Transcript Integrated Care Programme Board`s

CCG Clinical Commissioning Forum
Thursday 1st October 2015
THE OUTLOOK
OCTOBER 2015
MONEY
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CCG good position and done lots – but where next?
December - 3 year CCG allocation?
New capitation formula – impact and pace of
change???
New requirements in Planning Guidance?
CCG growth could be 0
New capitation formula for primary care
PMS reviews – money stays in CH primary care
NHSE primary care budget decreasing
LOCAL ECONOMY
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Doing OK
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Collaboration and work of local GPs
No deficits so far…
£32m Non recurrent schemes to evaluate
Tough in provider land – no let up on money,
performance and quality ->deficits?
In year and recurrent cuts to Public Health
LA cuts brutal
CCG CONTRACTS – 15/16
Contract
Recurrent
Non recurrent
Total
FHV
276
1058
1334
Mental Health
385
385
maternity
259
259
Vul Childrens
1000
1000
1874
3386
EOLC
160
160
Extended hours
840
840
Duty doc
1485
1485
6417
8849
LTC
1512
2432
Clinical commissioning is recurrent; phlebotomy and anticoag = new recurrent
contracts with Homerton and Confederation
CONFLICTS
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Direct and indirect financial
Reputational
Loyalty
Please score evaluation bids with professional
integrity for patient benefit
PROCESS FOR CCG
CONTRACTS
1
2
3
• Programme Board develops an idea
• Test if GPs are “best” provider
• Service spec - consult CCG members – Consortia, CCF - and
PPI. WILL THIS BRING BENEFITS TO OUR PATIENTS
• Discuss with Confederation and LMC
• CEC signs off the service spec
• CCG clinical leads step out
4
5
6
• Programme Director works with Independent GP Advisor and CCG Contracts
team on KPIs and contractual arrangement
• In most cases contract will be framed as delivery expectations of GP
Confederation not individual practices
• Local GP Provider Contracts Committee considers the spec, KPIs, outcomes,
what payment will be made on and whether VFM
• Recommends contract to Governing Body
• Once agreed contract negotiations commence between CCG and Confederation
(and LMC)
• Once contract agreed Confederation recommends payments to Programme
Boards and then onto LGPCC
THE FUTURE
WHATS THE LEAST WORST
OPTION?
THE PERSPECTIVE FROM
COMMISSIONING
NHS POLICY
No top down reorganisation – permissive not prescribed!
DEVOLUTION
1
1
ACCOUNTABLE
CARE
ORGANISATIONS
DEVOLUTION IN LONDON
ESTATES
(LONDON)
DEEP
INTEGRATION
DEEP PREVENTION
(PAN BOROUGH)
1
2
ACO/VANGUARDS
INTEGRATED
SERVICES –
Primary care,
acute, CHS, mental
helth, social care
1
3
Capitated budget
Delivering
outcomes
Accountable to
NHS
Accountable to
patients
LOCALLY…
•“Leaders summit – working together and
understand each others issues
•New models of care/vanguards
•Financial challenges for LA
•Enthusiasm from providers to pilot integration
CCG & Confederation
•Maintain NHS commissioning responsibility – not
delegate to LA
•One Hackney is a building block
PILOT DEEP INTEGRATION?
• WORK
TOGETHER
HACKNEY HEALTH AND SOCIAL
CARE PARTNERSHIP
Homerton
GP Confederation
Social Care
ELFT
CHUHSE
CCG
1
5
DEVLOVE A BUDGET
PART CCG
PUBLIC HEALTH
SOCIAL CARE
• MOVE TO FORMAL
PARTNERSHIP &
GOVERNANCE
• ACO
OVERSIGHT BY
HWBB
A PERSPECTIVE
PROS
ISSUES
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Head of steam/pilot opportunity
•City
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Providers already working together
via One Hackney
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Reduce transaction costs in
providers and commissioners
Agree to move away from PBR and
tariff – understand costs
Provider savings by working
together
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Collective responsibility
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Make best use of Hackney £
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Transparency
•Non Hackney care – (£70m)
•Shrinking budgets – CCG; Social Care; Public Health
•Whats in and out (?Children social care, specialist, core
GP contract)
•Political influence
•?Clinical voice
•?Patient voice
•Making tough decisions on how to share the £
•Incentives to keep down referrals
•Organisational form to allow the delegation
•Residual commissioning function
•Procurement
•Patient choice
•Regulation and oversight
ALTERNATIVES
DO NOTHING
WORK AS INEL
•CCG within Inner North
•Keep heads down and
stay as we are
•Chaos around us?
