LEICESTER, LEICESTERSHIRE AND RUTLAND PCT CLUSTER ...

Paper 1 

LLR PCT Cluster Integrated Board meeting 

8 September 2011 

LEICESTER, LEICESTERSHIRE AND RUTLAND PCT CLUSTER 

INTEGRATED BOARD MEETING 

Front Sheet 

Title of the report: Annual report on emergency preparedness 2010/11 

Report to: 

Section: 

LLR PCT Integrated Board meeting 

Public 

Date of the meeting: 8 th September 2011 

Report by: 

Sponsoring Director: 

Presented by: 

Andy Kelly, Emergency Planning Co-ordinator 

Deb Watson, Director of Public Health and Health 

Improvement 

Deb Watson, Director of Public Health and Health 

Improvement 

Report supports the following corporate objective(s) 2011 – 2012: 

Handing over a good legacy √ Deliver the six identified transitional 

strands of work 

Manage Providers’ performance against 

updated health goals and identified 

health inequalities 

Deliver agreed performance targets 

against the six identified transformation 

work streams 

Develop and maintain an energetic 

stakeholder engagement programme 

throughout the transition 

√ 

EXECUTIVE SUMMARY: 

1. The purpose of this paper is to provide the Board with an update on activity in 

emergency preparedness during the year 2010 / 11. It will provide assurance that, as 

outlined in DH Emergency Planning Guidance 2005 “…Boards receive regular 

reports including…a specific statement relating to the emergency preparedness 

including reports on exercises, training and testing undertaken by the organisation 

and that adequate resources are made available to allow discharge of these 

responsibilities.” 

2. It also contains details of 

Incidents that have occurred in the past twelve months 

Planned training and exercising for the coming year, including preparation for 

the 2012 Olympics, Paralympics and Torch Relay 

Assurance that the Cluster is in a good position to prepare for the new NHS 

landscape 

1

RECOMMENDATIONS: 

Paper 1 



The Trust Board is requested to: 

RECEIVE an update on the work undertaken in the last twelve months 

RECEIVE the current progress in this area on the Shared Operating Model for PCT 

Clusters (DH, July 2011), 

APPROVE the work schedule for the coming year, and; 

APPROVE the outlined revisions to the Major Incident Plan and Business Continuity 

Policy 

2

Paper 1 





8 SEPTEMBER 2011 

Report on Emergency Preparedness activity 2010/11 

Introduction 

1. The purpose of this paper is to provide the Board with an update on activity in 

emergency preparedness during the year 2010 / 11. It provides assurance 

that, as outlined in DH Emergency Planning Guidance 2005 “…Boards receive 

regular reports including…a specific statement relating to the emergency 

preparedness including reports on exercises, training and testing undertaken 

by the organisation and that adequate resources are made available to allow 

discharge of these responsibilities.” 

Incidents in 2010 / 11 

2. During the period covered by this report, there were a number of incidents that 

required the organisation to be involved in the response. 

3. Operation Pennant – September 2010 was the planned response to the 

lawful demonstration in Leicester City by the English Defence League. 

Working with the Police and Ambulance Service, the PCT supported the 

response by the deployment of a doctor close to the scene to deal with any 

minor injuries and reduce the impact on the Emergency Department. It was 

also involved in the co-ordination of the response to ensure that the impact on 

the delivery of health care was reduced as far as possible. As a result of the 

plans put in place, there was no impact noted on community services or Out of 

Hours primary care, no impact on performance of the Emergency Department 

or Ambulance Service. A debrief report was sent to the Department of Health 

who commended the health community in the way in which we prepared for 

and responded to this event. 

4. Seasonal Influenza – December 2010. In December 2010, the LLR area was 

the first in the country to notice an increase in the level of respiratory illness in 

the population. Working with the Health Protection Agency, the PCT coordinated 

the response of partners in health and social care to ensure that the 

impact was managed as effectively as possible. With clear strategic objectives 

the impact was controlled as much as possible. Although the impact in UHL 

was significant, prompt actions to increase the availability of antiviral drugs to 

GPs and increase influenza vaccinations amongst staff staff and members of 

the public more vulnerable to the complications of influenza prevented an 

even greater impact in terms of illness and NHS capacity. The seasonal 

influenza experience in 2010 highlighted the need for influenza vaccination 

amongst staff and amongst those vulnerable to complications from influenza, 

such as those suffering from diabetes, respiratory or heart disease. 

3

Paper 1 



5. Loughborough Fire – May 2011. In the early hours of the May Bank Holiday 

Monday, a fire at Jayplas in Loughborough sent a heavy plume of smoke 

through housing in the north of Loughborough. In collaboration with the Health 

Protection Agency, the PCT Cluster was involved with the co-ordination of 

response to this fire, providing clear and consistent advice to the public and 

other responders. Although there was a significant quantity of thick black 

smoke coming from the fire, there were no reports of people suffering health 

consequences as a result of exposure to the smoke. A debrief process is still 

underway to identify lessons to be learned 

6. Operation Horizon – August 2011. This was the name of the local police 

response to the potential spread of civil disorder from London and other 

metropolitan cities. The PCT was involved by representing the LLR health 

community in the strategic co-ordination of the response from local partners; 

the provider organisations were involved in the tactical co-ordination. There 

was no impact on NHS services during this period. A multi-agency debrief 

process is being managed by the Local Resilience Forum support team 

Exercises in 2010 / 11 

7. During the period of time covered by this report, the PCT Cluster took part in a 

number of multi-agency exercises. 

8. Exercise Brownfield – May 2010 was an exercise to test the way in which 

NHS organisations can work together in managing communications with both 

staff and public during an incident. As a result of this exercise agreements 

were made about how different organisations would be involved in either 

leading or supporting the response to an incident. Effective communications 

has been shown many times to be key in how we respond to an incident. The 

PCT was involved in developing and delivering this exercise, as well as taking 

a full part in it. 

9. Exercise Earthquake – October 2010 was a live exercise to test the 

response to a Chemical Biological Radiological or Nuclear (CBRN) incident. It 

involved the decontamination of over 150 volunteers from a simulated release 

of radioactive material at Leicester Racecourse. This venue was chosen for its 

facilities rather than any suggestion it would be at risk of such an incident. This 

tested the processes from decontamination of members of the public through 

to onward support in a Local Authority Survivor Reception Centre. The PCT 

Cluster was involved as part of the tactical co-ordination of the incident. A 

debrief process has identified where improvements to plans and procedures 

will improve the response to such incidents in the future 

4

Paper 1 



10. Exercise Greystoke – July 2011 was a live exercise to test the 

response to a mass casualty incident. The exercise involved over 500 people 

responding to an incident at Loughborough University. The scenario was 

around a fire and explosion at one of the laboratory buildings, and tested the 

Ambulance Service response to dealing with large numbers of casualties. UHL 

was involved in testing its plans through use of a simulation process (known 

as EMERGO) of its management casualties, alongside Nottingham and Derby 

Hospitals. A total of seven other hospitals across the region were also 

involved in the exercise to test the way in which large numbers of casualties 

are distributed to hospitals around the region. The exercise also tested the 

strategic co-ordination of the response by the Ambulance Service and NHS 

East Midlands. The PCT Cluster was involved in the strategic co-ordination of 

the response. A debrief process is still underway, and will be used to further 

develop and refine plans and procedures. 

Plans and testing of plans 

11. Prior to the transfer of services from the PCT under the Transforming 

Community Services programme, the business continuity and other relevant 

plans were reviewed and ensured that they were updated to transfer with their 

services to their new providers. This ensured that there was no risk to 

business continuity during the transfer period and enabled the integration of 

these plans with their new host’s arrangements 

12. The PCT Cluster has also developed a document that outlines the 

expectations of commissioners on all providers of NHS funded services with 

respect to emergency preparedness. This document details how organisations 

are expected to work both individually and collectively in preparation, training 

and exercising to ensure a prompt and effective response to incidents. 

13. The PCT Cluster’s Major Incident Plan has been revised in April 2011. This 

has been done to take into account the Cluster arrangements, and the 

maintenance of the PCT Cluster’s responsibility for strategic leadership of the 

local NHS. As the new arrangements across the NHS develop in the coming 

months, the plan will be revised further. The full revised plan will be published 

on the PCT website, as required under the Civil Contingencies Act 2004, 

following discussion of this report by the PCT Cluster Board. 

14. A test of the PCT Cluster’s Major Incident Plan is scheduled for early 2012 by 

means of a tabletop exercise. Some testing of directorate business continuity 

plans have also been scheduled for the PCT Cluster directorates. 

15. The Corporate Business Continuity Policy has also been revised in August 

2011 to take into account changes including the Cluster arrangements. This 

will be published on the Website following discussion of this report by the PCT 

Cluster Board. 

5

Paper 1 



16. The plans for setting up of antiviral distribution centres as required in 

pandemic influenza have also been exercised. This has involved setting up 

the pre-identified centres with the staff that would be expected to run them. 

This has taken place in two centres in Leicester City in January and June 

2011, and all nine designated centres across LLR will have had such an 

exercise by March 2011 

Training 

17. Training has been provided for PCT staff in the management of incidents at a 

strategic and tactical level, with a total of 12 staff attending exercises. The 

PCT Cluster has been involved in the testing of plans of other organisations 

with a statutory duty to develop plans, such as those produced under the 

Control of Major Accident Hazard (COMAH) Regulations, which could present 

a threat to the health of the local population. 

18. The PCT Cluster has also maintained its support for independent practitioners 

in developing business continuity plans, since training sessions in 2009 when 

71 of 152 GP practices attended one of three workshops held across LLR. At 

present, 135 of 152 GP practices (89%) have business continuity plans, and 

all remaining practices have been offered one-to-one support in development 

of plans. 

19. In September 2010, three business continuity exercises were arranged (in the 

City, Syston and Ashby-de-la-Zouch) but in the event, only two practices 

registered for the exercises in the City, one for the exercise in Ashby-de-la- 

Zouch, and three at Syston. There remains an on-going need to develop 

Business Continuity Management within General Practice, including further 

exercises to validate plans 

Future work programme 

20. There are a number of areas of work that are being undertaken in the year 

2011/12. These will be based around the requirements to maintain the 

capability to respond to an incident, while working through the challenges 

posed to this by the changes in structure to the way in which NHS funded 

services are commissioned and provided. Working with partners in the Local 

Resilience Forum (LRF), this will be driven by the priorities identified in the 

Community Risk Register. These priorities include: 

 

 

 

 

 

 

Pandemic influenza 

Flooding 

Incident involving transport of hazardous chemicals 

Low temperatures and heavy snow 

Heatwave 

Loss of telecommunications 

6

Paper 1 



Pandemic influenza remains at the top of this list as the overall risk has not 

reduced despite the recent pandemic. For full details of the assessment of 

risks in the local area, the Community Risk Register can be found in the 

Leicester, Leicestershire & Rutland LRF - Library 

21. Upcoming exercises in 2011 / 12 will be focussed around the need to prepare 

for the Olympics. The planned schedule for the exercise programme is 

summarised below: 

Date 

Exercise 

Oct 2011 Loughborough Evacuation, Phase 1 

Nov 2011 

East Midlands Airport Exercise 

Jan 2012 

Mass Casualties / Fatalities 

Feb 2012 

Rest Centre Exercise 

Mar 2012 

Leicester City Evacuation 

April 2012 Loughborough Evacuation, Phase 2 

May 2012 

Torch Relay Event 

June 2012 

Leicester City Evening Event 

22. The PCT Cluster will be involved in the planning of these exercises and will be 

responsible for overseeing the involvement of Providers in these exercises. 

23. In addition, the PCT Cluster will be organising and delivering an exercise for 

all major providers of NHS funded care in LLR to test their Major Incident 

Plans. This will also test the PCT as co-ordinators of the response across LLR 

24. The PCT Cluster retains a resource to ensure that it has the capability to 

respond to incidents with no or short notice through the PCT Cluster Director 

on call rota, supported by the Emergency Planning Co-ordinator. The pack of 

information provided to the on call Director has been revised in August 2011, 

and further specific training has been agreed. 

25. Over the coming year, the PCT Cluster will also continue to work on 

developing and testing their business continuity plans, as well as the 

development and testing of the plans of independent contractors. We will also 

be involved in the testing and exercising of plans, both internally and with 

partners, in preparation for the London 2012 Olympics. The British Olympic 

Team will be based in Loughborough prior to the games themselves, which 

will impact upon the local area. 

Future structures 

26. This section summarises the requirements for Emergency Planning, 

Response and Resilience in the Shared Operating Model for PCT Clusters 

published by DH in July 2011, and the PCT Cluster’s progress against these 

responsibilities 

7

National context 

Paper 1 



27. The new proposed model will establish a robust and resourced structure which 

operates at all NHS levels, providing the Secretary of State with a direct ‘line 

of sight’ to local providers of NHS funded care. This will allow the NHS CB to 

consistently lead the NHS response to any emergency or incident that has the 

potential to, or impacts on, the delivery of NHS services or requires the 

services/assets of the NHS to be mobilised at the most appropriate level 

Local requirements 

28. PCT Clusters are expected to maintain the capacity of NHS Commissioners to 

carry out Emergency Preparedness, Response and Resilience (EPRR) during 

the transition period. They are also expected to support the development of 

the new Emergency Planning and Resilience function within the NHS. In the 

transition to the new structures, clusters are expected to: 

 

 

Maintain a health emergency planning network, ensuring all NHS 

organisations in their area meet at least quarterly to agree health resilience 

issues 

Appoint/nominate a director who is responsible for health emergency 

planning; this person should: 

o Chair the Health Emergency Planning Network 

o Report to the board regularly on local risks to either delivering 

health care, and/or the health of the local population 

o Be responsible for representing the local health economy at the 

Local Resilience Forum Executive 

 

Provide a 24/7 arrangement to provide strategic leadership to the local 

NHS in the event of a major incident. This should be able to: 

o Operate via a suitably equipped control room for period of up to 

two weeks 

o Have clearly delegated authority to mobilise and direct the 

resources of any NHS organisations across LLR during an 

incident across the local health economy 

 

Maintain a sufficiently resourced and adequately trained health emergency 

planning team that can manage the day-to-day preparedness work, and 

support the Director and Cluster PCT board. This will include: 

o Promote, develop and facilitate relationships between NHS 

funded providers and other partners, including local authorities 

with regards to emergency preparedness and response 

8

Future arrangements 

Paper 1 



o Ensure sufficient testing and exercising of communication plans 

in accordance with the 2005 DH guidance. This should include 

testing both in hours and out of hours 

o Ensure the local NHS contributes fully to any local multi-agency 

training and exercising programme 

o Ensure mechanisms are in place to support local system wide 

response, including cross boundary mutual aid for emergency 

response 

29. It is emerging that these requirements will in future be those of the “field force” 

of the NHS CB. The NHS CB will in future set a risk-based national 

Emergency Preparedness, Response and Resilience (EPRR) implementation 

strategy and planning structure for the NHS. It will also put in place a 

consistent national EPRR assurance framework for all providers of NHS 

funded care. At the sub-national level, it is proposed that NHS CB will 

commission, direct and assure the local EPRR structure to ensure delivery of 

the national EPRR strategy. At the local level, it is proposed that the NHS CB 

will discharge its EPRR function via 39 Local Health Resilience Boards 

(LHRB) which will map onto existing Local Resilience Forum boundaries. The 

sub-national hubs of the NHS CB will be responsible for appointing a suitable 

local NHS CB lead who will chair the LHRB. Supported by a NHS CB funded 

team, this lead will have responsibility for local planning, assurance and 

response. 

Current position in LLR 

30. Most of the major areas detailed in the local requirements are already in place 

in LLR. We have a mutual aid agreement that provides the background to our 

ability to support organisations involved in the response to incidents. We also 

have a memorandum of understanding that details the executive support for 

the “NHS Gold” role that would provide the strategic leadership required. 

Although we currently have two potential control rooms (which are currently 

being reviewed) this will need to be reviewed again in light of any estates 

changes in coming months. 

31. In order to make sure that emergency preparedness is maintained in the 

future, the Health Emergency Planning Group has been reconstituted to reflect 

the new and emerging landscape of the NHS. Membership includes those 

providers from outside of LLR who now provide core services within the 

boundaries including the George Eliot Hospital NHS Trust (Urgent Care 

Centre) and Central Nottinghamshire Clinical Services (GP Out of Hours 

service).This now meets as the LLR Health Emergency Preparedness and 

9

Paper 1 



Response Group, which is a standing sub-group of the Local Resilience 

Forum. Its terms of reference are available on request. 

32. At present, the Chief Executive represents the Cluster on the LRF, with a lead 

DPH in Emergency Preparedness identified. With Directors of Public Health 

expected to move to Local Authorities by April 2013, the lead Director 

arrangements for NHS emergency preparedness, resilience and response will 

require review prior to April 2013. This is to ensure that a suitable NHS 

Director is designated to lead NHS resilience and response. 

33. During August and September 2011, the Department of Health is holding a 

series of national workshops to “road test” an outline model for future NHS 

Emergency Preparedness, Response and Resilience after April 2013. The 

Department of Health is expected to issue further guidance following these 

workshops 

Recommendations 

The Board is asked to: 

RECEIVE an update on the work undertaken in the last twelve months 

RECEIVE the current progress in this area on the Shared Operating Model for PCT 

Clusters (DH, July 2011), 

APPROVE the work schedule for the coming year, and; 

APPROVE the outlined revisions to the Major Incident Plan and Business Continuity 

Policy 

10

Paper 2 

LLR PCT Cluster Integrated Board Meeting 




Front Sheet 

Title of the report: 

Report to: 

Section: 

Leicester, Leicestershire & Rutland Winter Resilience 

Planning 2011/12 

Leicester, Leicestershire and Rutland PCT Cluster 

Integrated Board Meeting 

Public 

Date of the meeting: 8 September 2011 

Report by: 


Presented by: 

Amita Chudasama, Planning & Delivery Manager 

Catherine Griffiths, LLR Cluster Chief Executive and Chair 

of the LLR Emergency Care Network. 


Handing over a good legacy 

Deliver the six identified transitional 


Manage Providers’ performance against Develop and maintain an energetic 





Deliver agreed performance targets x 


work streams 


Update on the arrangements put in place by the Leicester Leicestershire and Rutland 

health and social care community to maintain access to services throughout Winter 

11/12 including, the Christmas and New year holiday period. 


The Trust Board are requested to: 

Note and Approve the Winter Resilience Plans for the LLR health and social care 

economy. 

1

Paper 2 






Leicester, Leicestershire & Rutland Winter Resilience Planning 2011/12 

INTRODUCTION 

Context 

1. Winter impacts upon the full spectrum of health and social care services with 

extra demands on services during winter on all parts of the NHS including 

primary care, ambulance and acute hospital services, particularly the 

Emergency Department, critical care and medical inpatient beds, as well as on 

partners such as social care. 

Leicester, Leicestershire & Rutland Winter Resilience Plan 2011/12 

2. A co-ordinated, multi-agency approach is essential to ensure that preparation is 

robust and that processes are in place that can adapt to the different pressures 

as and when they arise. The LLR winter resilience plan has been coordinated 

through the LLR Winter Resilience Group, co chaired by the PCT Cluster and 

UHL. This multi agency group includes representation from all organisations 

across LLR involved in the delivery of urgent and emergency care, either in 

person or ‘virtually’ and has the full support of the local health and social care 

economy and is a sub-group of the LLR Emergency Care Network. 

3. The aim of the plan is to: 

Support the health and social care community to respond to periods of high 

and unusual demand by ensuring that service flexibility and capacity is at 

optimal levels as winter approaches. 

Provide assurance of business continuity between providers and 

commissioners. 

Prompt service responsiveness to increase during the winter months 

especially in relation to flexibility and capacity. 

Clarify escalation triggers, ensuring an integrated and shared process 

between primary and secondary care providers and partner agencies such as 

social care. 

Describe agreed communication and reporting channels to enable appropriate 

responses to be made in the event of escalation due to additional winter 

activity. 

2

Paper 2 



4. The LLR PCT cluster has led the formulation of the winter plan with partner 

agencies to harmonise procedures across the City and County, including each 

Urgent Care lead GP from each of the 3 Clinical Commissioning Group’s. The 

plan has also evolved following feedback from the national IMAS team and 

lessons learned from winter 10/11. It also aligns with the plans for pandemic 

flu. 

5. The winter plan is designed to form part of the long-term local strategy and the 

commissioning of responsive services that meet patient need. Although every 

effort has been made to prepare for winter, it is recognised that from time to time 

all care providers are likely to be functioning under extreme pressure and that 

there will be an increase in demand for health and social care services during this 

period. 

6. Overall, the winter planning process has followed a route of logical, informed 

planning and preparation, good practice and collaboration, and contingency 

planning to deal with problems as they arise. 

7. The Winter Plan and the Escalation Plan are attached. All other appendices are 

in the process of being finalised in collaboration with stakeholders and are 

available if required. 

RECOMMENDATIONS 

The Trust Boards are requested to: 

Note & Approve the Winter Resilience Plan for the LLR health and social care 

economy. 

3

LEICESTER, LEICESTERSHIRE AND RUTLAND HEALTH AND SOCIAL CARE COMMUNITY 

Emergency Escalation Plan 

August 2011 

1

Index 

Page 

Background 3 

Introduction 4 

Role of the Leicester, Leicestershire and Rutland PCT Cluster 4 

UHL Bed Management Policy 5 

Leicester, Leicestershire & Rutland Whole System Escalation Plan 2011/12 7 

Escalation and De-Escalation Process 17 

Contacts 18 

2

BACKGROUND 

This plan has been developed in conjunction with representatives from the following organisations:- 

Leicester, Leicestershire and Rutland Cluster 

University Hospitals of Leicester NHS Trust 

Leicestershire Partnership Trust (incorporating City and County Community Health Services) 

East Midlands Ambulance Service NHS Trust 

West Leicestershire Consortium 

Crescent Consortium 

One Leicester Consortium 

Leicester City Social Services 

Leicestershire County Social Services 

Central Notts Clinical Services for Out of Hours Service 

George Eliot NHS Trust for Urgent Care Centre 

The Leicester, Leicestershire and Rutland Emergency Care Network have reviewed this escalation plan and will review at regularly determined 

intervals. 

3

INTRODUCTION 

EMERGENCY ESCALATION PLAN 

The Leicester, Leicestershire and Rutland Health and Social Care Community escalation plan includes separate escalation plans for the different 

partner agencies and areas of the Health and Social Care Community. The alert status declared by the University Hospitals of Leicester NHS Trust 

(UHL) determines the overall Leicestershire health and social care community alert status. 

Whilst detailed planning has taken place to profile expected activity against capacity, there are instances when any of the health or social care 

partners may have difficulty in providing their normal services. The escalation plan identifies actions that will be taken by each area and / or as a 

whole community to meet the demands being put on the service. The expectation is that each area will take all necessary management action to 

resolve local difficulties and pressures. However, it is recognised that despite all interventions there will be occasions when pressures cannot be 

easily contained by one organisation. 

The plan is designed to maintain a safe and good quality service for patients at all times and is not designed to shift the pressure from one area to 

another but to share the burden in order to achieve balance across the Health and Social Care Community. 

There are several levels of alert status for the escalation plan: 

Normal Working 

Level 1 

Early signs of difficulty/some excess pressure requiring some extra management intervention 

Level 2 

Persistent excess pressure requiring significant additional management action 

Level 3 

Level 4 

Severe and/or prolonged excess pressure requiring support for all agencies 

Extreme pressure requiring immediate and significant action 

ROLE OF THE LEICESTER, LEICESTERSHIRE AND RUTLAND PCT CLUSTER 

The LLR PCT Cluster will act as the “communication cell” for the escalation plan. The different organisations will communicate their pressure 

problems and status of alert to the Urgent Care Lead, Rachna Vyas 0116 295 4179 so that the overall picture in the Health and Social Care 

Community is known at any one time. 

Each organisation will be responsible for developing their own organisational mechanisms to communicate any pressures. For example UHL Bed 

Bureau will act as UHL’s internal “communication cell” for escalation. The different areas will communicate their pressure problems and status of 

alert to the Bed Manager via the Bed Bureau so that the overall picture is known at any one time. 

4

The LLR PCT Cluster’s role will also be: 

• To lead the strategic development of emergency services for the local health and social care community. 

• To be the single point of contact for the Strategic Health Authority (SHA) for emergency services in relation to SITREPs and escalation planning 

with the exception being if a serious untoward incident occurs when the relevant Trust should notify the SHA directly as well as the LLR Cluster. 

• To be made aware by the Emergency Care Lead (ECL) of the organisations of the health and social care community of any issues that could 

affect the service delivery of emergency care i.e. bed/ward closures/exceptional demand for services. 

• To co-ordinate the SITREP submission for the local health and social care community liaising with each Trust who has data to submit against 

the SITREP timetable. 

• To oversee the delivery of the Escalation Plan, being informed by any organisation who wished to declare a 'major incident' of the situation and 

being part of the senior officer discussions prior to the formal declaration of the alert status. The organisation wishing to declare the alert would 

co-ordinate the meeting. 

• To chair the Daily Escalation Conference Calls and oversee any actions resulting from the calls. 

UHL BED MANAGEMENT POLICY 

The Major Incident Policy and the Bed Management Policy for University Hospitals of Leicester NHS Trust (UHL) interfaces with the escalation 

policy as the impact of the major incident may be to compromise capacity within UHL. It will therefore require co-operation from all agencies within 

the health and social care community to manage the situation as well as the ongoing health and social care needs of the population. The Level 4 

status may be exceeded if the situation continues to escalate or a major incident occurs but especially if a situation results in mass casualties, i.e. 

over 100, when the emergency plans in place for these situations will be implemented. 

If it is apparent that the Red alert status is not going to be stepped-down, then a meeting of the Directors/ Senior Officers from the partner agencies 

will be called by the organisation who is asking for the alert status to be escalated to ‘Black. This meeting, chaired by the organisation wishing to call 

a major incident, will make the decision whether the Health and Social Care Community should declare this. The actions to be taken will be agreed 

by the Senior Officers group which includes LLR PCT Cluster who is the strategic lead for emergency services. This group will also ratify the 

decision to downgrade the alert status. 

5

The University Hospitals of Leicester NHS Trust’s Bed Management Policy, details actions that UHL will take to manage the emergency admission 

process, bed capacity and the associated hospital status for internal escalation. The Bed Management Policy is Appendix 2 to the 2011/12 Winter 

Resilience Plan. 

Each day following assessments of overall bed capacity, the Admissions and Discharge Manager will determine the level of bed alert within UHL in 

hours Monday – Friday 8am – 5pm, out of hours this is the responsibility of the duty manager in discussion with the senior manager on call. 

The Trust’s aim is to start each day on a Normal Status and escalate where appropriate i.e. after discussions of bed capacity at the 8.30 bed 

meeting. The decision will be based on the predicted shortfall in capacity. 

The status of UHL beds is divided into the categories below and a “Bed Alert” is declared against this criteria 

Normal Status 

 

 

No problems identified 

Normal day to operation plan of bed management 

Stage One 

Bed Alert 

 

 

The rate of emergency admissions is exceeding the rate and which beds will become available. 

Elective Admissions are still prioritised – NOT Cancelled 

Stage Two 

Bed Alert 

 

 

 

 

The rate of emergency admissions has exceeded the number of beds available. 

Elective category B&C cases for non ring fenced beds reviewed for cancellation. 

Extra capacity to be created 

Outlying of patients to alternative Business Units/Divisions. 

Stage Three 

Bed Alert 

 

 

 

 

 

Situations deteriorating. 

Major shortfall in the number of beds available for emergency admissions. 

All available extra capacity to be created 

Outlying of patients to alternative Business Units/Divisions. 

Review of all electives cases for cancellation 

6

Leicester, Leicestershire & Rutland Whole System Escalation Plan 2011/12 

NORMAL WORKING 

System Triggers 

INDIVIDUAL ORGANISATION TRIGGERS 

URGENT CARE CENTRE/ MIU’S/ WIC 

EMAS 

UHL 

SOCIAL CARE 

• Urgent Care Centre, WIC’s & MIU’s 

working normally 

• No excess pressure on Emergency & PTS 

transport 

• No 30 minutes or more turnaround time 

• No ambulance diverts 

• Sickness Absence

NORMAL WORKING 

System Triggers 

LPT – COMMUNITY HEALTH SERVICES 

• No delays within Community Hospitals/ 

IC Teams 

• In Hours Services working normally 

LPT – MENTAL HEALTH SERVICES 


PRIMARY CARE 

• Currently status is ‘normal for season 

• Preparatory work is underway 

• Available appointments at GPs 

• Reviewing plans for business continuity 

• normal operation 

OUT OF HOURS 

• Out of Hours Services working normally 

System Actions 

• Daily teleconference at 11.45am involving urgent care leads from each organisation with Objective of identifying issues early on to avoid disruption to patient flow across LLR. 

