Governing Body meeting (held in public)

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1 ENCLOSURE: J Agenda Item: 92/6 Governing Body meeting (held in public) DATE: 2 July 206 Title 360 survey report and analysis This paper is for information Recommended action for the Governing Body Potential areas for Conflicts of interest That the Governing Body: Note. The contents of the 360 survey report and analysis. None identified from this report. Earlier in 206 NHS England commissioned Ipsos-Mori to undertake a stakeholder survey to provide feedback and assurance on all CCGs regarding engagement and working relationships with a range of stakeholders. This report provides an overall analysis of the CCG s 360 survey results, and compares them to previous years results and to London, cluster and national averages. Executive summary The CCG again achieved a relatively high response rate (74%), which was the fourth highest in London and 27 th best in the country. Overall, the results of the 206 survey are extremely positive and signify a vast improvement in the CCG s relations with its stakeholders. In 25 out of 27 measures asked of all stakeholders the CCG is above its 205 scores, and above all scores when compared to 204. For nearly every question the CCG is above the national, cluster and London average. The report highlights the many areas where there has been significant improvement, including on one of the cornerstone questions how would you rate your working relationship with the CCG - showing with a result of 94% saying very/fairly good, a 23 percentage points rise on 205 s score.

2 How does this paper support the CCGs objectives? What are the Organisational implications Engagement Audit trail Comms plan Author: Jon Winter AD Communications and Corporate Services The report summarises the verbatim comments, which reflect on the positive engagement by the CCG and its work to involve members and other stakeholders more. The report also highlights some areas for learning for next year that build upon this year s very positive results. Patients: People: Pounds: Process: Key risks Equality Financial Data Legal issues NHS constitution Date 3 July 206 Supports the CCG to further enhance its engagement with patients and patient groups. Data from stakeholders will help the CCG to improve its working relationships. Understanding the results will support eh CCG in being effective and efficient organisation. The results and analysis will help the CCG to improve the way it conducts its core business, the way it engages and communicates with others and will ultimately help to commission safe, sustainable and equitable services. None arising directly from this report. None arising directly from this report. None arising directly from this report. None arising directly from this report. None arising directly from this report. None arising directly from this report. The survey is carried out on behalf of CCGs and engages with our key stakeholders. July s EMC received a presentation on the overall results and analysis. Aspects of the survey s results will continue to be shared with staff, members and other stakeholders. Clinical lead: Executive sponsor: Dr Nikita Kanani Anne Douse NHS Chair Director of Quality, Performance and Business Services (Interim)

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4 NHS 360º stakeholder survey report 206 Background For the fourth time NHS England has (via Ipsos-Mori) undertaken a stakeholder survey on behalf of all CCGs to provide feedback on their working relationships with a range of stakeholders. It was previously run in 205 and 204 and prior to that as part of the authorisation process in 202. The purpose of the survey is:. Feed into the assurance process of CCGs with NHS England 2. Provide CCGs with useful information to help develop their relationships with stakeholders. NHS England provide guidance on the stakeholder groups and CCGs provide names and contact details for stakeholders to be surveyed. In addition to mandated groups, CCGs were allowed to name up to ten additional stakeholders to include in the survey. The table below shows the stakeholder groups that received the survey. Each member practice (practice representatives) [27 surveyed] Chairs of NHS Bromley, Greenwich, Lambeth, Lewisham and Southwark CCGs [5] London Borough of Bexley officers and councillors [5] Bexley Health and Wellbeing Board reps (including chair) [2] Bexley Healthwatch [] Patient group representatives [3] Providers - Lewisham and Greenwich NHS Trust; Dartford and Gravesham NHS Trust; Kings NHS Foundation Trust and Oxleas NHS Foundation Trust [8] Additional patient and public representatives and stakeholders [8] There was a core set of questions for all stakeholders as well as segmented questions for each group of stakeholders. Reponses were anonymous to the CCG; only aggregate data was reported. Respondents were made aware the with verbatim comments they could possibly be identified through the nature of their responses. The CCG also took the opportunity of asking five additional bespoke questions to be included in the survey. These were in line with those asked in previous years to allow for benchmarking. Fieldwork The survey period ran from 0 March until 4 April 206. Ipsos-Mori distributed electronic links to the survey to all participants, once contact details had been received from the CCG. Reminder s were sent to stakeholders by Ipsos-Mori with a final telephone reminder and the CCG included reminders via s and updates in its fortnightly bulletin and locality briefings.

