In October the Citizens' Panel met and discussed:
- Childrens/ Maternity webiste
- Gluten Free
Ginny Fieldsend who works in Public Health for the SYB ICS provided an update on the QUIT programme. The QUIT programme will see the implementation across all acute Trusts and mental health Trusts across SYB of the treatment of tobacco dependency in secondary care and then onward referral to stop smoking services. It recognises that tobacco dependency should be seen as a chronic relapsing clinical condition that prematurely kills. It is in line with commitments in the NHS Long Term Plan that by 2023/24 all people admitted to hospital who smoke will be offered Ottawa style NHS funded tobacco treatment services.
Questions from the Citizens Panel, and answers from Ginny Fieldsend:
Q: How are you going to stop people smoking outside hospital doors?
A: It won’t happen overnight, it requires a massive culture change, particularly with some of our staff, but we hope to encourage and empower them to stop smoking. NRT will be offered on admission to all patients who smoke or vape with nicotine-containing products.
Q: Is this a government priority?
A: It is in the Long Term Plan. We are the first ICS or STP to roll it out on this scale. It has been very successful at Wythenshawe hospital in Manchester so we are basing what we do on that and what was done in Ottawa in Canada.
Q: Are electronic cigarettes a quit aid or not? And do the hospitals have clear guidance on that?
A: We are currently working through the pathways with the hospitals. We continue to follow current NICE guidance and PHE guidance on this.
Q: Is there a walk in stop smoking service for people not in hospitals?
A: All areas have a community stop smoking service but how they deliver services is different in each area.
Q: Is a 4 week follow up in a community setting long enough?
A: We will be following up their quit status at 4 weeks and 12 weeks but that doesn’t mean their community stop smoking support will just be 4 or 12 weeks, it is on a case by case basis.
Jenna Wallhead who works on mental health and learning disabilities for the ICS spoke about the outcomes of an Autism workshop held on the 10 October 2019, and the priorities identified at the workshop. The workshop was co-produced by Speak Up, and had representation from schools, health, voluntary sector organisations, social care, police, experts by experience, parents and carers. Patient stories supported the workshop. She also gave feedback on proposed next steps, including engagement with hard to reach groups.
Jenna talked about the three priorities identified in the workshop: Education, Physical health and wellbeing, and employment and asked the CP for their opinion on how patient/ public voice should play into the development of these priorities into actions going forwards. The CP felt a group of patients/ carers could be brought together to work in an ongoing way with the three task and finish groups for each of the priority areas, and that this would be better than expecting one or two people to sit on the task and finish groups and represent the voice of their communities.
Questions from the Citizens Panel, and answers from Jenna Wallhead:
Q: Will there be a clear commitment at some point from the ICS to addressing issues faced by people with autism?
A: We will use the pledges that people made on the 10th October to help shape a clear commitment.
Q: Are you looking at learning from elsewhere?
A: Yes, particularly Manchester and West Yorkshire. Also much of what we are hearing from patients and their carers in SYB is mirrored in national research.
Q: How much pressure can the ICS put on education colleagues?
A: We are trying to ensure their engagement in the work going forwards. There were engagement representatives on the 10th and there was a commitment in the room to change.
Childrens/ Maternity website
James Scott who works on Childrens and maternity for the ICS spoke about a proposal to introduce a Healthier Together Website for SYB to support young people and their families with their health needs.
Questions from the Citizens Panel, and answers from James Scott:
Q: Why is it different to what’s there already?
A: This is about providing a resource that clinicians would feel comfortable signposting their patients to so clinical engagement is key to making this work. It would contain both a space for clinical professionals to store / access guidelines, etc., and public facing areas, making sure that advice and signposting matches our local clinical guidelines and protocols.
Q: If you decide to take this forward and create this for SYB will you engage with grandparents and seldom heard communities to ensure it fits local need?
Q: Is there a live chat function on it?
A: I understand there could be but it is not something we have explored.
