Process for agreeing our Strategy

1. 2017 - 2019 STRATEGY AND PLAN Development and Sustainability for Nottingham and NottinghamshireVersion 7: 26 July 2017

2. Process for agreeing our Strategy

3. Merger • The Local Authorities, Nottingham City Council and Nottinghamshire County Council, have agreed that the two Healthwatch organisations should be combined into one body by April 2018. Substantial merger plans need to be in place by September 2017. • The advantages that merger will bring are: • It better reflects the future organisation of NHS services around the Sustainability and Transformation Plans across Nottingham and Nottinghamshire. • Given the budget reductions both the Local Authorities and Healthwatch are facing the merger will result in savings. • It will enable improved use of shared information, data collection and adoption of standard approaches and frameworks, thereby increasing our capacity to deliver evidence and insight work.

4. How Healthwatch can add value within a challenging environment Background and context

5. A reminder of why Healthwatch was formed in 2012 and still remains essential • Healthwatch was formed to ensure service users are at the heart of health and social care delivery. • The Health and Social Care Act 2012 stipulates that local Healthwatch must be independent organisations that are not-for-profits and for run community benefit only. • They were set up specifically to support the stated intention of increasing patient and public centred care, generating world leading health outcomes, enhancing collaboration and co-operation between health and social care bodies. • The intention was for local Healthwatch organisations to be an effective, powerful, representative and independent local public and patient voice for all aspects of health and social care services within a community.  The local Healthwatch bodies would also act to support local views in influencing national policy and practice through Healthwatch England. • Key aims for local Healthwatch organisations were broadly: • Obtaining the views of patients, service users, and the public • Influence the planning and delivery of public-centred health and social care services • Provide feedback, advice and information to help people access health and social care services and support and make informed choices • Hold commissioners and service providers to account

6. The state of Health and Social care in 2017 • Health and social care is experiencing one of the worst crises in a generation, with austerity, staffing shortages and service silos threatening the very future of our care services. • Although the Government announced further funding for the NHS in the 2016 Budget, there are concerns that this was not new money and will not alleviate the increasing demand will placed on health and social care services. • The lack of funding for social care services adds to these pressures, with hospitals being unable to release patients back into the community during recovery due to a lack of care places and reduced community support. • There is a staffing crisis across health and social care that needs to be addressed in the face of increasing pressures around ageing populations, skills shortages and uncertainty around the impact of Brexit. • The focus continues to be on how we can best integrate our care services to not only improve efficiencies, deliver financial savings but also improve the quality of care. However the ability for local systems to invest in this vital strategic work and meet immediate pressures is limited leaving resources and capability very stretched. • The two Sustainability and Transformation Plans (STPs) for Nottingham and Nottinghamshire and South Yorkshire and Bassetlaw have been identified as potential candidates to become Accountable Care Systems (ACS). ACSs will aim to integrate NHS organisations (both commissioners and providers), in partnership with local authorities to take on clear collective responsibility for resources and population health to provide joined up, better coordinated care.

7. The challenges that have emerged for Healthwatch Nottingham and Nottinghamshire to play this vital role • The role that Healthwatch Nottingham & Nottinghamshire is required to play in the local health and social care system is an increasingly demanding one, our activities are wide-ranging and our capacity to deliver this is often limited. • We have great potential for improving how the wide range of data reflecting local people’s concerns and priorities, collected by ourselves and by others, can be used for improving how responsive and inclusive the system and system change is. • We have a sizable challenge in ensuring that our distinct local role, which balances being an independent voice, being part of key decision-making processes and as one of the local system leaders guiding change, is clear and well understood by all of our stakeholders. • To ensure our legitimacy and maintain our credibility, we have a need to maximise our effectiveness, demonstrate our impact, prioritise our focus and work more productively in partnership with others. • Our core funding will continue to be derived from statutory bodies, but will be augmented by commissioned work which will amount to no more than 25% of grant income, provided this does not compromise our independence or integrity.

8. Our focus Vision and goals

9. Focusing the strategy for 2017-19 • It is essential we continue to build on the good work achieved in 2016 and become even a more influential and effective collective voice of the public, facilitating targeted improvements in health and social care design and provision. • There are five key areas of improvement that must be achieved through our Vision, Goals and Objectives: • More emphasis on being representative of all of our local communities, by focussing more on the voice of those who are ‘seldom heard’. • Building our profile and influence through a clear purpose that adds value and developing more effective partnerships and networks • Building our capability and maximising our resource to realise greater capacity to deliver our core functions as well as our priority projects. • Systematically identifying and demonstrating the impact of what we do in ways that are meaningful to our stakeholders projects thereby ensuring greater transparency and accountability. • Augmenting our expertise and our reach by growing our contracted income and using that to reinvest in our capability.

