Using your feedback

Long covid rehabilitation pathway

Health and care professionals worked together to plan new rehabilitation services needed for the people who have had COVID-19 and as a result require ongoing health and care support.

In order to capture the views of patients to inform the service development, an engagement exercise took place. This included a wide-reaching survey, which received more than 60 responses, a focus group with patients and their carers and work with seldom heard communities. The work with seldom heard communities was overseen by the South Yorkshire Community Foundation (read their report here). 

Feedback has helped to shape the development of the services, including ensuring mental health considerations are taken on board and broad communication about the service is undertaken. The full engagement report can be found here. 

Read more about our work during COVID-19 to better understand patient and public voice during this period of time (March 2020 - onwards).

The Full Report is now available to view.

In June 2017 the Joint Committee for Clinical Commissioning Groups (JCCCG) for South Yorkshire and Bassetlaw took a decision to change the way some children’s surgery and anaesthesia services are provided in South and Mid Yorkshire, Bassetlaw and North Derbyshire. At that time, the JCCCG agreed to clinical recommendations that children needing an emergency operation for a small number of conditions, at night or at a weekend, would not be treated in hospitals in Barnsley, Chesterfield and Rotherham, and would instead have their surgery at Doncaster Royal Infirmary, Sheffield Children’s Hospital or Pinderfields General Hospital in Wakefield.

Since that decision, a number of factors have changed (as detailed in the report to the JHOSC) which mean that a new recommendation has been put forward by local clinical experts. The new recommendation is for surgery for three of the four conditions covered by the previous decision (post-tonsillectomy bleeding, foreign body in the airway, torsion of the testes) to continue being provided in the local District General Hospitals, i.e. with no change to the current provision. The recommendation for the fourth condition – suspected appendicitis – is that for children aged under 8, and for children with complex needs, appendicectomies should be conducted at Sheffield Children’s Hospital. This would affect around 45 children a year from across South Yorkshire and Bassetlaw. Arrangements for mid-Yorkshire children are now configured under their own local ICS. 

We have a number of sources of information showing the views of patients, the public, parents and carers from across South Yorkshire and Bassetlaw on potential changes to children’s surgery. In total we have received over 3500 responses about this issue over the course of the last four years.

Read the engagement report on this work here

Read the verbatim responses to the recent survey here

Autism is a key priority for the ICS across ‘all-ages’ and there is a clear commitment to becoming more autism friendly.

To take this forward, and to ensure all stakeholders, including patients and their carers, are involved in developments a Workshop, co-produced by Speak Up, was held on the 10 October with representation from schools, health, voluntary sector organisations, social care, police, experts by experience, parents and carers. Patient stories, from people who weren’t able to be at the workshop but wanted their story told, were gathered by the ICS engagement team, and were heard at the workshop. Some of the outcomes include:

Sunflower Pledges here

What should the ICS work on first here

Postcards here

During the workshop areas of focus for the SYB wide autism work were agreed and these are now being taken forward by Task and Finish Groups for each of the themes. The ICS engagement team continues to work on behalf of the workstream, and with Speak Up to ensure patients and their carers are given the opportunity to share their views and help shape the direction of travel. This includes ensuring the voices of the seldom heard communities and those not directly involved with autism support services are heard.

Following a One Year Review (2019 - 2020), we have also produced a Final Report for the latest developments across SYBs autism pathway.

The development of a South Yorkshire and Bassetlaw Healthier Together Website

Engagement Summary

The Care of the Acutely Ill Child workstream wanted to seek public opinion on the idea of developing a Healthier Together website (similar to one in Hampshire https://what0-18.nhs.uk/) for pregnant women, children, young people and their families to provide local up-to-date, evidenced patient information on a range of health issues including information about what to do when your child becomes unwell.  The workstream lead and manager, supported by the ICS engagement team developed an online survey linked to the established Healthier Together Website in Hampshire to seek public opinion and views.  While the website supports pregnant women, children and their families, it is also used by health professionals and practitioners to facilitate consistent advice and information given to families across primary and secondary care.   The survey was circulated across system networks, parent carer forums, and maternity voice partnerships and through Clinical Commissioning Groups and Hospital Trusts.  Sheffield Children’s Hospital also used a medical trainee to use the survey with families in outpatient clinics.

This report documents a summary of the key themes from patients.

The majority of people responded very positively to the website with most saying that they would be extremely/very likely to use the website if it was available locally (today).   Views from health professionals including GPs and Paediatricians were similar.  The availability of the website in a phone application (app) was considered a great feature by children and families, and health professionals were positive about the ability to text pages (via SMS) to patients and families to avoid printing costs and lost patient information.

