work over the coming years. We are already planning how the JFP conversations will lead into the Alliance Local Delivery Plans at Place, and then into neighbourhood plans. We can see how Collaboratives and programme boards can build their workplans on the foundations we will set through this process, and it will be a tool we can use in the development of our quality dashboard.