• Community hospital bed state to be faxed/emailed daily to UHL Bed Bureau by 9am/2pm 



INDIVIDUAL ORGANISATION ACTIONS 

PRIMARY CARE 

OUT OF HOURS 

 

Daily monitoring of demand across 

services 

 


services 

 


services 

 


services 

8

ESCALATION LEVEL 1 – EARLY SIGNS OF DIFFICULTY/SOME EXCESS PRESSURE REQUIRING SOME EXTRA MANAGEMENT 

INTERVENTION 

System Triggers @ Midday 

No. of patients in ED 40 -50 Time to see Senior Decision Maker > 1.5 hours ED breaches 4-6 Cancellation of elective admissions for capacity related issues Critical Care Capacity = 0 Admissions unit 

capacity/bed capacity – 100-110 More than 6 patients awaiting Community beds (excluding those waiting for choice reasons EMAS REAP Level 1 Ambulance turnaround times >15 mins 



EMAS 

UHL 

SOCIAL CARE 

• Urgent Care Centre /WIC waiting times 

consistently 3 hours 

As above and 

• Jobs awaiting vehicle allocation does not 

exceed 

• 70 EMAS wide or 

• > 35- 40 for one control desk 

• >30 ‘on day’ transport request for 

PTS 

As above and 

• Planned discharges not sufficient to 

accommodate admissions from the 

admissions units and ED 

• The rate of emergency admissions is 

exceeding the rate at which beds will become 

available. 

• Increase in volume of referrals from wards to 

both Acute Trust Social Work Teams and 

Area Teams. 


• Service provider should in the first instance inform the contacts above, dependant on whether in or out of hours and agree the escalation level required. This should be confirmed at the next daily 

teleconference. 

• PCT leads will send out alert to the Emergency Care Network regarding service pressures. Each member of the ECN to implement actions listed below to help increase the flow of patients across the 

system. 

• Implement flu pandemic plan should a pandemic alert be called & FLU DIRECTORS NOTIFIED 

• Patient & public targeted communications strategy enacted across LLR 



EMAS 

UHL 

SOCIAL CARE 

• Urgent care Centre/WIC’s to review staffing 

and place off-duty on standby 

• Duty Control Manager to contact A&E Duty 

Control Manager. 

• Implement Level 1 Escalation 

• Manage pressures with internal escalation 

measures. 

• Site Duty Manager to confirm with CBU leads 

for bed management that all actions outlined 

in the daily operational plan have been taken. 

• If appropriate actions have not been taken the 

Clinical Business Manager will be informed 

• Review the potential shortfall in the number of 

beds and confirm that all capacity has been 

utilized before determining the alert status 

• Appropriate staff are made aware of 

increasing bed pressures verbally or via email 

(consultants on-call /manager on-call / senior 

nurses & managers 

• Ensure that all low risk actions are in place 

consider invoking moderate risk actions 

• Communicate Bed Status to Leicestershire 

Health Social Care Community 


• Ensure no delays to transfer of care from 

community hospitals. 

• Alert A&E worker of possible pressures in 

A&E –UHL & LRI 

• Alert duty worker for EMU/MAU. 


9

ESCALATION LEVEL 1 – EARLY SIGNS OF DIFFICULTY/SOME EXCESS PRESSURE REQUIRING SOME EXTRA MANAGEMENT 

INTERVENTION 


No. of patients in ED 40 -50 Time to see Senior Decision Maker > 1.5 hours ED breaches 4-6 Cancellation of elective admissions for capacity related issues Critical Care Capacity = 0 Admissions unit 

capacity/bed capacity – 100-110 More than 6 patients awaiting Community beds (excluding those waiting for choice reasons EMAS REAP Level 1 Ambulance turnaround times >15 mins 




PRIMARY CARE 

OUT OF HOURS 

• Reduced bed capacity 

• Staff shortages resulting in some reduced 

capacity 

• Early signs of increased demand on services. 

• Some staffing difficulties linked to e.g. flu 

outbreak 

• Some increase in demand for appointments 

• Staff shortages linked to an impending 

situation e.g. flu outbreak 

• Increased early discharges from secondary 

care 

• Specified pharmacy closure 

• Increased demand during out of hours 


• Service provider should in the first instance inform the contacts above, dependant on whether in or out of hours and agree the escalation level required. This should be confirmed at the next daily 

teleconference. 

• PCT leads will send out alert to the Emergency Care Delivery Group regarding service pressures. Each member of the ECDG to implement actions listed below to help increase the flow of patients across the 

system. 






PRIMARY CARE 

OUT OF HOURS 

• On call capacity manager to implement 

community capacity plan. 

• Situation to be monitored by LPT Senior 

Operations Team with appropriate 

intervention as necessary. 

• Situation to be monitored by LPT Senior 

Operations Team with appropriate 

intervention as necessary. 

• Additional clinics and/or different ways of 

working required to meet the demand 

• Number of routine appointments reduced 

• Enhanced coordination between health and 

social care 

• PCT communications to circulate Bed Bureau 

alerts 

• Practices to review capacity & demand plan 

• If practice specific, notify Consortium/PCT 

• Consider whether activation of the practice 

Service Continuity Plan is appropriate 

• Alert Single Point of Access (SPA) team 

• If practice specific, notify Consortium/PCT 

• Consider whether activation of the practice 

Service Continuity Plan is appropriate 

• Alert Single Point of Access (SPA) team 

• Alert Pharmacy Contractors/LPC of potential 

of increased demand for prescribed 

medicines, and to avoid possible supply 

problems 

• Invoke Pharmacy Closure protocol 

 

 

Real time monitoring and escalation 

where needed 

Daily capacity reviews 

10

ESCALATION LEVEL 2 – PERSISTENT EXCESS PRESSURE REQUIRING SIGNIFICANT ADDITIONAL MANAGEMENT ACTION 

No. of patients in ED 50 – 60 Time to see Senior Decision Maker > 2hours ED breaches 6-10 Cancellation of elective admissions Critical Care Capacity = 0 Admissions unit capacity/bed capacity – 80-100 

More than 10 patients awaiting Community beds EMAS REAP Level 2 Ambulance turnaround times >30 mins WiC/UCC time to see Senior Decision Maker Consistently 3.5 hours 



• As Level 1 

EMAS 

As above and 

• Continuation of factors as stated in Level 1 

• Jobs awaiting allocation not decreasing after 2 

hours. 

• Functional failure of CAD, COMS, Radio in 

Control. 

• Demand & Capacity plan breached 

UHL 

As above and 

• Early morning elective patients placed but 

difficulty in placing later admissions 

• The triggers to escalate to an Amber Bed Alert 

will take place when there is a predicted 

shortfall in capacity across UHL. All of the 

actions outlined in the Bed Alert Status will 

take place with the addition of those for a 

Amber Bed Alert that are given below 

SOCIAL CARE 

• Increase in volume of referrals from wards to 

both Acute Trust social work teams and area 

team. 


• Service provider should in the first instance inform the contacts above, dependant on whether in or out of hours and agree the escalation level required. This should be confirmed at the next daily teleconference. 

• PCT leads will send out alert to the Emergency Care Network regarding the escalation. Each member of the ECN to implement actions listed below to help increase the flow of patients across the system. 





• Diverts and mutual aid between UCC and ED 

EMAS 

• Implement Level 2 escalation 

• Mobilise additional A&E and PTS support to 

deal with increased sustained activity 

UHL 

• Confirm all action on level have been taken 

• Wards/departments, CSSD, Imaging and 

Pathology are made aware of alert status 

verbally or via emailed bed status 

• CBU bed management leads informed of the 

need to asses for moderate risk actions 

• Confirm that all available capacity has been 

utilised before escalation declared 

• Elective specialities to prepare for possible 

cancellation of Category B elective admissions 

according to prioritised list - to prepare for 

outlying 

• CBU(s) Senior Medical / Nursing & mgmt 

teams informed of the need to assess for 

moderate actions 

• (OOH– on-call clinicians, Senior nurses, bleepholders 

informed) 

• Inform elective specialities to cancel planned 

admissions (B & C cases) in order to create 

additional capacity 

• Communicate Bed Status to LLR Health Social 

Care Community 

SOCIAL CARE 

• As for Level 1 


• Alert all Social Services staff based in Acute 

Trust, areas and Out of Hours Team to need to 

expedite discharges. 

• All Service Users already having received a 

full care needs assessment, & awaiting “Home 

of Choice” will be asked to move immediately 

(with carers/Family consent) where 

appropriate 

• Need for earlier approval of funding. 

• Check staffing levels 

• Check capacity in Intermediate Care and LA 

short-term care beds. 

11

ESCALATION LEVEL 2 – PERSISTENT EXCESS PRESSURE REQUIRING SIGNIFICANT ADDITIONAL MANAGEMENT ACTION 

No. of patients in ED 50 – 60 Time to see Senior Decision Maker > 2hours ED breaches 6-10 Cancellation of elective admissions Critical Care Capacity = 0 Admissions unit capacity/bed capacity – 80- 

100 More than 10 patients awaiting Community beds EMAS REAP Level 2 Ambulance turnaround times >30 mins WiC/UCC time to see Senior Decision Maker Consistently 3.5 hours 




PRIMARY CARE 

OUT OF HOURS 

• Reduced bed capacity 

• Staff shortages resulting in reduced capacity. 

• Increased demand on services. 

• Staffing difficulties linked to e.g. flu outbreak 

• Routine appointments unavailable 

• Reduction in non-critical services 

• GP/PN clinical triage of patients trying to 

access service 

• Implementation of admission and discharge 

criteria that are different to normal practice 

• Practices facing significant demand for 

appointment and/or home visits 

• Difficulty in accessing secondary care beds 

• Consortium/PCT Alert issued 

• Practice(s) Service Continuity Plan activated 

• Alert received from SPA or County Primary 

Care Coordinators 

 

As for level 1 with evidence of breaches 

against National Quality Requirement 

standards 


• Service provider should in the first instance inform the contacts above, dependant on whether in or out of hours and agree the escalation level required. This should be confirmed at the next daily teleconference. 

• PCT leads will send out alert to the Emergency Care Network regarding the escalation. Each member of the ECN to implement actions listed below to help increase the flow of patients across the system. 






PRIMARY CARE 

OUT OF HOUR’S 

• Monitoring admissions from UHL 

• SPA to provide regular capacity updates 

• Early discharge to community supported by 

DN teams 

• UCC to contact Communication Centre – non 

urgent appointment deferred 5 hours (within 

QR standard) 

• Implement Level 2 Escalation. 

• Implement Daily Service Situation Reporting 

(Refer to LPT Emergency Plan) across all LPT 

services. 

• Monitoring of situation by LPT Senior 

operations Team. 

• Monitoring admissions from UHL. 

• Implement Daily Service Situation Reporting 

(Refer to LPT Emergency Plan) across all LPT 

services. 

• Implement Staff Mobilisation Plan, if 

necessary, (Refer to LPT Emergency Plan) to 

support hot-spots. 

• Early discharge to community with appropriate 

support if safe to do so. 

• Monitoring of situation by LPT Senior 

operations Team. 

• UHL to provide PCT info on high admitting 

practices 

• PCT to follow up with individual practices 

• PCT to monitor attendances at ED, UCC and 

WICs and identify trends 

• Surge prioritisation plan to be initiated 

• Practice-specific situation: Advise patients to 

use NHS Direct and alternative health 

site/phone number until recovery plan 

implemented 

As for level 2 

Additional resource allocation to affected 

areas 

Alert Clinical and none clinical agencies that 

additional resources may be needed 

12

ESCALATION LEVEL 3 – SEVERE AND/OR PROLONGED EXCESS PRESSURE REQUIRING SUPPORT FROM ALL AGENCIES 


No. of patients in ED 60 – 70 Time to see Senior Decision Maker > 2.5 hours ED breaches 10-15 Averaged ED attendance by midday more than 130 Cancellation of elective admissions Critical Care 

Capacity = 0 Admissions unit capacity/bed capacity – 60-80 More than 15 patients awaiting Community beds EMAS REAP Level 3 WiC/UCC time to see Senior Decision Maker Consistently 4 hours 



EMAS 

UHL 

SOCIAL CARE 

• Urgent Care Centre waiting times consistently 

4 hours 

As above and 

• Jobs awaiting allocation not decreasing after 

4 hours. 

• Full/protracted failure of CAD, COMS, Radio 

in Control. 

• Substantial negativity against Demand & 

Capacity plan. 

As above and 

• Deteriorating situation. Major shortfall in the 

numbers of beds for emergency admissions. 

Major incident has been declared 

internal/external to UHL and extra capacity 

needs to be created. 

• All of the actions outlined within a Bed Alert 

Status will take place with the addition of 

those for a level 3 Bed Alert Status that are 

given below: 

• Nursing placements signalling 97% 

occupancy 

• Staffing absences over 50% in Care 

Management and Home Care Staff 

• Residential placements signalling 97% 

occupancy 



• ECN briefed on a daily basis after daily teleconference at 11.45am and again at 4pm to review situation and actions required. 

• UHL/COMMUNITY HOSPITALS to identify patients for awaiting discharge and any delays in accessing packages of care, community beds, community equipment CHC assessments to be raised to PCT 

leads. PCT leads to ensure actions to reinstate flow be implemented where possible. 

• Increase capacity in community by offering additional hours to bank nurses /AHPs and / or commission additional hours from agency 

• Open up closed beds, spare beds in community hospitals 

• Chief Exec to decide to cancel operations 

• The executive on call will give consideration to instigating the PCTs Major Incident Plan should Acute Trust instigate theirs or the demand placed on the PCTs community services become excessive 



URGENT CARE CENTRE / MIU’S/ WIC 

EMAS 

UHL 

SOCIAL CARE 

• Diverts and mutual aid between UCC and ED 

• Stand by staff called in 

• Implement Level 3 



• Continue to mobilise and use additional 

resources whilst re-prioritising sustained 

activity. 

• Ensure all actions outlined in the daily 

operational plan have been actioned 

• If appropriate actions have not been taken the 

Clinical Business Unit Manager will be 

informed. 

• Divisional Senior medical/Nursing & 

Management teams informed of the need to 

implement high risk actions. 

• Inform health and social care community and 

Strategic health Authority of agreed level of 

community wide status 




• Commission additional interim care beds from 

nursing/care homes subject to appropriate 

funding approval 

• Extra staffing hours made available on a 

case-by-case basis, agreed by Area manager. 

• Adult duty workers and managers and Rapid 

response teams to put services in to prevent 

admission for suitable community based 

referrals. 

13

ESCALATION LEVEL 3 – SEVERE AND/OR PROLONGED EXCESS PRESSURE REQUIRING SUPPORT FROM ALL AGENCIES 


No. of patients in ED 60 – 70 Time to see Senior Decision Maker > 2.5 hours ED breaches 10-15 Averaged ED attendance by midday more than 130 Cancellation of elective admissions Critical Care 

Capacity = 0 Admissions unit capacity/bed capacity – 60-80 More than 15 patients awaiting Community beds EMAS REAP Level 3 WiC/UCC time to see Senior Decision Maker Consistently 4 hours 


LPT – COMMUNIITY HEALTH SERVICES 


PRIMARY CARE 

OUT OF HOUR’S 

• Significant reduction bed capacity 

• Significant and sustained staff shortages 

resulting in reduced capacity. 

• Sustained increased demand on 

services. 

• Sustained staffing difficulties linked to 

e.g. flu outbreak. 

• UHL declare major incident 

• Practices facing significant demand for 

appointment and/or home visits 

• Difficulty in accessing secondary care 

beds 

• Consortium/PCT Alert issued 

• Practice(s) Service Continuity Plan 

activated 

 

Sustained increase in call volumes 

across all operational areas with 

significant breaches against National 

Quaility Requirement standards. 




• UHL/COMMUNITY HOSPITALS to identify patients for awaiting discharge and any delays in accessing packages of care, community beds, community equipment CHC assessments to be raised to PCT 

leads. PCT leads to ensure actions to reinstate flow be implemented where possible. 









PRIMARY CARE 

OUT OF HOURS 

• As per level 2 

• On-call Director/Manager informed 

• Surge plans activated for NHS LC CHS 

• Stand by staff called in 

• Implement Level 3 

• As per level 2. 

• On-call Director/Manager informed 

• Implement Staff Mobilisation Plan, if 

necessary, (Refer to LPT Emergency 

Plan) to support hot-spots. 

• Systematic review of in-patients with 

discharge to community with appropriate 

support if safe to do so. 

• GP’s offering telephone consultations 

• GPs offering more urgent appointments 

• 999 Cat C patients being taken directly to 

WIC’s, UCC, 8-to-8 centres instead of 

ED. 

• Implement relevant actions specified in 

Service Continuity Plan 

• Follow Consortium/PCT/PH advice or 

action plans 

• Implement available bank/agency 

arrangements to cover 

doctor/nurse/admin shortages 

• Support or seek support of neighbouring 

practices, especially for single-handed 

practices 

• Support of OOH service 

 

 

 

 

 

 

Additional resources where appropriate 

Additional PCC sessions 

Clinical streamning to bases and home 

visiting teams 

Daily performance and capacity reviews 

Escalation to GP consortia 

Cross working with other CNCS locations 

14

ESCALATION LEVEL 4 – EXTREME PRESSURE REQUIRING IMMEDIATE AND SIGNIFICANT ACTION 


No acute beds available or in near future No capacity in ED (all trolleys and bays full) Increasing number of patients waiting in ED >6 hours Time to see Senior Decision Maker > 4 hours 

EMAS REAP Level 4/5/6 



EMAS 

UHL 

SOCIAL CARE 

• Urgent Care Centre waiting times consistently 

4 hours 

As above and 

Continuation of level 3 factors 

As above and 

• On very rare occasions, the Trust may find 

itself in a position whereby it continues to be 

on a Red Bed Alert with all available capacity 

used and minimal predicted discharges 

occurring over the next 24 hours. The situation 

may be compromising the care and safety of 

patients with the increasing risks associated 

with prolonged waits in ED. 

• As for level 3 




• UHL/COMMUNITY HOSPITALS to identify patients for awaiting discharge and any delays in accessing packages of care, community beds, community equipment CHC assessments to be raised to PCT leads. 

PCT leads to ensure actions to reinstate flow be implemented where possible. 







URGENT CARE CENTRE / MIU’S/ WIC 

EMAS 

UHL 

SOCIAL CARE 


• Deployment of Major Incident Support Unit 

• Activation of Major Incident Plan 

• Exceptional bed management meeting to be 

held at the LRI to identify actions to improve 

bed situation. 

• Chair – Director of Operations/Nursing 

• Divisional /Senior Managers for all Divisions/ 

Divisional/ Clinical Director for 

Medicine/CSSD/EMAS/Pathology/Discharge 

Team/Imaging/ED/on call manager and 

Director on call/Admission and Discharge 

Manager 

• Trigger points for identifying the need for 

exceptional bed meetings will be during the 

site bed meetings throughout the day. 

As for Level 3 

15

ESCALATION LEVEL 4 – EXTREME PRESSURE REQUIRING IMMEDIATE AND SIGNIFICANT ACTION 


No acute beds available or in near future No capacity in ED (all trolleys and bays full) Increasing number of patients waiting in ED >6 hours Time to see Senior Decision Maker > 4 hours 

EMAS REAP Level 4/5/6 




PRIMARY CARE 

OUT OF HOURS 


• Significant reduction bed capacity 

• Sustained and severe staff shortages 

resulting in significant reduced capacity 

with potentially unsafe situations 

occurring. 


• Significant demand on services. 

• Sustained and severe staffing difficulties 

linked to e.g. flu outbreak. 

As for level 3 plus 

Practice experiencing severe and continuing 

difficulties in providing or maintaining services, due to 

pandemic situations, staff shortages or other practice 

specific emergency 

Continued and extended activation of Service 

Continuity Plan 

Closure of practice or associated pharmacy 

Service delivery difficulties notified by 

Community/DN teams 





• UHL/COMMUNITY HOSPITALS to identify patients for awaiting discharge and any delays in accessing packages of care, community beds, community equipment CHC assessments to be raised to PCT leads. 

PCT leads to ensure actions to reinstate flow be implemented where possible. 









PRIMARY CARE 

OUT OF HOURS 

• Emergency Plan triggered with TCG convened. 

• Consideration of Implementing LPT Service 

Reduction Plan (Refer to LPT Emergency 

Plan). 

• Reallocation of staff to support DN Teams as 

per Business Continuity Plans 

NHS DIRECT TRIGGERS AND ACTIONS 

• Emergency Plan triggered with TCG 

convened. 

• Consideration of Implementing LPT 

Service Reduction Plan (Refer to LPT 

Emergency Plan). 

• As for Level 3, plus 

• Notify Pharmacies of practice closures and 

vice-versa 


NHS DIRECT 

• CALL Abandonment rate less than 4% 

• Calls transferred immediately to a Nurse Advisor 

• Staff deployed to normal duties 

• Incoming call volume stable 

NHS DIRECT 

• Expect increased call volume 

• Put out information on health alerts and how to 

care for viruses. 

• More staff rostered on at Christmas particularly 

OOH period. 

• Issue information on repeat prescriptions over 

bank holidays 

NHS DIRECT 

• CALL Abandonment rate above 4 % 

• Only priority 1 calls not transferred immediately to 

a Nurse Advisor 

• Some redeployment of staff onto other duties 

• Peaks in call volume 


NHS DIRECT 

• CALL Abandonment rate above 4 % 

• Only priority 1 calls not transferred immediately to 

a Nurse Advisor 

• Some redeployment of staff onto other duties 

• Peaks in call volume 


16

ESCALATION AND DE-ESCALATION PROCESS 

LLR ESCALATION PROCESS LLR DE-ESCALATION PROCESS 

Urgent Care Leads: Urgent Care Leads: 

LLR PCT Cluster Rachna Vyas 0116 295 4179 / 07935 390 092 

UHL Richard Jarvis 07950 661 644 

LPT John Mullan 0116 225 2878 / 07970051282 

Social Services County Jackie Wright 07881 836331 

Social Services City Ashraf Osman 0116 221 1555 / 07794 053 465 

EMAS 999 Mick Jones 07970 399 643 

EMAS PTS Mick Byrne 07974247583 

LLR PCT Cluster Rachna Vyas 0116 295 4179 / 07935 390 092 

UHL Richard Jarvis 07950 661 644 

LPT John Mullan 0116 225 2878 / 07970051282 

Social Services County Jackie Wright 07881 836331 

Social Services City Ashraf Osman 0116 221 1555 / 07794 053 465 

EMAS 999 Mick Jones 07970 399 643 

EMAS PTS Mick Byrne 07974247583 

17

CONTACTS 

A full list of contacts including roles and job titles is included as Appendix 1 to the 2011/12 Winter Resilience Plan. 

The LLR PCT Cluster will act as the “communication cell” for the escalation plan. The different organisations will communicate their pressure 

problems and status of alert to the Urgent Care Lead so that the overall picture in the Health and Social Care Community is known at any one time. 

LLR PCT Cluster in hours contacts are: Rachna Vyas 07768 746 689, Amita Chudasama 07825 113 656 and Ket Chudasama 07760 990 396. 

The table below details how to contact organisations during out of hours. 

ORGANISATION 

Director on call for Leicester, Leicestershire and Rutland PCT Cluster 

CONTACT NUMBER 

07623 908865. Leave a message and a contact number 

Senior Manager for Leicester City Community Health Services 07789 865076 

Senior Manager for Leicestershire County and Rutland Community 

Health Services 

Director on call for University Hospitals of Leicester 

Director on call for Leicester Partnership Trust 

01509 611600 and ask to be put through to the CHS Senior Manager on 

call 

0300 303 1573 and ask to be put through to the Director on call. 

0116 225 6000 and ask to be put through to the Director on call. 

Out of Hours on Call Manager 0116 295 0076 

CNCS on Call Manager 03000 241118 

Urgent Care Centre (George Eliot on call Director) 

02476 351351 and ask for the on call Director 

18

Leicester, Leicestershire & Rutland Cluster 

Director Lead - Dr Simon Freeman, Director of Contracting, Information and Performance, LLR PCT Cluster 

Management Lead - Rachana Vyas, Planning and Delivery Speicalist, LLR PCT Cluster 

LLR EMERGENCY CARE NETWORK: Emergency Care Network (ECN) 

Chair: Cahterine Griffiths, Chief Executive, LLR PCT Cluster 

Facilitation of group: Rachna Vyas, Planning and Delivery Specialst, PCT LLR Cluster 

The LLR Emergency Care Network is operationally supported by the Senior Operational Group and the Clinical Interface Group. Stakeholders from across 

the Health Economy are present at this monthly meeting including Clinical Commissioning Group representation. During periods of surge the group will: 

1. Move to weekly meetings 

2. Communicate escalation levels across the health economy 

3. Facilitate mitigating actions to resume flow through the system 

4. Manage any other issues affecting system performance where possible 

Leicester, Leicestershire and Rutland 

Winter Resilience Plan 2011/12 

Governance and Performance Management 

Full details of all organisational leads and contact details can be found in Appendix 1 

ESCALATION PROCESS: 

1. The ECN will nominate urgent care leads from each organisation in the health economy to participate in a short daily 

telephone conference call at 11.45am to advise of pressures and initiate mitigating actions. 

2. The chair of this teleconference will send out an alert to the ECN distribution list, detailing the escalation level and mobilising 

agencies to enact the escalation plan, (detailed as Appendix 3). 

3. If necessary, a further teleconference will take place at 4pm to assess progress against the actions required. 

LLR wide SITREP reporting guidance is shown in Appendix 4. LLR Cluster will be copied into SITREP submissions and any 

cancellations will be outlined at the daily 11.45am teleconference. 

Plans will also be shared across the East Midlands area to enhance cross-border working and promotion of best practice across the region. 

Performance management of the system 

The ECN receive a weekly performance report. 

The ECN receive a performance dashboard detailing the system performance monthly. 

Each part of the system will be performance managed against agreed targets and ECN meetings will focus on those areas which are red rated 

Page 1

Operational management of the LLR Urgent and Emergency care system 

Management of system capacity & demand 

All providers have submitted evidence that gives assurance that capacity will meet both elective and emergency demand over the winter months. 

This is listed as Appendix 8: Contingency Strategies, Flu Pandemic plans, Business Continuity Plans and Incident plans are complete andare kept in a 

central folder by LLR PCT Cluster. 

A joint workshop was held with all stakeholder organisations to revise the Escalation Plan. A LLR wide escalation plan has been created and 

distributed to all organisations for use as required during periods of surge. This is shown in Appendix 3. 

Specific arrangements made for 11/12: 

The 3 Clinical Commissioning Group's (CCG's) across the city and county have developed individual Business Continuity 

Plans detailing the critical and non-critical functions of service provision. Trigger points have been identified in conjunction with 

the Winter Resilience Group which will enable them to identify if and when to temporarily stop routine tasks until demand 

reduces. These plans were developed in response to a Flu Pandemic with the support of the LMC but can be used in all 

emergency planning situations. 

Primary Care 

In addition, each Primary and Community Care directorate has an overarching Business Continuity Plan which details how 

operational activity would be maintained in case of any incident (including adverse weather and influenza pandemic). The plan 

also details how members of the team would communicate with all independent contractors to make them aware of issues 

affecting the wider health community. 

Primary Care Contracts teams have encouraged GPs and Pharmacists to open additional hours over the Christmas/New Year 

period to ease pressure on Secondary Care and Out Of Hours services. The collated list of opening times will be published to 

patients so they know when and where to go if they become ill. Also all GP Practices in the CIty and County have a buddy 

practice, practices use their buddy for relocation purposes if their practice became uninhabitable due to a business continuity 

incident, some practices use their buddy to share staff if either were faced with severe staff shortages and some have an 

agreement for both. A list of "Buddy Practices" can be found at Appendix 5. 

• Single Point of Access/Bed Bureau - A 3 month pilot was completed in October 2010. The aim of the pilot was to deflect any 

unnecessary acute hospital admissions to either a Community Hospital bed or a community service. This project was aimed at 

strengthening the interface between Secondary and Primary care. Gaps in service pathways were identified through the SPA 

integration pilot and exposed specific pathways that required further work, such as AUR. Pathways have been put in place 

since the end of the pilot and further work continues on other specific pathways. 

