Dec 8, 2016 - The below diagram was created at the Bridge Centre event and appears to be attempting ...... Andy ki cks o
Healthwatch Stoke-on-Trent
STP Events in Stoke-on-Trent
Paul Astley December 2016
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Contents .....................................................................................................................................................................................1 Big Conversation, Stoke Events – Context............................................................................................................................2 Discussion...................................................................................................................................................................................3 Cooperation......................................................................................................................................................................3 Equality & Diversity.........................................................................................................................................................3 Community Assets ..........................................................................................................................................................4 Carers ................................................................................................................................................................................6 Holistic Health..................................................................................................................................................................6 Frail Elderly Care..............................................................................................................................................................7 Jubilee Hall Event – 10th November 2016 ...........................................................................................................................8 Questions and Notable Comments ..............................................................................................................................8 Jubilee Hall - Round Table Summaries ............................................................................................................................... 10 Long Term Care............................................................................................................................................................. 10 Urgent and Emergency Care ...................................................................................................................................... 10 Information and Technology ...................................................................................................................................... 11 Enhanced Primary and Community Care ................................................................................................................. 11 Feedback from Jubilee Hall Event ............................................................................................................................. 12 Bridge Centre Event – 8th December 2016....................................................................................................................... 13 Questions and Notable Comments ........................................................................................................................... 13 Bridge Centre – Round Table Summaries .......................................................................................................................... 14 Urgent Care ................................................................................................................................................................... 14 Enhanced Primary Care............................................................................................................................................... 16 After a Crisis .................................................................................................................................................................. 17 Keeping Well ................................................................................................................................................................. 17 The Tools for Staying Well .......................................................................................................................................... 18 Digital ............................................................................................................................................................................. 19 Feedback from Bridge Centre .................................................................................................................................... 19 Appendix.................................................................................................................................................................................. 20 Tweets from Jubilee & Bridge Centr e Events .......................................................................................................... 20
Full Presentation - http://www.slideshare.net/healthwatchstoke/big-conversation-events-presentation John McDonald Video - https://youtu.be/m0BX3okUYVM Go Pro Vid (Jubilee Hall) - https://youtu.be/yZ1BiGW_1jI
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The coming Staffordshire and Stoke on Trent Sustainability and Transformation Plan (STP) will set out the NHS spending locally for 5 years and is likely to be broad in its scope. Local health and Care Leaders have been asked to answer questions on three themes including new models of care, improving health and wellbeing and improving efficiency of services. With all of this set within a need to ‘balance the books’ it is likely that the plans will bring significant change. This of course has already triggered much media and public interest and will continue to do so. Healthwatch Stoke-on-Trent’s role is to ensure voices are heard when they concern health or care services. This is even more so when important, impactful changes are taking place. Healthwatch is keen to enable people to be able to participate in the design of services in a meaningful way. In doing this, it is carrying out its prescribed duties. The rights of the community to participate are enshrined in The Health and Social Care Act 2012 as well as the NHS Constitution. Not only this, but Stoke-on-Trent Clinical Commissioning Group’s constitution states that it will, “Make arrangements to secure public involvement in the planning, development and consideration of proposals for changes and decisions affecting the operation of commissioning arrangements.”1 Indeed, there are good reasons for including community voice in decision making. It is acknowledged that; “Services are better designed around the needs of patients, service users and carers when they are involved in the commissioning process” NHS England2. In pulling together feedback shared by over 50 attendees at the two engagement events for the STP, this report assists in this process. It is hoped that the comments shared in these pages can add to the construction of these plans in a way that ensures effective bottom up service design is achieved, rather than aspired to. For full responses to questions in the Q&A, see videos3.
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http://www.stokeccg.nhs.uk/consitutionhttps://www.england.nhs.uk/wp-content/uploads/2013/09/trans-part-hc-guid1.pdf See page 1 (additional media)
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This short piece summarises many of the comments received at these events into a short narrative with analysis and comment from the team at Healthwatch Stoke-on-Trent. Remember that the time of writing was prior to the release of the STP plans so comments are based upon the contents of the presentation delivered which can be found here4.
Cooperation This has been a busy time in the local health and care economy. The My Care My Way proposals and move to close community beds did not feature heavily at discussion tables, but did colour the atmosphere and set the tone to some extent. It raised questions about the form of engagement and consultation, and how this can be developed moving forward to further build a sense of cooperation. “ . . . . . . you have to be as open as possible with us!” “Engage more with the public – Don’t have to get them out, send them a survey!” As the STP plans are announced there is likely to be a very heavy period of consultation. This provides a good opportunity to get things right and work closely with citizens in partnership. To do this there needs to be a real effort to demonstrate how contributions are taken forward into action. As well as this, accountability and transparency have to be considered as bedrock if people are to have a sense of being listened to, rather than done to.
