Working with Clinical Commissioning Groups

Transcription

1 NAVCA Health Research Briefing. March 2014 Working with Clinical Commissioning Groups NAVCA (The National Association of Voluntary and Community Action) is the national voice of local infrastructure charities in England. We are a charity that champions and strengthens voluntary and community action by supporting our members in their work with over 160,000 local charities and community groups. NAVCA is a member of the Voluntary Sector Strategic partner programme. This programme builds transparent relationships between the Department of Health, NHS England and Public Health England and the voluntary sector and increase capability and knowledge within the voluntary and community sector (VCS). In December 2013, NAVCA distributed a survey to its members and the wider voluntary and community sector, to find out about attitudes and experiences of local health organisations, including influencing the Joint Strategic Needs Assessment (JSNA), working with local Clinical Commissioning Groups (CCGs), and working with the local Healthwatch. The survey received 122 responses, from organisations working with a range of beneficiaries. Organisations covered a range of incomes, and a range of geographical areas. Organisations with an income of between 100,000 and 500,000 represented the largest share, and almost half had a geographical scope of a single local authority area. Just under a third of organisations identified other charities and community groups as their main beneficiary group, with around 20 per cent selecting the general public, 10 per cent selecting older people, and the remainder working with a range including, but not limited to, those with physical disabilities, long-term conditions, children and young people and Black and Minority Ethnic (BME) communities. Appendix one contains a more detailed breakdown of this information. About this Briefing This briefing focusses on responses relating to work with local CCGs. NAVCA asked organisations to respond to three statements: The local CCG(s) engage with the local voluntary and community sector in order to find out about local needs. The CCG(s) has engaged with our local organisation in order to find out about local needs. The needs and views of our main beneficiary group are taken into account by the local CCG(S) Overall, results suggest that there is considerable variation between separate CCGs, even within single counties. Respondents repeatedly stressed that work with CCGs is in its early days and were, on the whole, positive about its development. A considerable share of organisations had been engaged at least to some extent already with their local CCGs. However, responses also highlight that there remains a significant share of organisations who have not been able to engage with CCGs, and which feel that their beneficiaries needs and views are not taken into account. Work around identifying barriers and means of overcoming them would be useful in the future, as well as sharing what works in terms of building productive relationships with CCGs. NAVCA (National Association for Voluntary and Community Action), The Tower, 2 Furnival Square, Sheffield S1 4QL Tel Fax Textphone navca@navca.org.uk Registered charity no Company limited by guarantee Registered in England no Registered office as above

2 The local CCG(s) engage with the local voluntary and community sector in order to find out about local needs. 47 per cent of respondents strongly agree or agree that their local CCG has engaged with the voluntary and community sector, which is encouraging. There was, however, a mix of written responses that highlighted variation across different CCGs, and a sense that there is still work to do. Figure 1: percentage responses to The local CCG(s) engage with the local voluntary and community sector in order to find out about local needs Don't know 7% Strongly disagree 9% Strongly agree 9% Disagree 14% Neither agree nor disagree 23% Agree 38% There are some strong examples of good practice within the responses, and of attempts to build new relationships with what are, still, fairly new organisations: The CCG is proactive in holding community engagement and some specific engagement events for minorities. Emphasis seems to be on patient involvement rather that community engagement but we working to engage with the CCG." Here the CCGs are definitely trying to link into the voluntary and community sector and specifically report back on actions taken as a result of this feedback. This relationship is still quite new but there is a real commitment to build relationships. They do this via a project we run on contract with them. Currently this is patchy at best, there is a tendancy for the CCG to enage with Healthwatch in isolation. We are in the fortunate position of hosting local HW which is helpful in developing appropriate opportunities for both HW and the VCS generally and begining to educate CCG colleagues about the VCS. 2

3 A significant number of respondents commented on the fact that the area in which they worked is covered by multiple CCGs and, as such, there are multiple relationships involved. For many, there is considerable variation in the quality of relationships across these CCGs: Some [Local Commissioning Groups] do involve VCS - but patchy across the county. One is exemplary. One is not even off the starting-blocks. There are 5 CCGs in [this area]. Some are more open to meaningful engagement with the VCS than others, but all are developing their understanding of the need to inform, if not to be directly influenced by the VCS in their commissioning priorities. Finally, a smaller number stated that they had not had good experiences in trying to engage with the CCG: We have little contact with the CCG despite making an effort to interact with them. Despite invitation to Neuro Networks involving third sector partners, engagement has not been established. They try to but assume we have time and resources to attend meetings/ take part in consultations. Trying to but don't always get who we are and seem mistrustful of infrastructure orgs and old PCT expertise. This should have happened before the CCG had completely been formed... This suggests that, whilst there are many examples of good engagement, in some areas CCGs have not been able to work with particular voluntary and community organisations, or that organisations are struggling to make their voices heard. More work could be done to find out the reasons for this, what the barriers in these areas are, both to CCGs and to voluntary and community organisations, and how they could be overcome. 3