5 Response rate Response rates are seen as a good indicator of a CCG s local impact and its overall reputation with local stakeholders. The CCG had overall response rate of 74% - against a national average of 6% but slightly down from its rate 79% in 205. The CCG s rate was the fourth highest in London and the 27 th best in country (out of 20 CCGs). The response rate of practices was 70% - percentage points higher than the national average. And the response rate among patient groups/representatives and HWB reps response rate was 00% Result reporting Results were made available to CCGs in May 206 in the form of a main report and a copy of verbatim comments from stakeholders. The main report (attached to this report as an appendix), includes the results for all questions in the survey with results shown for each stakeholder group where relevant and structured across the five components (replacing six domains from previous years). The main report also contains an initial summary (slides 3 and 4) on questions asked of all stakeholders. Some questions also include data to compare results to: the 206 national CCG average the 206 average in the regional team (London) the 206 average across the CCG cluster (CCGs with a similar demographics and characteristics these are listed on slide 95) the CCG scores in 204 and 205 Some of the questions not asked in previous years, so full comparisons cannot be made for every question. In some cases the sample size is very low and some answers are only from two or three people - such small sample sizes can skew percentages. Verbatim comments gave additional insight into stakeholders views. Results and summary analysis Overall, the results for the CCG are very positive, and reflect significant improvement across all components (previously domains) when compared to previous years and very favourably with other comparator groups. Out of the 27 questions asked of all stakeholders this year s results are better than 205 on 25 of them and on every one from 204. For nearly every question in the survey the CCG is above the cluster, London and national average. In particular, the results reflect significantly improved relations with GP member practices since 202, 204 and 205. This is could be attributed to a number of factors: The continued evolvement of the CCG 2

6 The development and embedding of service redesigns, eg urgent and unscheduled care Increasing opportunities for practices to engage and work together with the CCG The development of co-commissioning Development of services and the sites of Queen Mary s and Erith hospital Active role in the development of the OHSEL programme On the back of last year s report, which had itself show an improvement on 204 s results, the CCG identified some areas for development: Enhancing the CCG s processes to ensure members and wider stakeholders are more confident and aware of how decisions are made and the engagement that has taken place beforehand, eg ensuring the decision to procure, through to the decision to award is even more transparent. Expanding engagement with stakeholders to ensure stakeholders feel their suggestions are being listened to and acted on. Sharing with members details of how the CCG effectively monitors the quality of commissioned services Actions had been taken in all these areas to enhance understanding and support of the CCG by stakeholders. It can be considered that progress this year may have been enhanced by the CCG s actions in these areas. The survey represents a small proportion of the many local people, patients and groups the CCG engages with, although overall the feedback from Healthwatch and patient representatives is positive and suggest the CCG has embedded positive ways of engaging and involving the public. Highlighted results There are increases over 205 s results in the six areas of questions asked of all stakeholders, broken down as follows: o Overall engagement +4% (average percentage point increase) o Commissioning services +8% o Overall leadership +4% o Clinical leadership +6% o Monitoring and reviewing services +6% o Plans and priorities + 8% Some of the key questions where there are positive changes are detailed below. Many of these show very significant increases on 205 scores and in relation the national average. 94% rated their working relationship with the CCG as fairly or very good (8% points above the national average/23% points above CCG s 205 score) 89% said they had been engaged by the CCG over last 2 months (+9%/+%) 3