Equality & Diversity Stoke-on-Trent has its own demographic, it being different to Staffordshire in many ways, not to mention levels of deprivation. This means that some areas can be understood as hard to reach, however no decision should be made without the latter and should be with all members of the community. Methods need to be sought that will allow for full inclusion which may involve the STP Programme Team going to people in their communities.
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See page one for links.
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Community Assets A consistent theme is one of health promotion and staying well. Participants clearly understand well the need for a more proactive approach. As one puts it; “ . . we need a paradigm shift that focusses upon health rather than ill health” This currently seems a long way off. Indeed, it’s unclear what levers can be pulled or who should pull them. The below diagram was created at the Bridge Centre event and appears to be attempting to tackle this issue through the lens of the Duty of Care. It demonstrates the breadth of services and beyond when it comes to staying well. Currently, looking across the health economy, approaches to this could reasonably be described as piecemeal. Despite the efforts of Public Health, the current scale of delivery is nowhere near that needed to achieve some of the things mentioned at these events. A good example is the aspiration to both use existing and build new community assets empowering communities from the bottom up to engage in remaining healthy. To do this, communities will need to be systematically supported in real terms, if not it will struggle to build upon any legacy left by ‘Big Society’ 5. It would be a huge strategic shift away from focussing upon skills and understanding deficiencies towards building community resilience through understanding its assets. This will mean the considerable long term investment in both communities and the skills needed to develop and maintain these assets. This is an example of where the third sector can be utilised well, as it has the skills here in the way the local NHS has not. However, this method needs to take place in partnership and importantly, within the overall vision, it cannot be a ‘bolt-on’. Participants did acknowledge this risk; “(it) feels like consistent themes and a sincere wish for change. However, will these be coherently pulled into the program?. Things seem to be being commissioned outside of that vision (coherent)?”
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https://www.civilsociety.co.uk/news/big-society-has-failed--concludes-civil-exchange.html
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This plan has to be multidisciplinary and operate across the health and care economy. Without effective leadership, silo’s will remain. This is critically important. The locality does not have a good history in this regard which results in impacts beyond the abstract, it has real negative outcomes. As stated, in developing community assets, the NHS certainly may not have the skills to do this alone, locally at least, and without leadership may continue to focus only upon its own delivery rather than what it is needed, which is to be part of a system. Without a true systems approach that goes beyond aspiration, there may not be the investment or sheer will to see the things suggested by contributors come to fruition. These things, such as an effective signposting service, health literacy, use of technologies for long term conditions (LTC’s), tackling loneliness or improved communications for example need all agencies to work together effectively. It must be a whole system approach or it risks becoming nothing more than a means to better manage the most resource heavy patients, in spite of the opportunity for more holistic change. This opportunity needs to be seized by practitioners and citizens alike.
Photo of presentation taken from the twitter feed (see page 1 for link to presentation)
“Whilst fully supporting the need (for change), I’m not sure that the NHS (CCG) is capable of identifying the ‘correct’ solutions because of the magnitude of culture and management change that will be required” - Feedback from Bridge Centre
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Carers
Respondents were quick to make reference to the social determinants of health, for example, in providing warm housing. Regard was made to those with neurological conditions and their needs, with 90% of them described as hard to reach, thus at risk of experiencing loneliness and becoming socially excluded. In the middle of all this on the front line are carers who are mentioned strongly, “If all carers walked away now there would be a different financial scenario.” This is a pertinent point. In 2011 there were 27,339 6 (11% of the population of Stoke-onTrent) delivering unpaid care. Treating people closer to home could mean more pressure for carers. The potential relief that would have come through the step up/down system may soon be gone. There has to be an opportunity for respite. Carer’s are often seen to be an underacknowledged group in the health economy. They need to be properly recognised and supported as part of the overall health and care economy.