More detailed comments from pregnant women, children, young people and families were made about the website being clear and easy to read.  Many people commented about the traffic light system used t help support decision making and action to take in response to an acute illness e.g. high temperature/fever.

Over half of Health professionals and practitioners felt that a website like this was something that pregnant women, children and families definitely needed in providing easy and quick access to evidenced based health information.  Many health professionals like the simple and clear layout and welcomed the aim of providing a web-based resource to support consistent health information being given across the system, between primary and secondary care.

The survey helped inform a business proposal for developing an SYB Healthier Together Website that was approved in principal in November 2019.  Subject to transformation funding, the website will be developed from April 2020.  Co-production and further engagement will form an integral part of the website development, implementation and review.

Reducing Emergency Admissions from Care Homes

 Engagement Summary

 The urgent care workstream wanted to look at how in SYB we might reduce the numbers of people who are taken to hospital when it isn’t clinically appropriate. The ICS engagement team visited three care homes in June 2019 and spoke to staff and residents to gain some insight into why they typically call ambulances and whether the residents would prefer to have the support they need to stay where they are living or would prefer to go to hospital or a hospice.

This report documents a summary of the key themes from staff and residents.

Some staff said they use the ambulance service when they feel the Emergency Care Practitioner hasn’t responded as quickly as they would like.

Some staff felt that often residents are taken to A&E and then straight back, demonstrating some unease that they are being taken unnecessarily, but they were also keen to highlight that isn’t always the case.

One resident with a long term condition reported having to go to hospital in an ambulance often but always being sent back to the home without a stay, however the same resident thought they were probably safer being cared for in that scenario in hospital as they ‘have more equipment and are more used to dealing with my condition’.

Some staff felt that the key to reducing the number of 999 calls would be training - giving staff the confidence to manage the situation in-house.  Suggestions included providing a higher level of first aid training, more training around end of life care, extended eat. It was also suggested that working in partnership with other care homes could mean staff could access more training or things like working with St Lukes around end of life care.

Some staff felt that nurses in care homes weren’t utilised as well as they could be – for example could they deliver the flu vaccine rather than a different nurse having to come in to deliver it, and the same with venepuncture and diabetic screening.

Staff felt that retaining staff is difficult and that solutions to that could include having more students visiting the homes, and more access to training for all staff to give them an incentive to stay. 

Some staff reported that staff don’t feel confident to make judgements and that having an ambulance crew or paramedic on site to make a decision takes the onus off them.

Residents had mixed opinions on whether it was better to be cared for in hospital or in the care home. Some felt they would be safer in a medical setting, others felt they wanted to keep the familiarity of the place and staff they knew.

Staff felt that most of their residents would prefer to stay in the home to pass away and that more training would enable them to make sure it is as dignified at the end of life as possible.  They said that for staff who hadn’t seen anyone at the end of life before it could be very upsetting and cause worry that they don’t know if they are doing everything the right way. 

Virtual appointments for hip and knee patients

Engagement Summary

The elective and diagnostics workstream wanted to get views from patients to a proposal that hip and knee replacement follow up appointments would continue to be provided in each hospital, however where a patient is in agreement the one year follow up appointment would be virtual, meaning the patient doesn’t need to attend a clinic and be seen in person. The ICS engagement team visited hip and knee outpatient clinics in Bassetlaw, Mexborough and Doncaster hospitals in June 2019 and spoke to patients waiting for their appointment.

This report documents a summary of the key themes from patients.

Nearly all patients agreed that they would be happy with the proposal, reasons stated included:

• Not wanting to make unnecessary visits
• Having caring responsibilities
• Difficulty getting to hospitals
• Not wanting to take up unnecessary appointments
• Feeling like they spend more time at hospital than home
• Reliance/impact on family members for journeys to hospital

Patients did stress the importance of clear explanations for them and reassurance.              

One patient had experience of a friend outside SYB who had been followed up in a different way and therefore saw the proposal as positive.           

One patient said they valued having the follow-up appointment if they were having problems so that they could talk to someone. However they also said they use technology so would be happy if the virtual appointment still offered the opportunity to ask questions.

Some patients said their support for the virtual follow-ups was dependent on the technology being easy enough for patients to use.      

One patient would prefer face to face but could see that it would be helpful for other people to have the virtual option. This was the only patient who suggested that digital wouldn’t work for them.                                                  

When asked if there were other areas of their follow up care that could be improved the majority of respondents said no, that they had been happy with their follow up care, some people were particularly complimentary about follow up physio. However a couple of people said they felt it was very important that there was easy access to someone to speak to after the procedure should they have concerns/ questions.