7 86% said they were fairly or very satisfied with how the CCG has engaged with them (+6%/+24%) 80% strongly or tended to agree that they had confidence in the CCG s clinical leadership delivering its plans and priorities (+ 8%/+23%) 80% strongly or tended to agree that they were confident in the CCG commissioning high quality services (+5%/+26%) 74% strongly or tended to agree that they had confidence in the leadership of the CCG delivering improved outcomes for patients (+2%/+25%) 69% tended to agree or agreed that the CCG had taken their comments on board on our plans and priorities (+20%/+8%) One area that showed a small decline on 205 is knowing about the CCG s plans and priorities, which went down from 85% to 80%; although this score is still above the cluster, regional and national averages. Practice feedback - there was also generally very positive feedback from practices in a number of key areas. This is especially reflected in a 43% increase in the proportion rating their working relationship with CCG as being very or fairly good. Details of key questions are as follows: 95% rate their working relationship with CCG as very/fairly good (67% in 205) 89% said they were very or fairly satisfied with way CCG has engaged with you (62%) 68% strongly/tend to agree their views have been listened to (52%) 84% strongly/tend to agree that reps from practices are able to take a leadership role if they want to (76%) 68% strongly/tend to agree that they have confidence in the CCG commissioning high quality services (48%) 58% strongly/tend to agree that the CCG s plans will deliver continuous improvements in quality (38%) When asked how often they have the opportunity for direct discussions with CCG leaders % said weekly (5%), % twice a month (4%); 32% said monthly (43%) and 47% said quarterly (38%) 68% strongly/tend to agree that there is clear visible clinical leadership in the CCG (57%) 4

8 42% strongly/tend to agree that the clinical leadership of the CCG is delivering improvements to reduce health inequalities' (48%) 89% strongly/tend to agree that if they had a quality concern they would know how to raise it (7%) 53% think the arrangements for member participation are good fairly good (62%) 58% are confident in the two way accountability arrangements (52%) There are mixed views on questions on co commissioning (slides 86 and 87) with 53% (-33%) feeling very/fairly involved in discussions about co commissioning while 74%(+7%) are confident the CCG is taking steps to prepare for co commissioning Local questions The CCG took the opportunity to ask five local questions. These were all asked in previous years so progress can be measured. Previous scores were generally good, although further progress over the last year can be seen on all questions. Those surveyed were asked how would you rate the CCG on each of the following : Leading the changes taking place at Queen Mary s Hospital (67% good/fairly good; +4% percentage points on 205)) Engaging patients and residents in the changes to local healthcare services (65%; +9%) The progress being made on delivering improvements to the urgent care system (63%; +4%) Addressing concerns about the quality of local healthcare services provided by local NHS organisations (62%; +2%) Collaborating with our partners to improve health and social care across the borough (7%; +%) The last two questions (..addressing concerns about the quality.. and collaborating with our partners ) saw especially significant increases over 205 s results. Observations from verbatim comments An overall summary of the verbatim comments is given below: Increased practice visits by the CCG are regarded as very positive by practices Having more staff and resources involved in supporting development of primary care is welcomed The GP events are seen as more positive through inclusion of primary care on agenda 5

9 There are lots of references to OHSEL work, which reflect that the CCG is seen as a good partner, involved at various levels There is much praise for communication materials/tools, and the CCG s clarity and ambition to communicate There is still some misunderstanding of the role of CCG and what we can and can t do There is recognition of changes at QMH and Erith hospital recognise that there are clear signs that stakeholders clearly understand that changes on the ground are actually happening There are many positive references to the engagement of the CCG with patients and stakeholders to ensure that there is an understanding of the CCG s work and an opportunity to contribute views and opinions The CCG needs to ensure it is reaching an even wider cohort of patients representatives, especially those from seldom heard groups Assessment of the results Overall, the results of the 360 survey can be seen as suggesting that: There are very good on-going positive engagement with stakeholders There is a clear view that the CCG is seen as well-led and has strong clinical leadership Stakeholders feel much more engaged with, listened to and their comments acted on The stronger primary care focus is leading to better feedback from practices and other local stakeholders Stakeholders have good understanding and support of what the CCG is striving to achieve The CCG s new chair has impacted very well with a number of stakeholders Lots of references to OHSEL work we are seen as a good partner, involved at various levels Generally what the CCG is doing and how it is doing is generally meeting approval from our stakeholders Learning from the survey Although the survey is extremely positive there are few areas where the CCG can learn and consider for further development over the coming year. Continuing to build on the improved relations we have with key stakeholders, such as the HWB, LB Bexley, BVSC and Healthwatch Ensuring that the CCG is clearly explaining its plans and how they dovetail in the OHSEL plans Ensuring practices feel involved in discussions about the development of primary care co commissioning Encouraging greater take up by practices in the survey 6