Holistic Health
At the events, there were plenty of references made about holistic health, meaning the whole person and lifecycle with notable a newly revitalised focus upon mental health. Statistics do indeed show that poor mental health impacts badly upon physical health and they cannot be separated. Contributors mentioned difficulty accessing mental health services, but the time of attempted access was whilst in crisis which future planning would attempt to avert. People are well aware of the length of time that Parity of Esteem has been on the agenda with little meaningful progress made to date. However, New models of mental health move away from a deficit based approach, for example the lack of a ‘mental health service’ until you are ill, towards one that is more asset based so maintaining good health (staying well). This thinking very much reflects what has been proposed so far as part of the STP in that it is proactive. However, this also again indicates risks (as above) in that true leadership and cross silo working is required in order to ensure that this is central to the vision and that commissioning takes place within it.
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Carers Strategy (appendices) – Retrieved on 12/12/16 from http://webapps.stoke.gov.uk/uploadedfiles/SOT%20Joint%20Carers%20Strateg y%202014%20Demogr aphics%20Appendix%203%201106.pdf
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Frail Elderly Care
Taken from the presentation (see page 1)
Given that this group have such an impact upon the local health economy and feature so heavily in the presentation, it is surprising that new models of care feature so little in the facilitated table discussions in this document. “Once a service user or family has been identified through crisis and supported, they need to be on a lower level of support to maintain wellbeing and help the person to manage independently... Sometimes services pull out as soon as the crisis is over” Perhaps the fact that other events about the closure of community hospital beds were running concurrently meant that this discussion became separated into that forum. However, this did mean that areas such as ‘Prevention and Wellbeing’ had coverage that might otherwise not have been the case.
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Questions and Notable Comments 1. Focus seems to be on elderly care. Could there be work done in secondary education? You may be able to access colleges and universities too? You may be missing a trick here. 2. We do have to tackle the longer-term solution which is about prevention. There was a national health promotion unity whose role to educate people. We need to underpin our message with self-care messages. 3. Are the plans heading in a fixed direction? 4. There is a lot of emphasis on care in the community, yet as I look around social care departments are being squeezed, GP services continue to suffer and community hospitals are also closing. So what the higher level of strategic thinking? This is in effect on the community architecture at a time we are moving things into the community we will find there is nothing left of the community, something doesn’t seem to be in sync. 5. Are you considering the social determinants of health, for example, warm housing? 6. Are we still consulting on community beds? Has the decision already been made?
Can we have assurance that if the consultation is universally in favour of keeping the beds, will the decision be reviewed?
7. A fundamental of change is the need to be transparent and accountable etc. Some of the community beds aren’t part of the STP, frankly at this moment in time there is a poisonous atmosphere of distrust. Community beds are being shut prior to consultation which adds to that and I don’t know how you are going to regain trust. I think a lot of us agree with the direction of travel but considering there has been premature closing of NHS resources and no facilities to accommodate people. I
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wonder how you are going to win the trust of the population? The population funds the local NHS and the care system. Given that there has been a considerable lack of collaboration throughout these processes, one can’t trust the STP process. I’ve heard that even in the south, they are going to close community hospitals. Comments on that please? 8. Had you done this 6 years ago, we would be in a better place. We are losing a lot of GP’s, and can’t recruit. We need to make more use of mixed practitioners and nurse providers. A lot of people are thinking “what’s the use”, you’ve already made your mind up so why are we consulting on it? You really need to get this right this time, you have to be as open as possible with us? I spoke to Penny at the Hw Stoke AGM and asked how much user involvement there had been so far in this process and there hasn’t! You need to make sure that this happens as soon as possible.
9. You said that you were not allowed to publish STP’s. There is a perception out there that the publication is something that local leadership do. So who’s actually? 10. What’s your timescale for production?
There is a national debate going on out there and we are in Staffs and don’t even know what’s in there?
11. We have a 50% deficit. What lessons have been learned? 12. What regard will be given to the effects of surrounding STPs?
How are you going to maintain integrity of services here but take into consideration what is in fact a north staffs footprint? We are very different to the north and south, how is that going to be maintained?
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Attendees were invited to sit and take part in facilitated discussions at tables with each having a different theme. These are some of the themes discussed.
Long Term Care 1. Use of technology for patients and clinicians; 2. Perhaps an information hub for LTC’s so that people can learn more about their conditions and how to manage them; 3. Shorten pathways for planned care. For example, post operation conversations with consultants via telephone for those that feel comfortable with that approach.
Urgent and Emergency Care 1. Difficulties with access, particularly for MH which is still difficult (clarity of esteem); 2. This is particularly of note in MH in children (some work has taken place recently though); 3. Access to primary care can be difficult, some even struggling for a simple flu jab; 4. The deaf community sometimes encounter wasted appointments as interpreters don’t arrive on time.