1
7
East London
•As well as local cost
pressures add in Barts
Health deficit.
•Loss of City & Hackney
perspective and focus
If went for pilot
•Is there common understanding and agreement
•Use pilot to explore what it means
•Describe the journey, steps and principles
•Decision points along the way – stop/go
•Formal partnership and delegated budget go hand
in hand – cant do one without the other
•More transparency and alliance contracts in 16/17
building on One Hackney
•More join up between Public Health and CCG
1
8
END
Dr Kathleen Wenaden
GP Clinical Lead for Diabetes
City and Hackney CCG
Current service
 Diabetic Centre: DSN’s/Dieticians
 Access to specialist advice – Diabetes advice line
 Questions: how do you feel DSN’s/Diabetic Centre
model is working?
 Is it mainly insulin focused? Lipid/Hypertension Mx?
 Annual review with DSN’s?
 Diabetic Care Plans?
 Comments?
Current Issues
 Still low on prescribing of high intensity statins
 Hypoglycaemia: esp elderly people on SU’s/insulin –
should be aiming for 8-9% depending on co-morbidity
 (as agreed by European Society of Geriatricians, and
American Geriatric Society).
 Will be trying to reach a local consensus with John
Robson, CEG in Newham/TH/City & Hackney.
END
Developing a primary care strategy – discussion at
the Clinical Commissioning Forum
1st October 2015
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In April 2015, C&H CCG asked its Primary Care Quality Programme
Board to develop a strategy for Primary Care for the next 1-3 years.
We have consulted with:
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Our patients and the public
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Our members
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Local stakeholder organisations (C&H LMC, NHSE, C&H GP
Confederation, voluntary sector)
Our consultation has told us that the strategy should be congruent
with the following principles….
Supports use of well designed,
robust, high quality IT to facilitate:
Works to reduce
unwarranted
variation in
quality of care,
and in its access
Supports the
delivery and future
development of high
quality services for
patients
Enhances morale
and resilience of
clinical and support
staff to make
general practice in
C&H an attractive
place to work
* empowerment of self-care
* near patient clinical decision
making
At all times is
mindful of (and
receives feedback
on) patients’
experience of care
* ease of recording of activity
undertaken
* effective transfer and sharing of
information
Primary
Care
Strategy
Supports greater
collaborative working
across practices
Works to reduce
health inequalities
Planning also
reflects joint NHS
England/CCG
strategic plans for
primary care
Funding decisions
will be based on
current intelligence
rather than
historical
precedent
Ensure streamlined
processes for quality
assuring the delivery
of services contracted
from practices
Supports equality of
opportunity to all GP
practices including
fairer distribution of
funding across the
CCG
Supports the role of
GPs as expert
generalists working
to provide
continuity of care
A vision for Primary Care
These are the aims we want to achieve for City and Hackney:
Be in the top 5 CCGs in London in terms of quality
Be an attractive place to work for existing and new primary care staff
Delivery of safe services
Services that are resilient by being productive, efficient, safe and value for
money
Services that are of high quality and offer comprehensive patient support
Services that are accessible
Reduce health inequalities
END
Planned Care Headline Commissioning Intentions
Community services:
•Increase capacity of community gynae, ENT and dermatology
•Develop a community based minor eye conditions service jointly with Islington CCG
•Implement community post operative wound care service and develop a shared plan with HUH
to improve leg ulcer clinic care
Cancer:
•Review service level agreement between HUH and Bart’s Health for Acute oncology service
•Review with two week wait/cancer office capacity with HUH to manage existing referrals and in
view of new NICE guidance
•Direct Access colonoscopy with triage
•Stratified follow up – prostrate, breast, colorectal – (building on Time to Talk?)