10 Document Name Here Month 206 Version Public Internal Use Only Confidential Strictly Confidential (DELETE CLASSIFICATION) CCG 360 o stakeholder survey 206 Main report CCG 360 stakeholder survey Report April 206 Version Public

11 Table of contents Slide 3 Summary Slide 6 Overall report Slide 7 Background and objectives Slide 8 Methodology and technical details Slide 0 Interpreting the results Slide Using the results Slide 3 Component : Well-led Slide 57 Component 2: Performance Slide 64 Component 3: Finance Slide 67 Component 4: Planning Slide 85 Component 5: Delegated Functions Slide 88 CCG s local questions Slide 94 Appendix CCG cluster 2

12 Document Name Here Month 206 Version Public Internal Use Only Confidential Strictly Confidential (DELETE CLASSIFICATION) Summary CCG 360 stakeholder survey Report April 206 Version Public 3

13 Summary The following chart presents the summary findings across the CCG for the questions asked of all stakeholders. This provides the percentage of stakeholders responding positively to the key questions, including year-on-year comparisons where the question was also asked in 205 and 204. Base = all stakeholders (206; 45, 205; 48, 204; 48) unless otherwise stated Overall Engagement Overall, to what extent, if at all, do you feel you have been engaged by the CCG over the past 2 months? And how satisfied or dissatisfied are you with the way in which the CCG has engaged with you over the past 2 months?* And still thinking about the past 2 months, to what extent do you agree or disagree that the CCG has listened to your views where you have provided them? % a great deal/ a fair amount % very/ fairly satisfied % strongly/ tend to agree % 79% 77% 87% 63% 63% 7% 60% 52% To what extent do you agree or disagree that the CCG has taken on board your suggestions? 58% 54% - % strongly/ tend to agree Overall, how would you rate your working relationship with the CCG? % very/ fairly good 93% 7% 75% And thinking back over the past 2 months, would you say your working relationship with the CCG has got better, got worse or has it stayed about the same?** % got much/ a little better 66% 52% 54% Commissioning services The CCG involves and engages with the right individuals and organisations when making commissioning decisions I have confidence in the CCG to commission high quality services for the local population % strongly/ tend to agree % strongly/ tend to agree % 58% 52% 80% 54% 58% I understand the reasons for the decisions that the CCG makes when commissioning services 73% 63% 63% % strongly/ tend to agree The CCG effectively communicates its commissioning decisions with me % strongly/ tend to agree 69% 60% 58% The CCG s plans will deliver continuous improvement in quality within the available resources % strongly/ tend to agree 67% 42% 50% *Base = all who feel they have some level of engagement with CCG (206; 45, 205; 48, 204; 48) **Base = all who feel they have a working relationship with CCG (206; 44, 205; 48, 204; 46) 4