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Information and Technology 1. Positive about linking information that supports care; 2. Security – Only patients are able to access; 3. Some challenges concerning the spread of information more widely; 4. Why should there be such scepticism about a doctor being able to access critical information?
Enhanced Primary and Community Care 1. Having the right information; 2. Getting the right service to the right place? 3. Being able to get a service that is on your doorstep within your practice but with a recognition that it may be with a bigger catchment, maybe 50 – 70,000 people (or unit of planning). 4. Linking in with LA’s relative to population needs. 5. Hospitals may not be in such need if people looked after their own health. In being well they would have more community assets (compound effect); 6. This is about holistic care from a physical and mental health point of view and social care perspective. 7. Must use existing community assets.
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Feedback from Jubilee Hall Event Contributors offered additional comments on the feedback forms.
The CQC is not accountable – they should be far more involved in the process;
What improvements can be made pre and post operation?
Should there be one centre of excellence rather than have 4 places doing the same thing?
Introduce the concept of ‘virtual GPs’ to offer a second opinion?
Will GPs accept a telephone call from consultant at the weekend? It might be a weekend operation and we have to provide a good level of care and expertise?
Discharge from hospital – flexibility given to leave on the same day for day operations or may be patient could wait?
Improve the use of technology – have an app which provides access by the patient, the GP and the Consultant?
Essential to make sure the right message gets across.
Make sure it is simplified by using media – TV campaigns – to promote the messages regarding using the correct medical provision?
Use Easy Read and cartoons to help the disabled and disadvantaged to gain a better understanding?
Are Care Plans shared with GPs? If not, they should be?
Caring for people in the community will only work if sufficient people are employed at ground level. They must have sufficient knowledge and training to provide a good level of clinical care. 12
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Questions and Notable Comments
1. 200,000 patients with neurological conditions in the UK and 90% of them are hard to reach, left to find their own way through fragmented services; i. The NHS needs to abandon silo mentality, organisations seem to compete with each other. This leads to good practice not being shared. 2. There appears to be no autism services in Stoke? 3. Feels like consistent themes and a sincere wish for change. However, will these be coherently pulled into the program. Things seem to be being commissioned outside of that vision (coherent)? 4. Mental Health is so hard to access (via a GP); 5. The 3r d Sector needs to be part of the plan. Voluntary services should be more central as should carers. If all carers walked away now there would be a different scenario; 6. Quality does have an impact on fiscal measures. In dementia for example, quality care and support can go a long way, lessening pressure on services; 7. We need to recognise and respect the 3r d sector; 1. Should be closer to the mainstream system; 2. Manage risk and speculate. 8. Loneliness is important and should be considered as part of planning, ie; funding to organisations like the RVS; 9. We need a paradigm shift that focuses upon health rather than ill health; 10. Partnership – Break down barriers;
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Attendees were invited to sit and take part in facilitated discussions at tables with each having a different theme. These are some of the themes discussed.
Urgent Care 1. Public see A&E as a complete failure; i. Forced to pay car parking (no idea how long you will be); ii. May be someone close to death (still have to pay); iii. Relative in corridor, bought in by ambulance, waited 5.5hrs to be seen, seen on a Monday night, boiling hot, family stood in corridor, actual treatment took 25 mins; iv. Paramedics very good (treatment at home before hospital); v. Told to come back next day for xray; vi. See drunks coming in with police and treated first. 2. Section A&E for different things? Not everyone in one place; 3. Need to educate public to go to A&E if all services in place; 4. People go to A&E who don’t need to be there; 5. Provision in the city centre for drunkenness (charge them); 6. A&E in trouble, people shouldn’t be there, too many cuts too staff; 7. Huge expectations of urgent care compared to 10 years ago? 8. Impact of GP’s not coming out at night? 9. Out of hours is miles away and out of the way; 10. Not all drop in centres provide the same so it’s a gamble, know most A&E will do everything; 11. Engage more with the public – Don’t have to get them out, send them a survey etc; 12. More prevention messages and funding; 13. 16-25 year olds, start messaging earlier. Person in charge of ill health is you;
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14. Not enough prevention/promotion; i. Build local links & support. Doesn’t have to be medical; 15. Give education in A&E; 16. Need to look at in a holistic way, not individual chunks; i. Should be essence of no re STP – more collaborative & connected; 17. Information sharing should be opt out not opt in; i. Educate public, give confidence, build trust back into NHS; ii. Ensure there are the correct safeguards; 18. Use anonymised NHS data to protect, eg google. 19. Use of technology for support; 20. Amazon Echo £30-£40; 21. Follow up appointments @ hospital – why not just call at home? 22. Lots of GP Consultations could be over the phone? 23. Inefficiencies in the system; 24. Queuing up in corridors, ambulances backed up becoming the norm; 25. Lets get back to health promotion; 26. Need good front line advice; 27. Too many initiatives.