Misc:
•Work with HUH to deliver a tier 3 weight management service
•On behalf of PHE, commission a new service for latent TB testing from primary care
•Review of Bi-lingual Advocacy service
END
Summary of Prescribing Programme Board’s
Commissioning Intentions
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Reduce the inappropriate use of antipsychotic, antidepressant, anxiolytic, hypnotic and antiepileptic medicines in
people with learning disabilities
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Increase the number of medication reviews carried out by a Practice Support Pharmacist (PSP), prioritising the
following high risk patient groups:
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Patients who have frequent hospital admissions
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Patients on compliance aids
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Patients in nursing homes
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Patients requiring domiciliary medication review
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Patients on polypharmacy
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Patients on high risk drugs which require shared care
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Patients with diabetes
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Patients on high dose inhaled corticosteroid
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Consider the introduction of Medicines Reconciliation for patients with CKD 3-5 who have been referred by practices
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Increase GP uptake of IT prescribing tools e.g. electronic formulary, antibiotic app and MUST Tool
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Deliver Respiratory Training for GPs and Practice Nurses by PSPs and ACERs Nurse
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Improve our sustainability by supporting interventions to reduce medicines waste e.g. charitable recycling of returned
medicines
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Supporting the uptake of dressings supply through the dressings optimisation scheme
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Support prompt implementation of national warnings and local Formulary agreements
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Ensure that practices are supported in undertaking Antimicrobial Training
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Continue to engage with practices at the annual prescribing visit and through the CCG medicines management
newsletter
END
Summary of Urgent Care Programme Board’s Commissioning
Intentions for 2016/17
Primary Care:
•Monitor the delivery of the Duty Doctor scheme to ensure patients with urgent care needs are being treated in the appropriate setting
•Work with the provider to increase population coverage for extended hours to ensure an equitable service is delivered for all patients in City and Hackney
•Implement the recommendations from the out of hours review to ensure we have high quality sustainable primary care out of hours as well as in-hours
•Support the delivery of the newly developed ParaDoc pathway to ensure complex, frail and elderly patients are treated at home when appropriate to do so
•Engage our community pharmacists in the overall urgent care strategy ensuring patients are sign-posted to appropriately and accordingly
•Continue to explore opportunities for working across the new urgent and emergency care network to ensure patients accessing urgent care are treated by the
right clinician, first time everytime.
Secondary Care:
•Continue to work with the local acute trust to ensure the A&E department continues to meet the 4hr performance target
•Explore opportunities to develop ambulatory care models that improve the patient journey, experience and outcomes
•Maintain the Primary Urgent Care Centre as a service for patients with urgent care needs that can be treated by primary care clinicians
Community Crisis response:
•Continue to support the delivery of the Integrated Independence team and its links with urgent care access points, ensuring patients in are treated by the right
clinician when in crisis
•Monitor the delivery of the action plan to engage care homes and housing with care schemes with the overall crisis response pathway
Emergency Care:
•Work with associate commissioners to ensure LAS performance continues to improve for its urgent and emergency/Red1 cases
•Engage LAS with continued work to refer into City and Hackney’s community crisis response pathways
•Ensure on-going referrals to the newly developed ParaDoc pathway, to improve experience for patients with complex health needs
Communications and engagement:
•Continue to work with our patient groups and patient representatives to raise awareness around the right care at the right time everytime including self care,
primary care and urgent and emergency care when in crisis.
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5
END
Integrated Care Programme Board’s
Commissioning Intentions
 We will reduce delays in discharge from hospital
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No more than 3% of medical beds will be occupied by patients who are ready for discharge.
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We will commission sufficient capacity of NHS services to support effective discharge, particularly continuing
healthcare and neuro rehabilitation services
 We will commission more proactive community care for frail patients
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Co-ordinated around their needs and delivered by new multi-disciplinary teams comprising health, social care and
the voluntary sector: One Hackney and the Integrated Independence Team
 All integrated community services (nursing, therapy and multidisciplinary services) will work in quadrants aligned
to GP practices
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They will adopt a common approach to implementing care plans
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Care across these services will be co-ordinated by a named lead professional for each patient.
 There will be effective transitions into community settings and good communication
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The lead named professional will be aware when patients are admitted
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Plans will be enacted with integrated community services as soon as possible during admission
 Elderly patients will spend less time in hospital
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All community services will be aiming towards reducing emergency bed days for elderly patients
 There will be better access to end of life care services for patients
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Patients will be identified as approaching end of life where appropriate
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Patients will be supported to express their wishes about care at end of life (these shared where appropriate) and
supported to die in the place of their choice
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There will be better communication between secondary and primary care about prognosis and conversations about
this
END
Maternity Programme Board
Commissioning Intentions
October 2015
Summary of Maternity Programme Board’s
Commissioning Intentions
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Improve pre-conceptual care and early identification of medical and social risk through
implement of an Early Years contract to be delivered via the GP Confederation.