When asked about the kind of information that would be helpful for patients to understand their follow up care many said that they were happy with the information they had been provided, however other suggestions included:

• Including an explanation of how, when and where they would be followed up in the existing patient information, which was seen as excellent
• Pictures of physio and xrays and other elements that would happen after the procedure
• One patient said a booklet/ leaflet would be better than the card, which they reported having been too easy to lose, however another felt the card gave exactly the information they needed
• Reminder letters
• A phone number to ring with any worries
• Many respondents wanted appointment letters to give more information about what the appointment was for
• It was overwhelmingly felt that paper letters/ leaflets would be better than digital for sharing important information about their follow up as it would be easier for people to keep and refer to if they needed

The respondents interviewed travelled to their appointment via a range of methods including, being driven by a friend/ relative, driving themselves, waking, and public transport.

Localising repeat echo scans

 Engagement Summary

 The elective and diagnostic workstream wanted to seek patient opinion on the idea of offering for patients’ repeat Echo scans to be undertaken locally. The ICS engagement team visited the Northern General in May 2019 and spoke to patients waiting to go into echo clinic.

This report documents a summary of the key themes from patients.

Most people felt that it made sense for patients to be followed up in a local hospital rather than having to travel. They said that ease of getting to your local hospital, easier parking, and familiarity with your local hospital were reasons for that choice.

 One person said they felt in principle it would be an excellent idea to have the service in their local hospitals but they would still value patient choice.

Some of the respondents had had experience of scans in their local hospitals, but the majority had always had to travel to Sheffield.

When asked about their experiences in Sheffield most had not had bad experiences, although parking issues was raised by a number of respondents. One patient reported waiting a long time for results, and one would like more of their care to take place in the same place at the same time.

The respondents interviewed travelled to their appointment via a range of methods including, being driven by a friend/ relative, driving themselves, taxi, patient transport services and public transport.

This summary of SYB ICS engagement activity was provided to partner CCGs for their annual reports covering the period April 2018-April 2019. Copy for the period April 2019-April 2020 will be provided in April 2020.

In 2018-19 the ICS involved patients, the public, staff and stakeholders on the Hospital Services Review, NHS 111 procurement, over the counter medicines and ophthalmology services and transport and travel with regard to accessing services. The Citizens’ Panel  continued to develop with members offering feedback on engagement planning and direct involvement in working groups. 

Hospital Services Review

In August 2017 the ICS commenced a piece of work looking at hospital services in the region. Patient, public and clinical involvement was key to this work. A number of methods were employed in order to discuss with and gather the thoughts of staff, stakeholders, patients and the public to help inform the independent report. The engagement which took place during the review included:  public events; an online survey, which was made available in an easy ready version; paper surveys at a range of events, by request and in hospital out-patient department waiting areas, main entrances, and areas convenient for staff; a telephone survey with 1000 members of the public who were selected to be as representative as possible of the demographic makeup of South Yorkshire and Bassetlaw; discussions with the Youth Forum of Sheffield Children’s NHS Foundation Trust; discussions with GP Practice Patient Participation Networks ; sessions with a wide selection of seldom heard groups including: young mothers, asylum seekers and refugees, members of ESOL (non-english speaking) groups, members of the deaf and mute community, Pakistani and Somali women, members of the Roma community, members of the LGBT community, young people’s groups, elderly people’s groups, recovering addicts, current drug and alcohol addicts, members of a support group for people with physical and/ or mental health conditions, and young people from the autistic community.

Findings from the engagement that took place before May 2018 can be found here:

https://bit.ly/2U3M0pY and https://bit.ly/2IwOqMg

Recommendations from the review, which were published in a report (including an easy read version) in May 2018, proposed that to continue providing high quality services, hospitals in Barnsley, Bassetlaw, Chesterfield, Doncaster, Rotherham and Sheffield must work together even more closely in a variety of different ways. This included ways for the hospitals to work together better with the development of hosted networks. It also included transforming the way we use our workforce, to make the best use of the staff we have at the moment, and to ensure that people receive care as close to their own homes as possible. The report, which can be found here: https://bit.ly/2U3M0pY details how patient and public involvement has influenced the report findings.

Following the publication of the Hospital Services Review report on the 9^th May 2018 (and subsequent easy read version of the report), the partners involved in the HSR were invited to consider their response to the Review and its recommendations. Stakeholders including patients and the public were invited to respond with their views on the full report by 12th July.