A single point of access is available for GPs and EMAS to access urgent response from community services 24/7. Work is 

underway to: 

Integrate City and County SPA/bed bureau 

Facilitate bed bureau pathway 

Complete and validate EDoS 

Roll out to SPA and associate clinicians 

A range of clinical pathways have been approved to support admission avoidance cellulites pathway, Acute Urinary Retention 

pathway, EOL Pathway. Agreed criteria for direct admission to community hospitals is shared with EMAS, GP and acute care 

colleagues. Access to community nursing service out of hours is centralised. Specialist Palliative Care Service available for 

city and county 2200-0800 7 days which is co-located with the out of hours service. Long term conditions hub is co-located 

with SPA and out of hours service communication centre. All LTC patients have special patient note with Out of Hours service 

to share end of life and acute exacerbation management plan. 

City Community Health Services 

Community Health Services • On a weekly basis the AD of Adult services meets with Operational leads to discuss service delivery 

• Daily review of all patients in intermediate care and rehabilitation beds to improve bed occupancy. Additional bed capacity 

available for up to seven beds in spot purchased care home beds. 

• 24/7 day a week service based on our Clinical Intermediate Care Unit with 11 beds. 

• Where possible, the Rapid Intervention Team (RIT) will provide care at home in order to reduce demand on bed space. 

• Process in place to identify vulnerable patients as part of the pandemic flu response. This information is updated weekly and 

provided to the Clinical Lead for Out of Hours. 

County Community Health Services 

• Community Hospital bed closures due to outbreak of infection are minimised by robust infection control procedures. 

• All organisations now have access to an ‘in-hours’ Countywide Bed Manager and bed escalation plan in place, developed in 

collaboration with UHL. 

• Daily review of patients in UHL waiting to be transferred to Community services / Community Hospitals by Primary Care 

Coordinators 

• Admission criteria agreed to enable direct access to community beds by GPs, community staff and EMAS 

• Podiatric Surgery, General Surgery, Urology and Orthopaedic day Case capacity is available in community Hospitals. 

• Access to diagnostic services including Endoscopy & H- Pylori breath testing in community services to avoid unnecessary 

admissions (via GP surgeries for NHS LCCHS). All Imaging departments in LCRCHS will be open as usual apart from the 

Bank Holiday Days themselves offering support to Direct Access, MIU and OPD referral with access to x-ray, ultrasound and 

MR as planned 

• Telephone Help Line available to all patients known to LTC service and to health professionals requiring advice or access to 

LTC Service (Mon - Friday 0800-1830) 

Page 2

City and County Community Health Services have business continuity plans for community intermediate care service to 

support people in their own homes. 

• They have Single Point of access (for adult services), which helps direct clinicians to use pathways as an alternative to UHL 

Community Health Services 

and provides direct link to intermediate care service 24/7. 

– Intermediate care 

• Rutland’s Intermediate Care team directly commission home care from Fraser’s agency as appropriate 

• NHS LCRCHS has a 24/7 community nursing service available across all localities. 

• Specialist end of life team is available 7/7 over night to support end of life care in city. 

Urgent Care Centre, 8-8 

Centre's, Walk-In Centres 

and Minor Injury Units 

The Urgent Care Centre, co-located with ED will be open 24/7 over the winter period. This will take most minor 

injuries/illnesses releasing capacity in ED to deal with more complex cases. 

There is a WiC at Loughborough, two 8-8 centres, 1 in the City at Merlyn Vaz Health Centre and 1 at Oadby and three MIU’s at 

Rutland, Market Harborough, and Melton. All have differing criteria and different hours of service (dates/times of opening 

shown in holiday cover section of this plan) 

The range of community services and community hospital are available to the WIC and Out of Hours service through 

specifically trained Nurses who can navigate the patient to the most appropriate service. All patients contacting the out of hours 

service can e routed to an alternative community service seamlessly including access to Marie curie staff for EOL care. 

NHSD AND EMAS can warm transfer calls to the out of hours service when required. 

OoHs can warm transfer calls to EMAS if condition life threatening. 

EMAS on scene with patient can contact OoH and will be immediately put through to first available clinician. 

Cat C patients can be referred 24 hours a day to SPA for response by community services for agreed pathway or direct 

admission to community hospitals. 

OoHs GPs support Community Hospitals out of hours to support patients who require medical intervention to prevent transfer 

to acute sector. 

EMAS – 999 

• Senior decision makers at front door of receiving bay to prevent ambulance queuing and any negative impact on ambulance 

turnaround times 

• EMAS will liaise with UHL on a daily basis if there are any issues that need resolving, including those impacting on 

turnaround times etc. 

• Operational manager will be stationed at ED to ensure smooth turnarounds, both pre and post clinical handover. 

• A deep clean team will also be stationed at ED to facilitate faster post handover times. These will be monitored daily and 

trends will be highlighted to the ECDG where necessary. 

• All departments to accept handover within 15 minutes of arrival 

• EMAS will divert suitable Category C patients to the Urgent Care Centre instead of ED 

• Potential pathway in place to divert patients to either SSAFA 8-8 or Oadby 8-8 centres to reduce pressure on the urgent care 

centre and ED. 

• Currently if pressures arise EMAS look to divert at the borders, this is by local agreement at the time of the pressure. 

• EMAS have direct access to community hospitals, access to nurse advice via community nursing/Single Point of Access and 

direct transfer to Walk- in centre or Minor Injury Unit 

PTS is redesigning its delivery model in line to meet expected workloads throughout the coming year. This includes using 

existing technology to match resources with activity on a weekly basis. Establishment levels are also being reconsidered. 

EMAS – PTS 

Social Services 


Reablement services 

• Locality contract meetings and EMAS task and finish group meetings merged in preparation for winter pressures to ensure 

alignment between measures taken and contractual processes. 

• Both city and county social services will continue to deliver to the standards set for achievement of section 2’s and section 5’s 

within a set time period. 

• Identified social worker for all Community Hospitals integrated with Multi Disciplinary Teams 

• Access to social care re-ablement and assessment beds. 

• Step down beds available in residential homes 

• Involvement of social services in operational planning groups 

• Criteria for referral to Social Services respite/rehabilitation beds in place 

• LC Adult Social Services has existing systems of negotiation between Health and Social care i.e. Discharge Liaison Staff 

(Health) and Team Managers (Social Services.) Staff work flexibly over 7 days. 

• The hospital teams ensure that individuals are discharged safely with social care when and where it is needed. 

• The County HART reablement service takes patients directly from hospital into reablement through the customer service 

centre. 

• Additional capacity is sought from the independent sector when there is an overflow. 

• Reablement beds have been identified in independent sector residential homes to facilitate discharge and reablement, for 

example for stroke pathway patients. 

• Council is engaged in planning re: winter pressures. 

Discussed at standing management meetings as part of the capacity agenda where mitigation and planning takes place to 

ensure that cases presented are taken. 

Page 3

Care Homes/CHC 

Community equipment 

• Work is ongoing with the Care Homes Advisory Group to ensure that delays in assessments prior to discharge are minimised. 

• The CHC team will facilitate placements prior to tariff being agreed at times of surge. The CHC process has been 

streamlined and this work will continue throughout 11/12. 

Community equipment services have transferred to Nottingham Rehab Services from the British Red Cross on 1 April 2011. 

• Where a patient is ready for discharge and a delay is due to the lack of suitable community equipment being sourced, the 

Community Equipment team will expedite the ordering and delivery of emergency community equipment orders. 

• A process has been agreed with the community equipment team and communicated across the health economy. 

Mental health 

UHL – ED 

UHL – ED 

• LPT have liaison psychiatry service based in ED who take responsibility for all psychiatry referrals during 9-5 on weekdays to 

make single comprehensive assessments so that multiple assessments are avoided and patients wait times in ED are 

reduced. 

• Crisis resolution team to prioritise patients at ED in order to reduce demand on ED resource 

• LPT has access to NHS professional’s bank if required due to staff shortages. 

• LPT are part of the Winter Resilience Group and have a presence on the daily teleconference calls to help expediate any 

issues with mental health patients. 

• Medical staffing cover arrangements in place to address peaks in demand 

• STAT team in place and operational between 9 am and 6 pm every day. This should ensure patient flow through the 

department. 

• Breach analysis circulated each day to understand and mitigate against further breaches of the 4 hour standard. 

• Comjmunity Health Services have a primary care team working in UHL including in the Emergency Department to facilitate 

the flow of patients through Health and Social care system. These posts reduce inappropriate unscheduled admissions to UHL 

by facilitating packages of care in a community setting where appropriate and reduce occupied bed days by facilitating timely 

and appropriate discharge 

• All walk in, ambulatory patients presenting at adult ED between 10am and 10pm, 7 days a week (inc bank holidays) are given 

30 second initial assessment at the front door of the ED by a senior nurse practitioner. These patients will then be streamed to 

either ED or the UCC for any further assessment necessary and treatment. 

• Other ambulatory pathways are being put into place to minimise admissions via ED. The pulmonary embolism pathway is in 

place and this is being replicated for other relevant and appropriate ambulatory care sensitive conditions. 

• Escalation process put in place between ED and other specialties to ensure that specialties take ownership of patients 

waiting in ED. 

ED have recruited 6 Advanced Nurse Practitioners, 4 Physician Assistants and 4 Consultants in 2011. 

Emergency Department Standards 

Operational Standards 

• Medical Staff resources aligned to demand 

o Ensure junior staff aligned to demand and check for variance four monthly 

o Consultant clinical presence targeted at busiest times to ensure optimal early decision making and patient care. 

• Emergency Nurse Practitioners aligned to demand 

• Check for variance 4 monthly 

Timelines 

1) Resuscitation Area 

• Category 1 Patient – Seen on Arrival by Doctor and nurse 

• Category 2 Patient 

o Seen on arrival by nurse 

o Seen by doctor within 20 minutes 

• Decision made by 90 minutes 

• Ready for admission/transfer by 150 minutes 

2) Paediatric ED 

• All patients seen by practitioner within 45 minutes 

• Decision made by 90 minutes 

• Discharge/admit by 120 minutes 

• If other specialist needs to review discharge/admit within 150 minutes 

3) Majors Area 

• Category 2 patient s assessed (nurse+/- doctor) within 30 minutes 

• Category 3 patients assessed (nurse+/- doctor) within 45 minutes 

• All patients to have all necessary bloods and ECGs carried out within 40 minutes 

• All X-rays and scans required to be ordered within 40 minutes 

• All patients to have a decision by 120 minutes 

• All patients not requiring specialist review in department admitted or discharged within 3 hours 

• All patients requiring specialist review admitted or discharged within 3 hours 30 mins 

Page 4

UHL – ED 

UHL – ED 

MONITORING 

Real Time 

• Coordinator for each area monitors assessment, decision and dispersal times 

• Coordinator informs NIC when concerned re patients not likely to be seen within standard times. 

• NIC assesses information. Liaises with Consultant/SpR in charge and after assessing whole department and resources 

available institutes relevant escalation. 

Audit 

• Regular monthly audit of waiting time standards for each area 

• Discussed at CBU Manager/Lead Clinicain meeting and fed back to staff on a monthly basis 

• Resource allocation to demand reviewed 

• Run charts for each standard developed 

Escalation 

Will depend on severity of situation and resources available to resolve it already in place in ED. 

Resuscitation Area 

1) Category 1 patients must be seen on arrival by a doctor. 

• If escalated senior doctor must attend the resuscitation room and with the nurse coordinator quickly assess all patients not yet 

seen. 

• Allocate additional medical staff from other areas as required. Must ensure all patients in the department are safe 

2) Decision made in 70 minutes 

• Coordinator escalates to NIC at 45 minutes if not confident of decision being made in time. NIC and senior doctor assess 

situation and liaise directly with medical team. 

3) Category 2 patients in the resuscitation room must be seen by a doctor within 15 minutes. 

• If escalated senior doctor must attend the resuscitation room and with the nurse coordinator quickly assess all patients not yet 

seen. 

• Allocate additional medical staff from other areas as required. Must ensure all patients in the department are safe 

Paediatric ED 

4) Category 2 patients must be seen by assessed within 30 minutes 

• If escalated senior doctor must attend and with the nurse in charge to quickly assess all patients for rapid prioritisation. 

• Must ensure that the agreed processes of care are being followed. 

• Ensure medical staff are working on medical tasks only and are aware of the situation. 

• Where possible senior doctor should attempt to use any middle grade or consultant staff to reassess needs of these patients 

ensuring particularly that pain relief is given. 

• Some patients may be able to be categorised as a priority 3 by such actions. 

• Consider reallocation of medical resources 

5) Category 3 patients must be assessed within 60 minutes 

• If escalated senior doctor must attend with the nurse in charge to quickly assess all patients for rapid prioritisation 

• Must ensure that the agreed processes of care are being followed. 

• Ensure medical staff are working on medical tasks only and are aware of the situation. 

• Consider reallocation of medical resources 

6) Category 3 patients must have a decision made within 120 minutes 

• Senior doctor alerted by area 3 coordinator at 90 minutes if expects standard will not be met. 

• He/She will liaise directly with patient’s doctor to facilitate decision. 

7) All patients not requiring specialist review in department admitted or discharged within 3 hours 

• Senior doctor alerted by area 3 coordinator at 150 minutes if expects standard will not be met. 

• Senior doctor liaises directly with patient’s doctor 

Majors 

If any of standard times are unlikely to be met nurse coordinator and senior doctor for the area must ensure processes being 

followed. 

Will liaise with NIC and senior doctor to look at possible reallocation of doctors to the area for a limited time. 

Reallocation of Medical Resources 

• Assess medical staff on duty and number of ENPs. Ensure all are present. 

• Assess whether reallocation is necessary (eg if nothing changes will the situation resolve itself ( a small bulge of attendances) 

If possible reallocate staff from other areas 

• If paediatric ED is under pressure can we send an ENP from Majors or a doctor to help. Vica versa. 

• If adult areas 3 under pressure can Paediatric medical staff see all category 6 patients? Could a paediatric doctor be pulled to 

help see category 3 patients? 

• Medical staff must ensure that their patients are not forgotten if they move to another area. 

Strain on nursing Resources 

If nursing staff are stretched it remains essential that where possible investigations such as bloods and ECGs are done at the 

initial assessment, by the HCA/Phlebotimist 

NIC consider asking Transfer Team/Pulling Nurse to collect patients and X-ray to collect and return patients. 

Ensure senior doctor is aware of stresses and considers alternative staff to take bloods and order X-rays early. 

Page 5

UHL – ED 

UHL – General 

UHL - Bed Management 

General Principles 

• Nursing staff at initial assessment follow investigation guidelines and discuss immediately with area coordinator or senior (not 

junior) doctor if unsure of relevant tests or patient has abnormal physiology 

• Junior doctors to ask for advice from SpR/consultant immediately after seeing a patient if not sure of a plan (waiting for 

bloods is not a plan) 

• Junior doctors must not ask for additional tests without consulting a senior 

• Any doctor asked to move from one clinical area to another must hand over his/her patients to a colleague before moving 

• If one clinical area is quiet senior doctor should look at reallocating medical staff before any escalation is required. 

• A timely correct assessment will help ensure a timely decision and good patient care 

• Patients in severe pain must be a category 2 as a minimum 

CLINICAL STANDARDS 

Based on CEM clinical standards 

1) Myocardial Infarction If Thrombolysis 

• Door to ECG 10 minutes (90%) 

• Door to Needle 30 minutes (75%) 

• Aspirin given 90% (if not contraindicated) 

2) Pain 

• Patients in severe pain (pain score 7 to 10) should receive appropriate analgesia according to local guidelines, 

• 50% within 20 mins of arrival or triage whichever is the earliest. 



• 90% of patients with severe pain should have documented evidence of re-evaluation and action within 30 minutes of 

receiving the first dose of analgesic. 

• Patients with moderate pain (pain score 4 to 6) should be offered or receive analgesia, according to local guidelines, 



3) Fractured Neck of Femur 

• Pain should be managed as above 

• 75% of patients should have an X-ray within 60 minutes of arrival or triage whichever is the earliest. 

• Only patients fit to be fast tracked should follow this pathway 

• 100% of patients should be admitted within 4 hours of arrival. 

• Hip fracture pathway should be used within ED 

4) Paracetamol Overdose 

• Patients should not have plasma levels measured earlier than 4 hours after the estimated ingestion time. 

• Staggered overdoses. Treatment started within one hour of arrival. 

• Patients arriving < 8 hours after ingestion. Treatment given appropriately as judged by presentation time and the treatment 

guidelines from National Poisons Information Service 2003. 

• Patients arriving 8 to 24 hours after ingestion. Treatment started before blood results available if there is a clear history of > 

12 g ingestion (or 150 mg/kg whichever is the smaller). 

• Patients presenting > 24 hours. INR, urea and electrolytes, bicarbonate & LFTs performed 

• Three times a day there will be a Trust Wide bed meeting at 8.30am, 12pm and 4pm to discuss the available capacity, 

staffing, ED attendences, EMAS capability and all other UHL issues relating to admission and discharge. This will then 

determine the appropriate escalation and de-escalation measures as that are required. 

•Information from the 10am bed meeting is then collated for the 11.45 health community conference call chaired by the PCT 

commissioners where de-escalation will be declared. 

•Twice daily ward/board rounds including at weekends and bank holidays and other peak periods. 

• Patients will be outlayed in other directorate beds where capacity and infection control policies allow. 

• If required elective activity will be reduced, notwithstanding the fact that the 18-week target will not be compromised. 

• Each Clinical Business Unit has it's own internal staffing Business Continuity Plan to cover managing patient flows and for 

escalating staffing issues. A step by step approach for ensuring that staffing shortages are escalated and covered accordingly 

is in place in each CBU. If staffing levels are not appropriate and all measures are taken to assist then it will be escalated via 

the bed meetings in hours and to the duty manager out of hours. 

•Appropriate use of bank/agency staff has been agreed. In addition, UHL would look to utilising staff with a clinical registration 

to assist where appropriate. 

• Stringent infection control measures are in place, with work ongoing to identify and agree a separate ward space for infection 

control purposes. 

•At all times patient safety is paramount and no actions should take place that will put patients at risk whilst endeavouring to 

meet national targets. 

The UHL Bed Management Policy, details actions that UHL will take to manage the emergency admission process, bed 

capacity and the associated hospital status for internal escalation. The Bed Management Policy is Appendix 2 to the 2011/12 

Winter Resilience Plan. 

Each day following assessments of overall bed capacity, the Admissions and Discharge Manager will determine the level of 

bed alert within UHL in hours Monday – Friday 8am – 5pm, out of hours this is the responsibility of the duty manager in 

discussion with the senior manager on call. 

The Trust’s aim is to start each day on a Normal Status and escalate where appropriate i.e. after discussions of bed capacity at 

the 8.30 bed meeting. The decision will be based on the predicted shortfall in capacity. 

• The multi-agency Transition Planning Steering Group has replaced the Discharge Operational Group to deal with delays in 

discharge. This group will escalate any unresolved issues to the ECN. 

The LLR Cluster jointly with UHL are working on a project to increase the number of patients discharged by lunchtime. The 

focus will be on acute medical wards and work will be carried following a review of data and benchmarking against other 

organisations. A project plan is in place and roll out has commenced. 

• Patients ready for discharge who are suitable for the discharge lounge to be identified at the 11am bed meeting. These 

UHL – discharge processes 

patients should be in the discharge lounge by 1pm. HCA’s from the discharge lounge to aid movement of these patients at 

times of surge. 

• The discharge lounge and EMAS PTS coordinator to commence regular meetings to facilitate communications. 

• Working to the Delayed Discharge Act, Hospital Social Work Teams and Intermediate care Social Work teams have priority 

access to domiciliary care and interim residential beds. 

• Leicestershire County Adult Social Services – Emergency Discharge Team cover is commissioned for unplanned provision 

needed during OOHs periods. 

Page 6

The Trust use the following predictive tools to forecast bed occupancy and to help inform decisions relating to escalation 

levels. 

1) ED regression model (using historical levels and predicted temperatures) updated weekly which shows expected levels of 

daily attendances for the next couple of weeks 

2) Duty managers and bed managers working to an expected level of 150 acute emergency admissions a day with 3 meetings 

a day to monitor progress and agree plans to use contingency beds as appropriate. 

3) Weekly reports made available looking at historical monthly levels of emergency patients staying in hospital overnight for the 

last 5 years for reference. 

4) Daily ED reports e-mailed showing daily levels of ED attendances, breaches and admissions to the Trust. 

Page 7

UHL - Escalation Planning 

& Predicitve Tools 

UHL - Children's Services 

UHL – critical care services 

This year UHL have introduced e-Bedstate. This software system aims to: 

Make use of appropriate technologies, leveraging existing systems to better deliver bed status and availability information 

around the trust. 

To develop predictive elements that can assist with highlighting potential issues earlier, linking with ED and expected 

discharge information. 

To raise awareness of the importance of timely PAS updates, thus improving retrospective as well as real time analysis. This 

links with initiatives around electronic ordering and potentially e-prescribing both of which require up to date information about 

the location of a patient. 

To reduce the time taken to collate bed information, with the aim of reducing the frequency of or eliminating regular meetings 

entirely in future. 

To reduce the volume of email traffic associated with transferring files relating to bed meetings 

Further information on this can be found at Appendix 7 - Electronic bedstate at UHL 

• There is senior CBU manager/nurse on-call 

• Ensure that critical services are identified and maintained. 

• Ensure staff are deployed appropriately to meet service needs. 

• Formal communication with all staff that may be redeployed. 

• Contain and minimise the spread of infection and protect vulnerable groups of patients and staff. 

• Work effectively with partner health and other agency organisations in the community, CRAFT and Check it out 

• Ensure that all services are maintained and delivered safely and effectively for a long as possible. 

Actions 

• Communicate plan widely within the directorate 

• Develop and deliver an education programme for clinical preparedness. 

• Monitor bed availability 

• Monitor CICU/HDU bed availability 

• Monitor emergency activity 

• Monitor Planned Care ( for example chemotherapy) 

• Monitor Urgent work 

• Consider cohorting patients 

• Monitor cancelled non emergency/elective activity which will inform the recovery plan 

• Ensure that a robust recovery plan is in place. 

• Monitor manage staffing 

o Receive staff sickness/absence details 

o Hold directorate staff rotas & off duties 

o Monitor and co-ordinate staffing, including the redeployment of staff where necessary 

• Liaise with Infection Control 

• Ensure that information is clearly communicated within the directorate. 

• CBU bed meeting twice a day to review activity and plans and report to the Trust bed meeting 

• UHL conforms to the Intensive Care Society Transport standards which is guidelines for transportation of Critical care 

patients. This is summarised as the CENet guidance document listed in Appendix 2. 

• EMAS - Current arrangements are in place and operate with regard to transportation. There are no formal plans for this but it 

is locally agreed that at times of pressure transportation can be arranged and facilitated. 

Page 8

Operational readiness for Bank holiday and OOH period 

A multi-agency Christmas and New Year planner highlights availability for the various services over the holiday period detailing opening hours, levels of 

cover etc 

OOH provision must be maintained throughout the winter period to achieve appropriate patient flow through the system. The health community will address 

the Christmas and New Year Bank Holidays through agreement of minimum levels of service during this period to ensure continuity of high quality services to 

our patients. 

Access to GP 

When practices are closed, the OOHs service will be available for patients that will offer telephone triage, consultations and 

home visiting services along with the Urgent Care Centre based at the Leicester Royal Infirmary which is open 24/7, 365 days 

per year. 

Loughborough WIC, Oadby 8-8 & SSAFA 8-8 centres will also be open. 

Emergency Hormone Contraception will be offered by some general medical practices during their opening times. During the 

festive period when practices will be closed access to emergency contraception will be limited, however XX PHARMACY 

WILL BE OPEN ON XXXX FROM XXXXX and they will be offering EHC. The Urgent Care Centre will be open during the 

holiday period (24/7, 365 days per year) where EHC will be available. 

Primary care 

Access to community pharmacy 

Contractors will submit their proposed hours over the Christmas period by xx xx (i.e. 90 days prior to December 25th) and this 

will be communicated across LLR. 

Access to dental care 

The Dental Access Centre (DAC) is open during the holiday period and its opening times will be communicated to all dental 

contractors. 

The Dental OOH service operates Monday – Thursday from 18:30 pm to 08:30am pm and at weekends and bank holidays 

from Friday 18:30 to 08.30 Monday, with an on-call dentist available between 18.30 and 22.00 Monday to Friday, and 13.00 to 

18.00 at weekends and bank holidays. OOH is accessed via NHS Direct who offer triage and advice including advice available 

for pain control from GP OOH services and refer patients to the on call dental service. 

City Community Health Services 

OOH/UCC: Extra staffing to cover the expected demand over the Xmas period 

RITS: Normal working over the Xmas period 

DN service: Normal working over Xmas period 

Community matrons and specialist nurses: Normal working over Xmas period 

City Community beds: Normal working over Xmas period 

SPA: Normal working over Xmas period 

On call manager: As normal (usual number) 

On call Director: As normal – contact through on call manager 

CHS 

EMAS – 999 

NHS LCRCHS 

The out of Hours service has undertaken a full capacity and demand review to ensure clinical and non-clinical resources are 

deployed effectively during the winter period 

Revised Service Level agreement with associated pay rise has been agreed with sessional medical staff 

Capacity for the Christmas and New year periods will be examined carefully and resources matched to the expected demand. 

Escalation plans with predefined trigger points are in place for all service elements and will be managed by the clinical shift 

lead on duty at the Communications Centre. 

A Senior manager from Out of hours services is always on call. 

Rotas set for cover over holiday periods for all nursing and medical staff. 

Loughborough Walk-in Centre and all MIUs will work as usual during the Christmas Holiday period, with the exception of 

phlebotomy services. 

A review of the out of hours formulary has taken place to ensure provision of essential medication within the out of hours period 

in association with the on call pharmacist and 100 hour pharmacies. 

24 hour community nursing service in place and linked to the Out of Hours service 

Normal working over the xmas period 

EMAS – PTS 

UHL 

PTS capacity running throughout the holiday period and xxx extra crews will run for xx days from 

Possibility of increasing PTS capacity at times of severe surge or through the 'bank holiday' days will be considered as and 

when required through ECDG. Financial and operational implications have been clarified with EMAS in readiness. 

Clinical Business Unit Escalation plans are being developed to manage assist in managing high inflow into ED. Senior 

Manager and Executive Director on-call will communicate regularly with the site Bed Management teams. Rotas will be set to 

cover holiday periods for medical, nursing, allied professionals and non-clinical support staff. Each Clinical Business Unit will 

submit a Bank Holiday and Weekend plan to support capacity. 

Page 9


Enhanced access to social care assessment/beds in out of hours. Emergency service on DATES TO BE CONFIRMED, three 

member of staff per day working and they will attend the morning bed meeting and work with the most pressing case [or cases] 

identified. 

A review of capacity to speedily assess the assessment of patients with mental health problems in ED departments is to be 

undertaken by LPT Senior Operational Group. 

It is planned that all services will remain open during the winter period. Cover over the Bank Holidays will be in line with normal 

OOH arrangements, including a doctor in ED in line with OOH arrangements. 

Mental health 

The Trust retains comprehensive contact details, external and internal, within its Emergency Policy and Plan including for 

Services’ On-Call Managers. These can be contacted OOH via the LPT On-Call Director (Contactable via LPT Switchboard 

0116 2256000). However, the Trust will publish its’ Christmas Services working arrangements in 

LPT Teams have identified social workers in each locality and details of OOHs access. There are systems in place for LPT 

staff to contribute to discussions about packages of care. Where contact is already established for individuals out of hours 

and holiday contacts are communicated. 

Operational readiness for Seasonal Flu 

The LLR Cluster with NHS partners and the Local Resilience Forum have in place (and is continuing to develop) plans to minimise 

the impact of pandemic flu. All organisations have submitted Flu Pandemic - Business Continuity Plans, these are shown in Appendix 2. The plans are 

kept in a central folder. 

Immunisation campaign 

All organisations will actively encourage frontline health and social care workers to be vaccinated because they are both at an 

increased risk of catching swine flu and of spreading it to at-risk patients. 

LLR organisations will follow DH guidelines to immunise priority group, including pregnancy women, those with compromised 

immune systems and people over 65 in at-risk groups. 

Antiviral collection points 

Across LLR we have identified sites for antiviral collection should this be required. All pharmacies will be advised to stock up 

on antivaral medications if required. 

Flu assessment service 

Additional arrangements 

The Flu assessessment service will be encapsulated into streaming to the Urgent Care Centre, all patients preseting with flu 

like symptoms will be sent to the Urgent Care Centre. The UCC has turned an office at the back of the UCC into a holding 

area for children under 17 who present with flu like symptoms. This area is fully staff by a qualified nurse at all times, charged 

with taking obs etc throughout the wait. 

