Agenda item

Covid-19 has fundamentally changed the way we provide health and social care in Buckinghamshire.  The Buckinghamshire ICP agreed to undertake a comprehensive programme of public engagement about the changes we have made and discuss some the changes we are considering in order to reset health and social care services for the future.

The engagement programme has been developed around the following 4 themes – reducing health inequalities, community services, keeping people safe and non face-to-face services.

The programme and survey launched on 24^th August 2020 and the survey closed on 19^th October 2020.  Further engagement work is planned in November.  A fuller discussion on the outcomes of this work will be discussed at the January meeting.

Presenters:

Mr D Williams, Director of Strategy, Buckinghamshire Healthcare NHS Trust

Papers:

Cover report

Report which went to the Health & Wellbeing Board, July 2020

The Chairman welcomed Mr D Leveson, Deputy Director of Strategy, Buckinghamshire Healthcare NHS Trust (BHT).  Mr Leveson explained that he and Mr D Williams had been leading on the engagement process during which an online survey had been held from 24 August to 19 October 2020.  There were four themes in the survey; reducing health inequalities, community services, keeping people safe and digital appointments.  Phase 2 of the engagement process was underway and would run during November and December; a social research company had been employed to run 12 in-depth focus groups and 20 in-depth one-to-one interviews to target hard to reach groups e.g. carers, young people, those living in deprived areas and the Black, Asian and Minority Ethnic (BAME) community; these would be completed by the end of 2020. 

Approximately 2,800 responses had been received; the average age of respondent was 61 and the majority were white with over 70% being white women.  Initial analysis had shown that there were over 20,000 pieces of free text to be coded and themed. 

Mr Leveson highlighted a few key points from the survey data:

• More than 50% of respondents felt they were healthy or very healthy.
• Of those who responded saying they were not healthy; a number were receptive to making lifestyle changes, particularly in obesity.
• 80% of respondents had had a phone or video appointment in the last three years and were generally satisfied with the appointment.  The majority were happy to continue with a digital appointment in the future but the number declined with increased age. The biggest concern over online consultations was when people needed a physical examination; it needed to be clear that a face to face appointment would be available when required.
• When asked about planned care e.g. ophthalmology, and what was most important to people, the following points were made:

Ø  Receiving a diagnosis and being treated as quickly as possible.

Ø  Being treated locally; people were willing to travel if being seen at a centre of excellence resulted in quicker treatment but it was important to consider the frequency of need and the age of the person. 

• People were generally receptive of dialling 111 or visiting a pharmacy but there was a slight reticence over clinical credibility; particularly by those with a long term condition or older people.
• Community services – the response rate for those with experience of a community hospital bed was low; however, there could be detail in the free text.  When asked about rehabilitation and recovery and whether they would prefer to recover at home or in a hospital bed; it depended on the circumstance; the security of a hospital bed was appealing for older people.

During the discussion, Members asked the following questions:

• The Chairman queried the timing of this piece of work as people were accessing services differently during the pandemic.  Mr Leveson stated that the use of digital appointments and NHS 111 had been planned before the pandemic but Covid-19 had accelerated the changes.  The pandemic had forced BHT to think slightly differently about how to reach people. 
• The Chairman stressed it was an online survey and that huge swathes of the community were not comfortable with digital technology and had not seen the survey.  The Chairman commented that her local Patient Participation Group (PPG) had not been contacted by the Primary Care Network (PCN) for over a year and were not aware of the survey and queried whether 2,500 was a good number of responses. 
• A Member asked whether the results of the survey would be subject to independent review and scrutiny.  In response, Mr Leveson advised that a report would be prepared on the first phase of the engagement and would be open to scrutiny.  Mr Leveson agreed that a large number of the population struggled with digital technology and they would take the opportunity to engage with areas of the population not historically reached.
• A member of the committee asked for a breakdown of the age of respondents   Mr Leveson stated he would provide a full breakdown to the Committee & Governance adviser for circulation to the committee members.

ACTION:  Mr Leveson to provide a breakdown of the ages of respondents for circulation

• Concern was raised over the difficulty of measuring health inequality during the pandemic, particularly in terms of access to IT to conduct online consultations.  Mr Leveson stressed that when people needed to be seen in person they would be given a face-to-face appointment and when a person was in a life threatening situation they would be seen in the right setting.  The important message was that the video appointments worked but were not right for everyone and every condition.
• A committee member highlighted that people who were suspicious of authority would not take part in a consultation.  Engagement with travellers, working mothers or the LGBT community could be done but would take time and money and reassurance would be needed on how the data would be used.  The digital revolution could cause a breakdown in society; healthcare benefitted from being face to face.
• A Member asked whether there was the budget to support the initiatives that might come to light following the engagement, particularly in light of the financial strains due to the pandemic. Mr Leveson added that the costs of running the survey had been afforded by the Integrated Care Partnership and stressed that investment in engagement was important.  Part of his job was to develop the strategy for the next five to 10 years and it would need to be sustainable.  Prevention, keeping people at home and health inequalities were fundamental for the sustainability of the system as a whole and would be a challenge for everyone.

It was agreed that the Chairman would put any further questions to Mr Williams and Mr Leveson on any areas of concern.  The Chairman explained that this item will be discussed in more detail at the January Select Committee meeting when the results of the survey would have been analysed and the further engagement exercises undertaken.

RESOLVED:  The Committee NOTED the contents of a report to the Health and Well-Being Board and RECEIVED a verbal update on how the community engagement exercise was progressing.