The specific written responses to the Hospital Services Review final report have been included in Annex A of the Strategic Outline Case and have, along with the wide range of public views collected during 2017-18, helped to shape the drafting of the Strategic Outline Case. The public feedback received, as well as the review team’s response, is detailed in Annex A of the Strategic Outline Case, which can be found on our website here: https://bit.ly/2Nm0r5X .

In order to ensure patients and the public were given enough time to give their responses, engagement did not cease on the 12^th July and continued until the end of September. In recognition of the length and complexity of the Hospital Services Review Report materials which highlight the recommendations and key points in the report, and an accompanying easy-read survey were developed.

At this stage engagement was carried out with over 400 patients, the public, staff and stakeholders, again using range of methods to gather peoples’ views. Face to face workshops were held with organisations and groups of people including Sheffield Futures young people’s groups, the prisons service, SAVTE (charity for people for whom English isn’t a first language), mother and baby groups, dementia groups, groups for people with physical and mental disabilities, groups for vulnerable women, groups for people with alcohol dependencies, people from a traveller background, asylum seekers, ROMA communities, children and families affected by deprivation, carers, young carers, victims of domestic violence, sex workers, people who live in isolated rural communities, deaf community and armed forces/veterans. Survey responses on the review recommendations were also obtained from workplaces including Stagecoach, South Yorkshire Fire & Rescue, Distinction Doors Ltd Barnsley, GP practices, Patient Participation Group Network meetings and National Citizenship Service events. Work was also carried out to communicate to wider audiences at public events such as NHS 70th Birthday celebrations, Annual General Meetings of NHS organisations, Sheffield University Health and Social Care nursing students lecture. Flyers were handed out and conversations held at local events and leaflets were also sent to local community centres and libraries. A report on this stage of the engagement can be found here: https://bit.ly/2XgSoMu

In January 2019 focus groups with pregnant women, new mothers and groups most affected by gastroenterology conditions were conducted to help understand what is most important to the population, in particular current or recent service users, should there be any reconfiguration of services. The report is currently being pulled together and will be given to the maternity, paediatric and gastroenterology workstream leads to inform their thinking and development of business cases, should the decision be made to further explore potential reconfigurations in these services.

Citizen’s Panel

In January 2018 the ICS launched a Citizens’ Panel in recognition that as its work develops, it is vital that the voice of local people is at the heart of what it does. The Panel brings together people from across South Yorkshire and Bassetlaw to provider an independent view and critical friendship on matters relating to the work of the Integrated Care System.   There are currently 13 volunteers who sit on the Panel with all areas of the region represented. The Citizen’s Panel has been speaking to different communities about the Hospital Services Review, contributed to the 569 million reasons medicines campaign shared their views on the orthopaedics pathway for hip and knee replacements as well as the NHS 111 procurement.

Transport and Travel Panel

Following the formulation of the recommendations from the Hospital Services Review a transport panel comprising of patients and members of the public from each area of South Yorkshire and Bassetlaw was set up in November 2018. The panel looks at the potential impact changes to services would have on patients, the public, carers and families with regard to travel including testing journey times where possible to provide realistic insight into the impact of any service change. The panel looks at how to improve transport and travel planning and infrastructure around NHS services.

NHS 111/ Integrated Urgent Care Service Procurement

The Citizen’s Panel has also taken a role in the procurement of a £17.6 million contract which will see the Yorkshire Ambulance Service provide an Integrated Urgent Care Service to the people of Yorkshire and the Humber. The Yorkshire Ambulance Service will continue to provide the NHS 111 call handling service which provides patients with core clinical advice but now patients will benefit from a number of enhancements. The new enhanced service has been procured in partnership by Yorkshire and Humber’s CCGs and will commence in April 2019. The Citizen’s Panel were involved throughout this procurement work providing the patient representative voice.

Long Term Plan

The NHS Long Term Plan was published by NHS England in January 2019 and sets out how the NHS will improve the quality of patient care and health outcomes. It also explains how the £20.5 billion budget settlement for the NHS, announced by the Prime Minister in summer 2018, will be spent over the next 5 years.

The South Yorkshire and Bassetlaw Integrated Care System (ICS)  has been tasked with working with their local partners to develop their local response by producing an ICS five-year strategic plan by the Autumn of 2019. As an essential part of this process wide engagement with health and care staff, patients, the public and other stakeholders across South Yorkshire and Bassetlaw about the ambitions the Long Term Plan sets out, as well as the process by which we will translate it into local action is underway.

Discovery Days

In November 2018 the ICS worked with NHS England and all South Yorkshire and Bassetlaw partners to develop a co-designed communications and engagement approach. In January 2019 the organisations came together again to develop a co-designed action plan for clinical engagement and leadership.