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Enhanced Primary Care
1. Tick box assessments; 2. Policy driven rather than person driven; 3. Disjointed PALS. Sometimes just want to comment rather than complain; 4. No-one to answer questions, narrow areas; 5. People not taking responsibility, passing on; 6. Health and Social Care competing, not sharing best practice; 7. Staff working at full speed; 8. EOL care good; 9. Key worked/Health Care facilitator (specialist help when needed good idea) ; 10. Being put to bed at 7pm; 11. Isolated at home when carers not there; 12. Carers views (are these taken as professional view?); 13. Community support services; 14. Voluntary sector/3 r d sector under utlilised (prominence in STP?)
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After a Crisis
1. Once a service user or family has been identified through crisis and supported, they need to be on a lower level of support to maintain wellbeing and help the person to manage independently... Sometimes services pull out as soon as the crisis is over; i. Could be 3rd Sector rather than NHS; ii. Focus on what the person was like before the crisis, identify positive influence. 2. Important to signpost help at an earlier stage before acute need – but how will people know what help is available? i. How do people know what help is available? ii. GP Surgeries/ Health premises could be open to external organisations. Space issues can be addressed; iii. Full directory of services available; iv. Drop in sessions; v. Support/training for primary care staff from community & voluntary sector;
Keeping Well
1. Empower people to take control – lots of control makes people unwell; 2. Provide choices for people, options about how to get where they want to be; 3. Taking responsibility for yourself; 4. Recognising positive influences and behaviours – making this the expectation; 5. Positive role models; 6. Value and respect people; 7. Start with young people – while they are healthy, before the problem; 8. Build resilience – give young people the skills to stay well.
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The Tools for Staying Well
1. Information – i. Knowledge is often assumed eg, what is eating healthy, what is the point of joining in? ii. Signposting; 2. Practical skills – i. Cooking, shopping, managing money; ii. Getting out, where do they go? iii. Joining in with other people, what if you need support with this? 3. Timing and availability of practical activities – i. Accessibility; ii. Day time is no good if you work full time or you’re a carer travel may be difficult & cost is a factor; 4. Duty of Care; i. The individual has a duty of care for themselves; ii. The local community, family and friends provide networks; iii. Statutory agencies support where and when needed; iv. Government makes decisions about budgets and national policy priorities.
Individual 3 rd Sector, GP Friends & Family, Stat Agencies, local authority, NHS hospitals
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Digital
1. There are digital solutions for LTC’s (asthma etc) (ipad/App etc); 2. Increase in skype in GP practices; 3. Supporting responsibility; 4. More simplified information at the time of diagnosis – information that they can understand? 5. Need for a digital package at time of diagnosis which include app/digital leaflet etc;
Feedback from Bridge Centre
I am not sure if the health providers have either properly listened to my concerns, or that they will act on them;
Whilst fully supporting the need (for change), I’m not sure that the NHS (CCG) is capable of identifying the ‘correct’ solutions because of the magnitude of culture and management change that will be required;
