1. Collaborative: bringing together clinicians, staff, patients, service users and the community together as equal partners Evidence-based: engaging to co-design evidence based and locally appropriate solutions to promote integrated health and social care Asset-based : developing the capacity of patients, service users and the community to engage effectively in identifying needs, project planning and development, procurement, implementation and evaluation. Continuous and iterative: engaging to build and refine sustainable models for local delivery that reflect the needs and aspirations of local people and frontline staff 1.Initial workshop held with CCG Lay/Patient Reps and PPI Engagement Leads to develop a draft definition of patient experience and a draft patient experience strategy (6 th June) 2.Follow up workshops were co-ordinated and facilitated involving patients, communities, clinicians and managers to share and further refine the draft definition and strategy so that it reflects the views and perspectives of all stakeholders (July – Dec. 2013) 3.Review of relevant documents/reports was undertaken to further inform the development of the definition and strategy (Sept. 2013). 4.A Final Patient Experience in Contracts workshop Service User Panel and Lay Reps took place to present and agree the final draft of the Patient Experience Framework and priorities which have been taken into consideration the contracting round (Jan. 2014). Co-designing a Patient Experience Strategy: Overview of Approach and Outcomes SBO

2. HOW DID WE USE THIS INFORMATION? The engagement with patients and staff has highlighted key priorities for us to take forward during 2014/2015 include: Delivery of Series of Seminars and Learning Events for Staff and Governing Body Members on ‘Effective Leadership to enhance Patient Experience’. Development and Implementation of programme of training for CCG Lay Reps and Patient Champions to enable them to promote patient perspective at decision making levels and in considering CCG plans and proposals. Work with providers to deliver quarterly patient experience Learning Events themed around a the service and issues highlighted below across health and social care o Impact of staff Experience on Patient Experience o Experience of people with Dementia and their Carers o Transfer of Care Map out the current data gathered on patient experience against the statements highlighted in the Patient Experience Statements o Where there is ambiguity or gap in information, a piece of work would be undertaken to work with local patient groups and Healthwatch to gather patient and carer feedback to address the gap in data. o Work with providers to produce quarterly patient experience reports that real-time qualitative as well as quantitative feedback and captures the diversity of patients, service users and carers SBO

3. Theme Patient Experience Indicator* 1. Promoting and recognizing independence in care (1a) I have access to information about services (including what services are available, how services work, what I can expect and how systems are changing), support, care (including what is best practice), illness and health promotion that is relevant, useful, sensitive, up-to-date and available in different formats (1b) Staff provide me with time to talk, ask questions, discuss issues and options, and give me explanations and information that is understandable and useful. (1c) My care is planned with me, is centered on my needs and is inclusive of my family and carers (1d) My family, carers and I have access to volunteers and the opportunity to learn and gain support from other patients (1e) I am provided with opportunities to get involved in shaping and influencing the service and the organization as a whole 2. Coordination, Integration and Continuation across Care Pathway (2a) My care is coordinated across health, social care and third sector services (2b) Staff work in partnership with me, my family and carers, and other professionals (2c) Staff are effective at communicating and sharing information with me and also with other staff within and across health, social and third sector services (2d) I receive consistent and continued care which helps me to build relationships with staff promoting holistic approaches More Specifically, It enabled us Identify the following statements to capture experience *Based on Patient Experience information collected across tri-borough through workshops and a consolidation of reports, 2005 – 2013, outlined in Appendix 1 and 2 SBO

4. Theme Patient Experience Indicators* 3. Safety, dignity and respect (3a) My care is provided in appropriate environments that are accessible, clean, welcoming and enable privacy and dignity to be maintained (3b) Staff maintain my confidentiality, privacy and dignity and treat everyone with respect (3c) Services are valued and used responsibly by both me and staff caring for me 4. High quality care (4a) Organizations provide comprehensive services that are easily accessible, responsive, offer choice and that provide timely treatment and care (4b) Equipment and resources are available to meet my needs and demands (4c) Staff are prepared and informed about me, my care needs and other services 5. Confidence and accountability in providers (5a) Staff/services/organizations are committed to learning and improving - a no blame culture exists in which people take complaints seriously, respond quickly and learn from mistakes (5b) Staff have a positive experience of work (5c) Senior managers, as well as frontline staff, are professional, honest and accountable (5d) Staff have good communication skills and use clear and appropriate language (5e) Staff are approachable, kind, compassionate and empathetic (5f) Staff have the right knowledge, attitude and skills and adhere to policies (5g) Staff are culturally aware and sensitive to the needs of and state of mind of patients, families and carers *Based on Patient Experience information collected across tri-borough through workshops and a consolidation of reports, 2005 – 2013, outlined in Appendix 1 and 2 SBO