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Early booking (by 10 weeks) to improve outcomes of pregnancy.
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Continuity of care in the antenatal and postnatal periods.
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Ensure a high quality safe service, with the aim of reducing neonatal and maternal morbidity
and mortality.
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Ensure women have a good experience of care throughout the antenatal, perinatal and
postnatal periods.
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Ensure parents can help to shape maternity services in City and Hackney through listening to
patient’s feedback.
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Improve the uptake of the flu and pertussis vaccinations.
Improving Women’s Experience
AIMS
WHAT WILL BE DIFFERENT?
HOW CAN WE DELIVER THIS THROUGH
OUR PROVIDERS?
• We want to ensure women have a
good experience of care throughout
the antenatal, perinatal and
postnatal periods.
• Increase the response rates of the Friends and
Family test so we can accurately monitor patient
experience.
• Social Action for Health have been
commissioned to work with the MSLC
to improve recruitment of members
and engagement with local families.
• We want to ensure parents can help
to shape maternity services in City
and Hackney through listening to
patient’s feedback.
• We wish to strengthen our excellent
Maternity Services Liason
Comminttee (MSLC) so it can
engage with more families in City
and Hackney and empower parents
to demand the best possible care.
• Review complaints to ensure themes are identified
and mitigated wherever possible.
• Ensure women are given adequate information
about choice of birth, with the aim of increasing
numbers of low risk women delivering in the midwife led birth centre and at home.
• Have a rolling programme of ‘Walk the patch’,
whereby the MSLC gain feedback from users of the
service to help inform our commissioning
intentions.
• We will build on the CQUIN improving
the response rates to the Friends and
Family test.
• We will regularly review complaints at
the Maternity Programme Board.
• The Homerton are considering
running the ‘Whose Shoes’
programme to help gather more user
feedback.
Pre-Conceptual Care
AIMS
WHAT WILL BE DIFFERENT?
HOW CAN WE DELIVER THIS THROUGH OUR
PROVIDERS?
• Improve pre-conceptual care
to improve outcomes of
pregnancy
• All women should be offered
opportunistic pre-conceptual care.
• Commission Confederation to provide pre-conceptual
care for women with the following conditions:
 Diabetes
 Hypertension
 Asthma
 Epilepsy
 Mental health
 Thyroid disease
 Rheumatological conditions
 BMI >35
.
• Women with chronic diseases should
have their condition and medication
optimised prior to conception. Diseases
requiring good pre-conception care
include:
 Diabetes
 Hypertension
 Asthma
 Epilepsy
 Mental health
 Thyroid disease
 Rheumatological conditions
 Obesity
 Mental health illnesses
• Women with complex medical/obstetric
history or with more than one chronic
disease should be referred to the preconceptual clinic at the Homerton.
• Homerton: (via tariff)
-pre-conceptual clinics for complex patients
-obstetric advice service
• ELFT
Perinatal Mental health support for women taking
medications as treatment who may be planning a
pregnancy
Identify ways women can be referred or signposted to
support (preconception pathway)
Antenatal Care (part 1)
AIMS
WHAT WILL BE DIFFERENT?
HOW CAN WE DELIVER THIS THROUGH OUR
PROVIDERS?
• Safe, joined-up antenatal
and postnatal care delivered
by a woman’s GP and named
midwife with input from
obstetricians when required
• Early identification and
referral for medical and
mental health conditions
• Medical and mental health
conditions managed in a
timely and appropriate way
• Improve uptake of healthy
start vitamins
• Increase aspirin prescribing
• Improve uptake of flu &
pertussis vaccinations
• Early identification of
vulnerable families, including
relationship difficulties,
safeguarding issues and
adequate support provided
Patients who present to their GP when first
pregnant will
•receive advice on diet, smoking, alcohol and
healthy start vitamins
•have their BP and BMI checked
•be prescribed aspirin if indicated
•have a social psychological and medical risk
assessment undertaken
•have medical issued addressed, including
increasing levothyroxine if necessary, full
medication review, assessing asthma, reviewing
their mental health
•be referred on for antenatal care in a timely
manner using pan-London referral form to share all
relevant information with secondary care
•be referred for specialist services if indicated, e.g.
perinatal mental health, primary care psychology,
public health or specialist midwives, FNP, medical
obstetric clinics, bump buddies, benefits advice,
Family Action, relationship counselling
•All pregnant women will be screened for
depression and referred on for further care if
necessary
Confederation
•Introduce a payment for ‘First contact
appointment’, i.e. when women first present
pregnant to GP
•Confederation and Maternity programme board
could produce a pack for GPs to give women
containing:
Advice leaflet including signposting to further
information and important numbers
Healthy start vitamin form
Form for free prescriptions/dental care
Information on local services and antenatal
classes
Tailored information for women e.g. FNP,
mothers health support group.