14 Summary cont. Overall leadership of the CCG The leadership of the CCG has the necessary blend of skills and experience 80% 7% 65% % strongly/ tend to agree There is clear and visible leadership of the CCG % strongly/ tend to agree 82% 83% 79% I have confidence in the leadership of the CCG to deliver its plans and priorities % strongly/ tend to agree 80% 67% 63% The leadership of the CCG is delivering continued quality improvements % strongly/ tend to agree 76% 52% 50% I have confidence in the leadership of the CCG to deliver improved outcomes for patients % strongly/ tend to agree 80% 56% 52% Clinical leadership of the CCG There is clear and visible clinical leadership of the CCG % strongly/ tend to agree 80% 67% 7% I have confidence in the clinical leadership of the CCG to deliver its plans and priorities % strongly/ tend to agree 80% 58% 52% The clinical leadership of the CCG is delivering continued quality improvements % strongly/ tend to agree 64% 50% 50% Monitoring and reviewing services I have confidence that the CCG effectively monitors the quality of the services it commissions % strongly/ tend to agree 7% 56% 54% If I had concerns about the quality of local services I would feel able to raise my concerns with the CCG % strongly/ tend to agree 9% 79% 8% I have confidence in the CCG to act on feedback it receives about the quality of services % strongly/ tend to agree 80% 60% 67% Plans and priorities How much would you say you know about the CCG s plans and priorities? 80% 85% 79% % a great deal/fair amount I have been given the opportunity to influence the CCG s plans and priorities % strongly/ tend to agree 76% 67% 60% When I have commented on the CCG s plans and priorities I feel that my comments have been taken on board % strongly/ tend to agree 69% 52% 52% The CCG has effectively communicated its plans and priorities to me % strongly/ tend to agree 7% 63% - The CCG s plans and priorities are the right ones % strongly/ tend to agree 62% 50% 52% 5

15 Document Name Here Month 206 Version Public Internal Use Only Confidential Strictly Confidential (DELETE CLASSIFICATION) Overall report CCG 360 stakeholder survey Report April 206 Version Public 6

16 Background and objectives Clinical Commissioning Groups (CCGs) need to have strong relationships with a range of health and care partners in order to be successful commissioners within the local system. These relationships provide CCGs with on-going information, advice and knowledge to help them make the best possible commissioning decisions. The CCG 360 o stakeholder survey is a key part of ensuring these strong relationships are in place. The survey allows stakeholders to provide feedback on working relationships with CCGs. The results from the survey will serve two purposes:. To provide a wealth of data for CCGs to help with their ongoing organisational development, enabling them to continue to build strong and productive relationships with stakeholders. The findings can provide a valuable tool for all CCGs to be able to evaluate their progress and inform their organisational decisions. 2. To feed into assurance conversations between NHS England and CCGs. The survey will form part of the evidence used to assess whether the stakeholder relationships, forged during the transition through authorisation, continue to be central to the effective commissioning of services by CCGs, and in doing so, improve quality and outcomes for patients. 7

17 Methodology and technical details It was the responsibility of each CCG to provide the list of stakeholders to invite to take part in the CCG 360 o stakeholder survey. CCGs were provided with a specification of core stakeholder organisations (outlined in the table opposite) to be included in their stakeholder list. Beyond this however, CCGs had the flexibility to determine which individual within each organisation was the most appropriate to nominate. CCGs were also given the opportunity to add up to ten additional stakeholders they wanted to include locally (they are referred to in this report as Wider stakeholders ). These included: Commissioning Support Units, Health Education England, lower tier local authorities, MPs, private providers, Public Health England, social care / community organisations, Voluntary Sector Council/Leader, voluntary / third sector organisations, local care homes, GP out-ofhours providers and other stakeholders and clinicians. Stakeholders were sent an inviting them to complete the survey online. Stakeholders who did not respond to the invitation, and stakeholders for whom an address was not provided, were telephoned by an Ipsos MORI interviewer who encouraged response and offered the opportunity to complete the survey by telephone. Core stakeholder framework GP member practices Health and wellbeing boards Local Healthwatch Other patient groups NHS providers Acute NHS providers Mental health trusts NHS providers Community health trusts Other CCGs Upper tier or unitary local authorities One from every member practice Up to two per HWB Up to three per local Healthwatch Up to five Up to two from each provider Up to two from each provider Up to two from each provider Up to five Up to five per LA 8

18 Methodology and technical details Within the survey, stakeholders were asked a series of questions about their working relationship with the CCG. In addition, to reflect each core stakeholder group s different area of expertise and knowledge, they were presented with a short section of questions specific to the stakeholder group they represented. Fieldwork was conducted between 9th March 206 and 4th April of the CCG s stakeholders completed the survey. The overall response rate was 74% which varied across the stakeholder groups as shown in the table opposite. Survey response rates for Stakeholder group Invited to take part in survey Completed survey Response rate GP member practices % Health and wellbeing boards % Local Healthwatch/patient groups % NHS providers % Other CCGs % Upper tier or unitary local authorities % Wider stakeholders % 9

