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SRG 1 - Background and Context

The first Moving Forward Together (MFT) Stakeholder Reference Group (SRG) meeting took place on the morning of 06 December 2017 at West Glasgow Ambulatory Care Hospital. A range of staff involved in the Programme and 15 patient, service user and carer representatives attended the meeting (details at the end).

The Chair, Dr Ian Ritchie who is a Non-Executive Member of the NHS Greater Glasgow and Clyde (NHSGGC) Board and a retired orthopaedic surgeon opened the meeting. He welcomed everyone and stated the important role the Group will have in the development of a Transformational Strategy for the delivery of health and social care for the whole of Greater Glasgow and Clyde. He said that if real change is to occur then everyone needs to better use the resources we have more effectively –  staff need to develop innovative systems and approaches that deliver better care and people need to change their expectations of what is delivered, by who and where.  He went on to say that for the Group to fulfil their role everyone needs to participate, comment, discuss and where needed challenge the ideas and thinking driving the Programme.

John Barber, the Patient Experience and Public Involvement Manager leading on public engagement for the Programme, presented and explained the purpose of the SRG. He asked that everyone, as someone who has or is currently using or supporting people to use health and social care services, use their individual and collective experience to bring that insight and perspective to discussion - remembering that at any given time we are all potential users of all services and are all therefore invested in giving our best to the process. As well as using their channels of communication to share information about the Programme, he asked permission to not produce and formal minute, but to work with the Group to develop an online commentary of meetings. This, as well as providing transparency of process would aim to provide a narrative to better engage with and describe their work to the wider public. The Group agreed with this approach and also accepted the offered Terms of Reference.

Dr David Stewart, the Board’s Deputy Medical Director, lead clinician on the MFT Programme and a practicing consultant geriatrician, presented information on the background to the work being undertaken. He stated that it is was very early in the process, but that the Core Team drawn from across health and social care felt it was important to have stakeholder input. He described that the large scale change was not new and the Health Board had undertaken similar work in the past and recognised that some Group members had participated in this. However, this was the first time that changes across healthcare and social care services that could be delivered in people’s homes, their communities or in hospitals was being looked in its entirety – admitting that the task was more than a little daunting.

David explained that to deliver change on the scale required the Health Board and 6 Integrated Joint Boards that deliver care through the Health and Social Care Partnerships (HSCPs) will need to work together. In addition the Programme will recognise the important role of key partners such as Scottish Government, other Health Boards, Local Authorities, the Ambulance Service, education and others will play in achieving the aims of developing new ways of working to improve care and outcomes for everyone. He touched upon how the Programme aimed to do that through wide-spread engagement across everyone involved - healthcare and social care service users, patients, staff, members of the public, carers, volunteers, and the voluntary organisations which represent them.

Barry Sillers, Head of Planning for Transformational Change, then presented more detail about the Programme aims, how these might be achieved and the work undertaken to date. He started by again saying that transformation was not something new and that previous work by NHSGGC on the Acute Services Review and more recently the Clinical Services Review meant that staff have and can, even to the scale now required, deliver change. He stated that the main output from the work being done from now until June next year was to deliver a strategy for change and not the plan for change. Explaining that the key difference is that in a strategy we describe what needs to change, but not how we will physically implement those changes.

Barry described how the overall approach was anchored in the Government’s 2020 Vision for Scotland and other key national and local policies and strategies. This meant that the foundation for any change would be grounded in providing high quality, safe, effective and person centred health and social care. The Core Team would work with clinical teams and other health and social care specialists to develop proposals for new models of delivery and any outcomes would need to be aligned to and meet the 9 criteria drawn from the strategies:

  1. People can look after and Improve their own health and live in good health for longer
  2. People are able to live independently and at home or in a homely setting in their community
  3. People have positive experiences of those services, and have their dignity respected
  4. Care is centred on helping to maintain or improve the quality of life of people
  5. Services contribute to reducing health inequalities
  6. Unpaid carers are supported to look after their own health and wellbeing and to reduce any negative impact of caring
  7. Service users are safe from harm
  8. Our staff feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide
  9. Resources are used effectively and efficiently

He described what this might look like in terms of transforming the delivery of care and that we will continue to provide the same level of high quality specialist care that we currently provide and that most change will be in services to ensure people can live at home either independently or with support.

Barry explained that, in what are the early phases of this work, local population data, intelligence and evidence from across the world is being compiled by public health experts, health economists, senior health planners and librarians and presented to 21 different medical speciality groups. This will be used as a basis for discussion at meetings that also include GPs, nursing and allied health professionals who will the use their local expertise and knowledge to develop proposals to transform their service. Similar meetings will also take place to look at services across primary, community and social care. Finally, once all the specialties have met they will be brought together to look at ways of how they can work together to develop integrated system-wide approaches.

He then described how in the latter phases the system-wide approaches would be checked to see if they fit with Regional planning and checked against the 9 criteria to ensure they meet aims and objectives. These approaches would be presented to the SRG for them to help us develop messages and information that we’d use to engage with the wider public and hear their feedback. Comments heard from all stakeholders would be used to help shape the development of the strategy which would be presented to the Board in June 2018.