There is also a multi-agency flu meeting to deal with upsurges in levels of seasonal flu. The purpose of this meeting is to 

ensure that the health economy is as well prepared as possible for the Christmas and New Year period taking into account the 

significant levels of flu expected. This is complementary to the process already undertaken around winter pressures rather 

than instead of it. This applies particularly to services put into place to support discharges over the Christmas / New Year 

period. 

• Active participation and support by all Community Health Services with national winter campaigns including "AWAITING 

DETAILS OF NATIONAL WINTER CAMPAIGNS’. 

• Flu Awareness and agreed messaging is prepared and will be provided to callers during the expected flu season. All Media 

enquires are handled through internal Communications Department. 

• Joint working between the practices and community nursing teams to vaccinate housebound patients. District nursing teams 

to vaccinate housebound patients on their case load. 

• LPT Infection Control nurse is leading on current campaigns including flu vaccines and information about these and a plan is 

in place for all older person wards and learning disability homes 

• All practices are incentivised for Flu Immunisation & for Pneumococcal immunisation. This covers the provision of influenza 

immunisation for those aged 65 and over and 64 and under at risk groups (all those aged over 6 months in a clinical risk 

group) of patients registered with the Practice. This can avert the need for the patient to be hospitalised. 

Page 10

Norovirus 

The LLR Norovirus Tool kit that has been agreed by the whole health community and forms part of the supporting documents to this winter plan. 

Reporting of Norovirus Outbreaks as a Serious Untoward Incident (SUI) 

Inpatient Providers (including Acute Trusts, Mental health and Learning Disabilities, Prison Health, Community Providers) 

Either of the following two triggers will result in the organisation reporting and SUI 

1. One or more wards closed due to norovirus 

2. An outbreak meeting has been called. 

A report of the full outbreak all areas affected needs to be submitted within 20 days of the end of the outbreak. 

For all other providers (Nursing Homes, Residential Homes, Care Homes) 

The current system will remain in place where all outbreaks will be reported to the HPA. The HPA will share the information they have with all Directors of 

Infection Control in Primary and Secondary care, NHS East Midlands, Public Health, Microbiologist and Ambulance Trust. 

Adverse Weather 

The LLR Local Resilience Forum consists of all organisations and agencies involved with emergency response in the community. The 

Local Resilience aims of the group include assessing the risk of emergencies in the area, put in place business continuity management arrangements. 

Forum They also make arrangements to warn, inform and advise the public in the event of emergencies, severe weather etc. 

Primary Care 

During periods of severe weather if GP's/Medical Practitioners are having difficulty accessing people in need of medical attention, i.e. 

rural/remote areas the Local Authority co-ordinate a 4x4 Resilience Team. This is a pool of volunteers who are not a substitute for 

Business Continuity or normal House calls, they are for if the Emergency Services are having difficulty in accessing people 

UHL 


EMAS 

LLR PCT Cluster 

The Severe Winter Weather - UHL Response Plan (part of the supporting documents from UHL) addresses both business continuity and 

service response. The plan is written to mitigate risks to normal provision and to meet additional service pressures arising from snow, ice 

and extended periods of very low temperatures. The specific objectives of the plan seek to deliver the following: 

- Additional emergency service capacity, as appropriate, to manage increased trauma (RTAs / falls) and cold weather related illness 

- Business continuity of all vital UHL clinical services 

- Business continuity of elective care 

- Business continuity of key non-clinical support services 

- Co-ordinated decision making within UHL concerning contingency measures and any variations to normal service provision 

- Close collaboration and co-ordinated decision making with NHS and other multi-agency partners concerning contingency measures 

- Effective communication within and external to UHL 

During a pandemic situation, the Local Resilience Forum's Strategic and Tactical Groups will meet regularly and County and City Council 

attend these meetings. All Departments have identified their critical services that must be maintained during a Pandemic. The ‘supercritical’ 

services (i.e. life and death) have also been identified, and in the event of very severe staff shortages the maintenance of these 

services would be the Council’s priority. 

The EMAS Winter Pressure Framework (part of the supporting documents from EMAS) covers severe weather pressures and highlights 

actions to be taken to minimise the impact of severe weather.This includes sickness, shortfalls in staffing, reduced manning levels, slips 

and falls, vehicle breakdowns, snow and icy conditions, fuel shortages and meeting response times. 

The LLR PCT Cluster have Business Continuity plans in place that ensure any business interruption incident from severe weather to 

pandemic flu can be dealt with. This is done through a tactical (corporate plan) and operational (CBU plans) approach to ensure 

communications, decisions and business functions are carried out during an incident. 

Communications Strategy 

Comprehensive communications plans have been developed by the LLR PCT Cluster. These plans will complement the communications plan that has been 

developed by the Local Resilience Forum. 

• All local and regional comms plans will follow similar themes to the national campaigns to ensure minimal patient confusion. 

• LLR PCT Cluster will lead the local communications campaign regarding winter pressures/Pandemic Flu for the health community. 

• Flu advice for parents and guardians is readily available for those who have children and young people returning to school/college/university. There is also 

information for Swine Flu available on the LLR PCT Cluster website as well. 

• NHS Direct has an advertising strategy in place for core services. 

• Leaflets with information specifically around swine flu are also available in Bengali, Gujarati, Polish, Urdu, Punjabi and Somali languages from the LLR PCT 

Cluster website 

Choose Well campaign : The LLR PCT Cluster Choose Well Plan is in place and will be rolled out in partnership with stakeholder agencies. The campaign 

is designed to make the public aware of the various alternative healthcare options for non-emergency situations, to prevent inappropriate use of A&E. The 

full Communications Plan is attached as Appendix 6. 

Page 11

Paper 3 





Front Sheet 

Title of the report: 

Report to: 

Section: 

Date of the meeting: 

Report by: 


Presented by: 

Real Accountability 

LLR PCT Integrated Board Meeting 

Public 

8 September 

Emma Cannaby 

Liz Rowbotham 

Liz Rowbotham 


Handing over a good legacy √ Deliver the six identified transitional 


Manage Providers’ performance against 



Deliver agreed performance targets 


work streams 

Develop and maintain an energetic 



√ 


The Real Accountability report contains details of 47 consultations leading to service 

change across Leicester Leicestershire and Rutland including work from the East 

Midlands Specialised Commissioning Group. 

The Department for Health requires PCTs to produce the report annually. The 

Report is to be submitted to the Strategic Health Authority mid-September. 



NOTE The contents of the paper and the Report 

AGREE to the sign off the report for submission on 14 September 2011 

1

Paper 3 



INTRODUCTION 



8 SEPTEMBER 2011 

Real Accountability 

1 Real involvement is a requirement under the statutory guidance in Section 242 

of the NHS Act 2006. Primary Care Trusts (PCTs), NHS trusts and Strategic 

Health Authorities have a statutory duty to involve patients and the public 

whether by consulting or providing information, or in other ways. Such 

involvement and consultation is required in: 

• planning the provision of services 

• the development and consideration of proposals for change in the way 

services are provided, and day to day processes, commissioning, 

prioritising and service re-design 

• decisions to be made affecting the operation of services 

2. The July 2010 White Paper Equity and excellence: Liberating the NHS said 

“We will put patients at the heart of the NHS, through an information revolution 

and greater choice and control.” 

• shared decision-making will become the norm: for patients this must mean 

“no decision about me without me” 

• we will also look at existing mechanisms, including relevant legislation, to 

ensure that public engagement is fully effective in future, and that services 

meet the needs of neighbourhoods 

• we will proactively seek and build continuous and meaningful engagement 

with the public and patients, to shape services and improve health 

• we will lead continuous and meaningful engagement with clinicians to 

inform strategy, and drive quality, service design and resource utilisation. 

3. In April 2010 the Department of Health published new guidance for the NHS, 

which asked local PCTs to produce an annual report about how they have 

acted on feedback from patients and the public, and to highlight forthcoming 

consultations. This requirement is called ‘Real Accountability’. The report must 

also include influences that have been made as a result of the consultation. 

4. This is the second report covering all consultations from April 2010 to March 

2011. It is a joint report for both NHS Leicester City and NHS Leicestershire 

County and Rutland, which began working collaboratively as a single PCT 

cluster in the autumn of 2010. We have already begun transferring increased 

responsibility to the three clinical commissioning groups (CCGs) for our area – 

Leicester City CCG, West Leicestershire CCG and East Leicestershire and 

Rutland CCG, which are due to take full legal responsibility for most local 

commissioning functions by April 2013, subject to Parliamentary approval of 

the Health and Social Care Bill and the successful authorisation by the 

2

CONTEXT 

Paper 3 



Department of Health for these CCGs to undertake their relevant 

commissioning duties. 

5. NHS Leicester City, Leicestershire County and Rutland along with all other 

NHS trusts are required to proactively engage with all stakeholders in all 

groups: staff, public, patients, partner organisations, voluntary, independent 

and private sector to collect and collate their feedback on consultations. This 

is not only a legal duty, but it is also best practice to feedback outcomes form 

the consultations locally. This is to be fed into the Real Accountability report 

once a year. This will further underpin the vision of the organisation to reduce 

inequalities and to represent, support and enable the population of Leicester 

Leicestershire and Rutland to have their say on such major changes. 

6. More and more people across the country should feel better informed and 

encouraged to have a say about what really matters to them about their area’s 

healthcare services. NHS Leicester City and NHS Leicestershire County and 

Rutland have been making great strides in involving local residents in the 

development of these services. Our goal is to ensure that Leicester residents 

are among the most informed and empowered in the country. It is also our 

ambition that we are as demographically representative of the city and two 

counties as is realistically possible to ensure that typically hard-to-reach and 

seldom heard groups also have appropriate opportunity to have their say. The 

two PCTs’ new Cluster Board and the area’s three CCGs are using the 

feedback and insight into patients’ needs and wishes in order to inform 

improvements in health services. 

7. In future we need to illustrate best practice engagement and lead the way 

ready for the time when legal responsibility for engaging with the population of 

Leicester Leicestershire and Rutland transfers to our CCGs. There are various 

high quality patient and public groups available, who have been or can be 

contacted to feed into future engagements. NHS Leicester City and NHS 

Leicestershire County and Rutland are looking into the facilitation of the 

transition of engagement from local trusts to the CCGs to empower GPs and 

their clinical colleagues to meaningfully engage with their patients in future. 

RECOMMENDATIONS 


NOTE: The contents of the paper and the Report 

AGREE to the sign off the report for submission mid-September 2011 

APPENDICES: 

Appendix 1: Real Accountability 2010 - 2011 

3

Consultations and public engagement 

projects to inform decisions on 

commissioning healthcare

Real Accountability Annual Report 2010-2011 

Introduction 

Real involvement is a requirement under the statutory guidance in Section 242 of the 

NHS Act 2006. Primary Care Trusts (PCTs), NHS trusts and Strategic Health 

Authorities have a statutory duty to involve patients and the public whether by 

consulting or providing information, or in other ways. Such involvement and 

consultation is required in: 

• planning the provision of services 

• the development and consideration of proposals for change in the way 

services are provided, and day to day processes, commissioning, prioritising 

and service re-design 

• decisions to be made affecting the operation of services 

The July 2010 White Paper Equity and excellence: Liberating the NHS said “We will 

put patients at the heart of the NHS, through an information revolution and greater 

choice and control.” The Paper set out the following: 

• shared decision-making will become the norm: for patients this must mean “no 

decision about me without me” 

• we will also look at existing mechanisms, including relevant legislation, to 

ensure that public engagement is fully effective in future, and that services 

meet the needs of neighbourhoods 

• we will proactively seek and build continuous and meaningful engagement 

with the public and patients, to shape services and improve health 

• we will lead continuous and meaningful engagement with clinicians to inform 

strategy, and drive quality, service design and resource utilisation. 

In April 2010 the Department of Health published new guidance for the NHS, which 

asked local PCTs to produce an annual report about how they have acted on 

feedback from patients and the public, and to highlight forthcoming consultations. 

This requirement is called ‘Real Accountability’. The report must also include 

influences that have been made as a result of the consultation. 

This is the second report covering all consultations from April 2010 to March 2011. It 

is a joint report for both NHS Leicester City and NHS Leicestershire County and 

Rutland, which began working collaboratively as a single PCT cluster in the autumn 

of 2010. The Cluster has already begun transferring increased responsibility to the 

three clinical commissioning groups (CCGs) for our area – Leicester City CCG, West 

Leicestershire CCG and east Leicestershire and Rutland CCG. The groups are due 

to take full legal responsibility for most local commissioning functions by April 2013, 

subject to Parliamentary approval of the Health and Social Care Bill and the 

successful authorisation by the Department of Health for these CCGs to undertake 

their relevant commissioning duties. 

3

Foreword 

The people of Leicester, Leicestershire and Rutland have every right to make their 

voices heard on the healthcare services which their NHS commissions for them. 

Good engagement must be integral to all commissioning decisions. It is not only a 

legal duty, but it also makes good sense – socially, financially, clinically and 

strategically - and no business case for a new or modified service will succeed 

without it. 

The Secretary of State for Health presented to Parliament the White Paper Equity 

and excellence: Liberating the NHS in July 2010. It includes the policy to phase out 

primary care trusts and create a lead role for clinical commissioning groups in future. 

It also gives weight to the principle of “fuller engagement with primary care 

professionals, patients and the public” and sets out “to ensure that public 

engagement is fully effective in future, and that services meet the needs of the local 

neighbourhoods”. 

The engagement expertise we have developed in Leicester, Leicestershire and 

Rutland will prove a valuable asset to future local commissioning bodies. So in the 

interim we need to maintain the standard we have set, as an example of best 

practice for those who follow us. The practice based commissioning groups, who 

played such a vital role on our former Commissioning Executive, provided an ideal 

forum for this expertise to be shared and its legacy continues in its successor body, 

the clinical Collaborative, and during the ‘shadow clinical commissioning group’ 

phase of the ongoing NHS reforms. 

Our clinicians know that Leicester, Leicestershire and Rutland is a complex area. 

What suits one area may not suit another. There is no longer a place for a ‘one size 

fits all’, or ‘top-down’ mentality when it comes to designing clinical pathways and 

other areas of our healthcare services. If we cannot make the service fit the local 

need – clinically and culturally – we are not doing our job to the standards required 

by the principles of ‘equity and excellence’ set out by the government. 

Engagement is not only part of the service development and procurement process, 

but also an essential part of the evaluation process. The public will have a major say 

in the ‘last word’ on whether our commissioning decisions worked. As the Secretary 

of State for Health, Andrew Lansley, has said on behalf of patients: “There should be 

no decision about me without me”. 

Catherine Griffiths 

Chief Executive 

4

Contents 

Page 


Foreword 4 

Background 7 

Part I: Joint partnership engagements 8 

Adult mental health strategy 9 

CFS (Chronic Fatigue Syndrome) and ME (Myalgic Encephalomyelitis) 12 

Children and Adolescent Mental Health Service strategy 13 

Children and young persons needs assessment 16 

Community consultation on equality outcome objectives 18 

Community development worker project 19 

Drug and alcohol strategy 22 

End of Life Care 25 

Greater Choice and Control and the Information Revolution White Paper 28 

Maternity and neonatal services review 30 

Maternity Service Liaison – designing a 12-month rolling programme 32 

Naming the IAPT service 33 

Older Persons Month 35 

Pharmaceutical Needs Assessment 36 

Public Health White Paper 39 

Quality, Innovation, Productivity and Prevention (QIPP) 41 

Quality Innovation, Productivity and Prevention: Strategic Operating Plan 42 

Quality Innovation, Productivity and Prevention (QIPP) event 3: Right Care – 

Planned Care 44 

Transforming community services 46 

The White Paper Equity and excellence: liberating the NHS 47 

Part 2: Leicester City engagements 49 

Beaumont Leys Surgery – procurement training 50 

Belgrave Medical Centre closure and patient registration 51 

“Call time on drink” campaign 53 

Medicines Use Review survey 54 

New arrivals engagement 55 

Out of Hours Service 57 

Patient Participation Group event 59 

Sexual health website 60 

Part 3: Leicestershire County and Rutland engagements 61 

Bowel cancer and bowel cancer screening awareness 62 

Dental access 63 

5

Contents 

Page 

Health care for older people, patients and carers 64 

Loughborough University health and wellbeing event 65 

Membership Consultation 66 

Pacesetters Bowel Cancer Screening Awareness Project 68 

Patient experience 71 

Perinatal psychosis 72 

Public Consultation on the proposed closing of Ketton and Gretton branch surgeries 

by Uppingham General Practice. 74 

Smoking, diabetes and eyes event 75 

Women’s Cancer Event 76 

Part 4: East Midlands Specialised Commissioning Group (EMSCG) 

engagements 77 


Forward 79 

Teenage and Young Adults Cancer (TYA) 80 

East Midlands Renal Network (EMRN) 81 

Midland Burn Care Network (MBCN) 82 

Safe and Sustainable - National Paediatric Congenital Heart Surgery Review 83 

East Midlands Haemophilia Management Group 84 

National Commissioning documents for Haemoglobinopathy 85 

Involvement of regional Expert Patient Committees in the commissioning and 

development of Specialised Perinatal Mental Health Services in the East Midlands 86 

Policy Development 88 

EMSCG Commissioning Policy for the use of Pre Implantation Genetic Diagnosis 

(PGD) (version 2). 88 

How to contact us 92 

Do you need help understanding this report? 94 

6

Background 

NHS Leicester City, Leicestershire County and Rutland along with all other NHS 

trusts are required to proactively engage with all stakeholders in all groups: staff, 

public, patients, partner organisations, voluntary, independent and private sector to 

collect and collate their feedback on consultations. This is not only a legal duty, but it 

is also best practice to feedback outcomes form the consultations locally. This is to 

be fed into the Real Accountability report once a year. This will further underpin the 

vision of the organisation to reduce inequalities and to represent, support and enable 

the population of Leicester Leicestershire and Rutland to have their say on such 

major changes. 

More and more people across the country should feel better informed and 

encouraged to have a say about what really matters to them about their area’s 

healthcare services. NHS Leicester City and NHS Leicestershire County and Rutland 

have been making great strides in involving local residents in the development of 

these services. Our goal is to ensure that Leicester residents are among the most 

informed and empowered in the country. It is also our ambition that we are as 

demographically representative of the city and two counties as is realistically 

possible to ensure that typically hard-to-reach and seldom heard groups also have 

appropriate opportunity to have their say. The two PCTs’ new Cluster Board and the 

area’s three CCGs are using the feedback and insight into patients’ needs and 

wishes in order to inform improvements in health services. 

In future we need to illustrate best practice engagement and lead the way ready for 

the time when legal responsibility for engaging with the population of Leicester 

Leicestershire and Rutland transfers to our CCGs. There are various high quality 

patient and public groups available, who have been or can be contacted to feed into 

future engagements. NHS Leicester City and NHS Leicestershire County and 

Rutland are looking into the facilitation of the transition of engagement from local 

trusts to the CCGs to empower GPs and their clinical colleagues to meaningfully 

engage with their patients in future. 

7

Part I: Joint partnership engagements 

8

Adult mental health strategy 

What was the issue? 

The Joint Commissioning Strategy for Mental Health sets out the commissioning 

intentions of NHS Leicester City and Leicester City Council in respect of services for 

people with mental health over the next 18 months. As the key partners to this plan 

NHS Leicester City is responsible for commissioning health services locally and 

Leicester City Council is responsible for commissioning social care services. In the 

summer of 2010 consultation took place about the commissioning priorities with 

service users and family carers, facilitated through voluntary organisations and 

existing forums. 

Who was consulted? 

The strategy has been developed through the NHS Leicester City Mental Health 

Programme Board, which brought together a range of stakeholders who are 

interested in mental health and wellbeing. The role of the Programme Board was to 

develop the strategic direction for commissioning and delivery of mental health 

services in Leicester and monitor its implementation. In drawing up this strategy we 

took into account the needs of service users, expert and clinical knowledge, 

evidence of what works and most importantly how the people who use services 

would like to see them developed. The stakeholders consulted included: 

• staff and clinicians working for Leicester City Council and the Leicestershire 

Partnership Trust 

• services users and carers 

• residential Care providers within Leicester City 

• other independent Providers of mental health services within Leicester City 

• GPs and primary care staff 

• voluntary organisations 

Additional focus groups were also held with the South Asian community, a Bengali 

women’s group and the Somalian community. 

The focus groups were facilitated by the following local voluntary sector 

organisations and they also supported the completion of questionnaires: 

• LAMP (Leicestershire Action for Mental Health) 

• Adhar (meaning ‘support’ – for adults with mental health problems and their 

carers) 

• Network for Change 

• Akwaaba Ayeh (advocacy and advice on mental health for BME communities) 

• Community development workers 

What information was given? 

A covering letter was sent to stakeholders via email and through the post which 

outlined the intentions for the Joint Commissioning Strategy for Mental Health. 

Information with a link to the questionnaire was also put on the PCT and local 

authority websites including links on the voluntary sector organisations’ website. A 

presentation was given in the focus groups meetings explaining the need for a new 

strategy highlighting the identified priorities for discussion. In all engagement it was 

explained that the feedback would be used to inform the development of the 

strategy. 

9

What were people asked to comment on? 

Consultation about the priorities, their current experiences and the type of services 

they would like in the future took place over August and September 2010. An online 

survey was developed including the provision of paper based surveys to gather 

people’s views. Furthermore, a series of focus groups took place across the city. The 

focus groups were held with groups with which the organisations do not often 

engage. The service users and carers were given the draft priorities and asked to 

state whether they agreed or disagreed. They were then asked to rate the 

importance of each priority. Questions were asked about the different types of 

support on offer with recommendations for improvements. 

Summary of feedback 

Overall there were over 240 responses to the survey. A total of 79% of the 

respondents were mental health service users and 21% were carers. 

In total 65% of the respondents were female and 35% were male. The ethnic 

breakdown of the respondents is as follows: 

• Asian/Asian British – 56% 

• Black/Black British – 8% 

• Chinese – 0% 

• mixed/dual heritage – 1% 

• White – 23% 

• other Ethnic Group 4% 

• non-respondents 8% 

When analysing the ethnicity data it is pleasing that we had such a high percentage 

response from the Black Minority Ethnic groups. This is vital in a diverse city like 

Leicester. 

Just fewer than 54% of the respondents considered themselves to have a disability. 

Over 96% of the respondents considered their mental wellbeing to be very important. 

The respondents considered that the following were very important to their 

wellbeing: 

• physical Health – 86% 

• housing – 86% 

• financial position – 76% 

• local environment – 73% 

• employment – 59% 

Over 86% of the respondents felt that access to mental health support was 

important. When asked what type/s of services/support people accessed when they 

or a family member/friend needed support; we received the following responses: 

• GP – 70% 

• family members – 54% 

• psychiatrists – 41% 

• friends – 40% 

• counselling services – 28% 

10

A total of 39% of the respondents indicated that they/friend/family member were an 

inpatient in a mental health hospital. Only 4% did not access any support for their 

mental health issue/s. 

Over 83% of the respondents felt it was very important to have mental health 

services that are local i.e. within 3-5 miles of where they live. Over 89% said that 

services need to be easily accessible i.e. convenient opening hours, parking, meets 

their specific cultural and religious requirements, good disability access and public 

transport links. 

People were asked what types of services would have met/would meet their or their 

family member/friend’s needs. The following types of support were highlighted by the 

respondents: 

• group support – 64% 

• drop-in services – 56% 

• 1:1 support – 49% 

• community based services – 49% 

• peer groups – 39% 

• support into education – 24% 

Only 42% wanted hospital based services. 

Just over 68% felt it was important to be able to choose the services or packages of 

support would help maintain their mental wellbeing if they were given the money to 

do so. 

Decisions made 

The feedback supported the identification of the joint commissioning priorities and 

the development of the strategy and the implementation plans. These were shared 

back with service users, carers, stakeholders and partners. 

11

CFS (Chronic Fatigue Syndrome) and ME (Myalgic 

Encephalomyelitis) 


There are many different possible causes for these conditions, which are better 

known by their abbreviated title CFS/ME. Potential causes include neurological, 

endocrinal, immunological, genetic, psychiatric and infection-based factors. All have 

been investigated, but the diverse nature of the symptoms cannot yet be fully 

explained. 

The World Health Organisation (WHO) classifies CFS/ME as a neurological illness. 

Leicestershire’s CFS/ME services are currently provided by Leicestershire 

Partnership Trust (LPT) and predominantly cover the psychological aspects of 

care. Following the NICE guidelines (2007), nationally the majority of CFS/ME 

services now sit in acute care services, mainly within neurology. We needed to know 

if we were providing the most clinically appropriate services for people with this 

condition. 


In 2010/11 a local task and finish group engaged with ME Positive (the local user 

group) and collated feedback on the current service and views on what a future 

service should look like. 


The current service based at LPT was discussed with the group, who were already 

familiar with many aspects of it, and the service specification documentation and 

NICE guidelines were scrutinised. 


ME Positive, a patient representative group were asked to comment on the current 

service specification, the NICE guidelines and draft a proposed new pathway for 

CFS/ME sufferers. 


The main recommendations from this engagement were: 

• more GP engagement on CFS/ME to ensure better diagnosis within primary 

care 

• a neurological rather than a psychological pathway for CFS/ME patients 

• improved availability of alternative therapies 

• a personalised approach to the management of the condition and symptoms. 

A proposed pathway was also developed by the group with recommendations for a 

redesigned service. The current service specification was examined and suggestions 

were made based on direct patient experiences. 


Discussions are currently taking place about the service review and proposed 

pathway redesign. The next step in this process includes wider engagement with 

clinicians, stakeholders and other user groups. 

12

Children and Adolescent Mental Health Service strategy 


NHS Leicester City and NHS Leicestershire County and Rutland reviewed the 

Children and Adolescent Mental Health Service (CAMHS) for the period of 2011 to 

2014. This is to provide clear, timely and honest information about the direction of 

travel for CAMHS in Leicester, Leicestershire and Rutland. It was not possible for 

this consultation to be a simple strategy review or questionnaire, as this is a complex 

part of the health service. 

Not only does the CAMHS strategy need to reflect the needs of a diverse 

community, it also needs to prioritise actions and service requirements to suit the 

needs of the patients, who are young people, and be sensitive to their needs. As the 

patients have mental health problems, NHS Leicester City led the consultation to 

identify all stakeholders who needed to participate in the service redesign. The 

communication and feedback channels had been designed to enable patients to 

express their views without bias. 


There were several groups of people involved in the project. The approach taken led 

to several groups being consulted. There were several media releases promoting 

feedback throughout September 2010 to February 2011. There was a publically 

available questionnaire for patients, public, children and young people, parents and 

carers, service staff and partners of the CAMHS service. 

There was an easy read questionnaire with instructions of how to help the child or 

young person fill in the questionnaire. There was a questionnaire written by specialist 

nurses, with supporting pictures, to enable children with mental health and learning 

disabilities to be able to contribute to the consultation. 

There were several stakeholders meeting from November 2010 to February 2011 to 

collect stakeholder and partner organisation feedback on the strategy. There were 

also some focus groups with children and young people with an interest in the 

CAMHS service who took part in the consultation. 


Existing information was used to design the questionnaires and surveys. Local 

partner organisations shared feedback from their patients to help design which 

issues needed to be considered as priorities for the period of 2011 to 2014. 

Alongside this, there was easy read information describing the purpose of the 

consultation and why people need to feedback honestly. 

The pathway and service delivery was also described in basic English along with a 

visual interpretation of the CAMHS system. This was done using a hand-drawn 

graphic illustration of the process (please see image): - 

13


The public, children and young people, carers, parents, staff and partners were all 

asked to comment on the principle and priorities, which had been selected from 

previous feedback. This was done by selecting on a rating scale of how important 

this would be to them. Alongside this we asked for their reasons. These included 

which conditions or mental health categories they felt needed prioritising for 

Leicester, Leicestershire and Rutland. 

In the focus groups, people were shown the pathway diagram and asked to feedback 

on experience and potential improvements for each stage and the transfers between 

stages, including communication. 

Once the draft strategy was completed, the draft document was consulted with the 

stakeholders to make it an appropriate document to be used by partner 

organisations across the city. 


Some of the comments leading to the redesign included: 

• there is a lot of untreated childhood anxiety 

• families need to be more involved in children’s and young people’s treatment 

• service delivery locations need to be child friendly in a comfortable 

environment 

• children and young people should get a say in the treatment they receive. 

The stakeholders wanted the assurance that plans developed were fed back to 

interested stakeholders and people who participated, complying with the standards 

of engagement for all organisations involved. 


Using this feedback, the CAMHS service is working on: 

• maintaining and developing mental health promotion and prevention to 

increase resilience and reduce risks 

• ensuring that good links with adult services are maintained is relation to 

transition from children to adult services and taking the ‘whole family 

approach’ work forward 

• making all services child and young person friendly 

14

• continually getting feedback from patients, carers and partner organisations 

about the service they are providing, and acting upon realistic suggestions or 

improvements. 