19 Interpreting the results For each question, the response to each answer is presented as both a percentage (%) and as a number (n). The total number of stakeholders who answered each question (the base size) is also stated at the bottom of each chart and in every table. For questions with fewer than 30 stakeholders answering, we strongly recommend that you look at the number of stakeholders giving each response rather than the percentage, as the percentage can be misleading when based on so few stakeholders. This report presents the results from 's stakeholder survey. Throughout the report, the CCG / your CCG refers to. Where a result for the cluster is presented, this refers to the overall score across the 20 CCGs that are most similar to the CCG. For more information on the cluster and how this has been defined, please see the Appendix. Where results do not sum to 00%, or where individual responses (e.g. tend to agree; strongly agree) do not sum to combined responses (e.g. strongly/tend to agree) this is due to rounding. 0

20 Using the results the reports This report contains a summary section, a section on overall views of relationships and a section for each of the five components of assurance which show detailed breakdowns of responses to each question. The overall summary slides show the results at CCG level for the questions asked of all stakeholders (i.e. only those in section of the questionnaire). This provides CCGs with an at a glance visual summary of the results for the key questions, including direction of travel comparisons where appropriate. The remainder of the report shows the results for all questions in the survey including any local questions where CCGs included them. The results for each question are provided at CCG level with a breakdown also shown for each of the core stakeholder groups where relevant. This allows CCGs to interrogate the data in more detail.

21 Using the results comparisons For some questions, data has been included in the reports to compare the results for the CCG with: The CCG s result in 204 The CCG s result in 205 The 206 average across all CCGs in the CCG s cluster The 206 average across all CCGs in the CCG s regional (DCO) teams National CCG average in 206 The comparisons are included to provide an indication of differences only and should be treated with caution due to the low numbers of respondents and differences in stakeholder lists. Any differences are not necessarily statistically significant differences; a higher score than the cluster average does not always equate to better performance, and a higher score than in 205 does not necessarily mean the CCG has improved. The comparisons offer a starting point to inform wider discussions about the CCG s ongoing organisational development and its relationships with stakeholders. For example, they may indicate areas in which stakeholders think the CCG is performing relatively less well, for the CCG to discuss internally and externally to identify what improvements can be made in this area, if any. 2

22 Component : Well-led CCG 360 stakeholder surv ey 206 Report April 206 Version Public 3

23 Overall, to what extent, if at all, do you feel you have been engaged by the CCG over the past 2 months? All stakeholders By stakeholder group 5 Stakeholder group Base Great deal / Fair amount Not very much / Not at all % GP member practices 9 84% (6) 6% (3) 42% 9 Health and wellbeing boards 2 00% (2) -% (0) Local Healthwatch/patient groups 6 00% (6) -% (0) 2 47% NHS providers 5 60% (3) 40% (2) Other CCGs 5 00% (5) -% (0) A great deal A fair amount Not very much Upper tier/unitary local authorities 4 00% (4) -% (0) Not at all Don't know Wider stakeholders 4 00% (4) -% (0) CCG comparisons Percentage of stakeholders saying a great deal / a fair amount Base 206: All stakeholders 45 Base 205: All stakeholders 48 Base 204: All stakeholders 48 Base national average: All stakeholders 8244 Base CCG cluster: All stakeholders 697 Base CCG DCO: All stakeholders 295 4