Following the presentations Ian Ritchie asked the SRG if they had any questions and chaired discussion around these. The first topic was raised by Susan asking if patients were being involved in the speciality discussions about developing new ways to deliver services and would they not play an important role alongside the staff, especially if they are to be person centred? Anne Marie, who had taken part in similar work for the Clinical Services Review, also backed this up by saying that clinicians need to hear what is important to people and Aileen asked for some clarity on who was in the working groups. David Stewart said we recognised the important role patient’s views could play; however at this stage the discussion was very technical and clinical in nature. He reiterated and clarified  that at this stage it was about the multidisciplinary teams of specialists discussing what is potentially possible and not how that might actually be delivered.

John Barber explained that although this Group would play an important role in influencing the early discussion with the wider public. He also said there was recognition that the SRG wouldn’t be representative of all patient groups and if required condition specific feedback would be sought through direct engagement and feed into the process. Martin, who had also been part of similar work in previous years, described how more recently there had been a change in how people were being involved and he welcomed this early preparatory engagement recognising it as more than a necessary evil, but the most productive way to work together.

Betty asked about funding and is there money to deliver the types of change required. Ian Ritchie stated that the Health Board already received substantial funding and that there is a need to look at how this is used more effectively. David Stewart said that it was possible that there might be a bigger bill than what we can currently afford and that compromise might have to be made; however the work still needs to be done to look at how we might best deliver services and the engagement of people –staff, patients, service users, carers and the groups and organisations who represent them would all play a key role in this.

Gordon gave his initial thoughts from the perspective of mental health services and how some of the language used might be interpreted differently by users of these services. He said that if we are to deliver person centred care then time limits to services needs to be challenged; work with people should take as long is required; and self-management and prevention are crucial.  He also asked about engagement with sub-groups from an equalities perspective and whether poverty, diversity and other issues had been considered. David Stewart confirmed that mental health was part of the Core Team and they were much further ahead in terms of strategy development and there would be a presentation to the SRG early in the New Year. John Barber also said that he was working with the Board’s Corporate Inequalities team and information and engagement would be tailored where required to ensure we speak to as broad a range of people as possible.

There was discussion about communication and technology with Karen saying holistic approaches need to be taken that look at a person’s whole journey across and through services and this needs to be joined-up. Morag Cullen said that there needs to be much better and earlier communication between GPs, hospital services and social care. Betty said that it’s important that the information gets to the right person who can interpret it properly. David Stewart agreed and said we need to understand what the journey looks like to the patient and can we make better use of technology to make this more seamless. He said that eHealth would play a large part in making this happen and how, for example shared access to information is now occurring across healthcare and social care systems and services so better decisions can be made. Ian Good said that we need to make much better use of technology to help patients and improve communication and for instance it can be used to get people to the right service quicker. Gordon expressed caution that not everyone has access to technology, but when used properly can be beneficial and empower people.

Thomas raised concerns about GPs being independent contractors and the increasing role that they need to play in delivering important changes. He said that there are already known issues with people getting appointments and how this leads to pressure elsewhere as people then just go to A&E. David Stewart and Barry Sillers explained that new GP contracts supported by new roles and teams needs to be in place so they can focus on a more medical role and that where appropriate people can by-pass their GP e.g. direct referral to a physiotherapist for muscular of joint pain. Jewels said that she got the impression that much of what was being discussed were medical issues; however social care had an important role in this and asked about their involvement. Stuart Donald identified himself as a Principal Social Work Officer and part of the Core Team explaining that social care services were also being looked at in a similar way to the medical specialties

Karen said that a lot of what we do is also reliant on how we change culture about how and when people access services and mentioned the pilot project for community healthcare services in Inverclyde. John Barber said that this would be the topic of one of the presentations to the Group in the New Year. Susan also said that there needs to be focus on prevention and health improvement needs to be considered. Barry Sillers agreed and said that this is key to having more people living independently at home and that the Board’s Public Health Specialists are part of the planning process for the Strategy Development.

Morag McIntosh said that as well as having people improving health to have them living at home longer we need to consider social isolation and the impact that loneliness can have. She described how again technology can be used lessen this but time needs to be taken to teach the older generation how to use it better. Thomas asked if there was a strategy looking at the use of technology and how this can play a wider role, for example in monitoring diabetes. Barry Sillers said that there was a huge focus on eHealth and the crucial role it would play and that the Board’s leads for it were part of the Core Team and would in fact be presenting to the group at the next meeting.

Ian Ritchie closed the meeting by thanking everyone for their input and that everyone’s questions and comments had been very welcome and extremely useful. He said that although this was just the beginning of the process he had been encouraged by the approach of the Core Team and the level of engagement and support around the table.

 

In Attendance

 

Dr Ian Ritchie (Chair)

NHSGGC Non Executive Director

Liz Porterfield  (Co-Chair)

NHSGGC – MFT Core Team

John Barber (Facilitator)

NHSGGC - MFT Core Team

Stuart Donald

Glasgow City Council – MFT Core Team

Laura Nixon

NHSGGC

Louise Wheeler

Scottish Health Council

 

Presenting

Dr David Stewart

NHSGGC – MFT Core Team

Barry Sillers

NHSGGC – MFT Core Team

 

Patient, Service User and Carer Representatives

Aileen Hills

 

Alison Stewart

 

Anne Marie Kennedy

 

Betty Graham

 

Gordon McInnes

 

Ian Good

 

Janet Nicholls

 

Janice Woodburn

 

Jewels Lang

 

Karen Haldane

 

Martin Brickley

 

Morag Cullen

 

Morag McIntosh

 

Susan McDonald

 

Thomas Cassidy