Transparency in Outcomes a framework for the NHS Question 1 Do you agree with the proposed principles that should

d underpin the NHS outcomes framework? Should focus on service users and carers not just patients Should focus on patients needs and what matters to them. It should be a principle that people can define their own outcomes Should put carers in the principles alongside family members friends etc. Needs to emphasise carers more throughout the whole of the document. voice is needed for those who cannot speak for themselves. !hat about the "oluntary Sector# $ommunity %rganisations? !hy are health care professionals not in the statement? &ocus on what matters to patients and clinicians ' outcome measures for patients and clinicians should be separate( clinicians will be influenced by )overnment targets. *rinciples should specify +non,medical- measures. .alance of both measures and outcomes. *eople should be at the centre of their care. *assing over to )*s is a concern ' +do not care or understand mental health issues-. Not mentioned recovery. /o clinicians now buy into the recovery method? Highlight )*s who are interested in mental health and who know about recovery outcome measures +)*s claiming depression does not e0ist-. )*s accept they are not good at mental health and work in conjunction with consultants. 1ore training will be needed in *rimary $are. )*s working with employers does not happen. $onsultants#)*s do not understand what is happening in the community. )*s do not engage ' need more partnership working with local authorities( charities( providers and 2rd sector organisations. Holistic integrated approach between NHS and social Services. *ower to )*s to enable them to commission takes away power to the public. $omparison with other countries ' valid and useful. /ignity is not mentioned within this documents. 34uity ' build up to a level 5e4ual across all areas6. 34uity should be a principle. Specialist service may be done away with i.e. 7/( personality disorder. 1easures e0ist now i.e. H%N%S( 8%1 need to be implemented properly. 9se what is good in the system already ' do not re,invent for the sake of it. :oo 4uick

Question 2 Do you agree with the proposed structure and approach that could be used to develop the Framework ? 3ngagement comments *revention of illness not mentioned. *romoting good health. *revention is better than cure. Stakeholder in your own health. Not much inclusion from the patient side. ;uality of life different for different people i.e. allowing mental health patients to smoke. Individual enhancing the 4uality of life for people with long term conditions as set out by the service user( carer and health professional. Short term conditions ' enhancing 4uality of life( to include short term conditions take out long term conditions 3nsuring more localised needs are included. How can we ensure what it is a safe environment in the community? !ant#needs. /oes not address issues around dual diagnosis( drug and alcohol( seem to been non important issues. 7ocal authorities refusing to house people. $an and do recover from mental health. )ot to reach a crisis to access certain services( different across services. Structure and framework ' locks out local possibilities. *rinciples and functions lack accountability and alienate. Structurally ' *$: staff will still do job but employed by )* consortiums. How will service users and carers and the public actually engage with the )* consortium? Should cover morbidity as well as mortality !hat about people who dont have a )* or use their )*? Need signposting to services other than through the )*.

Question 3 How can the proposed outcomes framework support equality across all groups and help reduce health inequalities *artnership working is effective to reduce health ine4ualities. &urther improvements with partnership working between health and social care needed. 3veryone must know about it. 8esources in different languages 5needs base6 and regular reviews ' is this an ine4uality on how we spend money? 2

1ental health poor relation. 8ecognises local needs. 8eflective of local needs. /ifferent areas have different needs. 1ental health needs to be e0pressed within more principles. Should read <including mental health. :reatment 5take out the word in the =st paragraph of the five national outcomes6. &ramework should be person centred planning. :reating people as individuals. 7ook at individual needs. :iming. *opulation based ' word should be e4uity not e4uality. Same service where ever you live. 1oving population. lcohol( drugs( homelessness dont receive certain treatments if they have a label. )*s dont listen. ssumption on what people have come to )* for instead of listening Information :echnology can support ' standardising care. Health ine4ualities wont have all the tools. "isions ' but have to deliver structure and timetable. !hat are the cuts? .ig omission of 2rd sector. im to improve +life chances- ie employment( housing( reduce deprivation etc. NHS should have targets to employ people with mental health problems and 7/. Individuals > families should set their own outcome measures. How does the silent majority become heard ' the people who have no voice. ge shouldnt matter at ?@ !ho is going to ensure this happens?