5. “I don’t want a doctor who patronizes me. I want a doctor who lets me talk about what matters to me, before deciding what to do…” Diabetes Service User “The NHS and Council, they’re doing a lot of things, but the missing link is pushing it right through to the community.” Community Champion, White City Promoting and recognizing independence in care Coordination, Integration and Continuation across Care Pathway Safety, dignity and respect High quality care Confidence and accountability in providers “ It’s my doctor who let me know about this place (Nubian Life). He gives me good information and I am grateful. ” Elderly African Caribbean Man “It is against our ethos to just kick people out onto the street but that’s what happens… At present, we’re not really sure when we direct people what kind of service they are going to get and whether they are actually going to get the help they need.” A&E nurse talking about a Polish Rough Sleeper “I had my second child at my local hospital; the midwife was fantastic and the nurses on the ward were very kind, I was very happy. When I was leaving I bought them some flowers as a thank you and on the way out one of the nurses said ‘see you next year…’. I know she didn't’t mean it but that comment made me so upset and its what stayed with me. If I do have another child I don’t want to go there again”. Somali Woman “I think when you go to a normal doctor they look down on you, I think they are a bit worried in case you give them something, its just the way they were talking, looking, sitting away from me. ” Polish Rough Sleeper *Based on extracts from Patient Experience Workshops across tri-borough through workshops and a consolidation of reports, 2005 – 2013, detailed in Appendix 1 and 2 SBO

6. THE PICKER MEASURE OF INTERGRATED HEALTH AND SOCIAL CARE Picker developed an integrated measure for assessing people’s experience of integrated care, based on consultation and engagement in four focus groups with patients, service users and carers aged 21 – 85 years with a range of comorbid mental health / physical health diagnoses Items are grouped into six key themes, yielding 18 questions, with adapted carer versions, and 12 corresponding ‘I’ statements ThemePicker ‘I’ Statements* My Goals(A1) All my needs as a person are assessed (A2) My carer / family have their needs recognized and are given support to care for me (A4) Taken together, my care an support help me live the life I want to the best of my ability Care Planning(B6) I have regular reviews of my care and treatment, and of my care and support plan (B7) I have regular, comprehensive reviews of my medicines (B8) When something is planned, it happens Communication(C4) The professionals involved with my care talk to each other. We all work as a team (C5) I always know who is coordinating my care (C6) (a) I have one first point of contact. (b) They understand both me and my condition(s). (c) I can go to them with questions at any time Decision-Making(E1) I am as involved in discussions and decisions about my care, support and treatment as I want to be (E2) My family or carer is also involved in these decisions as much as I want them to be Transitions(F3) I know in advance where I am going, what I will be provided with and who will be the main point of professional contact *Source Measuring health and social care integration: new research and recommendationsMeasuring health and social care integration: new research and recommendations SBO

7. ThemePicker ‘I’ StatementPatient Experience Indicators Promoting and recognizing independence in care (A1) All my needs as a person are assessedNone (A2) My carer / family have their needs recognized and are given support to care for me None (A4) Taken together, my care and support help me live the life I want to the best of my ability (1a) I have access to information about services (including what services are available, how services work, what I can expect and how systems are changing), support, care (including what is best practice), illness and health promotion that is relevant, useful, sensitive, up-to-date and available in different formats (E1) I am as involved in discussion and decisions about my care, support and treatment as I want to be (1b) Staff provide me with time to talk, ask questions, discuss issues and options, and give me explanations and information that is understandable and useful. (E1) & (E2) My family or carer are also involved in these decisions as much as I want them to be (1c) My care is planned with me, is centered on my needs and is inclusive of my family and carers None (1d) My family, carers and I have access to volunteers and the opportunity to learn and gain support from other patients None (1e) I am provided with opportunities to get involved in shaping and influencing the service and the organization as a whole HOW DO THE PATIENT EXPERIENCE INDICATORS COMPARE TO THE PICKER ‘I’ STATEMENTS? Picker Theme(s): Goals & Decision-Making SBO