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Tweets from Jubilee & Bridge Centre Events o Healthw atch Stoke @HealthwatchSoT Nov 10 "grouping gp practices helps protect their future" - #bigconversation 0 replies 0 retweets 0 likes Healthw atch Stoke @HealthwatchSoT Nov 10 Local authorities and local integrated care teams key to keeping plan localised. - #bigconversation 0 replies 0 retweets 0 likes Healthw atch Stoke @HealthwatchSoT Nov 10 "the plan doesn't quite balance yet, there is more w ork to be done on that" #bigconversation 0 replies 0 retweets 0 likes link to Tw eet Healthw atch Stoke @HealthwatchSoT Nov 10 "using expensive facilities, theaters not used as efficiently as they could be. We need 2% efficiency a year" - #bigconversation 0 replies 0 retweets 0 likes Healthw atch Stoke @HealthwatchSoT Nov 10 "w e have £57m deficit, w hat lessons can be learned?" #bigconversation 0 replies 0 retweets 0 likes Healthw atch Stoke @HealthwatchSoT Nov 10 Consultation - http://www.northstaffsccg.nhs.uk/my-care-my-way #bigconversation Healthw atch Stoke @HealthwatchSoT Nov 10 "you need to get it right this time" " you need to have service users involved" #bigconversation 0 replies 2 retweets 1 like Healthw atch Stoke @HealthwatchSoT Nov 10 "Agreement w ith direction of travel but premature closure of facilities has led to distrust" #transparency #bigconversation 0 replies 0 retweets 0 likes Healthw atch Stoke @HealthwatchSoT Nov 10 Consultation over community beds to take place in 2017. Can w e be assured that the consultation w ill be listened to? #bigconversation 0 replies 2 retweets 0 likes Healthw atch Stoke @HealthwatchSoT Nov 10 STP needs to be broader to consider social issues such as housing - #bigconversation 0 replies 0 retweets 0 likes More New Moment Healthw atch Stoke @HealthwatchSoT Nov 10 Successful partnership being built betw een health and social care locally. #bigconversation 0 replies 0 retweets 0 likes Healthw atch Stoke @HealthwatchSoT Nov 10 STP is currently a direction of travel rather than a plan. Delay in publication not been helpful in terms of engagement - #bigconversation
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0 replies 2 retweets 0 likes Healthw atch Stoke @HealthwatchSoT Nov 10 STP cant be published because of a national process - #bigconversation 0 replies 3 retweets 0 likes Healthw atch Stoke @HealthwatchSoT Nov 10 We need to build capacity before we take it out - #bigconversation 0 replies 0 retweets 0 likes Healthw atch Stoke @HealthwatchSoT Nov 10 Q&A - "w hen do you intend to make the plan public? Have procedures already been made that take us in a certain direction?" 0 replies 2 retweets 0 likes Healthw atch Stoke @HealthwatchSoT Nov 10 Q&A - There is a lot of w ork going on around this outside the STP 0 replies 0 retweets 0 likes Healthw atch Stoke @HealthwatchSoT Nov 10 Q&A - "at some point w e do need to focus on prevention in the long term" "all w ork needs to be underpinned by this" #bigconversation 0 replies 1 retweet 0 likes Healthw atch Stoke @HealthwatchSoT Nov 10 Q&A - "should the NHS be accessing secondary schools or uni to educate rather than just focusing on the elderly?" 0 replies 1 retweet 0 likes Healthw atch Stoke @HealthwatchSoT Nov 10 Feedback from tables - Health literacy, information hubs can be useful #bigconversation 0 replies 0 retweets 0 likes Healthw atch Stoke @HealthwatchSoT Nov 10 w hy arent we sharing information already> - #bigconversation Healthw atch Stoke @HealthwatchSoT Nov 10 Feedback from tables - Really positive about sharing information via IT in a safe and controlled w ay #bigconversation Healthw atch Stoke @HealthwatchSoT Nov 10 good progress locally on accessing mh services for young people in A&E - #bigconversation 0 replies 0 retweets 0 likes Healthw atch Stoke @HealthwatchSoT Nov 10 Feedback from tables - In an emergency facility it is difficult to access mental health services #bigconversation 0 replies 0 retweets 0 likes Healthw atch Stoke @HealthwatchSoT Nov 10 Mobilising communities is a key piece of w ork - #bigconversation 0 replies 1 retweet 0 likes Healthw atch Stoke @HealthwatchSoT Nov 10 Feedback from tables - How do w e facilitate holistic care in primary care. Mobilising community assets - #bigconversation 0 replies 2 retweets 0 likes Healthw atch Stoke @HealthwatchSoT Nov 10 Engagement needs to understand w hat people need and w hat they want #bigconversation 0 replies 1 retweet 0 likes Healthw atch Stoke @HealthwatchSoT Nov 10 There needs to be some thought about how planned care can less affected by unplanned care.#bigconversation 0 replies 0 retweets 0 likes Healthw atch Stoke @HealthwatchSoT Nov 10 More patients to be done as day cases. #bigconversation 0 replies 0 retweets 0 likes Healthw atch Stoke @HealthwatchSoT Nov 10 It is acknow ledged that there needs to be more GP's in SOT #bigconversation