•Continue with GP 16 week check and adding in:
Depression screening
Medication review
Prompt for flu vaccination
•Continue with regular meetings with midwives
Antenatal Care (part 2)
AIMS
WHAT WILL BE DIFFERENT?
HOW CAN WE DELIVER THIS THROUGH OUR
PROVIDERS?
• Safe, joined-up antenatal
and postnatal care delivered
by a woman’s GP and named
midwife with input from
obstetricians when required
• Women will be booked by 10 weeks gestation
(if they present early enough) in the
appropriate place, e.g. for low risk women in a
community clinic, for high risk women in the
medical obstetric clinic, for vulnerable women
by public health midwives.
Homerton (via tariff):
-Booking by 10 weeks (when referred before this
time)
-Continuity of care by midwife
-Obstetrician input where required
-Public Health Midwife
-Obstetric advice service
- CO screening CQUIN
• Good communication
between professionals
• Early booking (by 10 weeks
gestation) to improve
outcomes
• Preparation for parenthood
and introduction to health
visiting service
• Women will receive continuity of care
throughout the antenatal and postnatal
periods (definition of continuity TBC)
• Women will receive high quality targeted
antenatal education
• Vulnerable families will have joint antenatal
and postnatal visit by their midwife and Health
visitor
• Women will be screened for CO levels
(smoking)
• Improved communication between health
care professionals
Others:
-Joint midwife and health visitor antenatal and
postnatal visit for vulnerable women
-Targeted Antenatal classes – monitoring outcomes
and evaluating programmes and reviewing the
mental health messages/content.
Intrapartum Care: high quality and safe service
AIMS
WHAT WILL BE DIFFERENT?
HOW CAN WE DELIVER THIS THROUGH OUR
PROVIDERS?
• Reduce stillbirths
Many changes have been implemented at the
Homerton in response to the external review
of the 5 recent maternal deaths and the
recent CQC inspection. The impact of these
changes will be monitored.
• Completion of action plans from maternal death
reviews and the CQC inspection.
• Reduce neonatal morbidity
and mortality
• Reduce maternal morbidity
and mortality
• Promoting normality
including increasing
deliveries in birth centres
and at home.
• Ensure timely admission and
timely access to pain relief
• Auditing and reviewing changes which have been
implemented to ensure they are embedded in
practice.
Areas focused on will included:
•
•
•
•
Recognition of the deteriorating patient
Escalation of the unwell patient
Staff competency and training
Timeliness and quality of investigations in
to serious incidence
• Ensure learning from significant events are
embedded into practice
• Ensure access to interpreter and advocacy
services
• Review of performance data and increase
its use in identifying poor performance and
areas for improvement
• Monitor the timeliness and quality of significant
event reporting.
• Benchmarking against and implementing London
Strategic Clinical network (LSCN) toolkits
• Evaluation of the enhanced CTG training (funded by
NRF)
• Build on 15/16 CQUIN that aimed to increase births
at home and in the birth centre
• Continue to use patient feedback to assess admission
and pain relief timings
Postnatal Care
AIMS
WHAT WILL BE DIFFERENT?
HOW CAN WE DELIVER THIS THROUGH OUR
PROVIDERS?
• Continuity of care in
postnatal period
• Women will receive community postnatal
care from their named midwife.
Confederation:
-GPs to continue to provide 6-week postnatal
appointment
• Early identification of
vulnerable families, including
relationship difficulties,
safeguarding issues, mental
health conditions, domestic
violence.
• Women will have a comprehensive 6
week check by GP and be sign posted on
to other services as required.
• Follow up of difficult
pregnancies or difficult early
years to plan subsequent
pregnancies for improved
outcomes
• Mental health assessment (including
depression screening and referral on for
further care if necessary).