15

Children and young person’s needs assessment 


This is a needs assessment for Leicester City, which was aimed to outline the 

priorities for services in different areas. It was designed jointly between NHS 

Leicester City, Leicester City Council, Voluntary Action Leicester, Connexions and 

associated partners. Engaging with children and young people is one of the least 

practiced and they are nationally seen as a ‘seldom heard group’. 

This needs assessment identified groups in particular need: 

• disabled children 

• children in care 

• young offenders 

• teenage parents 

• young people not in education employment and training 

• young carers 

• children and young people with parents who use drugs and alcohol 


The Children Trust was the vehicle for consultation. Therefore, representatives from 

this group was asked to use the presentation and executive summary to deliver the 

key findings from the needs assessment and then feedback into the process. A wide 

range of partners were consulted, many of whom did not provide written feedback 

however, written feedback was received from: 

• Leicester City Children’s Trust and associated thematic groups 

• Investing in Children’s Priority Board Leicester City Council 

• Parents of young offenders 

• Parenting strategy Advisory Board 

• CAMHS partnership 

• NHS Leicester City Childrens Commissioner and Safeguarding lead 

• Drug and alcohol commissioning manager 

• Leicester city PE and school sports Board 

• Healthy weight strategic group 

• 12 Neighbourhood Advisory Boards 0-12 and 13-19 

• Early Prevention Services Strategy team Leicester City Council 

• Voluntary and community sector - feedback from 21 organisations. 


Stakeholders and members of the public were informed of the discrepancies of the 

quality of life in different areas of the city. A presentation was used to give examples 

of a child growing up in two areas in the city and how different their expected 

outcomes were due to the area they lived in. Information included health outcomes, 

educational outcomes, and other life indicators. 

There was also a needs assessment summary which was shared for comment 

including the priorities the city would have to improve the health and quality of life 

outcomes of areas that are lower than the national standards. 

16


People were asked if the summary of the needs assessment was accurate in the 

context of their knowledge of the city and the areas within the city, and, if not, why. 

They were then asked if there was any significant information in the needs 

assessment that had been missed out, that they felt needed to be included. After the 

presentation these questions were posed by the presenter and feedback collated 

and returned to public health. 


The life course stories of two children in different parts of the city resonated with 

those that fed back on the work. A range of feedback received including the 

identification of some groups that had been missed in the earlier iterations and these 

have now been included, along with more recent data that was included in the final 

version. 


The revised Leicester City Children and Young People’s Plan has now been 

published and the focus on outcomes reflects the needs of the children and young 

people in the city. City youth advisors have commented and agreed on the plan. 

17

Community consultation on equality outcome objectives 


NHS Leicester City, and NHS Leicestershire County and Rutland and Leicestershire 

Partnership NHS Trust needed assistance to identify and meet its Public Sector 

Equality Duty (PSED) under the Equality Act 2010. They needed to identify and 

agree with the NHS workforce and community stakeholders a set of equality 

outcome objectives and priorities for 2011-12. 


Internally we consulted staff members throughout NHS Leicester City, NHS 

Leicestershire County and Rutland, University Hospitals of Leicester NHS Trust, 

Leicestershire Partnership NHS Trust. Externally; service users, voluntary and 

community groups including service level agreement organisations reflecting 

ethnicity, disability and sexual orientation were consulted. Also involved were 

Leicestershire Working Together Forum which represented all protected 

characteristics across Leicestershire. 


Information was given on the new integrated equality service for NHS Leicester City, 

Leicestershire County and Rutland, along with an overview of Equality Act 2010 

including: 

• public sector equality duty – due regard 

• analysis of equality (equality impact assessment) 

• equality delivery system (the Department of Health Framework for Equality, 

Diversity and Human Rights in all we do) 

• organisations to assess their equality performance against 12 outcomes 

grouped into four objectives. 

Participants were also given a detailed overview including evidence to support each 

proposed equality outcome objective and enabler. 


Internal and external stakeholders were asked to comment and provide preferences 

on a set of draft equality outcome objectives and priorities. This included an 

opportunity to vote on each objective and outcome. 


Feedback included comments that could be grouped under the following themes: 

• focus on outcomes not process 

• be clear in communications 

• make more of what we have 

• don’t lose quality and focus in the drive for greater efficiency 

• keep it real 

• involve local people and groups 

• be transparent. 


The project planning and implementation is still ongoing at the time of going to print. 

18

Community development worker project 


The aim was to review the effectiveness of a three-year project to improve referrals 

within Black and Minority Ethnic (BME) communities to access mental health 

services in Leicester City, Leicestershire and Rutland. It had been set up as part of a 

national Department of Health programme called Delivering Race Equality (in mental 

health). 

The ethnicity of the Leicester City, Leicestershire and Rutland population is diverse. 

In Leicestershire and Rutland nearly 95% of the population are from white ethnic 

groups. The main minority ethnic group is south Asian with large populations in 

Loughborough and Oadby and Wigston. 

Approximately 40% of Leicester’s population has an ethnic minority background and 

evidence suggests that it is becoming more diverse. Statistics show that 28% of the 

Leicester population are Gujarati Indians, originally either from East Africa, especially 

Uganda and Kenya, or from Gujarat. Other smaller communities in the city include 

the African Caribbean and Somali communities, at around 3% each, as well as 

people from Pakistan, Bangladesh, along with other African or Chinese communities. 

The age profile of these population groups is younger than average with 54% of 

Leicester’s school pupils from a minority ethnic background. 

The project’s host organisation was Age Concern, who had employed a team of 

CDWs to run the project. The project lead wanted to review the service and identify if 

there were any gaps which were not covered by other existing services in Leicester 

City, Leicestershire County and Rutland. This was important as not only are there 

various communication barriers, but there can also be a lack of knowledge of 

services available and unwitting negative stereotyping within the service. Therefore a 

consultation was run from October to November to gain feedback on the knowledge 

and attitudes of the service provided, and gaps that would be left if there was to be 

no replacement service, following the end of the existing project contract 

arrangement in March 2011. 


There were three separate consultations. The host, Age Concern, and relevant staff 

were consulted about services they had provided and referral success rate. They 

were also asked for details of activities and successful projects during the three-year 

project. 

The partner organisations who worked closely with the CDW project were also 

consulted. This was done by an online and paper questionnaire going to each 

member of staff working with the CDW project. Finally service users were also asked 

to complete a questionnaire either online or a paper copy. 


NHS Leicester City, and NHS Leicestershire County and Rutland shared information 

and agreed that an evaluation of the service was needed. The overall objective of 

the evaluation was to assess the extent to which the CDW project had successfully 

contributed to the delivery of the DH’s wider agenda of achieving equality and 

tackling discrimination in mental health services. 

19

The evaluation reviewed the service against the four main roles as set out in the 

policy guidance and the output specification, as set out by the two primary care 

trusts as commissioning bodies. It also aimed to assess the value-for-money 

element within the current climate of financial constraints. Finally, the evaluation 

aimed to identify the ways in which the agenda for tackling discrimination and 

achieving equality in mental health services might be sustained. 


To assess the impact of the CDW project, all people consulted were asked for 

feedback on the extent to which the following project aims had been achieved in the 

past three years: 

To act as a change agent by: 

• raising levels of understanding of the mental health needs of BME population 

groups 

• identifying gaps in services 

• improving communication between BME community services and statutory 

services. 

To facilitate access to mental health services by: 

• identifying the barriers which prevent BME communities from accessing timely 

and effective mental health services 

• helping to overcome those barriers. 

To develop services by: 

• advising on training and education of staff 

• highlighting the importance of cultural awareness in service systems and 

practice 

• developing joint working between statutory and community services. 

To build community capacity by: 

• helping the BME population group to develop grassroots solutions to mental 

health issues 

• supporting the development of BME community resources for mental health 

• helping local groups and networks to develop the relationships and know-how 

which will enable them to make their views known and play an effective role in 

local partnerships for mental health. 


Overall, the CDWs were seen as having been fairly successful in engaging with 

community organisations and undertaking specific programmes which have 

contributed to the raising of awareness of mental health issues within the BME 

community. Much of the work by the CDW team has included developing and 

managing relationships with key stakeholders, partners and services, aimed at 

raising the profile of the CDWs and the Delivering Race Equality (in mental health) 

programme. 

It has been through the development of such links that the CDWs have been able to 

gather intelligence about gaps in service provision for BME communities and begin 

to devise and implement some solutions. Feedback showed that the CDWs had 

undertaken awareness raising sessions and had made contact with a number of 

voluntary and statutory organisations, users and carers to promote further 

awareness. 

20

The project has been less successful in demonstrating the outcomes of the initiatives 

and their sustainability. There were areas where there appeared to be a lack of 

continuity and evidence of CDW work which demonstrated the need for capacity 

building. 

The feedback also suggested that the CDWs were strong in identifying gaps in 

services, but had not been sufficiently innovative, had missed opportunities for 

greater integration and had not become sufficiently effective agents of change. 


It was decided that the existing contract could be terminated at the end of the third 

year, March 2011. There would still be a service gap for the African Caribbean 

community, therefore a CDW would need to be commissioned specifically for this 

community. 

21

Drug and alcohol strategy 


The National Drug Strategy (NDS) 2008-2018 emphasizes the need to focus more 

on families, addressing the needs of parents and children as individuals, as well as 

working with whole families to prevent drug use, reduce risk and get people into 

treatment. The NDS also clearly states that we need to deliver new approaches to 

drug treatment and social re-integration. The Alcohol Harm Reduction Strategy for 

England: Safe. Sensible, Social, (2007), outlines the next steps in the alcohol 

strategy. Priorities include engaging harmful and dependent drinkers with prevention 

and treatment services, tackling alcohol-fuelled crime and disorder; and promoting 

sensible drinking. Services were being re-designed to reflect local and diverse 

needs. We were also seeking to test the market in line with Leicester City Council’s 

procurement policy and EU (European Union) procurement law. 

The Safer Leicester Partnership (SLP), Drug and Alcohol Action Team (DAAT) are 

responsible for the commissioning of adult and young people’s substance misuse 

treatment services. NHS Leicester City is responsible for commissioning adult 

alcohol prevention and treatment services. SLP DAAT and the NHS Leicester City 

are in the process of undertaking a re-commissioning (and service redesign) of their 

adult treatment service with the aim of improving access to and quality of service 

provision and to develop an integrated drug and alcohol treatment model. 


Questionnaires were available on-line, and a further 2000 paper questionnaires were 

disseminated across the city via council run locations and drug and alcohol treatment 

providers. 

Stakeholders, including the general public were made aware of the consultation 

process, and how to respond through a variety of promotional means, including 

email alerts, web site signposting, and use of the media. Specifically this included 

adverts, posters, radio interviews and local publications across the city, in particular, 

faith, language and cultural based publications (Leicester Link, Ramadan 

Publications, Kohinoor Newsletter, Clasp Newsletter, Service Users News (SUN), 

Helping Hands Newsletter, NHS customer and patient involvement newsletter. 

Participants were given the opportunity to give their views via the website, or via 

paper and electronic questionnaires. Translated questionnaires, special needs 

versions (large print / Braille) and translators were available on request. 

In addition to the completion of questionnaires, a community engagement approach 

was adopted to target key groups to provide their views. Community and 

neighbourhood support groups for feedback were organised to support the inclusion 

and involvement of vulnerable and underrepresented people and communities. 

Small informal discussion groups, with target groups were undertaken, alongside 

presentations, displays interviews, exhibitions, and advertising, to promote and 

encourage participation. 

A single large event for key stakeholders was organised, focus groups were used to 

feedback their responses to the questionnaires. 


22

All people including stakeholders were given a briefing note and access to other 

informative resources before given the questionnaire or attending one of the groups 

or meetings. Information included: 

• a background to the Drug and Alcohol Services 

• The current treatment system 

• gaps and weaknesses in the current drug treatment system 

• gaps and weaknesses in the current alcohol treatment system 

• key changes being proposed included those to address the following topics: 

o accessibility 

o the range of services available 

o moving towards primary care services 

o quality of life issues 

o criminal justice role 

o one single point of access / treatment 

o one venue for both drugs and alcohol services. 

Finally there was information on why people should take part in the consultation 

process by providing views and comments on the proposed changes to drug and 

alcohol treatment services, also there was information on where to get a 

questionnaire and alternative feedback methods available. 


There were questions based on a combined drug and alcohol pathway including: 

• accessibility of services 

• a wider range of services 

• having services accessible through primary care, ie, GPs 

• should ‘quality of life’ services (for example housing support, relapse 

prevention, education and life skills training) be included in drug and alcohol 

treatment 

• should the service be flexible to suit the service users needs 

• should the service be community based 

• should the service be in a neighbourhood setting 

• should there be a single drug and alcohol service for people in the criminal 

justice system (before sentence and following release) 

• should non-drug and alcohol children and young person agencies have 

support available 

• should there one venue for both drug and alcohol services 

People who worked with alcohol services only were asked an additional question 

about an assessment of treatment being completed in a single point of access. 


There were 404 responses for the adult survey and 110 responses for the young 

person’s survey. 

The stakeholder groups within the adult and young person’s community engagement 

group varied from those having no experience or knowledge of drug and alcohol 

services to those who were currently or had previously been in receipt of services or 

had worked in services and this was reflected in their responses. 

23

Those that had less knowledge and experience were able to make valuable 

contributions. For example, the positive impacts of accessible community based 

services, and the contributions that families and communities could make to support 

both service users and services at local level. 

Overall people were supportive of the changes. Negative responses centred on adult 

drug and alcohol users receiving treatment within GP surgeries. There was overall 

support for this change, but on the principle that this service would be located within 

a different part of the surgery and at different times to regular GP appointments. 

There was positive support for the proposed changes to young people’s drug 

treatment services. One community based service for young people was principally 

supported on the basis that young people should feel safe and that the service was 

available especially for them. 

Service providers gave mixed responses to the service redesign changes. Better 

accessibility received the most positive responses, including weekend and late 

opening and operating times, with neighbourhood based services meaning less 

travelling was involved. Negative responses highlighted drinkers not wanting to 

associate with drugs users and the potential barriers due stigmatisation of drug and 

alcohol users within the community. 

Service providers considered the impact of equality issues within their stakeholder 

event, relating to the proposed changes to treatment services. This will contribute to 

the Equality Impact Assessment for service redesign and change. 


The redesign of young person’s alcohol and drug services is being carried out in 

conjunction with the adult drug and alcohol treatment redesign. It is proposed that 

the end product of the redesign process will be a specialist treatment service that will 

deliver treatment and support the delivery of information, advice and guidance in 

mainstream services. 

Based on the findings of the adult and young person’s stakeholder consultation, it 

was recommended the feedback and proposed changes to drug and alcohol 

treatment are implemented and should inform the commissioning and service 

redesign processes. 

24

End of Life Care 


We aimed to develop a strategy to deliver the best quality care pathway for all those 

of 18 years and over who are approaching the end of their lives. 


Broad and wide engagement took place to inform the strategy. Two stakeholder 

events took place attended by staff across Leicester, Leicestershire and Rutland and 

included staff from University Hospitals Leicester, LOROS, Community Health 

Services, East Midlands Cancer Network, local authorities, Leicester University, East 

Midlands Strategic Health Authority, Voluntary Action Leicester, Foundation Housing, 

Hospice Hope, Confederation of Indian Organisations, NHS Leicestershire County 

and Rutland, NHS Leicester City, GPs, palliative care consultants; out-of-hours GP 

services, pharmacists, the public and carers. 

A questionnaire was developed and sent to all those who had joined the NHS 

Leicestershire County and Rutland membership scheme (approx 3,000 members) 

and members of NHS Leicester City membership scheme who had previously 

expressed an interest in end-of-life care. 


The first event held in May 2010 was designed to identify the improvements that 

stakeholders felt were important. It was themed around the National End of Life 

Strategy. 

The second event held in July 2010 was designed to confirm and challenge the three 

supporting documents developed to deliver the improvements. Therefore, 

information given included the NHS Leicester, Leicestershire and Rutland End of Life 

Care Strategy, Action Plan and the High Level Care Pathway. 

The questionnaire was designed to canvas the views of members about the strategy. 

Its purpose was to provide a local snapshot, in time, to gauge local current 

awareness and views of the population on end-of-life care. 


At the first stakeholder event, people were asked to comment on improvements they 

felt to be most important. The objectives of the event were: 

• to achieve a common understanding of what was happening currently across 


• to identify and understand current gaps in the services. 

At the second event people were asked if they were happy that the priorities 

identified at the first stakeholder event could be identified in the three documents 

including the strategy, the action plan and the care pathway. If not, stakeholders 

were asked to challenge this apparent omission. 


The priorities identified were at the first stakeholder meeting were: 

• choice 

25

• co-ordination of processes 

• assessment 

• 24hr access to services 

• verification of death 

• care after death 

Following the event these priorities were reflected in the action plan. 

At the second stakeholder event held in July 2010 the stakeholder group were asked 

to confirm and challenge the three documents listed above. It was agreed that all the 

priorities identified at the first stakeholder group meeting had been included in the 

documents. 

In all, 2000 questionnaires were received from the questionnaire sent out to 

members. Information gathered from the feedback told the trusts that 60% of LCR 

members and 75% of LC members wished to die at home. 

To support ‘choice to die at home’ people felt it was important to be able to access a 

full range of services including specialist services, equipment and support for carers 

and family. These themes were also highlighted as the reasons people die in 

hospital rather than at home. 

To help people to talk about ‘planning a good death’, the top two themes were to 

provide leaflets in GP surgeries and raise awareness through the television and 

radio. 

The majority of respondents agreed that hospice care should be reserved for the 

most complicated cases. However, this was contradicted when the majority 

responded that, even if they did not meet the criteria for hospice care, they should 

still be allowed access. Alternative arrangements identified would be to provide 

hospice at home or nursing care home. 


The PCT Trust Boards agreed the strategy on 14 October 2010. With the 

introduction of the High Level Care Pathway, all patients approaching end of life, and 

their carers will: 

• have their physical, emotional, social and spiritual needs and preferences 

assessed by a professional with appropriate skills and competencies 

• have an effective care plan 

• have their needs, preferences and care plan reviewed as their condition 

changes with the appropriate systems in place to ensure that this information 

can be accessed by all relevant health and social care staff 

By 2014 end-of-life care will: 

• be effectively co-ordinated across all sectors 

• ensure patients and carers will feel well supported 

• provide good quality of care in the last months, weeks and days of life 

• have effective processes in place for the verification and certification of death 

and care after death 

• ensure that quality and effectiveness of care will be robustly monitored 

26

• ensure that there will be equality in access to and provision of end of life care 

services 

• ensure that all carers report their experience as ‘the best possible’. 

All those who had taken part by attending meetings and completing the 

questionnaire were informed of the results via the media, by publishing the strategy 

and our Trust Board papers online, and via the membership schemes’ newsletters. 

Members were also emailed the decisions taken. 

27

Greater Choice and Control and the Information Revolution 

White Paper 


The Department of Health released two White Papers - Greater Choice and Control 

and The Information Revolution. 

In Greater Choice and Control, the DH proposed a vision of an information revolution 

in which people have the information they need to stay healthy, to take decisions 

about and exercise more control of their care, and to make the right choices for 

themselves and their families. This includes an accurate record of their care which is 

available to them electronically. Health and adult social care information will be 

liberated from a closed, bureaucratic system in order to serve patients and the 

public, and to help drive better care, improve outcomes, innovation and better use of 

resources. 

In The Information Revolution the DH proposed moving: 

• away from information belonging to the system to information enabling 

patients to be in control of their care 

• away from patients and service users merely receiving care to being active 

participants in their care 

• away from information for administrative and technical needs to information 

based good clinical and professional practice 

• away from top-down information collection to a focus on meeting the needs of 

individuals and local communities. 

NHS Leicester City, and NHS Leicestershire County and Rutland’s objective was to 

capture the voice of all stakeholders, public members and communities in the city by 

inviting them to provide feedback on the consultation and inform them on the 

changes which will be happening as a result of these White Papers. 


The consultation was organised on behalf of Leicester City Council, NHS Leicester 

City and NHS Leicestershire County and Rutland. A number of communication 

channels and methods were used to gather the feedback required. Emails and 

letters were sent to over 100 local stakeholders. Over 5,800 emails and letters were 

sent to NHS Leicestershire County and Rutland and NHS Leicester City’s public 

members, who had chosen to provide feedback on health topics. Stakehloder 

briefings also took place. 

There were press releases to local media hubs for both radio and newspaper 

release. There was a session on Kohinoor Radio, a multi-lingual radio station, 

informing various communities of the proposed changes for public health. There was 

a fairly rounded response in terms of demographics, many of the communities 

invited either attended the consultation event or sent back their feedback via a 

questionnaire. 


A briefing of the main points of the White Paper was given out with the questionnaire 

and was presented at the consultation events. The easy read version of the White 

Paper was sent with the questionnaire to people requesting paper copies. 

28


The Greater Choice and Control consultation, launched on 18 October 2010, asked 

for views on: 

• what extending patient choice could mean and how it could work in practice 

• whether the proposed choices are the ones that people want 

• how shared decision-making can become the norm, in particular the 'no 

decision about me without me' ethos 

• having the right information, technology and infrastructure in place 

• arrangements to support choice of any willing provider, such as pricing 

• possible new duties on healthcare providers and professionals 

• personal health budgets. 

The Information Revolution consultation, launched on 18 October 2010, asked for 

views on: 

• transforming the way information is collected, analysed and used by the 

NHS and adult social care services 

• providing good information for patients and their families in line with the 'no 

decision about me without me' principles and a culture that enables people 

to make use of it 

• publication of data for public accountability 

• the role of information in improving outcomes for patients and service users 

• professionally endorsed and universally applied standards for recording 

care, including the role of informatics as a profession 

• giving people control of their care records and allowing them to share it as 

they see fit with others 

• encouraging greater use of technology and information to provide more 

convenient care and means of communication, and to create efficiencies to 

free up resources 

• an information strategy, including the NHS Commissioning Board and 

Department of Health's role in setting clear national informatics standards 

for both the NHS and adult social care. 


The responses of the people of Leicester, Leicestershire and Rutland to the specific 

questions asked in this national consultation have been submitted to the Department 

of Health. 

Based on the feedback from consultation channels, local respondees detailed that 

the way people can have greater choice and control over their care is to have GPs 

offer more consultation time. In addition they would like to have the statistics about 

the success or otherwise of operations performed by surgeons. In conclusion, people 

wanted hospital success rates so they could choose where they go based on 

treatment outcomes. The discussion prompted comments on topics not directly 

connected to the consultation issues, such as inadequate hospital parking and public 

transport to healthcare providers. 


Feedback was sent to the Department of Health as part of the national consultation 

process and the draft legislation, based on the principles of these White Papers is 

currently going through Parliament. 

29

Maternity and neonatal services review 


The engagement process for the Next Stage Review – Leicester, Leicestershire and 

Rutland maternity and neonatal services took place throughout November 2009 

aimed at service improvement in line with the vision report published in 2008. A 

summary of the 2009 engagement process and its impact is included in this 2010-11 

report, because the engagement informed Trust Board decisions taken in December 

2010. 


More than 1,600 questionnaires were sent to mothers who gave birth during a sixweek 

period earlier in the year. Questionnaires were sent out to 27 Sure Start 

centres across Leicestershire county and Leicester city, where staff helped parents 

to complete them. Also, questionnaires were sent to 973 nursery and toddler groups 

and 233 primary schools in Leicestershire. Members of the two PCTs’ public 

membership schemes received information about the questionnaire and were invited 

to attend the events. 

Teams also attended other events and meetings to speak to harder-to-reach groups, 

including asylum seekers, younger mums, those living in rural areas, women from 

the south Asian community and gypsies and travellers. A special easy read version 

of the questionnaire was also created for those with learning disabilities. 

More than 100 people attended the public events, and thousands of people were 

made aware of the questionnaire via the media and the distribution processes 

described. More than 800 questionnaires were completed. 


Presentations were given at the events to inform people on the NHS Leicestershire 

County and Rutland vision for the service and the challenges associated with making 

that vision a reality. This was followed by an overview of the current service. An 

introduction to distributed questionnaires also described the relevant information. 


People were asked to comment on maternity services and the care of newborn 

babies (eg, special care units). Women of childbearing age were asked to comment 

on the distances they were willing to travel to access maternity services and 

appropriate services for their newborn babies. 


More than 800 people had their say on the future of maternity and newborn services 

in Leicestershire and Rutland as part of an engagement programme. Their views 

were fed back into the ongoing planning for local maternity and newborn services. 


During the financial year 2009-10, as a result of this consultation the NHS health 

community covering Leicester, Leicestershire and Rutland improved early access to 

maternity services with new support workers and specialist midwives. A number of 

other options were developed for the future of maternity and newborn care in 

Leicester, Leicestershire and Rutland. 

30

In December 2010 these other options went to the Trust Board of University 

Hospitals of Leicester NHS Trust, NHS Leicestershire County and Rutland and NHS 

Leicester City. This was publicised via the local media and the trust websites, to 

inform the people who took part in the maternity and neonates engagement activities 

of the outcomes of the review. 

31

Maternity Service Liaison – designing a 12-month rolling 

programme 


NHS Leicester City and NHS Leicestershire County and Rutland’s Maternity Service 

Liaison Committee (MLSC) identified a need for a dialogue with mothers regarding a 

variety of issues in maternity services. Mothers are perceived as a difficult group to 

communicate with due to childcare and work responsibilities. To communicate 

successfully, two focus groups were set up, one in the city and one in the 

Leicestershire to identify the best communication channels. This research informed 

the design of a 12-month rolling programme of interaction to identify key issues and 

look for solutions. 


Initially two small focus groups of mothers were consulted, both with under 10 

members. 


It was explained that there was no extra funding available and not everything could 

be solved immediately, but wherever possible service changes and improvements 

could be made. There was also information on joining the liaison committee as a 

patient representative and options for communication. 


There were four main subjects for discussion initially, which informed the planning of 

the 12-month engagement plan. The subjects were essentially questions: 

• How did they want to be involved? 

• What do they think of having a workshop? 

• How did they want feedback to be given to them? 

• What topics did they want to discuss throughout the programme? 


People wanted to be involved using both newsletters and websites together, or 

through communication from children’s centres, Sure Start and interviews. 

They thought focus group were not appropriate, as the times of mothers’ availability 

varied. 

They said that feedback should be via website or a newsletter and include 

signposting to other available services and that topics should include ante-natal 

services, parent craft, communication, having the baby, post-natal care, breast 

feeding and bottle feeding and complaints. 


A newsletter has been produced covering specific topics of interest, and this is fed 

out via email, websites and relevant mother and baby groups and organisations. 

32

Naming the IAPT service 


As part of the government's £170 million investment in Improving Access to 

Psychological Therapies (IAPT) programme - which was designed to open up easy 

to access, effective mental health services to people in need - we have 

developed two new services to provide better access to talking therapies for people 

living in Leicester, Leicestershire and Rutland. 

The two PCTs consulted with the communities of Leicester City and Leicestershire 

and Rutland to rename the IAPT service to something more meaningful. This had to 

cover a variety of target groups, including the young and old, male and female and 

those of different ethnic origins. 


NHS Leicester City, and NHS Leicestershire County and Rutland consulted various 

patients, representative groups, community leaders and members of the two trusts to 

devise a list of potential titles and then vote on their preferred names from that list. 

There was a media release explaining when and how voting was taking place, 

explaining that it was open to all stakeholders and the public to vote on the preferred 

name. 


In the focus groups, members were given a brief background of what the service was 

about and why a new name had to be created to be meaningful to residents. This 

information was then put in a briefing for a media release, which was available on 

the website and was sent to the membership for the voting process. 


The focus groups were asked to respond to various parts of communicating about 

the service, this included: 

• creating some names for the service 

• commenting on how information should be communicated to patients, such as 

posters, leaflets and other paper based media 

• commenting on where the information on the service should be readily 

available 

• explaining how the service should be described including what type of 

language would be understood by the various communities. 


Comments were grouped under the following shared themes: 

• certain words related to mental health need to be avoided as they increase 

stigma and will reduce referral rates 

• leaflets which are discrete were chosen as the best paper based medium to 

promote the service as they can easily be slipped into a pocket or a bag 

• information to be available at relevant community locations such as support 

groups, local services, GP surgeries and pharmacies 

• radio and media releases would be a positive way of promoting the service. 


33

For people living in Leicestershire County and Rutland the service is called Good 

Thinking. 

For people living in Leicester City the service is called Open Mind. 