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1 reply 1 retweet 0 likes Healthw atch Stoke @HealthwatchSoT Nov 10 "Integrated Care record w ill be a game changer" #bigconversation 0 replies 0 retweets 0 likes Healthw atch Stoke @HealthwatchSoT Nov 10 MCP's to w ork together to break dow n barriers between health and social care. Both are part of the same journey #bigconversation 0 replies 0 retweets 0 likes Healthw atch Stoke @HealthwatchSoT Nov 10 "We cant have barriers that w e had before between primary and secondary care" (using technology) #bigconversation 0 replies 0 retweets 0 likes Healthw atch Stoke @HealthwatchSoT Nov 10 We need a joined up system that meets patient needs. An example of this is the use of technology - #bigconversation 0 replies 0 retweets 0 likes Healthw atch Stoke @HealthwatchSoT Nov 10 "many illnesses are made w orse by bed based care" #bigconversation 0 replies 0 retweets 0 likes Healthw atch Stoke @HealthwatchSoT Nov 10 Key principle of new model is rights and responsibilities. #bigconversation 0 replies 0 retweets 0 likes Healthw atch Stoke @HealthwatchSoT Nov 10 "a large propoption of people w ho come into A&E need some sort of mental health care" More integration required? #bigconversation 0 replies 0 retweets 0 likes Healthw atch Stoke @HealthwatchSoT Nov 10 "how do w e prevent people getting ill?" #bigconversation 1 reply 1 retweet 1 like Healthw atch Stoke @HealthwatchSoT Nov 10 "25% of people w ho come into A&E could have taken care of themselves" - #bigconversation 0 replies 0 retweets 0 likes Healthw atch Stoke @HealthwatchSoT Nov 10 "w e need to blur the boundaries betw een services" #bigconversation 0 replies 0 retweets 0 likes Healthw atch Stoke @HealthwatchSoT Nov 10 "Health service has huge deficit", "we cant continue like this" "#bigconversation 0 replies 0 retweets 1 like Healthw atch Stoke @HealthwatchSoT Nov 10 "w e don't perform very well as a system and admit too many people to hospital" #bigconversation 0 replies 0 retweets 0 likes Healthw atch Stoke @HealthwatchSoT Nov 10 "how do w e help people to live w ell?" #bigconversation 0 replies 0 retweets 1 like Healthw atch Stoke @HealthwatchSoT Nov 10 Aging population requires change. Impact upon health and social care "staggering" #bigconversation 0 replies 0 retweets 0 likes Healthw atch Stoke @HealthwatchSoT Nov 10 "s-o-t has highest levels in terms of the social determinants of health" - #bigconversation 0 replies 0 retweets 0 likes Healthw atch Stoke @HealthwatchSoT Nov 10 "this not consultation, it is the first stage in engagement" if big changes needed then there w ill be consultation #bigconversation
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Bridge Centre Tweets.
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Hea lthwatch Stoke @HealthwatchSoT 16h16 hours a go Stoke-on-Trent, England Tha nks for listening/reading! Join us a t a future event! #bigconversation Good night! 0 repl ies 0 retweets 1 l ike Hea lthwatch Stoke @HealthwatchSoT 16h16 hours a go Stoke-on-Trent, England We need a paradigm s hift that focus's upon health ra ther than ill health #bigconversation 0 repl ies 0 retweets 0 l ikes Hea lthwatch Stoke @HealthwatchSoT 16h16 hours a go Stoke-on-Trent, England We need to link in with communities to understand what assets there a re and direct people to them when needed. #bigconversation New Moment Hea lthwatch Stoke @HealthwatchSoT 16h16 hours a go Stoke-on-Trent, England Audi ence - Considering l oneliness is important. Orgs like @RoyalVolsStaffs invaluable #bigconversation 0 repl ies 1 retweet 2 l ikes Hea lthwatch Stoke @HealthwatchSoT 16h16 hours a go Stoke-on-Trent, England STP to be rel eased on 15th Dec. More engagement to follow before consultation. #BigConversation 0 repl ies 1 retweet 0 l ikes Hea lthwatch Stoke @HealthwatchSoT 16h16 hours a go Stoke-on-Trent, England "a l i ttle bit of ca re and support goes a long way" . . How good dementia care can help financially wi thin the STP. #bigconversation 1 repl y 0 retweets 0 l ikes Repl y ************ @CraggsMichelle 16h16 hours ago @HealthwatchSoT #bigconversation how do mental