Redesigning a service

When changing a service patients’ points of views should never be forgotten.
In Worcestershire it was decided those suffering with neurological conditions would be the first port of call before any alterations took place

The three Worcestershire clinical commissioning groups (CCGs), NHS South Worcestershire, NHS Redditch and Bromsgrove and NHS Wyre Forest cover a patient population of nearly 600,000 patients across 66 GP practices and are responsible for arranging health services on behalf of the local population.
The CCGs monitor the quality of the services that are offered in the county and are continually working on new pathways and services to offer the best possible care to the people in the county.
Although each CCG has its own clear identity and plans when commissioning services for its individual population, it is recognised that collaborative working across the county offers benefits and value, where a service model works best across a footprint that may be larger than one of the individual CCGs.
Working collaboratively is usual practice within Worcestershire as the three CCGs share a commissioning team, providing commissioning support at an individual CCG level, as well as at a pan-CCG level when appropriate. The main benefit of having a shared commissioning team is joint working across the health economy.

Brainstorming begins
One area each CCG identified as needing a commissioning focus was neurology services. Each CCG had gathered intelligence from a range of sources that highlighted aspects of the current service that needed improvement. Within the wide range of neurological conditions, the CCGs identified groups of patients and carers for the ‘Big Conversation’, an event set up for patients to discuss certain neurology services and one of those was epilepsy.
The CCGs are firm believers that co-production, whereby decision-makers work closely with patients, the public and partners to create a decision or a service, works for them all.
The CCGs have successfully developed a culture of co-production to ensure that the CCGs’ communications and engagement activities adopt this approach, so that those who are affected by a service are best placed to help design it.
There is strong evidence that effective communication and engagement with patients, carers, the public and other stakeholders helps to improve commissioning decisions, patient satisfaction and service use. Therefore, well-planned, robust, effective communication and engagement activities are essential to the success of the CCGs.
It is vital that the CCGs engage with their stakeholders on how decisions are made, about their choices and what services might be commissioned. These stakeholders include among others: Worcestershire Acute Hospitals NHS Trust, Worcestershire Health and Care NHS Trust, Worcestershire County Council, Healthwatch, Worcestershire Health and Wellbeing Board, NHS England, as well as voluntary organisations and patient participation groups.
In order to achieve this the CCGs use a range of effective communication and engagement tools and channels to build a climate of trust, honesty and openness.

Patient point of view
To assist in redesigning the service available in Worcestershire, the CCGs asked NHiS Commissioning Excellence, an NHS England-recognised specialist commissioning support provider, to review the neurology services that were currently on offer and to produce a report and recommendations. The aim of the report was to reflect the views of local people who have a neurological condition, like epilepsy or Parkinson’s, and focus on a range of issues – specifically to find out if current services meet the demands and needs of local patients.
The experiences and knowledge of patients, carers and health and social care professionals is vital to commissioning services. This was seen as a key factor for finding out if services available to people with neurological conditions could be better coordinated, allowing problems to be identified earlier and to pave the way to a more joined-up service.
To do this the CCGs, NHiS and local GPs hosted the Big Conversation event in 2015. The event was designed for anyone with epilepsy, motor neurone disease, multiple sclerosis or Parkinson’s disease, or for those who look after people with any of these conditions. The aim of the event was to help patients and carers come together to build their ideal pathway of care to offer better outcomes for patients but to also help reduce emergency hospital admissions.
The CCGs set out to ensure that they engaged with a wide range of stakeholders and the primary aim of the Big Conversation event was to capture the views of service users, carers and clinicians, this information would feed back into the wider review work and help inform the decisions made by the CCGs.
The event itself was a huge success, with a variety of patients, carers and stakeholders attending and contributing ideas and opinions on what areas of the service they thought were good and also what areas of the service needed improving.

The findings
The main findings from the event were:

Patients want access to advice seven days a week – seizures can strike at any time.
Ensure A&E has appropriate information for the patient plus information for family members.
Support networking opportunities and key helpful contacts for carers.
Improve communication between GPs/consultants.
Paediatric care was very good but transition to adult services needs to be improved.
Better social care support and prescribing/administering support is needed.
More education on how to self-manage and maintain a healthy lifestyle is needed.
Good practice – learning disability care plans.

The review has now been completed and a set of review documents have been produced that capture all the main areas of good practice as well as the areas that require improvement.
These reports will be presented to the three CCGs with a view to agreeing the way forward to address the recommendations in the report. This will enable the CCGs to push forward with their commitment to offering improved, integrated processes for neurology patients.

Simon Gartland, deputy director of commissioning for NHS South Worcestershire CCG, NHS Redditch and Bromsgrove CCG and NHS Wyre Forest CCG.