10. Healthwatch Nottingham & Nottinghamshire is the independent patient and public champion that holds health and social care services more accountable to their communities for the services they commission and provide. Our unique overview across the whole of Nottingham and Nottinghamshire, includes commissioning, public health, health inequalities, social care, children and young people. We listen, collect experiences and share insights with those with the power to make change happen. Our Unique Purpose • To achieve our unique purpose, we fulfill five key roles locally: • Facilitate Engagementby supporting and bringing together early, effective and widespread involvement of communities • An Independent Voiceproviding the means for people, particularly those who are seldom heard, to express their views and concerns • Evidence based Insightbeing a local hub for collecting and analysing intelligence and data • Influence Changeby linking with and providing compelling feedback to system leaders on sustained improvements • Raising Awarenessto information that allows individuals to make informed choices • We are a values based organisation and adhere to our core principles of: • Being representative, enabling all communities have to a meaningful voice • Supporting the long term sustainability of quality health and social care services • Being responsive to current concerns and issues raised • We are accountable to the public by ensuring we are transparent in everything we do • We add value by adopting best practice approaches and ensuring our professional standards at all times Our Strategic Approach • We facilitate targeted improvements in health and social care design and delivery • We influence care to be patient and public centred • We support collaboration, co-operation and integration; bring communities and systems closer together • We facilitate shared aims and promote openness and transparency of change agendas The difference we make

11. Our organisational goals for 2017-19 • Our organisational goals will enable us all to focus on how we can realise our purpose: • Adopt smarter working practices and processes, including streamlined project management and focused decision making to enable us to prioritise our time and resources more effectively (partners/mutual benefit). • Expand the reach of our voice by focused brand/PR awareness, developing an integrated communication and engagement strategy and more effective work with all of our stakeholders. • We will improve our use of information, rigorous data collection and adoption of standard approaches and frameworks thereby increasing and demonstrating our impact. • Develop a ‘One Team’ approach by all working together to a realistic overarching plan aligned to our purpose and priorities, with clear accountabilities and skills development to deliver our longer-term aims. • Ensure organisational sustainability with increased income generation aligned to our purpose, more effective use of resource and leveraging technology to support our key roles.

12. Developing our overarching plan and identifying our principles • There are 4 core principles applied in the process of developing, reviewing and updating our ‘One Team’ Plan: • We use quantifiable data and insights from both internal and external sources aligned to our unique oversight. • Our bottom up and top down intelligence and both quantitative and qualitative feedback is used to determine the most appropriate focus for our activities. • Our plan addresses both current concerns and looks to long-term sustainability of health and social care services. • It balances our full Healthwatch remit not just some of it, to focus on what is best for the public and communities.

13. Using our principles within a structured processes of planning for the City and the County Data from our Informatics system Prioritisation Panel Intelligence from our engagement activities Annual Planning Roundtable + Quarterly Planning Reviews Stakeholder Advisory Group Guidance System Leadership Feedback (HWB, STPs CCGs etc) Our e-network /Reference Group ?

14. Aligning our planning and prioritisation groups Team Quarterly Planning Review – One Team, One Plan • HW N & N Board • HW N & N CEO

15. Sustainability New ways of working

16. The vital importance of public and patient engagement and involvement right now • Healthwatch has a role ensuring that the voices of the vulnerable, the disadvantaged and people and communities who are often excluded, are listened to. • We have an important role in holding health and social care providers and commissioners to account for the quality of their public engagement, and the extent to which members of the public are involved in, and able to influence, the commissioning and provision of services. • Healthwatch will continue to develop and maintain links with groups and natural community leaders representing and supporting people who are seldom heard. • Depending on the work we are undertaking, as well as the personnel available, the level of engagement with the public will vary. In some instances we may just provide information to the public, whereas in other situations we may consult, collaborate with partners or fully engage local people in contributing to decision making. • In addition to the increase of public and patient involvement described above, providers and commissioners also need to be both supported and challenged with robust data and patient experience to enable them to make the right decisions and focus resources appropriately.

17. Sustainability • Securing our long term sustainability is paramount and that will be determined not only on demonstrating our impact, focussing on the right priorities and delivering for all of our stakeholders, but will also require us to adopt new ways of working: • We will be focussing on • Aligning our Engagement, Communication and Intelligence (Our Network of Networks). • Defining our focus on ‘seldom heard’groups. • Increasing our capability and capacity to take on contracted work at a level which does not exceed 25% of the statutory grant.

18. Aligning our City and County Engagement, Communication and Intelligence (Our Network of Networks) CYP Network CCG Patient Reference Groups Community/District Panels/CAG Patient Opinion Infrastructure CVS/NCVO/ ACEVO Patient and User Groups Networks National Voices NHS Choices CAB Lay Members/Groups All Provider PPG/PPI Self-Care/ Prevention/ Support Groups Engagement and Feedback Systems Communities / Third Sector InHealth Associates PALs Carers NAPP NHSE Patient Experience Scores NHS Surveys Seldom Heard/ Advocacy Organisations H & S Charities GP Patient Survey Healthwatch Nottingham and Nottinghamshire Partnership and Data Network H&WB County Forums HWE Royal Colleges / Societies Other LHWs/HAPIA Academic HS Network STP Groups LMC H & S System Leadership LA Health Scrutiny CCG CEOs Vanguards HoPE Network Professional Networks CLAHRC CLGC (LA) CQC Public Health JSNA Health Provider CEOs Local Networks Research and Universities Social C Directors Standards/Scrutiny Public Involvement Engagement PSA/GMC/NMC etc. NICE NHS CAS/MHA etc. Safeguarding boards