• Vulnerable families will receive a joint
midwife and health visitor visit to
formally hand over care
• Vulnerable women requiring extra
support will be referred on to ‘bonding
with baby’ programme
• Improve breastfeeding support
Homerton:
-Extend continuity to postnatal period so women see
their named midwife antenatally and postnatally
-Joined-up comprehensive breast feeding strategy
including evaluation of volunteer project and ensuring
community access to breastfeeding drop in support
Others:
-Evaluate ‘Bonding with baby’ programme
- Evaluate Breastfeeding peer support programme and
implementation of baby friendly standards
- Evaluate mothers health support project
- Joint midwife and health visitor postnatal visit for
vulnerable families to ensure handover over of care
- Mapping existing postnatal group offer to ensure
evidence based mental health support messages are
embedded.
END
Summary of Mental Health Programme Board’s
Commissioning Intentions 2016/17
•
Mental Health Alliances will be expanded bringing secondary care, primary care, third sector and local
authority providers together in a sustainable funding model, which incentivises outcomes, integration, quality
and innovation based on shared aims and shared outcomes.
•
Enhanced Primary Care services will continue to transfer higher numbers from secondary care services
based on a recovery model, following the recent service redesign and expansion of the service.
•
In line with the Crisis Concordat, the interface between organisations, including primary care, secondary
care, NHS 111, third sector, police and ambulance services will be improved to create a more responsive and
better integrated crisis pathway
•
CAMHS: new funding will improve eating disorders pathways and transform services to improve links with
schools and children’s social care and to continue to address early intervention and family support
•
IAPT services: we will continue to hit our access target and will work on improving recovery.
•
Dementia: we will maintain our prevalence identification and promote support for patients and carers through
funding the Altzheimer’s society workers and we will work through the dementia alliance to ensure efficient
pathways, avoiding duplication of service.
END
Long Term Conditions Commissioning Intentions 2016-17
Planned
Scheme
Revised version of
core LTC contract
Current Funding
Mixed
(£1,512,000
recurrent,
Potential
Future funding
Requesting
recurrent funding
£949,699
Scheme
Current Funding
Future Funding
LTC contract “time to talk” and “time for cancer
Non-recurrent
Requesting recurrent
Further development of virtual renal service
Non-recurrent
Requesting recurrent
Exercise on referral (specialist input)
Within PH offer
Requesting nonrecurrent
Neurology – service review
Recurrent
Recurrent
Social prescribing roll out
Non-recurrent
Requesting recurrent
Stroke – support for people with high care needs
after hospital
Nil
Potential request for
non-recurrent
Early adopter site for pre-diabetes lifestyle
intervention
Nil
No direct cost
implications
Further peer support programmes for LTCs
Non-recurrent
Potential request for
non-recurrent
Personal health budgets – continued roll-out
Within existing
budgets
No change
Learning disabilities – care reviews and support
into volunteering/employment
Nil
Potential request for
non-recurrent
non-recurrent)
Community heart
failure reprocurement
Recurrent
Hypertension remodelled pathway
Recurrent
Recurrent
Recurrent
END
Summary of the Children’s Programme Board
Commissioning Intentions
•
Improve transition pathway for children aged 12-18 years (up to 25 years for children with Special Educational Needs) to
provide seamless care , preparation for adult health services, and early identification of medical (including mental health)
and social risk.
•
Continue to invest in the Children's Community Nursing team extending the service hours and assessing the need for a
24hr service.
•
Combine the GP Antenatal contract and the GP Vulnerable Children's contract into a Children's and Families Primary
Care Support Contract.
•
Continue to commission improved identification and management of children’s long term conditions in primary care
•
Ensure a high quality safe service, with the aim of reducing unscheduled care and referrals to hospital services by
establishing a range of interface paediatric services / ways of working. Through greater access to specialist advice,
development of joint pathways and guidance, and a structured programme of education, there will be enhanced support in
primary care, informing increasingly empowered children, young people and their families. Monitoring will include audits,
internal review and benchmarking.
•
Establish a programme of education across secondary and primary care to support the management of children in primary
care / out of hospital, and to enhance the confidence of staff. This will be underpinned by improved access to documented
pathways / referral and service information.
•
Establish consistent approaches to obtaining and measuring feedback of care in primary, community and hospital settings
from both children / young people and their families.
•
Ensure children and families can help to shape children's services in City and Hackney through listening to patient’s
feedback, via a strong Children's and Families Forum
•
Continue the review of children’s community health services to ensure clarity of outcomes and alignment with new national
and local policy
END