4 The CCG(s) has engaged with our local organisation in order to find out about local needs. 64 per cent of respondents stated that they are engaged either to some extent or to a great extent with their local CCG(s). Figure 2: percentage responses to The CCG(s) has engaged with our local organisation in order to find out about local needs. Don't know 4% We are engaged to a great extent 16% We are not engaged 32% We are engaged to some extent 48% This seems to be an encouraging sign of engagement across a range of organisations. Some comments suggest that for many, this is a relationship that is in development, but on the whole a positive one: We could be more engaged, but it is early days for the CCG. Our dialogue with them remains open. Although we receive funding, we do not engage fully in relation to local needs, however, this could be put down to the fact that they have not been in place for a year yet and it is very early days. We are slowly identifying more opportunities for the CCG to engage with the VCS using [the Council for Voluntary Service] as the conduit. We have delivered engagement training to Board and Commissioners in partnership with Healthwatch, and are planning a roundtable discussion with CCG Board members and the VCS to help each to better understand the role of the other, and develop closer relationships. A number of respondents also stated that they felt engagement had only happened because they had taken the initiative in making contact and building the relationship. Others suggested that they would like to be involved, and were working towards better engagement, but had not been successful to date. Almost a third of respondents stated that they are not engaged with the CCG. Comments suggest a range of reasons, including variation across multiple CCGs, changes in personnel and problems with communication. 4

5 We support people across 7 CCGs - some are keen to have involvement from people with learning disabilities, others are less "accessible"/engaging. We are just starting to engage with the CCG, but with the two senior CCG managers concerned moving on, this is causing delays and uncertainty in the process. I have attended some CCG meetings for third sector / community input, but I am still not clear on what has come out of these meetings and what is happening next. It is encouraging that such a high percentage of respondents feel that their organisation has at least some engagement with their local CCGs. There is clearly some work to be done in building upon and improving relationships with CCGs, but respondents stress, as with other local health structures, that the CCGs are still in their development stages, and that, on the whole, there is hope for improvement. 5

6 The needs and views of our main beneficiary group are taken into account by the local CCG(s) Responses to this statement were much more evenly split than previous statements, suggesting that whilst organisations have been involved with CCGs to some extent, there is less certainty about beneficiaries views being taken into account. 36 per cent agree or strongly agree that the voice of their main beneficiary group is taken into account by CCGs, with a further quarter neither agreeing nor disagreeing. Almost 30 per cent disagreed or strongly disagreed. Figure 3: percentage responses to The needs and views of our main beneficiary group are taken into account by the local CCG(s) Don't know 10% Strongly disagree 10% Strongly agree 6% Agree 30% Disagree 19% Neither agree nor disagree 25% The overwhelming sense from the comments supplied was that it is too early to make a judgement regarding this statement, and that work is very much on-going to improve engagement and representation. But we are always working to improve this. GPs got to know us, then left due to pressure. New relationships to build now. The CCG has talked a lot about inclusion but we are waiting to see how this translates into action. Early indications are good but not many firm commissioning decisions have been made as yet. They appear to be at too early a stage in their development for engagement to be a priority yet. Mechanisms for gathering views still in the early stages, so too early to tell. 6

7 However, there were also some serious concerns raised regarding particular beneficiary groups in particular areas, and the extent to which their needs and views were taken into account. LGB&T communities and their needs are not mentioned in strategies etc. and it often feels as if only lip service is paid to equalities rather than meaningful consideration. We are getting information that GPs are not understanding the Access and Assessment Procedure nor supporting [Mental Health] patients in the primary sector.this worries me as the Trust implements its cuts and patients will be more likely to have only primary care support. The needs and views of children / young people with disabilities and their families is a long way down the list of priorities. Although we are not in touch with every CCG in the country, we know from previous research that epilepsy (and neurology) are poorly lacking in CCG commissioning plans. A few respondents noted that budgetary constraints had restricted the extent to which engagement could happen. This suggests that there is a certain tension between what is wanted, and what it is perceived that organisations are able to do. The financial 'envelope' shapes the commissioning context to a large extent, so whilst there is engagement would question whether anything changes as a result. While we believe that there is a willingness we believe that government directives and funding limits preclude it. Finally, there were some comments that described good practice and successful relationships. One organisation working in an area with four separate CCGs reported that mental health and the needs of older people were high on the agenda of each CCG. Another had been supported by two CCGs in a successful funding bid to the Department of Health for work with homeless people. One organisation whose main beneficiaries are other VCS organisations describes the following situation: They are getting there - this year they have commissioned 2m into the VCS as grants through a competitive grants programme - however the priorities that were used for the programme were not decided in partnership with the VCS so although they have provided funds they did not involve us in a needs assessment of [the] commissioning cycle. Whilst this emerging practice is positive, and the percentage results suggest more positive relationships than problematic, there is again clearly more work that needs to be done to ensure that particular beneficiary groups are represented, engaged and heard more consistently. 7