The patients chose leaflets to be the best form of information to be used and wrote 

the content together with the service commissioner via a reader’s panel format to 

reduce stigma and increase understanding. 

The leaflets are available in GP surgeries and relevant community groups services to 

increase self referral. 

Media releases were sent out to promote the service and information on where the 

service is and further information was also included in the media releases. 

34

Older Persons Month 


This was a project between numerous partners. The consultation was on behalf of 

NHS Leicester City, NHS Leicestershire County and Rutland, Leicester City Council 

and Leicestershire County Council. 

Older Persons Month is a local month of awareness-raising for issues affecting 

people over the age of 50. During this month, events are run to raise awareness of 

issues, promote tools and solutions to problems and help people interact and be 

active. This happens across Leicester City, Leicestershire County and Rutland. In 

September 2010, the city and the county joined forces to promote the event across 

the whole area. The problem which arose was that the city and the two counties 

have very different demographics and organisers needed to know what the key 

health issues were and what types of events would prove most effective for city 

residents. 


Members of NHS Leicester City, community groups and local representative groups 


All members involved were given a briefing explaining what the purpose of older 

persons month was and where there is thought to be health gaps which need 

consideration throughout the month. 


People were asked to comment on what they thought were health issues affecting 

people over 50 and what types of events would be useful to promote the different 

health issues in those areas. This was done in community meetings and at events. 


There were some enthusiastic responses resulting in further partnership working for 

running different types of events across the city. People highlighted isolation, low 

activity and fitness, safety, healthy eating and mental health as key issues affecting 

older people. They felt awareness events and activity events should be based on 

these issues and should be taken to the individual communities not be city centre 

based as this would result in less attendance of people who need to be targeted. 


The following events were run: 

• two mental health and wellbeing activity sessions in a care home 

• a Health and Safety event in Saffron 

• A Caribbean Culture Celebration Day was held in partnership with the 

Caribbean Court and delivered in Highfields 

• A Senior Citizens Health awareness event in Belgrave 

• An Older Person’s Fun Day including dance activities 

• A Young At Heart event including activity sessions in New Parks 

• A health talk on Alzheimer’s and dementia in partnership with Leicestershire 

Partnership NHS Trust was held in Braunstone 

• A health talk on Alzheimer’s and dementia in partnership with Leicestershire 

Partnership NHS Trust was held in St Marks 

35

Pharmaceutical Needs Assessment 


NHS Leicester, and NHS Leicestershire and Rutland has 206 pharmacies and 19 

dispensing doctors in the Leicestershire County and Rutland, ie, a doctor’s surgery 

which is able to supply medicine and which provides an increasingly wide range of 

services. We asked patients who access NHS services to tell us what they think 

about the service pharmacists and dispensing doctors currently provide. This is 

called the Pharmaceutical Needs Assessment (PNA). 

By law, all primary care trusts in England must publish a Pharmaceutical Needs 

Assessment by the 1 February 2011 to: 

• highlight whether there are gaps in the services provided by pharmacists 

• show pharmacists and dispensing doctors which services are required, 

where and by whom 

• assist NHS LCR with their commissioning of high quality services. 

The aims of the Pharmaceutical Needs Assessment are: 

• to gain a complete picture of the population within the NHS LLR area 

• to identify specific communities with particularly poor health 

• to enable comprehensive ‘benchmarking’ comparison with comparable 

populations 

• to give a clear view of unmet needs. 


In order to produce a meaningful Pharmaceutical Needs Assessment it was 

necessary to understand what people thought about current services offered by 

pharmacists and dispensing doctors and how services should be shaped for the 

future. Therefore, an engagement process was undertaken from mid June 2010 to 

mid July 2010. Engagement was broad and far reaching and included a 

questionnaire (available online, in hardcopy and as an easy read version) alongside 

face to face engagement with a variety of community groups, including 13 

community forums throughout Leicestershire and similar meetings in Rutland. The 

following seldom heard groups were also included: 

• people with learning disabilities 

• gypsy/travellers 

• older people 

• young people 

• asylum seeker and refugees 

• people with visual impairment 

• carers 

• people living in areas of health inequalities 

• BME groups 

• people living in rural isolation. 

In the Leicester City area, Officers organised meetings with relevant stakeholders 

who had interest in community pharmacy services, these included: 

• ADHAR - an organisation that provides support for Asian people with 

mental health conditions 

36

• LOROS - (Leicestershire and Rutland Organisation for the Relief of 

Suffering) a local charity providing skilled nursing and specialist care within 


• WISCP – (West Indian Senior Citizens Project) an organisation who provide 

a support service for the elderly Afro – Caribbean population 

• VAL – (Voluntary Action Leicester) a key voluntary organisation that 

involves volunteers in improving life in Leicester and Leicestershire 

• CLASP – (Carers of Leicestershire, Advocacy and Support project) a charity 

that provides support services for carers in Leicester, Leicestershire and 

Rutland 

• A young mothers group 

• A Travellers group 

An easy-read presentation was developed for these groups. 

Questionnaires were sent out to all pharmacies across Leicester, Leicestershire and 

Rutland for them to distribute to customers, and NHS LLR members were invited to 

complete the questionnaire. 

Leicester, Rutland and Leicestershire LINks invited their members to complete the 

questionnaire, and Rutland LINk steering group also received a presentation. By 

working in partnership with Voluntary Action Leicestershire and Rutland we were 

also able to invite members of the voluntary sector to be part of the engagement 

process. 

The second phase of this process began on 1 September, in the form of a 60-day 

consultation on pharmaceutical needs, which ended on 30 October 2010. 


When attending meetings a presentation was given to explain what the PNA was 

and why feedback was needed from the public on current services to ensure it was 

fit for purpose. As an introduction to the online questionnaire and the hard copy 

questionnaires a full briefing was attached. This included information on the purpose 

of the final PNA document. 

In the second phase of this process information was given on the feed back from the 

engagement process. 


During the engagement process stakeholders and members of the public were 

asked: 

• Who uses pharmacists and dispensing doctors? 

• Which services offered by pharmacies are used most? 

• Whether or not people think pharmacies and dispensing doctors are 

convenient 

• Whether people would like more services from their local pharmacy. 

During the consultation people were asked: 

• Do you agree that the eight smaller areas (localities) best reflect the areas of 

Leicester, Leicestershire and Rutland, and that they are the right areas? 

37

• From the information in the PNA and your personal experience do you believe 

your pharmaceutical needs are met? 

• Do you feel that the purpose of the PNA has been explained sufficiently? 

• Do you feel the pharmaceutical needs of the population of Leicester City, 

Leicestershire County and Rutland have been adequately reflected? 

• Do you feel that we have responded to the needs shown in the feedback 

through the engagement process and included the into the PNA document? 


More than 700 questionnaire responses were received in the engagement phase. 

Following the release of the final draft of the PNA the PCT received over 100 online 

responses and over 20 comments by letter from stakeholder organisations including 

the Local Pharmaceutical Committee (LPC) and neighbouring PCTs and LPCs. 

From the engagement and consultation process the PCTs have gained a wealth of 

knowledge. Overall findings identified that one fifth of respondents use a GP 

dispensary to obtain their medicines. Most respondents use pharmaceutical services 

on a regular basis for ongoing medical conditions and for the collection of medicines. 

A high percentage of respondents use the same pharmacy on a regular basis and 

this was mostly due to the convenient location and continuity of care. A high number 

of respondents are happy with their arrangements for repeat medication and more 

than half have never had any problems with their medicines. A high proportion of 

respondents reported that they had received enough information about their 

medicines and that the information was helpful. In Leicestershire and Rutland only 

8% had experienced problems in finding a pharmacy to meet their needs within the 

last 12 months. Of those, the problem was not generally related to access but more 

to the supply of medicines. There was a general awareness of some of the other 

services available from local pharmacies. 


Members of the public and stakeholders involved in the engagement and 

consultation process were informed when the PNA was to be agreed at the Trust 

Board in January 2010. The PNA was made available to view via the website and 

hard copies made available on request. They were also informed that the PNA would 

be used by the PCT as a commissioning and market-entry tool, ie, a tool to help 

them understand on what basis services are commissioned. It will also be used by 

the public as an information document. 

Enhanced service commissioning from community pharmacy is led by need, crucially 

a need that can be addressed by community pharmacy. The PCT currently 

commissions a range of enhanced services aimed at meeting needs that exist, 

across the City. This PNA has not identified any current health need that would 

require an enhanced service from community pharmacy and in the current economic 

position is not, realistically, likely to secure funding for such a service. However the 

PCT will continue to work with community pharmacy to understand the health 

outcomes from the range of non-commissioned services which are predominately 

related to health improvement, with a view to developing models for future enhanced 

services, should funding become available. 

38

Public Health White Paper 


The Department of Health released a national White Paper for consultation entitled 

Healthy Lives, Healthy People: Our Strategy for Public Health In England. It sets out 

the Coalition Government’s new approach to public health and some of the 

structures and processes that will support delivery. The vision is to protect the 

population “from serious health threats, helping people live longer, healthier and 

more fulfilling lives; and improving the health of the poorest fastest”. 

There were important factors to be considered when inviting stakeholders to take 

part to ensure all community voices were heard. Leicester’s predominant ethnic 

minority community is of south Asian origin. Leicestershire County and Rutland’s 

demographic profile is very different and has an ageing population, so it was 

important to gather a representative response to support the national consultation. 

NHS Leicester City, and NHS Leicestershire County and Rutland wanted to capture 

the voice of all communities, stakeholders and public in the city and county by 


changes which will be happening as a result of this White Paper. 


NHS Leicester City, and NHS Leicestershire County and Rutland undertook an 

engagement exercise including surveys, questionnaires and consultation events. 

The consultation events were held for patients, members of the public, NHS staff, 

clinicians, local authorities, voluntary sector organisations and seldom heard groups 

to ensure a wide range of views was collected. 


A briefing of the main points of the White Paper was provided with the questionnaire 

and was delivered verbally at the consultation events. An easy read version of the 

White Paper was sent to people requesting paper copies of the questionnaire. 


Everyone was asked to comment on the proposals being made in the White Paper, 

along with any concerns and potential solutions that all needed to be taken into 

consideration both locally and nationally. 


The strong partnerships across the city, two counties, local authorities and other 

statutory bodies have enabled us to gather a wide range of views. 

This indicated broad support for: 

• the focus on preventative health 

• the new role for the local authority, the establishment of Public Health 

England as a means of ensuring consistent health protection 

• the local focus – critical for effective services in response to people and their 

needs 

• the emphasis on the voluntary sector and wider contributions by individuals 

and communities 

39

• the Health and Well being Board as the local focus which may provide and 

ensure local coherence in the commissioning by the local authority for adults 

social care and public health and GP-led commissioning groups for health 

care 

• the ring-fenced budget for public health funding and the health improvement 

functions to be performed by the local authority. 

There were concerns that: 

• health may worsen due to the economic circumstances and the continuing 

effects of poverty, particularly on children 

• the voluntary sector may not be intact to work with local authorities and GP 

consortia in the provision of services and input that improve health and public 

health 

• the public health budget in general and for local authorities in particular will be 

insufficient. (The White paper itself says that funding has not gone into 

prevention and there was a concern that in the transition to these new 

arrangements might raise expectations but lower funding) 

• the Health and Wellbeing Board will lack the authority to create coherence in 

the local approach to health care, health protection and health improvement 

• the public health premium may distort the issues focussed on locally. 

• there is potential for performance indicators to be politicised locally and 

nationally – “long term outcomes do not benefit from changing goal posts”, 

was one expression of this. 


This information was fed back to the Department of Health and used to inform the 

current changes being delivered to the reforms of public health. 

40

Quality, Innovation, Productivity and Prevention (QIPP) 


NHS Leicester City and NHS Leicestershire and Rutland have taken several 

opportunities during 2010-11 to engage with the public on QIPP. Our aim was for the 

public to understand the current financial climate and challenges facing the NHS. 

The first QIPP event in September 2010 was a joint event without two PCTs, 

University Hospitals of Leicester NHS Trust (UHL) and Leicester Partnership Trust 

(LPT). 


Members of the public and major stakeholders including both PCT’s public 

memberships along with people from UHL’s and LPT’s membership schemes. 


Those attending were informed that each person in our area was allocated a per 

capita healthcare funding amount of £1,600 to pay for treatments, medicines and 

equipment, and that some also covered other costs such as the management of 

buildings, running vehicles and employing staff. A series of examples of the cost of 

services was also given. For example, the average cost for attending the Urgent 

Care Centre (open 8am – 6.30pm) is £40. Attending the Minor Injuries Unit is £59 an 

hour, and attending the GP out-of-hours service (available 6pm – 8am) is also £59. 

Attending the Accident and Emergency Department is also £59 and the average cost 

of an overnight stay in hospital is £147. Along with some ‘did you know that’ 

information, for example, the cost of a hip replacement is £6,000, a knee 

replacement is £6,000, a Caesarian section is £2,000 and a normal, uncomplicated 

birth is £1,000. 


Participants were then asked to vote by choosing options to answer a variety of 

questions about making services more cost-effective and efficient while maintaining 

quality of care. Participants used voting pads to feed back on how they thought 

unnecessary admissions could be avoided, where people would consider going for 

diagnostic scans, and where they would consider accessing minor surgery; and 

more. 


Feedback indicated that members of the public were willing to consider alternative 

options for service delivery. 


The public received immediate feedback totals from the voting system and were told 

that information gathered would be used for future QIPP considerations by 

healthcare commissioners and providers. This event was also used to inform the 

content of further QIPP engagement work. 

41

Quality Innovation, Productivity and Prevention: 

Strategic Operating Plan 


As part of the engagement about our spending priorities in our Strategic and 

Operating Plan for 2011-12, NHS Leicester City and NHS Leicestershire County and 

Rutland held a public event and workshop on the morning of 31 January 2011. 


Members of both organisations’ membership schemes were invited, and altogether 

more than 80 people attended. Key stakeholders from the voluntary sector and Local 

Involvement Networks were also invited, together with representatives of seldom 

heard groups, including people with learning and other disabilities, gypsy travellers, 

and people from BME groups. 

What Information was given? 

During the event, there were presentations about the financial context from Sue 

Bishop, Director of Finance for NHS LCR, and Dr Tim Daniel, Consultant in Public 

Health Medicine at NHS LCR. 


The participants were asked about their views on health spending via a number of 

simple statements. During the workshop, they decided by a vote how they would 

theoretically allocate funding to a number of common procedures and treatments, 

including drugs and preventative treatments. They were then given more information 

about each of the procedures, including their costs, success rates and clinical 

effectiveness, and were asked to vote again in the light of the new information. 

During feedback, they had opportunities to make comments, which were also 

captured. 


The notional budget at this event was in the form of a sheet of adhesive peel-off 

‘dots’. Attendees allocated as dots to each procedure in line with their priorities and 

preferences. The first time they voted, participants divided up their notional money in 

the following ways (the first figure refers to the number of peel-off dots, the second 

figure is the percentage of the notional budget): 

Total Workshop 1 

33.7% 

81, 21% 

89, 22% 

17, 4% 

36.5, 9% 

42, 11% 

42, 11% 

49, 13% 

42 

Wisdom teeth extract 

Stop smoking campaign 

Alcohol abuse prevention 

Hip replacement surgery 

New bowel cancer drug 

Bowel cancer screening 

Kidney transplant 

IAPT

Comments included: 

• prevention and public education is a priority 

• knee replacement - it is up to the individual to make the most of it, if it is to be 

effective and improve quality of life 

• treatment should not be age related 

• kidney transplants are saving lives and are cheaper than dialysis 

• mental health has additional costs 

• more investment and support for carers is needed 

• prevention must take priority - what is the benefit of alcohol treatment? 

• mental health had the most votes while wisdom teeth had a low priority 

After further explanation about the conditions and treatments, their costs, success 

rates and clinical effectiveness, participants voted again. These are the results: 

Total Workshop 2 

3, 1% 31, 8% 

92, 26% Wisdom teeth extract 

46, 12% Stop smoking campaign 

Alcohol abuse prevention 

Hip replacement surgery 

40, 11% 

57, 15% 

New bowel cancer drug 

Bowel cancer screening 

Kidney transplant 

77, 21% 

24, 6% 

IAPT 

In the second vote less was allocated to wisdom teeth extraction (just one per cent), 

stop smoking campaigns, a new bowel cancer drug which prolongs life for a few 

weeks, and bowel cancer screening. More was allocated to alcohol abuse 

prevention, hip replacement surgery, kidney transplant, and psychological therapies. 

A major theme in the discussion and feedback was the importance of prevention, 

including screening, eg, for different cancers, monitoring of school children. People 

also debated quality of life. Mental health was seen as important, and people were 

interested in the comparative costs of a transplant as against regular dialysis. A 

strong point was also made about the importance of support for carers. 

Other key themes included the importance of good health education, a sense that 

people should take some responsibility for their own health costs, concern about 

mental health issues, concern about the cost of drugs and the potential for saving 

some of the money spent on them. 


The findings from the event have been used to inform the planning for the financial 

year 2011-12 and will also help public health teams in their planning. All members 

attending the event were made aware that this is how there feedback would be used. 

43

Quality Innovation, Productivity and Prevention (QIPP) 

event 3: Right Care – Planned Care 


NHS Leicestershire County and Rutland and NHS Leicester City wanted to improve 

their approach to planned care and proposed changes which would help GPs decide 

the right care at the right time for patients through standardised referral thresholds 

for access to some services. This was intended ensure that the referral process was 

based on clinical need and benefits, and was fair and transparent for everyone. 


A briefing event took place to inform stakeholders of the proposed standardised 

referral thresholds for right care. Taking part were those from the membership 

schemes of the NHS Leicester City and NHS Leicestershire County and Rutland, 

members of the public, the Local Involvement Networks, while representatives from 

seldom heard groups were invited to attend the briefing. Those who attended were 

asked to complete a hard copy questionnaire at the event, and an online version was 

also made available. Those who had been invited to the briefing, but were unable to 

attend, were made aware of the online questionnaire and invited to complete it. 


Information given identified that the proposed changes were based on the expertise 

of local GPs, hospital consultants and other healthcare professionals in the city and 

two counties. In addition, recommendations on right care at the right time had also 

been drawn from evidence from across the region. 

People were also informed that the number of planned care procedures had risen 

exponentially over the last few years. Some of these procedures are shown to have 

limited clinical value in terms of improvements to the quality of life of patients. 

Procedures under consideration were: 

• primary knee replacements 

• primary hip replacements 

• carpal tunnel (wrist) and minor hand surgery 

• cataract removal 

• tonsillectomy 

• some hernia repairs 

• assistive conception services. 

People were also reassured that, in identifying these procedures, consideration had 

been given to the following factors: 

• the evidence base to support their development 

• the impact that their introduction will have for patients 

• clinical support for their introduction 

• the wider impact for the local health and social care economy. 

It was also explained how assessments would be made for each condition when 

using a standardised referral system. 


44

Following the information giving session, people were given the opportunity to ask 

questions. They were then asked to complete a questionnaire. People were asked if 

they agreed or not with standardised referral thresholds for each of the conditions 

identified. If people did not agree, they were asked to explain their reasons so that 

these could be taken into consideration by the trusts. 


At the briefing event 13 people completed the questionnaires and 92% agreed with 

the standardised referral thresholds for all the conditions identified. 


Following the consultation with the public, patients, carers and clinicians around the 

Right Care thresholds a final list of surgical and referral thresholds were developed. 

These have been circulated to primary care clinicians and within local providers. The 

referral thresholds have been in use from the 1 st of June 2011 and their impact will 

be reviewed on an ongoing basis. 

The consultation with the public provided invaluable in informing the development of 

the thresholds and ensured that the work we were undertaking was as responsive to 

local need as possible in what is a challenging time for the NHS. 

45

Transforming community services 


It was necessary to carry out engagement about the planned transfer of community 

services out of PCTs and into other provider arrangements, in line with national 

policy to separate healthcare commissioners from actual providers. Nationally it had 

been know as Transforming Community Services (TCS). The change was essentially 

a transfer of management arrangements, rather than a change to frontline services, 

but it was felt important to engage with the public and stakeholders to give them an 

understanding of what was happening. 


Members of the public and stakeholders were consulted at public meetings in Market 

Harborough, Leicestershire, and Oakham, Rutland, as well as at a stall as part of the 

pre-meeting ‘wellbeing markets’ at both NHS Leicestershire County and Rutland’s 

and NHS Leicester City’s AGMs, and at community forums in Wigston and Oadby. 

Key stakeholders had opportunities to comment after regular updates at quarterly 

stakeholder briefings during the period April 2010 to January 2011. 


Information was given about the national policy to separate commissioner and 

provider functions, our locally planned changes to community services and the 

perceived benefits. 


People were given information about the local plans for Transforming Community 

Services and asked to comment on how important they felt it was to create ‘one-stop 

shops’, to have care closer to home, to have health services that are efficient and 

cost effective, including efficient use of buildings and support services. They also 

had the opportunity to record any concerns about the plans, and to suggest 

improvements. 


In general, people were supportive of improving services in the suggested ways. The 

concerns they expressed were to do with whether re-organisation was needed and 

some cited the many reorganisations there have been in the NHS in recent years, 

whether re-organisation would improve services, and whether the process would b 

expensive. Suggestions for improvements tended to be about better, more 

convenient access. 


The TCS steering committee and Boards of both PCTs noted the feedback as they 

continued with plans to transfer community services. The transfer was completed on 

31 March 2011, involving the move of most of the services provided by both city and 

county community health services to Leicestershire Partnership Trust. 

46

The White Paper Equity and excellence: liberating the NHS 


The Department of Health published a White Paper for NHS reform entitled Equity 

and excellence: liberating the NHS in July 2010. The paper has wide-reaching 

implications for future of the NHS in England. 

On 22 July 2010, the DH launched a period of public consultation on the White 

Paper, specifying three key issues: 

• transparency in outcomes - a framework for the NHS 

• increasing democratic legitimacy in health 

• commissioning for patients 

NHS Leicester City, and NHS Leicestershire County and Rutland wanted to capture 

the voice of all communities, stakeholders and public in the city and county by 


changes which could happen as a result of the proposals in the White Paper. There 

were important factors that had to be considered to make sure all community voices 

were heard. Leicester’s predominant ethnic minority community is of south Asian 

origin, while Leicestershire and Rutland do not share this characteristic, but have a 

larger ageing population than the city. There are major differences, too, in the levels 

of deprivation and affluence between the city and county areas, and we felt it was 

important to gather a demographically representative response from across this 

diverse area. 


NHS Leicester City led on the consultation on behalf of both PCTs. The main 

channels of consultation were: 

• both PCTs websites 

• NHS Leicester City and NHS LCR holding consultation events for local 

residents of Leicester and other interested stakeholders 

• Questionnaires, both hard copy and electronically, were sent to NHS LCR and 

NHS Leicester City membership 

• attendance at community events with those stakeholders who possessed 

‘protected characteristics’ under the Equality Act 2010. 

• briefing and engagement with key patient groups, ie, LINk 

• a specially convened briefing and question and answer session with elected 

members of Leicester City Council as well as briefings for Leicestershire and 

Rutland County Councils. 

• consultation sessions with clinicians, especially GPs. 


All people involved were given information on the key principles of the changes: 

• PCTs and Strategic Health Authorities to be abolished from 2013 

• GPs to have responsibility and budgets for planning and paying for services 

• Greater emphasis on outcomes for patients, rather than simply meeting 

targets 

• putting patients and the public first 

• a greater degree of independence for health care providers and reduced 

bureaucracy 

47

• health improvement will be the responsibility of local authorities 


Everyone was asked to comment on the proposals in the White Paper, to express 

their concerns and/or to offer potential solutions which could be taken into 

consideration both locally and nationally. They needed to understand that the 

reforms would see radical changes across the NHS landscape and the provision of 

health and social care. 


Overall the proposals have been met with some support but also apprehension from 

a great many key stakeholders - both clinical and non-clinical. However, the 

predominant view of all who see the NHS as a vital national resource, is that it needs 

to work more effectively to ensure patients are its prime focus and that people’s lives 

and health are improved. 


The information gathered was sent to the Department of Health as part of the 

national feedback process, and the relevant legislation based on these White Papers 

is still on its way through Parliament at the time of this report’s publication. However, 

during 2010-11 PCTs started the process of implementing the key principles of these 

reforms, and GPs began the formation of clinical commissioning groups in readiness 

to take over most local healthcare commissioning functions from April 2013. 

48

Part 2: Leicester City engagements 

49

Beaumont Leys Surgery – procurement training 


NHS Leicester City had entered in to an open tender process to secure a new 

provider for the Beaumont Leys surgery. Patient representation on the evaluation 

and interview panel was sought to ensure that patient views were taken in to account 

as part of the process. Training was to be provided. 


Patients registered at the Beaumont Leys surgery. 


Patients attending the training session were given information about procurement 

and the steps involved in the tender process. 


Patients attending were asked to consider whether they would be able to participate 

in the procurement process. 


The attendees found the sessions useful and informative. 


Unfortunately those patients who attended the session were not available to 

participate on the evaluation dates, providing lessons to be learned in engaging 

patients in the stages of the procurement process normally undertaken by trained 

professionals. Alternative representation was secured to ensure that the process ran 

smoothly in future. 

50

Belgrave Medical Centre closure and patient registration 


In September 2010, the Belgrave Medical Centre, a surgery situated in the heart of 

Leicester, was closed following the death of the doctor who held the PCT contract. 

Due to unforeseen circumstances the lease extension for another GP to occupy the 

same premises could not be agreed and the GP in question was unable to secure 

alternative premises within the locality meaning the Belgrave Medical Centre had to 

be closed. The patients registered at the centre had to seek alternative 

arrangements at a ‘caretaking’ practice for a period of three months to ensure 

continuity of care. 

The patient list of the former practice reflected not only an extremely diverse 

population, but special consideration also had to be taken of those in need of 

specialised communication, such as those who were elderly, vulnerable and those 

for whom English was not their first language. 


All patients at the practice were initially consulted of the surgery’s closure via letter 

sent on the 1 September 2010. A patient meeting was arranged for the 10 November 

2010 to update them of the situation, gather feedback about individual issues and 

discuss a way forward with potential options. 

Patients who are unable to attend this event were given the opportunity to submit 

their comments by returning a patient questionnaire with translations offered. Over 

150 questionnaires were submitted to Leicester City PCT and all comments were 

recorded and fed into the decision making process. This was followed by 6 patient 

registration sessions to support patients to register at alternative practices. 

Interpreters were available at these sessions. 


Initially the situation and caretaking procedure was explained to the patients on the 

surgery’s list. This was carried out by letter in September 2010, with the option to 

phone a translation service. There was then a meeting in November 2010 where full 

details of the caretaking and possible options for future services were discussed. 

Following the meeting, once the PCT Board agreed the way forward, information 

was sent to patients through the post about alternative practices available and how 

to register. This was followed by six ‘drop-in’ sessions arranged for patients to speak 

to a member of the PCT primary care directorate about local practices and the best 

choice for their requirements. 


Patients were asked about any potential issues arising from the closure and for their 

help in deciding the best way forward from a selection of potential options. This was 

followed by comments on the type and location of practice they might like to be relocated 

to. 


The main themes that emerged from the engagement process, which patients 

commented on were the following: 

• practice quality 

51

• practice accessibility 

• appointment availability, 

• practice location 

• disabled access 

• parking access 

• location convenience 

• services available 

• choice of practice 


It was concluded that list dispersal provided a logical and sensible way forward. 

Prior to the implementation of dispersal of the patient list, NHS Leicester City 

requested that the patients could be assured of the capacity and quality of the local 

practices to ensure accessible, quality care was available to all patients. 

Patients were able to continue to receive care from the Caretaker practice until 31 

December 2010 before dispersal. The patient registration department and the PCT 

Customer Services team assisted patients throughout this process. 

The six patient registration drop-in sessions helped to register patients. However, 

any patient who was not registered with another practice by the end of the caretaking 

arrangements were contacted by Patient Registrations and offered additional 

assistance. 

52

“Call time on drink” campaign 


As a result of rising hospital admissions relating to alcohol, a social marketing project 

was embarked on to help reduce alcohol consumption in the city. This had to be 

designed to specifically target communities in particular locations. Therefore the 

marketing team engaged with members of the specific communities to design an 

appropriate campaign. 


After an analysis of hospital admission data and mosaic profiling, the project 

focussed on three areas of the city, New Parks, Braunstone Park and Rowley Fields, 

as well as Eyres Monsell. It was decided to target the 25 to 44 year-old group to 

tackle problem drinking at an early age to prevent hospital admissions in later life. 