Question ! How can the proposed outcomes framework support the necessary partnership working between the future public health service and social care services ;uestion mark around social care section due to means testing and criteria. Health care is free and not means tested. !hat resources are available? NHS protected 7ocal uthorities are not. In order to achieve you need to be working together. Should all be one organisation $ommunication within whole system needs to be improved. Shared accountability and joint accountability. 3

/ifferentiate between goals and targets. .etter understanding of each others roles. $ommunity reps 5from health groups such as 1H > 7/6 should sit on Social Services boards. Social services > health should have S 13 targets and goals( not similar to enable partnership working. Should be based around <enhancing the 4uality of life. *artnership .oards responsible for <whole person ' have to be influential and make a difference not just a talking shop.

Question " #re there any other possible methods or approaches for selecting improvement areas and outcome indicators :alk to the people who use the services. sk the service users and carers. *aternalistic. &le0ibility around moving between services. $ommunicate across organisations will be achieved if we have the same targets. ;uality of life measures should be everyones responsibility. /ifference around more affluent areas. /ifferent people have different e0pectations. 9nmet needs increased. *erson centred approach implemented properly. %utcome measures are individualised. )*s have a view ' what they see is a different vision. $entred on the individual and groups( take away the professional stance. )*s need to be aware of what their customers want. )* $onsortia must have sufficient representation to reflect the needs of the local community and must be listened to. !ill we be able to represent the local community? )et him mobile and get him home not what is at the root of the problem. Statutory duty to involve carers $arers have own outcome measures *enalty clauses for non achievement 7ocal outcomes re4uired use data that is available already.

Commissioning for Patients Question 1 How should $% consortia and local authorities collaborate to ensure &H'( public health( social care and children)s services are commissioned in an integrated way and meet the needs of local people( individuals and families Healthwatch. dvice from other agencies already doing it. 7egal duty to meet local assessments. Needs based assessments. 7isten to service users and carers. 1embership of the )* consortium should have service users and carers. 3lective membership from all stakeholders( 7ocal people( individuals and families. Involvement. Nationally set priorities for healthwatch. 7ook at their own target population and commission accordingly. Not 4uite joined up 1oderating structure. 7ocal accountability. !hat are the councillors doing in the local authorities? 3ngagement. Inclusive. $ommunication. 1ajor shift re4uired from where they are today to what is e0pected of them in the future. 3mploy a team of people to commission for them. Some will do it well( what about the ones who dont? %penly show public that they are a partnership. 1ore accountable. )ot to listen. Not sure whether having a 2rd sector party to commission would remove the idea that )*s know their public and how close they are to the public. %verspend#underspend. How is it going to be integrated? !ere does the voluntary sector and public section fit in? Include wider organisations. 5

Aeeping it simple. Not fragmented. :here will be healthcare members( &: members( 7 members etc( who do you feed up to when there is a problem? 7ocal elected members of the local council( local councillors. *harmaceutical companies ' vested interest( do not cloud judgement( unfair influences. )ive local community groups responsibility for part of )* funding. )ive )*s strict e4uality targets 8ing fence budgets 8e,write job descriptions and objectives to ensure this happens