8. ThemePicker ‘I’ StatementPatient Experience Indicators Coordination, Integration and Continuation across Care Pathway (B6) I have regular reviews of my care and treatment, and of my care and support plan None (B7) I have regular, comprehensive reviews of my medicines None (B8) When something is planned, it happens None (C6) (a) I have one first point of contact. (b) They understand both me and my condition(s). (c) I can go to them with questions at any time None (C4) The professionals involved with my care talk to each other. We all work as a team (2b) Staff work in partnership with me, my family and carers, and other professionals (C4) As above(2c) Staff are effective at communicating and sharing information with me and also with other staff within and across health, social and third sector services (C5) I always know who is coordinating my care(2d) I receive consistent and continued care which helps me to build relationships with staff promoting holistic approaches (F3) I know in advance where I am going, what I will be provided with and who will be the main point of professional contact (2a) My care is coordinated across health, social care and third sector services HOW DO THE PATIENT EXPERIENCE INDICATORS COMPARE TO THE PICKER ‘I’ STATEMENTS? Picker Theme(s): Care-Planning, Communication & Transitions SBO

9. ThemePicker ‘I’ StatementPatient Experience Indicators Safety, dignity and respect None (3a) My care is provided in appropriate environments that are accessible, clean, welcoming and enable privacy and dignity to be maintained None (3b) Staff maintain my confidentiality, privacy and dignity and treat everyone with respect None (3c) Services are valued and used responsibly by both me and staff caring for me HOW DO THE PATIENT EXPERIENCE INDICATORS COMPARE TO THE PICKER ‘I’ STATEMENTS? Picker Theme(s): None ThemePicker ‘I’ StatementPatient Experience Indicators High quality care None (4a) Organizations provide comprehensive services that are easily accessible, responsive, offer choice and that provide timely treatment and care None (4b) Equipment and resources are available to meet my needs and demands None (4c) Staff are prepared and informed about me, my care needs and other services Picker Theme(s): None SBO

10. ThemePicker ‘I’ StatementPatient Experience Indicators Confidence and accountability in providers None (5a) Staff/services/organizations are committed to learning and improving - a no blame culture exists in which people take complaints seriously, respond quickly and learn from mistakes None (5b) Staff have a positive experience of work None (5c) Senior managers, as well as frontline staff, are professional, honest and accountable None(5d) Staff have good communication skills and use clear and appropriate language None(5e) Staff are approachable, kind, compassionate and empathetic None(5f) Staff have the right knowledge, attitude and skills and adhere to policies None(5g) Staff are culturally aware and sensitive to the needs of and state of mind of patients, families and carers HOW DO THE PATIENT EXPERIENCE INDICATORS COMPARE TO THE PICKER ‘I’ STATEMENTS? Picker Theme(s): None SBO

11. COMBINED PICKER ‘I’ STATEMENTS AND PATIENT EXPERIENCE INDICATORS Picker ‘I’ Statements (A1) All my needs as a person are assessed (A2) My carer / family have their needs recognized and are given support to care for me (A4) Taken together, my care an support help me live the life I want to the best of my ability (B6) I have regular reviews of my care and treatment, and of my care and support plan (B7) I have regular, comprehensive reviews of my medicines (B8) When something is planned, it happens (C4) The professionals involved with my care talk to each other. We all work as a team (C5) I always know who is coordinating my care (C6) (a) I have one first point of contact. (b) They understand both me and my condition(s). (c) I can go to them with questions at any time (E1) I am as involved in discussions and decisions about my care, support and treatment as I want to be (E2) My family or carer is also involved in these decisions as much as I want them to be (F3) I know in advance where I am going, what I will be provided with and who will be the main point of professional contact Potential additions from Patient Experience Indicators (that were not covered by the Picker) (1d) My family, carers and I have access to volunteers and the opportunity to learn and gain support from other patients (1e) I am provided with opportunities to get involved in shaping and influencing the service and the organization as a whole (3a) My care is provided in appropriate environments that are accessible, clean, welcoming and enable privacy and dignity to be maintained (3b) Staff maintain my confidentiality, privacy and dignity and treat everyone with respect (3c) Services are valued and used responsibly by both me and staff caring for me (4a) Organizations provide comprehensive services that are easily accessible, responsive, offer choice and that provide timely treatment and care (4b) Equipment and resources are available to meet my needs and demands (4c) Staff are prepared and informed about me, my care needs and other services (5a) Staff/services/organizations are committed to learning and improving - a no blame culture exists in which people take complaints seriously, respond quickly and learn from mistakes (5b) Staff have a positive experience of work (5c) Senior managers, as well as frontline staff, are professional, honest and accountable (5d) Staff have good communication skills and use clear and appropriate language (5e) Staff are approachable, kind, compassionate and empathetic (5f) Staff have the right knowledge, attitude and skills and adhere to policies (5g) Staff are culturally aware and sensitive to the needs of and state of mind of patients, families and carers SBO