Residents of the three areas within the target age-group were consulted on their 

behaviours and attitudes towards alcohol and ideas were generated for interventions 

that would help to reduce their alcohol consumption. 


Background and current information about alcohol campaigns was provided. 


People were invited to join in discussions and activities with researchers in groups of 

three and in larger focus groups of 12. The discussions covered drinking behaviours, 

attitudes towards alcohol and campaigns as well as intervention ideas. 


• drinking is a by-product of socialising, therefore solutions would still need to 

provide opportunities for this 

• the campaign needed to be more hard-hitting than existing national 

campaigns 

• units and recommended drinking levels were not well understood 

• liver disease was a well-quoted side effect of excessive drinking, therefore the 

campaign also needed to address the wider spectrum of conditions 

• the audience was comfortable with receiving support in pharmacies for 

smoking cessation services and requested similar support for alcohol. 


A hard-hitting campaign was produced promoting the dangers to health of drinking 

too much and providing tips on cutting backing while still maintaining a social life. 

Drinking limits were discussed in terms of popular drinks as well as units. The 

campaign offered 10-minute brief advice in pharmacies in the three selected areas. 

53

Medicines Use Review survey 


A benchmarking exercise was carried out to identify training issues for community 

pharmacists in order to support them to deliver effective Medicines Use Reviews 

(MURs) with patients. 


We sent three individually tailored online questionnaires to community pharmacists, 

GPs and members of the public who had received an MUR in the previous six to 12 

months. 


A basic description of an MUR was given in the questionnaire. 


Community pharmacists were asked about the MURs performed recently including 

the number of medicines people are currently taking, the type of information given, 

the reason for conducting the MUR and any training needs. 

GPs were asked about any MURs received, the quality and usefulness of MURs, 

reason for the MUR and the effect on patient. 

Patients were asked about the reason they had an MUR, their understanding of the 

process, how useful it was and the quality of information given to them. 


Community pharmacists highlighted their MURs were performed for a variety of 

reasons and that most patients chosen were on multiple repeat medications. 

GPs highlighted that they felt many MURs were a waste of time and NHS resources, 

and that patients were often confused by conflicting information given by 

pharmacists. 

Overall, some patients stated that they found MURs to be useful but some did not 

understand why they were having a review at the time it was undertaken. 


The Local Pharmaceutical Committee (LPC) felt that the results were inconclusive as 

not all community pharmacists and GPs completed the survey. As a result the 

Pharmacy Development Group (based at NHS Leicester City) decided that a PR 

exercise was needed with GPs and community pharmacists to better understand the 

role of MURs and their purpose. 

Since then the Pharmacy Development Group has disbanded, and with the ongoing 

restructuring of the NHS, there has not been sufficient resource to carry out the 

planned PR campaign. However, a newsletter was sent out to signpost community 

pharmacists to training which was readily available. 

54

New arrivals engagement 


During the winter months local NHS services are put under considerable pressure, 

particularly the Accident and Emergency Unit (A&E). Extensive delays are caused 

often because people do not know where else to go. This project specifically takes a 

targeted approach, and looks at new arrivals to Leicester City. One of the ways of 

understanding why new arrivals attend A&E is to engage with a number of different 

groups gaining better insight. 

The New Arrivals Strategy (2006) defines new arrivals as “Asylum seekers, 

refugees, migrant workers, EU nationals who have chosen to make Leicester their 

home. A person, who has arrived in Leicester from abroad, and who, because of 

being new to the UK, has a significant need for support in accessing services and/or 

who needs different services to those of other residents.” 

The New Arrivals Strategy also states that, regarding the Leicester population and 

A&E interaction, it can mean that new arrivals may initially use emergency services 

unnecessarily and may require referral or signposting to mainstream services. 

This project aimed to explore and work with residents who have newly arrived ( 

within 0 to 24 months) in Leicester/UK and/or settled in Leicester and are using A&E 

for non-urgent primary care needs. This engagement exercise mainly focused on 

new arrivals, including students, who were new to Leicester and did not speak or 

understand English, either at all or well. 


Asylum seekers, refugee groups, Somali, Polish communities, and students were 

identified as new arrivals to Leicester. Attendees at A&E were also consulted when 

visiting the service. 


Information was given and gathered in a variety of ways. Members of the public who 

attended A&E were asked to complete a questionnaire. One-to-one interviews were 

also conducted with members of public when they came in for their GP appointments 

to the ASSIST surgery, a special Leicester City service for asylum seekers. 

Information was also given and gathered through focus groups, conducted at Sure 

Start centres targeting parents who had newly arrived to Leicester. 


We wanted to know: 

• who uses A&E? 

• why people use A&E? 

• what is their experience of Primary Medical Care? 

• are the Choose Well materials helpful? 

• does Choose Well help you go to the right place for medical care? 


The general consensus from engaging with asylum seekers and refugee groups was 

that when people come into the country, initially they are not aware of the provision 

of primary health care through GPs. Once given the information they are hesitant to 

55

use them due to the fear of being sent back to countries that they have successfully 

managed to escape. 

In trying to gauge a better understanding from newly arrived communities there is 

ample evidence to show that further work needs to be done in reaching out to these 

groups. There needs to be a targeted approach to educate, give information and 

signpost individuals to the correct service. The Choose Well campaign, launched 

nationally and locally should address some of these issues; increasing patients 

awareness of where to go to for the right treatment and also publicising the location, 

opening times and services offered in these centres. This, however, is only useful for 

those who can read English. 

The following recommendations were made with consideration to the findings from 

the new arrivals engagement: 

• work in partnership with the New Arrival Strategy group and deliver targeted 

campaigns to address the issues. 

• work on an ongoing basis with educational intuitions to create a better 

understanding particularly amongst International students. 

• promote the message that pharmacy services are available on the high street 

and can give people expert, confidential advice and treatment for a wide 

range of minor illnesses and ailments, without having to wait for an 

appointment. 


Work is ongoing to ensure new arrivals to the city receive the most appropriate 

information about accessing health care services. The report of the findings was fed 

back to the New Arrivals Strategy group and the marketing department to use as a 

basis for developing a new, more targeted Choose Well campaign. 

56

Out of Hours Service 


NHS Leicester City’s Quality Directorate needed to review the out-of-hours service 

and monitor improvements to patient’s experience. There had previously been a low 

response rate to questionnaires sent to the homes of patients after being seen. It 

was then decided that a team would interview patients after using the service to 

analyse their experience and observe the process during a visit to one of the out-ofhour 

options, an Urgent Care Centre, next to Leicester Royal Infirmary’s A&E unit. 


Staff from NHS Leicester City attended the city Urgent Care Centre unannounced to 

interview service users on a one-to-one basis. This was done on three occasions, 

one being a Saturday. 


Patients were told who the team were, where they were from and that the service 

review was an inspection to suggest improvements, and had not been undertaken 

with the intention of closing the centre. 


Seven broad questions were identified, with the option for the patient to identify key 

words in relation to each question: 

• Booking/ arriving for appointment 

• Information at reception 

• Waiting time to see doctor/ nurse 

• Meeting with doctor/ nurse Treatment offered 

• Information given about condition 

• Information given about follow up 

They were then given an opportunity to give reasons why and comment on any other 

aspect of the service. 

The result was that patients were able to give NHS Leicester City staff an overall 

snapshot view of their experiences. 


The following concerns and improvements were suggested for the service to 

improve: 

• approximate waiting times need to be available 

• the Jayex digital messaging display board could be used to show useful 

telephone numbers and health messages 

• provide Department of Health information on why prescriptions may not be 

the most appropriate treatment in the leaflet stand 

• provide NHS and trust magazines on information stand 

• provide a water cooler or information about where to get a drink of water 

• provide fans to ensure that the environment is comfortable for patients 

• have televisions or other media available to reduce ‘boredom’ 

• provide directions to a vending machine nearby 

• provide a static information display board for the waiting area 

57

• can there be signs saying if there are any problems to report them to 

reception? 

• chlamydia tests could be available in the toilets 

• better communication to patients for why you are testing or treating them, 

especially where there are language barriers 

• have alternative methods for printing off information if patients request it 

• ensure that information is displayed to inform patients and carers how they 

can make a complaint 

• the notice board in the corridor outside the Urgent Care Centre was very 

crowded and it was difficult to read some of the notices – this needs to be 

regularly checked and updated 

• maintain a comfortable temperature in the facilities 

• ensure that the board at reception displaying which staff were on duty is 

accurate each day. 


Many of the suggestions have already been adopted and the others are being 

investigated for the best possible solutions to improve the patient experience as part 

of a wider overall review of A&E, unscheduled and urgent care. 

58

Patient Participation Group event 


A Patient Participation Group (PPG) is a practice-based forum, which involves 

patient representatives and practice staff, who meet to contribute to the improvement 

of their GP services. The role of the group is to work together with the practice to 

improve services for patients and support good practice development. People who 

are involved with PPGs have said that they feel really involved and understand much 

more about how their views and feedback help to improve things for patients and 

service users. 

In Leicester City, although a growing number of GP practices now have a PPG in 

place, there are still many practices which have asked for support in setting up and 

running a successful PPG. A number of existing PPG members also asked for 

support with networking with other PPGs. 

In winter 2010 NHS Leicester City organised a public event to raise the profile of 

PPGs, to encourage practice managers, GPs and members of the public to set up 

new ones and to share ideas and best practice with those that already existed. 


GPs, practice managers, PPG chairs and members of the public were invited to 

attend. 


Presentations at the event outlined the purpose of a PPG, how to structure the group 

and recruit to ensure demographic representation. There were also presentations 

from local practices and patients who are part of PPGs who shared new ideas and 

best practice. 


The event gave attendees the opportunity to network with other PPG members and 

practices whilst encouraging questions from tables. A workshop session encouraged 

attendees to share ideas with topics of starting a PPG, health promotion, and 

planning for the future. 


Feedback from the event highlighted the need for improved communication between 

the Trust and PPGs with individuals asking for further information regarding setting 

up and running a successful PPG. There were many comments made asking for 

advice on how to handle difficult situations (such as complaints from patients and 

individual members) and comments were made on the design of the current 

information booklet with suggestions of how to make it more visually appealing. 

Through examination of the evaluation forms, most attendees found the session to 

be very informative, with the networking opportunity as the most valuable element. 


One of the outcomes from the event is that the Local Involvement Network (LINk) is 

now working to establish a PPG forum to offer consistent support to PPG Chairs and 

Practice Managers in the city. In addition a number of attendees expressed interest 

in starting their own PPGs and we are working to support them. 

59

Sexual health website 


The public health team wanted to develop a website that would be meaningful to all 

ages and cultures using the internet to be informative and cover all aspects of sexual 

health of interest to the residents of Leicester City. This is one of many approaches 

the public health team have been using to contact communities across the city. 

A key issue was that there are many different preferences in design and language 

between different cultures and members of those cultures, including differences 

between various target group members, depending on their gender, age and their 

sexual orientation or religion, among other social and cultural factors. 


A ‘scatter-gun’ approach of the membership was chosen to select 50 people who 

were from a range of different backgrounds. We also engaged with various 

community organisations and groups to feedback information on specific preferences 

and examined evidence from previous research on preferences for both sexual 

health information, language and website design. 


People were informed of the website proposition and purpose, and they were asked 

to review the proposed information pages and the website design. Members of our 

NHS trust membership scheme with online access were sent links to similar 

websites, to help them decide what styles they liked or disliked. They were also 

informed that, although it would not be possible for them to be identified through the 

process, their equality data was needed for the team to analyse what issues affected 

which cultures. 


A simple questionnaire was designed for residents to comment on the information 

they wanted, the language they wanted, the website to use, the website design 

preferred and any other comments or concerns they had. They were also asked to 

feedback their equality information, but it was emphasised that this information would 

not be used to identify them, and it was only necessary to analyse which 

communities had particular issues or preferences to better inform the project’s 

approach. 


People gave comments on topics they wanted to see, the layout preference, their 

preferred language, with explanations of why some words were inappropriate to their 

community and what other features they wanted to see on the website. 


The feedback is currently being used as a basis for the website development taking 

into account all the concerns and additional interests of the different communities. 

60

Part 3: Leicestershire County and Rutland 

engagements 

61

Bowel cancer and bowel cancer screening awareness 


To inform a social marketing campaign aimed at raising awareness of the symptoms 

of bowel cancer, and the uptake of the bowel cancer screening programme. 


The campaign was focused on ‘seldom heard’ groups and people from areas of 

health inequality. Six focus groups were held with people from Charnwood and North 

West Leicestershire, including people from a BME background. 


Questionnaires were sent to people in the membership scheme in older age 

brackets, and to members from a BME background to gain an understanding of their 

awareness of bowel cancer symptoms and the screening programme. 


People were asked questions about the symptoms of bowel cancer and whether they 

would seek medical advice. They were also asked if they were aware of a bowel 

screening programme and how confident they felt in the ability of screening to detect 

early symptoms of bowel cancer. 

At the focus groups information to be gained included: 

• what they knew about what effect bowel cancer has, and what it can lead to 

• what they knew about treatments for bowel cancer 

• what they knew about the symptoms of bowel cancer 

• what they knew about the test for bowel cancer (including showing them what 

they would receive if invited to take the test) 

• what were the barriers to them taking the test, if any 

• what would encourage/facilitate them to take the test 

• what were the barriers to them sharing suspicious symptoms with their GP. 


More than 2,000 people completed the questionnaires. Six focus group sessions 

took place and all feedback was collated. The feedback showed that more 

interventions were needed to improve awareness of symptoms to encourage so that 

people realised the importance of bowel screening. It also showed that people were 

more likely to take part in the screening process if their GP contacted them about it. 


The results of the focus groups and questionnaires have been used as insight to 

inform decisions about interventions to improve awareness of symptoms, and 

increase uptake of screening in at risk groups. A social marketing campaign has 

taken place including posters, radio, TV and bus advertising to increase awareness 

of the symptoms and the value of screening and including GPs contacting individual 

patients and asking them to take part in the screening process.. Further research 

planned in 2011 will evaluate the success of the campaign. 

62

Dental access 


People were not taking up available dental appointments that had been made 

available following public feedback saying they could not get a dental appointment. 

Therefore an event was arranged to inform the public of the importance of dental 

health and to engage with them on dental access. 


Members of the public living in areas of high health and social deprivation 


A public health specialist registrar and a practicing dentist spoke on the following: 

• importance of eating healthy food to keep teeth healthy. 

• negative effects of poor dental hygiene. 

• Self-help tips on what you can do at home to prevent tooth decay, infection 

and cavities. 

• NHS dental charges. 

A video was shown on how looking after your teeth from an early age can help 

prevent painful dental problems, such as abscesses. 

People attending then took part in a quiz to assess their understanding of the 

information given. 


A question and answer session took place where people could pose questions 

directly to the experts. 


People felt better informed and aware that they could access dental appointments 


To repeat this event annually. 

63

Health care for older people, patients and carers 


An event was organised to address feedback from the NHS Leicestershire County 

and Rutland’s “Be Healthy, Be Heard” membership scheme. Members felt that many 

people suffer with dementia, Alzheimer’s and Parkinson’s in particular, and wanted 

to learn more. In September, when the event was held, it was also Older Person’s 

Month, a celebration of older people involving a range of events organised by the 

public, private and voluntary sectors. 


“Be Healthy, Be Heard” members and members from NHS organisations across 

Leicester, Leicestershire and Rutland, along with volunteer organisations such as 

LINks and Carers Action and the Neurological Associations. 


Presentations were given on Alzheimer’s, Parkinson’s, and arthritis. After the 

presentations, the attendees had an opportunity to take part in a seated exercise and 

a ‘laughter yoga’ session. 


Following each presentation members of the audience were given the opportunity to 

ask questions. They were also asked to complete an evaluation form to assess the 

success of the event. 

Summary of evaluation feedback 

In all, 56 people attended. Attendees enjoyed the event and felt it was `excellent in 

all respects’. The presentations received a very good rating as the audience felt their 

needs had been addressed. Members of the audience also stated that they would 

have preferred more time for each topic. 

The aims of the event were achieved. Attendees felt more informed of the symptoms 

and prognosis of the conditions and felt motivated to discuss with their peers, 

friends, families and colleagues. Following the exercise participation sessions, 

attendees felt they could take away the simple and effective exercises they had been 

shown and continue at home. 


To do more individual topic-specific events such as this one. 

64

Loughborough University health and wellbeing event 


The vent aims were to: 

• to encourage staff to consider the importance of their own health 

• to pick up risk areas for individuals via screening and offer direction to 

services to minimise this risk 

• to raise awareness of current, relevant cultural health issues 

• to promote staff feeling supported and cared for in their working environment 

• to maximise uptake of good services available within the university community 

and Charnwood region. 


University staff were invited to attend via notifications on online notice-boards, 

newsletters and signage in communal staff areas. Reminders and requests to 

promote attendance were sent to heads of departments, sections and administrators 

to encourage staff to feel supported in attending by their managers. 


Approximately 10 different organisations attended to give information on healthy 

lifestyles including the NHS Leicestershire County and Rutland. 


In all, 220 members of staff attended the event. This was a very useful engagement 

event as it gave the opportunity to promote key health messages to a hard to reach 

group - those who work full time. 


A follow-up session has been arranged. This will be appointment based and 

specifically focus on the most popular tests cholesterol, blood sugar, blood, pressure 

and body weight / composition measures. 

65

Membership Consultation 


In March 2009 NHS Leicestershire County and Rutland started a membership 

scheme called ‘Be Healthy, Be Heard’. The aim of the membership scheme was to 

help the public of Leicestershire and Rutland become as healthy as possible, and to 

provide a mechanism for people to feed back their views into the organisation on 

policies and service development by taking part in consultations. 

The engagement team has also attended a multitude of community events including 

farmers’ markets, family wellbeing clinics and events held by charities such as 

VISTA and the neurological society. 

A number of talks were given throughout the county called “community medicine for 

members”. Members attending these talks received up-to-date information and key 

health messages from health experts on a variety of topics, such as prostate cancer, 

women’s cancers, dental health, diabetes and staying healthy for older people. 

A quarterly newsletter delivers key health messages to members and keeps the 

members updated on the work of NHS Leicestershire County and Rutland. In each 

issue members are invited to give their views by taking part in current consultations, 

enter competitions and find out what events are happening in their area. 

In November 2010 a membership questionnaire was sent to all members of ‘Be 

Healthy, Be Heard’ (almost 10,000 people) to find out if the aims of the membership 

scheme were being achieved. 


The questionnaire invited responses to the following statements: 

• being a member has helped me to be more healthy and to feel better 

• as a member I have felt more informed about ways to stay healthy 

• as a member I have had the opportunity to feedback on health services, for 

example, the opportunity to feedback my concerns about any proposed 

changes, and how I would like services to look in the future. 

• I find the information I receive as a member easy to understand 

• I find the information I receive as a member interesting 

• I would like to see more information on……. 

• one suggestion I would like to make on how to improve Healthy Times the 

membership newsletter is …….. 


When considering the aims of starting the ‘Be Healthy, Be Heard‘ membership 

scheme the results of the membership questionnaire indicate that the membership is 

indeed helping members to be more healthy and has given people a mechanism to 

feed back their views into the organisation. 

Over 50% of respondents agreed that being a member has helped them to be more 

healthy and feel better. Over 80% of respondents feel more informed about ways to 

stay healthy. More than 80% of respondents also agreed that membership gave 

them the opportunity to feed back their views and over 94% agreed that the 

66

information was easy to understand, along with over 85% of respondents agreeing 

that the information was interesting. 

The comments have provided a rich source of information on topics members would 

like to know more about and reflects the findings of the quantitative analysis. We 

have already begun to use this information in the planning of articles for our 

newsletters and in the planning of future events. For example, we have already held 

an event on dementia and have an event planned in the spring on how to navigate 

your way through the NHS. 

The demographics of our membership reflect that we have a representative 

membership including members from seldom heard groups such as people with 

physical disabilities, people with learning disabilities, older people and people from 

areas of high social and economic deprivation. The ‘Be Healthy, Be Heard’ brand is 

recognised and trusted in the community. We know this by the feedback we receive 

from the public at community events and by the number of invitations we now 

receive to attend community events. We always receive a good response from our 

members to all of our surveys. We are also aware that some of our members are 

eager to become more involved and are interested in becoming member volunteers. 

We also have over 100 corporate members and are currently working together to 

improve occupational health. 

We can therefore conclude that the NHS Leicestershire County and Rutland 

membership scheme is a successful scheme that engages with a large number of 

people from all walks of life, helping them to become healthier, be more informed 

and have a voice of influence in the decision making process for our organisation. In 

the future we hope to develop the scheme further as the membership along with our 

seldom heard strategy gives NHS Leicestershire County and Rutland a robust and 

meaningful way to engage with the public. 


NHS LCR will continue to have a membership and recommend it to our CCGs for 

future engagement and consultations. We also plan to stage some of the events 

suggested by members. 

67

Pacesetters Bowel Cancer Screening Awareness Project 


The NHS Pacesetters Bowel Cancer project was established to increase awareness 

of bowel cancer and the NHS bowel cancer screening programme amongst the 

South East Asian community in North West Leicestershire and Charnwood. 

Bowel cancer is the third most common cancer in the UK and the second most 

common cause of cancer death. It has been particularly noted that there is poor 

uptake of cancer screening programmes by Black and Minority Ethnic groups. There 

is a clear need to reduce the barriers to screening by raising awareness and 

increasing access through culturally sensitive and community based interventions. 

Pacesetters is a national programme that encourages the involvement of local 

communities The importance of community engagement and consultation was 

central to the successful delivery of this project. This provided an opportunity to 

increase community awareness of bowel cancer screening and also to enable 

identification of the barriers to participating in the screening programme. This project 

involved attending a Well Family Clinic multi-agency event and also a series of Asian 

elders focus groups. 

Who was consulted? And what information was given? 

There were three events: 

• Well Family Clinic Event 

Attendance at this multi-agency session provided an opportunity to engage in 

a general health event in an effort to promote bowel cancer awareness and 

the screening programme. The plan was to ascertain baseline information 

about the knowledge of bowel cancer and the bowel cancer screening 

programme from the individuals attending the ‘clinic’. A questionnaire was 

used to collect this information and on completion a discussion was held with 

the individual based on the responses given. 

The Well Family Clinic was well attended, with 70 participants overall. 29 

individuals approached the bowel cancer screening stand, in a very busy 

multi-agency ‘clinic’ with numerous displays, and illustrates the difficulty in 

reaching all attendees at a general health awareness event. This consolidated 

the decision to hold a single, focussed event and in doing so, highlighted the 

need to consult the South East Asian community. 

This consolidated the decision to hold a single, focussed event and in doing 

so, highlighted the need to consult the South East Asian community. 

• Asian Elders Focus Groups 

Six focus group sessions were held with Asian elders. This helped raise 

awareness of bowel cancer screening by identifying community knowledge of 

bowel cancer signs and symptoms, the risk factors for bowel cancer and the 

NHS bowel cancer screening programme. The barriers to participating in 

screening were discussed and the discussions suggested that the main 

barrier within this community was lack of awareness of the screening 

68

programme. The focus groups helped to shape the development of the final 

event by highlighting the activities that would encourage participants to attend. 

When it came to naming the project and final event, there was unanimous 

agreement within the focus groups (approximately 110 individuals) that we 

should avoid using a ‘strap-line’ for the project as this was seen as having a 

hidden agenda. It was felt that advertising the event as an ‘NHS Bowel 

Cancer Awareness Event’ was more transparent. 

• Bowel Cancer Awareness Event 

The aim of the day was to raise awareness of bowel cancer and of the NHS 

bowel cancer screening programme. There were presentations on bowel 

cancer, the NHS screening programme and diet and a healthy bowel. A 

highlight of the event was a presentation from a service user perspective that 

was delivered in Gujarati. 

A series of activities were delivered, based on the suggestions from the earlier 

focus groups: two vegetarian cooking demonstrations, smoothie making, yoga 

sessions, chair exercises and health screening (blood pressure and body 

mass index calculation). Attendees also had the opportunity to have a private 

consultation about bowel cancer screening and volunteer to become a 

community health champions, The event was attended by 103 individuals 

from the South East Asian community. 


This project highlighted that the South East Asian community in North West 

Leicestershire and Charnwood are willing to participate in health events and will 

participate in NHS screening programmes if they are aware of the importance of the 

programme. Evaluation of the event demonstrated that the methods used in this 

project can reach a significant part of a community to deliver health promoting 

messages and activities suited to their needs. It was also noted that event was 

primarily promoted through local groups, friends and family. This reinforces the 

importance of community health champions to promote a health message within 

these communities. 

Community health champions are the key to sustaining the delivery of health 

messages and converting these messages to actions that will result in significant 

changes in lifestyle and behaviour. As a result of this project three individuals have 

volunteered to train as community champions with a number of interested individuals 

requesting further information. It is also hoped that by disseminating this report within 

this community further individuals will be encouraged to become community 

champions. Ultimately this project has demonstrated that partnership working across 

health, social and voluntary agencies can successfully deliver a health improvement 

message to a South East Asian community. 


Knowledge and awareness of bowel cancer screening is a barrier to screening 

uptake. Information needs to be provided to communities in a format that is easily 

accessible and understood. The focus groups indicated quite strongly that the 

General Practitioner should be involved in this process of raising awareness of the 

bowel cancer screening programme, promoting it to eligible patients and 

encouraging participation. 

69

The report will be used to inform the Countywide project working with General 

Practice to improve cancer awareness and promote screening to support early 

diagnosis. 

70

Patient experience 


The aim was to gather a range of quantitative data provided by patients while also 

identifying some questions about the equality and diversity issues facing patients 

and carers. This information was gathered to inform the NHS Leicestershire and 

Rutland Patient Experience Strategy 2010-13. Also, information gathered would help 

the organisation to understand the needs, expectations and preferences of the 

public. 


Members of the PCT’s membership scheme “Be Healthy, Be Heard”. 


People were informed of progress made in responding to the experience of local 

patients and how this was currently assessed through Patient Advice Liaison Service 

(PALS), complaints, comments and compliments, patient safety incidents and patient 

experience surveys. Members were informed on how their feedback would be used. 


People were asked about their experiences either as a patient; using the services or 

as a carer of someone using the services. People were also asked to consider 

recent experience and what they believed would make future experiences better. 


Fifty people responded to the questionnaire. Taking the feedback into consideration 

the Patient Experience Strategy was developed. 


The Patient Experience Strategy was approved by the Trust Board and is now being 

implemented by the Quality Directorate. 

71

Perinatal psychosis 


The aim was to understand the views of women of childbearing age about services 

for perinatal psychosis, in order to create an East Midlands-wide specialised mother 

and baby mental health service. 


Women of childbearing age were selected from the membership database and 

asked for their feedback. Two meetings of BME women in Loughborough were also 

asked their views. 


Documentation explained plans for caring for women who become mentally ill before 

or following the birth of a baby. It covered plans for the whole of the East Midlands, 

including Leicester, Leicestershire and Rutland. The information was followed by a 

short questionnaire, to feedback views on these plans. 

Perinatal psychosis was also explained along with a description of current service 

provision for those who became ill. 


People were asked where they would prefer to go to if they needed to go to hospital 

with mental health problems after having a baby. They were asked if they felt they 

would be able to approach health professionals on any mental health issues they 

may experience during pregnancy or following the birth of their child. People were 

asked to give reasons if they felt they could not approach a health professional. 

Views on how to improve awareness on mental health services were also asked for. 


More than 50 women responded. All of women answered that they would prefer to 

go to a local mother and baby unit with their baby, if they needed mental health care, 

and 89% said they would be able to talk to a health professional. 

Feedback collected from the BME women’s groups included: 

• more information needed from the doctors or midwives – the information is 

unsuitable to the audience as the information given is too complicated 

• need for interpreters 

• time spent with doctor or midwife is limited 

• did not know what mental health was – it needs explaining by the midwife 

• maybe midwife needs to take more of a role in looking for changes – possibly 

have more appointments 

• accessing information at home, eg, the internet 

• leaflets that can be taken away, and which can be translated 

• post-natal classes to provide support. 

• need parenting classes or support classes to make sure they are aware of 

what is available to them and how to do things correctly 

• most new mums not sure of what to do in terms of good diet, creating a 

routine, feeding, etc 

• need to learn about planning a routine, balancing old life with new 

• help with how to include mothers’ partners 

72

• language and other barriers – midwifes and doctors do not understand the 

religious side or culture sufficiently 

• current leaflets are too complicated to read. 


The results will help with planning for treatment of women with perinatal mental 

health issues in the East Midlands, particularly those from a BME background. All 

those who took part in the consultation process were informed that this is what their 

feedback would be used for. 