health patients receive the care they need to lead a "normal" life Hea lthwatch Stoke @HealthwatchSoT 16h16 hours a go Stoke-on-Trent, England Ma rk Wi lliams - STP offers an opportunity to build from communities up #bigcommunity 0 repl ies 0 retweets 0 l ikes Hea lthwatch Stoke @HealthwatchSoT 16h16 hours a go Stoke-on-Trent, England Ca rers need to be acknowledged in the plan "i f a ll of these carers walked away the financial situation would be very dif" #bigconversation 0 repl ies 2 retweets 1 l ike Hea lthwatch Stoke @HealthwatchSoT 16h16 hours a go Stoke-on-Trent, England Audi ence - 3rd s ector s hould be central to the STP plan, not just an a dd on. #bigconversation 0 repl ies 2 retweets 0 l ikes Hea lthwatch Stoke @HealthwatchSoT 16h16 hours a go Stoke-on-Trent, England Audi ence concerns a bout access to MH.@CEO_Combined describes how waiting l ists have been l ong but now down to 18 weeks #bigconcersation 0 repl ies 1 retweet 0 l ikes Hea lthwatch Stoke @HealthwatchSoT 17h17 hours a go Stoke-on-Trent, England a udience - NHS needs to a bandon silo mentality to be able to s hare good practice #bigconversation 0 repl ies 0 retweets 0 l ikes Hea lthwatch Stoke @HealthwatchSoT 17h17 hours a go Stoke-on-Trent, England
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Ma rk Wi lliams, responsibilities come with power, we must empower communities #bigconversation 0 repl ies 3 retweets 1 l ike Hea lthwatch Stoke @HealthwatchSoT 17h17 hours a go Stoke-on-Trent, England Q&A begi ns #Bigconversation 0 repl ies 1 retweet 0 l ikes Hea lthwatch Stoke @HealthwatchSoT 17h17 hours a go Stoke-on-Trent, England For too l ong, mental health has been the Ci nderella of s ervices. #bigconversation. 0 repl ies 3 retweets 1 l ike You Retweeted @Sta ffsPartnership @StaffsPartnersh 17h17 hours ago Introducing the challenges of the health and care system @HealthwatchSoT conversation event i n #stokeontrentpic.twitter.com/ue6ZmFDON3
0 repl ies 5 retweets 1 l ike You Retweeted
@Sta ffsPartnership @StaffsPartnersh 17h17 hours ago The s cale of the financial challenge is presented @HealthwatchSoT conversation eventpic.twitter.com/FezWwxIZsz
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1 repl y 1 retweet 1 l ike Repl y ******** 16h16 hours ago @StaffsPartnersh @HealthwatchSoT #prevention .......need 'real/true' integration 1. Reply Healthwatch Stoke @HealthwatchSoT 16h16 hours ago Stoke-on-Trent, England @ClairUnderwood1 @StaffsPartnersh Nice that we can talk about silo's now. Lets keep the conversation going! Hea lthwatch Stoke @HealthwatchSoT 17h17 hours a go 85% of opera tions already day ca ses #bigconversation 0 repl ies 1 retweet 0 l ikes Hea lthwatch Stoke @HealthwatchSoT 17h17 hours a go Emergi ng hypothesis as set out by Andy #bigconversationpic.twitter.com/RmfD42iiae
0 repl ies 2 retweets 0 l ikes New Moment
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Hea lthwatch Stoke @HealthwatchSoT 17h17 hours a go Andy pres ents the financial situation #bigconversationpic.twitter.com/KEsIXisXmg
0 repl ies 1 retweet 0 l ikes Hea lthwatch Stoke @HealthwatchSoT 17h17 hours a go We hope to be a ble to share this PowerPoint in full so that you ca n make a n i nformed contribution #bigconversation STPpic.twitter.com/EwvdfzWuvu
0 repl ies 1 retweet 0 l ikes Hea lthwatch Stoke @HealthwatchSoT 17h17 hours a go The s cale of the STP l ocally a nd beyond #bigconversationpic.twitter.com/OJvkXLTE8O
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Hea lthwatch Stoke @HealthwatchSoT 17h17 hours a go Stoke-on-Trent, England Andy ki cks off the presentation #bigconversation 0 repl ies 0 retweets 0 l ikes You Retweeted
@Sta ffsPartnership @StaffsPartnersh 17h17 hours ago The pa nel presentation a nd q&a s ession has just started @HealthwatchSoTpic.twitter.com/Q0FtXbsJzj
0 repl ies 2 retweets 0 l ikes Hea lthwatch Stoke @HealthwatchSoT 17h17 hours a go Stoke-on-Trent, England Our pa nel Andy Bartlam, Ruth Chambers, Ma rk Williams and Sally Pa rkin. Chaired by our @l loyd_cooke 0 repl ies 2 retweets 3 l ikes Hea lthwatch Stoke @HealthwatchSoT 17h17 hours a go Stoke-on-Trent, England Li ve tweets s tarting s oon from the #bigconversation event.
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