12. APPENDIX 1: SUMMARY OF PATIENT EXPERIENCE WORKSHOPS* Workshop/eventAttendees Patient Experience Workshop 6 th June 2013 Over 30 attendees – Patients, Carers, CCG Lay Reps, Governing Body GP Patient Reps, Healthwatch, NHSE Quality Team, BME Health Forum, CWHH Engagement Leads and CLHARC North West London Family Mosaics, 8 th July 2013, 34 attendees – Bangladeshi, Somali and Residents on Church Street Estate Area Diabetes Service Users Group, 17 th July 2013, 18 attendees – Service Users and Carers in Tri-Borough Area Health and Wellbeing Voluntary Organisations Forum, 23 rd July 2013, West London CCG Over 50 participants – Voluntary and Community Sector Representatives across West London and Central London CCGs. Community Champions, Ladbroke Grove, 25 th July 2013, West London CCG 6 attendees – community champions and project leader Workshop for people living and working in Westminster, Greenside Community Centre, NW8, 5 th September 2013, 7 attendees – representatives from diabetes service user group and children’s centre, patient rep, CCG employees Workshop for people living and working in Westminster, Marylebone Road, NW1, 10 th September 2013, Central London CCG 6 attendees – patients/expert patients, user involvement service managers/leads, member of patient/user panel, student services representative, CCG employee Workshop for people living and working in Westminster, Victoria Medical Centre, SW1V, 12 th September 2013, Central London CCG 7 attendees – Healthwatch, representatives from Breathe Easy and Diabetes UK, carer, expert patient, representative from Migrants Resource Centre *This is just a selection of some of the many patient experience workshops that have been used to inform the CWHHE patient experience strategy and the Better Care Plans. SBO

13. APPENDIX 2: SUMMARY OF PATIENT EXPERIENCE REPORTS* Relevant Reports Community Interpreting and Translation Service, Feedback Notes on Patient Experience in GP Practices and Hospital Services, 2007 / 2009/ 2010 / 2012/ 2013 Focus Group with Clients Using Migrant Resource Centre, April 2013 (Eastern European and Middle Eastern Communities) Church Street Baseline Health Report, Bangladeshi Community Baseline Health and Wellbeing Survey, February 2013 H&F LINk, Community Mental Health Services – The Service User Experience in Hammersmith and Fulham, March 2013 (Hammersmith and Fulham CCG) Central London Community Healthcare NHS Trust 15 Steps Feedback on Jade Ward (Central London CCG) March 2013 Hammersmith and Fulham CCG, Report of a Diabetes Workshop, 13 th February, 2013 NWL Commissioning Support Unit, Patient Experience Report, West London CCG, 2013 BME Health Forum, A study into the experiences of Black and Minority Ethnic Maternity Service Users at Imperial College Healthcare NHS Trust, April 2011-March 2013 H&F LINk, Ravenscourt and Lillie Wards – Dignity Champion Assessment, West London Mental Health NHS Trust, 2012 (West London CCG) JSNA, Carers Evidence Pack for Kensington and Chelsea, Report, 2012 (West London CCG) CaVSA, Joint Strategic Needs Assessment: CaVSA Community Consultation Report, May 2010 (Hammersmith and Fulham CCG) Somali and Eritrean Project, A study into the experiences of Eritrean and Somali residents of accessing health services, Hammersmith and Fulham, 2005 Kurdish Association, Diabetes Consultation, West London, March 2005 *This is just a selection of some of the many patient experience reports that have been used to inform CWHHE patient experience strategy and the Better Care Plans. SBO