73

Public Consultation on the proposed closing of Ketton and 

Gretton branch surgeries by Uppingham General Practice 

What was the issue 

Uppingham GP practice approached the NHS Leicestershire County and Rutland 

Primary Care Panel with a request to close down the Uppingham GP practice branch 

surgeries at Ketton and Gretton. 


All patients who attend the Ketton and Gretton surgeries received a questionnaire to 

share their views and were also offered the option to complete the questionnaire 

online at the NHS LCR website or at the Uppingham practice website. They were 

also invited to attend one of three public meetings taking place in Ketton and Gretton 

to find out more and share their views with NHS LCR and the practice GPs. 


Information given included how many patients registered at Uppingham surgery lived 

in Gretton and Ketton and surrounding villages. 


People were asked if they accessed care in other places and what would they 

believed would change if the surgery closed. They were also asked to comment on 

benefits to them if the surgery closed, how often they had visited the surgery in the 

last 12 months, where the usually attended if they wished to see a GP, where they 

usually attended if they wished to see a nurse, if they had any objections to the 

closure of their branch surgery and the reasons for those objections. Over 250 

questionnaires were completed. 


The feedback focused mainly on issues of access if patients needed to go in to 

Uppingham to see a doctor. There were also useful suggestions from both Ketton 

Parish Council and Corby Borough Council with regard to how to progress. 


Once all feedback had been collated and considered the NHS LCR Trust Board on 

the recommendation of the NHS LCR Primary Care Panel was to keep Gretton 

branch surgery open. 

As requested by Ketton Parish Council the board gave a three-month period for 

suitable, alternative accommodation to be sought so that Uppingham branch 

surgery may remain open. 

74

Smoking, diabetes and eyes event 


To raise awareness of the effects of smoking with particular reference to diabetes. 

Also, to discuss eye disease in general and in relation to diabetes. 


Members of the public were invited to attend an engagement event. 


Before the event talks started members of the audience were asked to complete a 

questionnaire to assess their knowledge of the subjects to be talked about. 

Presentations were given on diabetes by the Deputy Director of Public Health for 

NHS Leicestershire County and Rutland, on eyes by an optometrist, and on the 

effects of smoking on health by a smoking cessation specialist for the PCT. 


Following each speaker members of the audience were invited to ask questions of 

the experts to improve their understanding. 


Members were asked to complete an evaluation questionnaire following the 

presentations. In all, 100% of the audience stated that they were now better 

informed. 


To continue to engage people through this type of event to keep people better 

informed on key health topics 

75

Women’s Cancer Event 


The aim was to raise awareness of women’s cancers. 


Members of the “Be Healthy Be Heard” PCT membership scheme were invited to 

attend along with members from University Hospitals of Leicester NHS Trust; NHS 

Leicestershire Partnership Trust and NHS Leicester City. 


Speakers presented on ovarian and cervical cancer, cervical screening, background 

to cancer research, current research trials for women’s cancers and genetics. 


Following each presentation women were encouraged to ask questions and the 

health specialists answered. 


This was a successful engagement event which informed women about women’s 

cancers and emphasises the importance of early intervention. 


The women enjoyed the event and gave very positive feedback finding the 

information given informative and useful. Therefore a similar event will be repeated 

in the future. 

76

Part 4: East Midlands Specialised 

Commissioning Group (EMSCG) engagements 

East Midlands Specialised Commissioning Group is an organisation hosted by NHS 

Leicestershire County and Rutland. 

77

Introduction 

The EMSCG is committed to ensuring it is accountable for the decisions it takes on 

behalf of the people of the East Midlands and uses patient feedback and proactive 

patient and user involvement as an integral part of service review and service 

redesign. 

We have Lay Members on our Board who provide the voice of the public and we 

engage with a variety of individual patients and patient groups to ensure the needs of 

patients are considered in all we do. 

As well as undertaking our own engagement and consultation we support national 

initiatives. A national review of children’s congenital heart services is being 

undertaken (Please visit www.specialisedservices.nhs.uk/safe_sustainable/ 

childrens-congenital-cardiac-services). The review is being led by the national Safe 

and Sustainable team on behalf of the 10 Specialised Commissioning Groups and 

their constituent Primary Care Trusts, and the EMSCG works hard at a regional level 

in support of the associated public consultations. 

78

Foreword 

Julia Cons 

“It has been fascinating to be a part of the work of the EMSCG. More importantly, it 

has been a privilege to be involved in the guidance of this highly proficient 

organisation, particularly in these times of great change. Every person with whom 

I’ve had professional contact has been visibly motivated and passionate about the 

NHS. Each individual member of staff so obviously understands the imperative to 

provide the best possible care to the most possible patients under ever tighter 

budgetary constraints, and works hard to add their utmost to the process. 

“I have attended EMSCG board meetings and Clinical Priorities Advisory Group 

(CPAG) meetings, where my opinions and input have been actively sought and 

valued, both as an individual and a representative of the ‘man in the street’. It has 

been impressive to be made to feel no less valued on the rare occasion when I have 

felt the need to metaphorically bang the table than when high praise has been due or 

decisions have been straightforward and courses of action obvious. 

“I was also actively involved in the designation process for the genetics services in 

the East Midlands, taking part in site visits and staff interviews in Nottingham and 

Leicester, where I was able to ask questions to help ensure that the services provide 

the best possible service from the point of view of patients and carers. 

“During the early part of 2010 I was a member of the team that peer reviewed the 

burn care services in Birmingham, Nottingham and Leicester, taking part in all-day 

visits to each service and reviewing the information and services provided. I was 

hugely impressed by the care in all of the services, by the obvious dedication of the 

staff, and by the positive views of the patients. It was gratifying to receive such a 

warm welcome at each hospital, and to be provided with such comprehensive 

information to demonstrate their compliance - and more - with the Burn Care 

Standards. I was so impressed with the provision of burn care in the Midlands that I 

was thrilled to be asked to join the Midlands Burn Care Network as a lay member, 

and to be invited to be a member of a national team who are currently reviewing the 

Burn Care Standards. 

“The last year has been most rewarding. I hope I have added as much - preferably 

more – to the organisation and the NHS, and I look forward to being an active part of 

the EMSCG in the coming months.” 

Lee Bartholomew 

As well as involvement in the EMSCG Board and Clinical Priorities Advisory Group, 

EMSCG Lay Advisor, Lee Bartholomew was invited to Chair the Project Board for 

the National Haemoglobinopathies Project. This one year project to define the 

designation standards model service specification and commissioning framework for 

Sickle Cell Disease and Thalassaemia. 

Lee said “I have found the work of the Project Board a fascinating insight into the 

challenges faced by patients, providers and commissioners. The efforts the Project 

Team has made to consult as widely as possible with the stakeholders are to be 

commended. I am sure their efforts will produce an invaluable set of tools for the 

health community to use.” 

79

Teenage and Young Adults Cancer (TYA) 

Why? 

To ensure that the East Midlands service meets the needs of teenagers and young 

adults, the EMSCG involved patients in developing and improving the service. 

What did we do? 

We sought patients’ views and suggestions on: 

• Current service provision 

• How the service can change to incorporate both the medical model and 

psychosocial model of care 

• Improvements for physical facilities (to ensure the hospital surroundings 

stimulate and motivate teenage/young adult cancer patients). 

This was achieved in a variety of ways including: 

• Informal discussions at youth groups in order to build trust enabling patients to 

share their experience of the diagnosis, treatment and hospital care 

• A user experience questionnaire which provided a confidential method for 

capturing experiences of patients and assisted in understanding things from a 

patient perspective. 

• A media campaign, newsletters, direct mail and business card distribution, 

providing a comments book for thoughts, posters, and work with clinical teams 

to encourage them to seek feedback on patient views. 

Some of the key issues identified were the need for: 

• A quicker referral from GP to the acute sector and the early identification of 

TYA patients 

• Improvements in communication i.e. in the explanation and understanding of 

diagnosis, treatment and consent to treatment 

• Psychosocial support services that meet specific age group needs, such as 

alone time, access to peer support, support relating to feelings of isolation, 

fear and motivation 

• Information on health care needs - body image, puberty, diet, health 

promotion, pathway journey 

• Good facilities with choice, a contact person and a care plan 

• Access to outreach support, moving on back in the community. 

What was the impact? 

The following actions were taken forward: 

• Update our policy with the responsibilities of the key worker role, ensuring the 

role is managed and service allocated according to patient need at the TYA 

multi-disciplinary meeting 

• Develop an information leaflet for patients and a communication and 

marketing plan to raise awareness of the service amongst patients and 

clinicians 

• Ensure age appropriate facilities incorporate patient requirements: i.e. the 

look of the building and provision of specific facilities including a 

complementary therapy room, WIFI access, area for space and education 

• Develop specialist posts such as the TYA Childrens Nurse Specialist (CNS) 

role to provide outreach support. 

80

East Midlands Renal Network (EMRN) 

Patient and Carer Forum 

The EMSCG hosts the East Midlands Renal Network and provides specialised 

commissioning expertise to assist the Network in their aim to continually improve 

kidney care for patients and carers living with kidney disease. During 2011 the East 

Midlands Renal Network established a Patient and Carer Forum. 

Why? 

The renal network believes that patient and carer involvement is integral to the work 

of the network to ensure services are patient focused. The main purpose of the 

group is to provide the Renal Network with a perspective of the quality and 

experience of care from the viewpoint of patient and carers. 

The basis of the forum is that there is always a story to be told from an experience 

and we focus on how the Network can best tell that story in a way that others can 

learn from and users can benefit from. 


Information about the East Midlands Renal Network and the proposed patient and 

carer forum was circulated liberally around renal dialysis units, local kidney patient 

associations and other relevant areas. This information asked for expressions of 

interests to joint the group. Further information was then provided and the first 

meeting took place. Meeting are held every 3-4 months. 


The forum is in its infancy and is working on ideas for assessing renal units from a 

patient and carer perspective. The forum provides a means of gaining patient and 

carer input in policy/guidelines development and service improvement initiatives. 

One quote was provided to the network manager in an e-mail following one of its 

meeting as follows; 

“I think the forum will do a great job in making the units all work as one and bringing 

them all to a certain high standard to give the patients peace of mind that they are 

getting the best.” 

(Patient: EMRN Patient and Carer Forum). 

81

Midland Burn Care Network (MBCN) 

Why? 

To understand the needs of those that use the burns services in the East Midlands. 


The MBCN has continued to develop patient surveys. The MBCN team has also 

developed a website which provides a means of providing information on burn care 

to the local the population. Results from the patient surveys and comments from 

patients are available from: www.midlandsburnnetwork.nhs.uk 


The development and participation of patients completing surveys has had a positive 

impact on Burns services in the East Midlands. Patient experience has been 

improved in the Dressing Clinic / Outpatient departments after patient feedback. 

Length of time for appointments has been slightly increased and this has led to more 

patients reporting that they have been seen on time. There has been an increase in 

appropriate patients being seen by the Therapy teams. Following patients answering 

questions on pain / discomfort actions have been taken to improve patients’ pain 

control and the advice given on analgesic medication. In the most recent survey 

patients / carers report an increase in satisfaction with their care. 

82

Safe and Sustainable - National Paediatric Congenital 

Heart Surgery Review 

Why? 

To engage patients and their carers in the consultation process of the national 

review of children’s heart surgery services and obtain their views on the proposed 

service model and configuration options. 


Extensive consultation documents and feedback mechanism have been made 

available by the national team supported by EMSCG. EMSCG worked with NHS 

Lincolnshire to engage with the local populations of Lincoln and Sleaford and have 

worked with Leicestershire Links. The engagement culminated in two events held on 

16 June attended by around 500 people. As part of the review the National Team 

commissioned an independent Health Impact Assessment (HIA). Individual 

interviews were held with parents and two events, supported by EMSCG, for hard to 

reach and disproportionately affected groups where held in the Belgrave and 

Highfields areas of Leicester. 


The views of patients from across the East Midlands have been fed into the 

reconfiguration decision making process. An interim HIA has been published and a 

report of the responses to the consultation is expected in the last week of August 

2011. 

83

East Midlands Haemophilia Management Group 

Why? 

EMSCG facilitated the establishment of the East Midlands Haemophilia Management 

Group to allow sharing of expertise and good practice, quality assure and inform 

commissioning decisions. This group has multi-professional representation from the 

haemophilia centres across the region and includes two patient representatives. 


Patients are involved in the discussions and able to influence the decisions of the 

group. 


The introduction of a patient contract and a patient education event was held on the 

16 March 2011 attended by around 40 patients and their relatives. 

84

National Commissioning documents for 

Haemoglobinopathy 

Why? 

The EMSCG were commissioned by the Department of Health to produce a series of 

national commissioning documents for haemoglobinopathy services. 


Patient group representatives were part of the Expert Working Party which informed 

the development of the documents. A patient workshop was help in London with 

patients from across the country in attendance. 


Patient views are explicitly represented in the final documents which will be used to 

inform the commissioning of local services for patients. 

85

Involvement of regional Expert Patient Committees in the 

commissioning and development of Specialised Perinatal 

Mental Health Services in the East Midlands 

Why? 

The East Midlands Perinatal Mental Health Clinical Network was set up to improve 

the care and treatment of pregnant and postpartum women who are seriously 

mentally ill. Working in collaboration with the EMSCG, the key principles of the 

Network are to support the development of comprehensive and integrated perinatal 

mental health services providing high quality care that meets the needs of mothers 

and their infants. Ex-patients have been involved in advising the Network on the 

various work programmes that have been set up to support this. From the outset, 

patients have actively participated in short life working groups, workshops and 

regional conferences. 


In 2009, as part of the NHS East Midlands Next Stage Review regional priorities 

programme, five Expert Patient Committees were established, one in each mental 

health trust. These are now a constituent part of the formal organisational structure 

of the Network. The emphasis has been to ensure that, through the Expert Patient 

Committees, the views and experiences of service users across the Network are 

adequately represented in the planning and implementation of changes in service 

provision and delivery for perinatal mental services, taking into account regional and 

national initiatives and to give advice and recommendations to the Network 

Executive Committee and Management Board. 

Over the period April 2010 – March 2011, the Expert Patient Committees have 

contributed towards the development of: 

• Quality standards for in-patient mother and baby units, perinatal community 

psychiatric teams and infant welfare. 

• A quality of life measure and care and treatment questionnaire developed by 

the Network in conjunction with a clinical software company, FACE 

(Functional Analysis of Care Environments). 

• Antenatal screening midwifery training programme, incorporating both an e- 

learning and tutorial component. 

• Regional care pathway and management guidelines. 

• Patient information leaflets. 

• Research proposals and grants. 


Patient involvement in service redesign/development has had an important impact 

on service delivery, as follows: 

• Evidence of real patient influence on the Network, with patient representation 

on the Network Management Board and Stakeholder Reference Group and 

input into all Network work programmes. 

• Evidence that recommendations made by the Expert Patient Committees are 

integrated into network planning and regional strategic decision-making (i.e. 

outcome measures, standards, training). 

• Input into the development of quality standards, training programmes and 

care pathways, which has led to improvements in: 

86

• Clinical practice, skills and decision-making in maternity, psychiatric and 

primary care services. 

• Management and referral of patients in a timely and efficient manner. 

• Promotion of good/best practice in accordance with national guidelines/peerreview; 

this has also promoted continuing professional development and 

learning. 

• Collaborative working between clinicians and an increased capacity for 

shared/joint learning. 

• Understanding and management of perinatal mental health disorders together 

with increased skills and capacity in primary care. 

• Emphasis on improving and streamlining the patient journey has helped 

ensure rapid access to the most appropriate level of care. 

• Development of Patient Related Outcome Measures, which are tailored to the 

specific needs of women who are under the care of Specialised Perinatal 

Mental Services, enables patients to provide feedback on the quality of 

services and provide a self-assessment of their personal situation. 

87

Policy Development 

The EMSCG draft policies are routinely sent out for engagement with patients and 

the public via our regional Primary Care Trusts. Draft policies are also sent to known 

patient support/interest groups (national and regional) for comment, and we place 

draft policies on our website to give people the opportunity to provide us with their 

views. We review our draft policies in light of all the comments we receive, making 

changes and amendments where appropriate before a final copy is sent to the Board 

for approval. The case study below shows the details of policy consultations. 

EMSCG Commissioning Policy for the use of Pre 

Implantation Genetic Diagnosis (PGD) 

Why? 

Pre Implantation Genetic Diagnosis (PGD) enables couples who are at a high risk of 

passing a serious genetic disorder to their children, from avoiding the conception of a 

child with the genetic disorder (an ‘affected’ child). It uses in vitro fertilisation (IVF) to 

create embryos, tests one or two cells from each embryo for a specific genetic 

problem and identifies embryos without the genetic problem for transfer to the 

uterus. 

A revised (second version) of the policy already in existence was proposed, with 

changes in access criteria. These were to include the removal of the criteria of ‘no 

living unaffected children from their current relationship.’ This would mean that 

couples with child/children who had not inherited the genetic condition could still 

apply for PGD. The number of IVF cycles would be changed from the first version 

which offered ‘three completed’ cycles to an ‘unlimited’ number of cycles instead, 

and proposed to allow PGD treatment on the NHS to couples who had previously 

paid for the treatment privately. 


The policy was posted on the EMSCG website. Leicestershire County and Rutland 

(LCR) PCT posted a link from their website to EMSCGs, and NHS Leicester City 

posted it on their website, on Facebook and Twitter. It was sent electronically with a 

plain English Question and Answer paper on June 8 2010 to the interest groups 

outlined in ‘Patient Interest/Support Groups’. Responses were received from the 

following: 

• Association for Improvement in Maternity Services (AIMS) 

• The CF Trust 

• East Midlands Public Health consultants (3) 

• Bassetlaw PCT 

• National Cystic Fibrosis (CF) Trust 

• Clinical Genetics, NGH 

• Derbyshire county public representative 

• Haematology, LRI 

• CARE Fertility, Nottingham 

• Leicestershire LINk 

• IVF patient representative 

• FAP Gene Support Group 

88


The following reflects the recurrent themes that arose through the comments that 

were received, and the EMSCG response to these: 

Comment: “There is Inequity in comparing the criteria for the IVF Tertiary Infertility 

policy and the PGD policy”. 

Response: The IVF and PGD policy are two separate policies because the IVF 

policy is for infertile/subfertile couples, whereas the PGD policy is for fertile couples 

and to avoid the risk of having an affected child, not as a necessity to aid them in 

conceiving per se. Unlike sub fertile couples, fertile couples could conceive an 

affected child. So if tight criteria for access were put in place it could be argued that 

the EMSCG endorse an illogical policy because it does not make financial sense. 

This is because it may be a false economy not to fund PGD because the costs of 

funding an affected child would be far more than paying for PGD. 

Comment: “There is concern regarding the unlimited access to PGD, the open 

ended access criteria and its links to affordability”. 

Response: It would cost the NHS far more to pay for a child affected by a genetic 

condition, in comparison to PGD. 

PGD in relation to conditions currently not licensed by the HFEA. 

Response: The HFEA advises that for practices who are licensed to carry out PGD 

and wish to offer PGD for a new genetic condition (i.e. a condition that has not 

previously been licensed by the Authority) then they must apply to the Authority to do 

so, setting out how they consider the genetic condition in question meets both the 

significant risk and seriousness requirements in the HFEA Act (2008). 

(http://www.hfea.gov.uk/5259.html). 

Comment: “How successful will PGD be?” 

Response: Data from the Human Fertilisation and Embryology Authority (HFEA) 

shows that in 2006, for women receiving PGD, the percentage of cycles started that 

resulted in a live birth was 33.3% for women aged under 35; (9/48) for women aged 

between 35-37; and (2/27) for women aged between 38-39. (Percentages are not 

calculated where there are less than 50 cycles. Figures in brackets show cycles 

resulting in a live birth/all cycles started). 

Comment: “The need to consider the child’s welfare statement in the criteria for the 

policy is very subjective”. 

Response: There needs to be regard to the interest of the potential child (as per the 

HFEA Act 1990). However, this has not been classed as ‘mandatory’ criteria in the 

policy and these needs have now not been classed as ‘paramount’ as they were in 

the previous version – as there is not a ‘test’ to be passed or failed by the presenting 

patient. 

Comment: “Would PGD for infertile couples be decided under the PGD or IVF 

criteria?” 

Response: If a couple were subfertile/infertile and were carrier(s)/had a genetic 

condition, then the couple would be considered under the IVF criteria. If they met the 

criteria under the IVF policy then they would be provided with IVF in accordance with 

that policy, whilst allowing them to also have PGD. This will be clarified in the policy 

document. 

89

Comment: “What happens if the patient has one abandoned cycle?” 

Response: Policy has been amended to allow for more than one abandoned cycle. 

Comment: “Since some of these inherited conditions are under diagnosed, poorly 

understood or insufficiently researched, potentially the policy could discriminate 

against these populations.” 

Response: There will be equal access to the policy if they meet the clinical criteria, 

and the condition is licensed by the HFEA for PGD testing. 

Comment: “This policy could increase the risk of multiple births.” 

Response: Within the policy, single embryo transfer (SET) will take place so only 

one embryo will be transferred. 

Amendments made to the final policy as a result of engagement were: 

• Clarification within the policy document that couples who are infertile but also 

have or carry a genetic condition to be subject to the criteria for IVF as set out 

in the tertiary infertility policy, but also provided with PGD for that one cycle if 

they meet the IVF tertiary infertility policy. 

• Policy amended to delete reference to PGD testing on frozen embryos. The 

inclusion of using remaining frozen embryos from self funded IVF in 

conjunction with PGD will remain in the policy. 

• The policy was amended to allow for more than one abandoned cycle. 

• The criteria requirement for a Clinical Pathology (CP) accredited lab amended 

within the policy to advise should be working towards CP Accreditation (in line 

with the HFEAs 2007 requirements). 

• The criteria requirement that ‘the centre must have a HFEA licence to provide 

PGD for the condition being considered’, amended as if the lab has a HFEA 

license which includes PGD it can test for any of the conditions on the HFEAs 

central approved list. 

• Clarification on the position on Human Leukocyte Antigen (HLA) matching to 

an existing affected child within the policy. Policy amended to include the 

position in line with the HFEAs regulations (as per CPAG recommendation 

03/09/10). 

Patient interest/support groups 

• Cystic Fibrosis Trust (national) 

• Cystic Fibrosis Trust (regional)* 

• Familial Adenomatous Polyposis (FAP) 

• Fragile X Society (National) 

• Genetic Alliance UK (National) 

• Huntingdon’s Disease association, Nottingham 

• Muscular Dystrophy Campaign (National) 

• Nottingham Department of Clinical Genetics 

• Nottingham Sickle cell and thalassaemia service - Mary Potter Hostel, Hyson 

Green, Nottingham. 

• OSCAR Organisation for Sickle cell anaemia research 

• Sickle Cell and Thalassaemia Centre – Charnwood Health Centre, Leicester 

• The Haemophilia Society 

• The National Childbirth Trust (sent 12/07/10 – extended deadline for 

comments to 20/07/10) 

90

• The Sickle Cell Society (national) (sent 12/07/10 – extended deadline for 

comments to 20/07/10) 

• Twins and Multiple Births Association (TAMBA) 

• UK Thalassaemia Society 

Other networks/interest groups: 

• CARE Nottingham 

• Community specialist nurses for the sickle cell and thalassaemia service in 

Nottingham and Leicester. 

• Derby City General Hospital Haematology Department 

• East Midlands Directors of Public Health (DPHs). 

• East Midlands Genetic Network Group 

• East Midlands Specialised Commissioning Group (EMSCG) lay 

representatives 

• Embryologist and Director, CARE Fertility Nottingham 

• Embryologist and molecular geneticist. Genesis Genetics, Nottingham 

• Equality and Diversity leads within the 9 East Midlands Primary Care Trusts 

(PCTs). 

• Human Genetics Commission 

• Individual Funding Request (IFR) Managers within the East Midlands PCTs 

• Individual Local Involvement Networks (LINks) leads within the East Midlands. 

• LINks lead for the East Midlands. 

• Members of the East Midlands Clinical Priorities Advisory Group (CPAG) 

• East Midlands Public Health Consultants* (3 

• PPI/EMSCG liaison leads in the 9 East Midlands Primary Care Trusts (PCTs). 

• Primary Care Trust Chief Executives 

• Primary Care Trust Contract managers 

• Provider (Trust) Chief Executives * (NGH 

• The East Midlands (EM) cancer network. 

References 

Department for Business, Innovation and Skills (BIS) (2010) ‘Producing a Summary 

of Responses’. Available from http://www.bis.gov.uk/policies/betterregulation/consultation-guidance/summary-of-responses. 

Accessed 14/04/2010. 

Human Fertilisation and Embryology Authority (HFEA), http://www.hfea.gov.uk/, 

accessed 17/08/2010. 

91

How to contact us 

NHS Leicester City 

St John's House 

30 East Street 

Leicester LE1 6NB 

For general enquiries: 0116 295 1400 (Mon-Fri 8.30am - 5pm) 

Email: enquiries@leicestercity.nhs.uk 

NHS Leicestershire County and Rutland 

Lakeside House, 4 Smith Way, 

Grove Park, Enderby, 

Leicester, 

LE19 1SS 

For general enquiries: 0116 295 7500 (Mon-Fri 9am - 5pm) 

Email: info@nhslcrmembership.org 

EMSCG 

EMSCG 

Fosse House 

6 Smith Way 

Grove Park, Enderby 

Leicester, LE19 1SX 

For general enquiries: 0116 295 0849 

Email: info@emscg.nhs.uk 

Customer Services 

Our joint Customer Services team handles complaints, Freedom of Information 

requests, and helps with queries from patients, carers and members of the public. 

Post: Customer Services, St John’s House, 30 East Street, Leicester, LE1 6NB 

Tel: 0116 295 7011 (Monday to Friday 9am to 5pm) 

Email: customerservices@leicestercity.nhs.uk or customerservices@lcr.nhs.uk 

NHS Leicester City Membership 

NHS Leicester City Membership scheme enables people from all sections of the 

community to participate in our work in a way that suits them. The main aims are: 

• to develop two-way communication between NHS Leicester City, patients, 

community and voluntary groups, and frontline staff 

• to keep members informed of developments in healthcare 

• to reflect the diversity of the local population 

• to recognise the knowledge and experience of Leicester residents and our staff 

92

Tel: 0116 295 4183 (9am to 5pm) 

Fax: 0116 295 1513 

Email: getinvolved@leicestercity.nhs.uk 

Post: Freepost RRUE JRBR RGGT, NHS Leicester City, St John's House, 

30 East Street, Leicester, LE1 6NB. 

NHS Leicestershire and Rutland Membership 

NHS Leicestershire County and Rutland has set up a scheme to enable us to work 

together to reach this aim and for you to have a say in how local NHS services are 

provided. It is called “Be Healthy, Be Heard”. We have a dedicated interactive 

website where you can access a wealth of information about the membership 

scheme, find out about the benefits of becoming a member, join online and much 

more. 

To join online, visit the website www.lcr.nhs.uk. Fill in the interactive form and submit 

it. If you would like to join by post please download and print the relevant form from 

the website, complete it and send it back to by post to: 

NHS Leicestershire County and Rutland (Membership), Lakeside House, 4 Smith 

Way, Grove Park, Enderby, Leicester, LE19 1SS 

LINks - Local Involvement Networks* 

Local Involvement Networks (LINks) are a network of people, organisations and 

groups who want to strengthen the quality of health and social care services. 

For Leicester LINk telephone: 0800 731 9432 

You can also write to Leicester LINk at: 

Freepost RSBR-AKKG-XAHC 

Leicester Link 

Unit 55 Business Box 

3 Oswin Road 

Leicester 

LE3 1HR 

Email: LeicesterLINks@carersfederation.co.uk 

For Leicestershire and Rutland LINk telephone: 0116 229 3103 

You can also write to Leicestershire LINk at: 

Beaumont Enterprise Centre 

Boston Road 

Leicester 

LE4 1HB 

Email: info@leicestershirelink.org.uk 

* Please note that all LINKs will transform into HealthWatch groups under the terms 

of the Health and Social Care Bill, subject to Parliamentary approval. 

93

Do you need help understanding this report? 

Our annual report can be provided in other languages 

and formats on request, including large print. 

If you require help understanding the contents of this 

leaflet, please telephone 0116 295 4743 for translation 

or other formats. 

94

NHS Leicester City 

St John's House 

30 East Street 

Leicester 

LE1 6NB 

NHS Leicestershire County and 

Rutland 

Lakeside House, 4 Smith Way, 

Grove Park, Enderby, 

Leicester, 

LE19 1SS

LEICESTER, LEICESTERSHIRE AND RUTLAND PCT CLUSTER ...

Create successful ePaper yourself

Delete template?

Save as template?