19. Defining our focus on ‘seldom heard’ groups • Within our strategic approach the term ‘seldom heard’ is used to describe groups of people who don’t have a strong collective voice or those that are often under-represented in consultation and involvement activities about services. • Our focus areas for engagement include: • Children and young people • People with learning difficulties and disabilities, including special educational needs • People with mental health problems / Long term conditions • Gypsies and travellers • Deprived or isolated communities • Substance misusers • Homeless people • Prisoners • The cared-for and carers • BME • LGBT+ • Working aged • A first language other than English • Domestic abuse It is about proactively connecting with those who we find hardest to reach, taking steps to overcome barriers to participation and encouraging everyone to have their say.

20. Work identified so far One team, one plan

21. Our 17/18 Plan: Working on a wider footprint – City and County and with other Regional HWs • Key focus areas • Primary Care and GP Access/transformation - may include work with partners/LMC and PPGs / Primary Care Homes Review ? • STP: QoTM – Engagement, Self Care, Digital • Health inequalities: Ongoing JSNA – Networks and Hub work – Seldom Heard • Public Health/Prevention Agenda – includes social prescribing, self-care and healthy living pharmacies - alignment to H&WB strategy • Mental Health – Service Transformation/ QoTM/ follow up Crisis Concordat • Enter and View - Expand current to also include A & E / Urgent Care? • Hospital Usage – Discharge/Missed Appointments • A Wider EM HW project - maybe EMAS • Commissioned work to be agreed • Safeguarding /Maternity Voices • Disability Residential Care – Blue Skye Care

22. ‘One Team, One Plan’Programme for April 17 – March 18 Develop integrated communication & engagement strategy , plan and support materials Branding and Communication (merger) Review of meetings, groups & events Talk to Us points Map and maintain relationships within the ‘Network of Networks’, including seldom heard groups Build on GP Access work – Mid Notts Follow up on LGBT+ report Support of PPGs and PPI across City and County Enter and View – planned programme Care Home visits - 1 City, 1 County Accountability: Work Stream Coordinator: Ensures that all activity in that work stream is aligned Project Lead: Accountable for that the project. Leads on scoping management and ensures the outcomes are delivered QoTM - STP QoTM - STP QoTM – Access/Appointments QoTM – Mental Health E & I Project E & I Project JSNA chapters – Nottingham City Council and Nottinghamshire County Council Development and consolidation of our partner and professional networks Bassetlaw Missed Apps Maternity Voices Blue Sky Care Crisis Concordat follow-up Develop approach to STPs and ACSs Identify potential tender and delivery partners Development of tender toolkit Develop Volunteering Strategy Investment in and development of volunteers /Develop Prioritisation Panel All roles, developments plans and objectives aligned to strategy Skill Development Map and Plan – staff and volunteers Team Building Day Joint team/board event HR Audit Policy Streamlining and alignment Development of a functioning website, informatics systems, metrics and reporting Further development of informatics, benchmarking and reporting Mapping of Network of Networks (data) Alignment to HWE data and CRM strategy Simplify and standard project management approached Strengthen data protection and information security - GDPR Develop Strategy and 1T1P approach Cascade to 2017 individual objectives Align budget to plan 1T1P Qtly Review 1T1P Qtly Review 1T1P Qtly Review Integration, Due Diligence, Legal and Regulatory work Merger proposal, Plan and engagement – includes joint premises

23. Role of Healthwatch in the STP • Patient Voice • To facilitate and champion a proactive and broad patient and public voice that feeds into the ongoing planning and delivery of the STP. To ensure that concerns, questions and ideas can be raised readily, in the right place and answered where appropriate. Where necessary to escalate the patient and public voice to the STP leadership team and to challenge when there is evidence that the patient and public voice is not being considered as part of the decision making processes. • Engagement and Communication • To challenge and support the STP leadership team with regards to transparent, clear and easily understandable communication. To challenge and support the STP leadership team to ensure that it engages all sectors and communities appropriately across the whole footprint. To challenge and support real co-design with patients and care users as the detail within the plan develops. • Impact and Outcomes • To appropriately challenge the STP leadership team with regards to the adequacy of health impact assessments, risk assurances and the adoption of evidenced best practice. To understand potential health inequalities that materialise as a result of the STP and ensure that these are bought to the attention of the STP leadership team and that plans are in place to address any inequalities. • Monitoring and Evaluation • To undertake, when suitably commissioned, more in-depth evaluations and longitudinal studies in the areas of Patient Experience, Quality and Access as the impact of the changes taking place with the STP begin to be known

24. Reporting on the Outcomes and Impact - The difference we make