Question 2 How can $% consortia( the &H' commissioning *oard and +ocal #uthorities best involve patients and those using services in improving the quality of health and care services /o it together as a $ommunity ' *artnership .oards Structures and level of involvement needs to be clearly defined. &ocus groups. *ublic and *atient &orums in each )* $onsortium .uild on the e0isting groups that are already out there /ont re,invent what we have already have. Aeep in touch with patients. $linicians and )*s need to be made accountable for involvement. Healthwatch ' to get the voice. /o not skew the results( NI$3 guidance re,evaluated. If we are working towards guidance ' need to plan guidance. Influence NI$3 guidance as these service users forums will feed into what we do. 1echanism to feed into NI$3 guidance and change these. International comparisons 5should be something in there about being transparent6. .eing truthful. :rying to influence things ' need to be honest what they can do and cant do. !hat is the point of comparing ourselves to other countries ' other countries pay different ta0 rates. 9se what the @ .oroughs *artnership do now in relation to engagement as a model. *ay volunteers for their time. Not one siBe fits all. How will we know we have been listened to? :ransparency of decisions

Question 3 6

,hat support might commissioners under the new structure need to allow them to take on their new and e-panded role 7ook at what is needed to support them across the whole system. .udget advice( business( finance( and management. 3nable them to have the time to still be clinicians. :ime to get out there and find out what the local needs are. 1ore understanding of local needs. Someone else employed to carry out the commissioning role. $ommunication. $linical support. *artnership. Specialist advice. .etter training. $ommissioning teams. ccountability. !hat are you doing to engage? 1onitoring. 7inks into the community. Independence. 1oney. Specialist mental health commissioner advisory board. 30pertise. Aeeping it simple. $ollaborate with each other. 7ocal people need support to talk to )*s as e4uals. *athways should be re,designed with patients 1anagement costs( will they just re,immerge in )* $onsortia over time.

Question ! ,hat support might commissioners .including $% commissioning consortia/ and local authorities need to resolve any local disputes that may arise $lear priority setting in the first place who will be setting local agenda? !hat about boundary issues? Independent .oard with patient representation with a pathway up to the National $ommissioning .oard. 7ocal( fast and listening arbitration with an %mbudsman for final appeal. Has to be seen to be non,corruptive. If you strip out too many layers not going to be useful. )ood strong advocacy. 7essons learnt. Not get to that point in the first place. 7

7ocal arbitration led by local community groups &ormal appeal mechanism if )*s neglect groups# sections of the community

White Paper - Engagement Questions Question 1 ,hat are the most important changes needed to enable patients to fully take part in decision making *atient fully in charge of their care , responsible. *atients and carers on the commissioning bodies. Involvement. Coint decisions with the patient. Not paternalistic. $ommissioners to get out there and engage with the local community. Have a CS9$&. 8esources for community groups so they can talk to professionals on e4ual footing &eedback from local forums ' need to be listened to( dont presume you already know. Information that is accessible( timely and appropriate for service users and carers. /ont presume everyone has access to a *$ ' we need to use local facilities such as libraries with specialists that people can talk to. Sign posting )*s more accessible to the public.

Question 2 How can patients be enabled to gain greater control over their health and care through information *atient centred care. 1ore in control around own health. :raining around patient centred care and the e0pert patient. ccess. .alance between professional and patient. 7/ accessible information. *assports. 8

nnual health checks. 1ore of what @.*: already do. 7isten. Individual input. $ollective input. 30pert patient to represent all areas 5dementia and 7/6. 2rd Sector. dvocacy. Information available when needed and clear.

Question 3 How can information be used to support clinicians and providers in delivering better health and care outcomes $onnection and engagement on the ground. Increase of knowledge of what is out there. :raining. 3ngagement. &i0ed in their ways( new ways of working. *assports and health care plans. :ransition between links and healthwatch( ensure links are working towards the goals and engage with local community. 7inks do need an advocacy arm. *ut +using the healthcare system- on school syllabus. Sharing best practice Networking .enchmarking Service 9ser $arer &orums

Question ! How can +0&1' evolve to become local Healthwatch organisations Sufficiently resourced to do the job. Involvement. .uild on what we have got , dont throw away what is already working Smooth transition. /ont close one down without the other organisation being fully up and running. de4uately paid staff. dvocacy arm.

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