Q: Can less well educated people access this website okay?
A: If we go forward and develop this for SYB we will work with people who are less literate when developing it to make sure it is right for all of our communities. That will also include helping describe and illustrate some of the conditions featured on the site.
Q: Are other parts of the country looking at having this?
A: Yes but we want to be ahead of the curve. It’s been used really successfully in Hampshire – it cut emergency attendances. It does take some time and effort to get it to take full effect, so we want to move ahead with this.
Q: Is it value for money?
A: Because we would be taking an existing site (Hampshire) and adapting it, it would be much more cost effective than starting from scratch. Evidence from Hampshire is that it is successful in supporting people to manage their own health better.
Q: What did Hampshire do to get clinician/ pharmacist buy in?
A: Lots of work – lots of going out to show clinicians and other healthcare professionals the site. We would invest in doing the same.
Q: How are you going to make sure the site is known about and used? Particularly with more seldom heard communities?
A: Clinical buy in is the key. We could do big marketing campaigns but the key to making this work will be clinicians and healthcare professionals recommending it to patients and the public. But making sure that it has a presence, e.g. via social media, fridge magnets, the things that people have in their eye lines,
Q: What are the next steps?
A: A business case will be developed. The feedback today from the CP, and some of the things you’ve pointed out that we would need to do, will help inform that business case.
Khalida Rahman who is a programme manager from the Yorkshire and Humber Academic Health Science Network (AHSN) talked about a pilot programme that is running in SYB – the polypharmacy project (Polypharmacy is the simultaneous use of multiple drugs to treat a single ailment or condition, or the simultaneous use of multiple drugs by a single patient, for one or more condition). This project focuses on piloting systematic medication reviews for people with polypharmacy.
Questions from the Citizens Panel, and answers from Khalida Rahman:
Q: Will pharmacists go into care homes?
A: There is medicines review work happening in care homes as part of a different project. This is a small project looking at five patients who are at risk of frailty per GP practice.
Q: What’s the ultimate aim of this project? Saving money or reducing harm?
A: Both – stopping patients taking medicines that they don’t need and therefore reducing the potential harm to them is the key driver but stopping people taking medicines they don’t need will also save money that the NHS can better spend elsewhere.
Q: What are you giving people instead of medicines?
A: Sometimes they might not need medicines but would benefit from a referrals/ signposting to other forms of support.
Khalida explained that a training event had been scheduled in November with the pharmacists who would be undertaking the polypharmacy medication reviews. This would include information around the other services/support available for patients within the SYB ICS area to help them manage their long-term conditions. An invite was extended to the citizens panel members to attend should they wish as it was thought that this would be helpful for the pharmacists to be able to appreciate some members of the publics’ viewpoints.
Rob Wise, Head of Medicines Management at Bassetlaw CCG and SYB lead for gluten free gave feedback on the current position regarding gluten free and public engagement. The Joint Committee of Clinical Commissioning Groups has agreed to undertake a period of engagement to assess the appetite for aligning prescribing levels across SYB. The plan is for this engagement work to be targeted engagement work. The Joint Health Overview and Scrutiny Committee will discuss this work at their next meeting.
Questions from the Citizens Panel, and answers from Rob Wise/Katy Davison:
Q: Can you access data on how many diagnosed coeliacs access foods on prescriptions vs how many don’t?
A: Only 10% of the population with Coeliac disease access prescriptions
Q: What will coeliac’s do if they can’t get gluten free products on prescription any more?
A: It is entirely possible to live a very healthy and balanced gluten free diet. Many natural products do not contain gluten – including fish, meat, fruit and vegetables.
Q: What are you asking people in this engagement?
A: A draft survey is currently being developed and we would be happy to share it with the CP for views
Q: Why are you talking about this being targeted engagement?
A: At this stage we feel it is important to have conversations with a range of stakeholders who we perceive will have an important view point on any potential change so we specifically want to target attending conversations with them.