8 Conclusions and Next Steps Work with local CCGs seems to be, on the whole, positive. There is clearly more work that could be done, particularly in terms of improving communication and identifying and breaking down barriers between the VCS and CCGs. What more do we need to know? A more in-depth piece of research would be needed in order to tell us more about the experiences of organisations working with particular beneficiary groups. Whilst this report provides a number of examples of organisations working with different groups, it is not representative of sub-sectors within the voluntary and community sector. It would be useful to have more examples of where charities and community organisations and local CCGs have successfully worked together, and what has happened as a result. It would also be useful to find out more about why barriers exist in certain areas, and what could be done to overcome them. A number of organisations were clear that these processes were in their early days, so it may take some time before the impact of voluntary and community sector involvement can be seen. Existing examples of good practice Newcastle Council for Voluntary Service held a networking event for CCGs and the local VCS in July 2013, which brought together 75 professionals from across the two sectors, to discuss better working relationships. As the report states, participants were keen that the sector is seen as an integrated partner and not as a bolt on. _Newcastle_-_CCGs_and_VCS_July_2013.pdf The Building Health Partnerships programme, run by NAVCA, Social Enterprise UK and the Institute for Voluntary Action Reasearch (IVAR) aims to improve health outcomes through the development and national sharing of best practice in partnerships and relationships between [CCGs] and the voluntary, community and social enterprise (VCSE) sector. The following report from July 2013 identifies emerging actions from each of the 12 geographical areas. f Tools and Resources The King s Fund has created a Health and Wellbeing Board Directory Map for England. The entry for each board includes links, where available, to its corresponding CCGs, as well as its JSNA, Healthwatch organisations and Joint Health and Wellbeing Strategy (JHWS) 8

9 NHS England has produced a range of tools and resources for CCGs, including the Commissioning for Value tool, which provides comparable data across all CCGs for a range of outcomes and indicators. Whilst this data is meant for commissioners, it can provide information regarding local action and outcomes that VCS organisations can use to influence their approaches. RAISE has created a Healthier Perspective Toolkit, which aims to encourage collaboration between commissioners of health and social care, voluntary sector providers and voluntary sector support organisations, which includes a section for VCS support organisations. 9

10 Appendix 1: data relating to respondents Figure 1: What is your annual income? Over 10 million 6% 1 million- 10 million 15% Less than 10,000 13% 10,000-50,000 10% 500,000-1 million 16% 100, ,000 34% 50, ,000 6% Figure 2: What size of area is served by your organisation? Region 4% All UK 5% All England 3% A neighbourhood or locality 7% International 1% More than one local authority area 31% Local authority area 49% Figure 3: What region is your organisation based in (for national and international charities please say where your headquarters is based). West Midlands 3% South West 11% South East 19% North West 11% East of England 19% North East 10% London 13% East Midlands 9% Yorkshire & the Humber 5% 10

11 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% 11 The general public / everyone Women Men Older people Children and young people Families/parents Carers People with physical disabilities and / or special needs People with long-term conditions People with learning difficulties People with mental health needs People from Black and Minority Ethnic communities People with a particular financial need (including poverty) Asylum seekers / refugees Homeless people People with addiction problems (e.g. alcohol, drugs) Faith communities Lesbian, gay, bisexual or transgender people Socially excluded / vulnerable people Victims of crime and their families Offenders, ex-offenders and their families Other charities, social enterprises and/or voluntary organisations Cannot say Figure 4: What groups of people does your organisation work with? (Please tick as many as apply.)

12 Figure 4: Who are the main beneficiaries of your work? (Please tick only one. If you feel there are more than one, please pick the group with whom you work the most, or select one group from across your work). 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% 12