24 How satisfied or dissatisfied are you with the way in which the CCG has engaged with you over the past 2 months? All stakeholders who have been engaged by the CCG By stakeholder group 6 Stakeholder group Base Very / Fairly satisfied Very / Fairly dissatisfied 3% GP member practices 9 89% (7) -% (0) 42% 9 Health and wellbeing boards 2 00% (2) -% (0) Local Healthwatch/patient groups 6 00% (6) -% (0) 20 44% NHS providers 5 60% (3) -% (0) Other CCGs 5 00% (5) -% (0) Very satisfied Neither satisfied nor dissatisfied Very dissatisfied Fairly satisfied Fairly dissatisfied Don't know Upper tier/unitary local authorities 4 50% (2) -% (0) Wider stakeholders 4 00% (4) -% (0) CCG comparisons Percentage of stakeholders saying very / fairly satisfied Base 206: All stakeholders who have 45 Base 205: All stakeholders who have 48 Base 204: All stakeholders who have 48 been engaged by the been engaged by the been engaged by the Base national average: CCG 8046 Base CCG cluster: CCG 682 Base CCG DCO: CCG 267 5

25 Still thinking about the past 2 months, to what extent do you agree or disagree that the CCG has listened to your views where you have provided them? All stakeholders By stakeholder group Stakeholder group Base Strongly / Tend to agree Strongly / Tend to disagree 24% 2% 2% 33% 5 GP member practices 9 68% (3) 5% () Health and wellbeing boards 2 50% () -% (0) Local Healthwatch/patient groups 6 83% (5) -% (0) NHS providers 5 40% (2) -% (0) 38% 7 Strongly agree Neither agree nor disagree Strongly disagree Don't know Tend to agree Tend to disagree I have not given any views Other CCGs 5 00% (5) -% (0) Upper tier/unitary local authorities 4 50% (2) -% (0) Wider stakeholders 4 00% (4) -% (0) CCG comparisons Percentage of stakeholders saying strongly agree / tend to agree Base 206: All stakeholders 45 Base 205: All stakeholders 48 Base 204: All stakeholders 48 Base national average: All stakeholders 8244 Base CCG cluster: All stakeholders 697 Base CCG DCO: All stakeholders 295 6

26 To what extent do you agree or disagree that the CCG has taken on board your suggestions? All stakeholders By stakeholder group 5 2 % 4% 22% 0 Stakeholder group Base Strongly / Tend to agree Strongly / Tend to disagree GP member practices 9 47% (9) 6% (3) Health and wellbeing boards 2 50% () -% (0) 27% 2 Strongly agree Neither agree nor disagree Strongly disagree Don't know 36% 6 Tend to agree Tend to disagree I have not given any suggestions Local Healthwatch/patient groups 6 67% (4) -% (0) NHS providers 5 60% (3) 20% () Other CCGs 5 00% (5) -% (0) Upper tier/unitary local authorities 4 25% () 25% () Wider stakeholders 4 75% (3) -% (0) CCG comparisons Percentage of stakeholders saying strongly agree / tend to agree Base 206: All stakeholders 45 Base 205: All stakeholders 48 0 Base national average: All stakeholders 8244 Base CCG cluster: All stakeholders 697 Base CCG DCO: All stakeholders 295 7

27 Overall, how would you rate your working relationship with the CCG? All stakeholders By stakeholder group 2 Stakeholder group Base Very good / Fairly good Very poor / Fairly poor 4% 2% GP member practices 9 95% (8) -% (0) Health and wellbeing boards 2 00% (2) -% (0) 7 38% 56% 25 Local Healthwatch/patient groups 6 00% (6) -% (0) NHS providers 5 60% (3) -% (0) Other CCGs 5 00% (5) -% (0) Very good Neither good nor poor Very poor I/we do not have a working relationship Fairly good Fairly poor Don't know Upper tier/unitary local authorities 4 00% (4) -% (0) Wider stakeholders 4 00% (4) -% (0) CCG comparisons Percentage of stakeholders saying very good / fairly good Base 206: All stakeholders 45 Base 205: All stakeholders 48 Base 204: All stakeholders 48 Base national average: All stakeholders 8244 Base CCG cluster: All stakeholders 697 Base CCG DCO: All stakeholders 295 8

28 Thinking back over the past 2 months, would you say your working relationship with the CCG has got better, got worse or has it stayed about the same? All stakeholders who say they have a working relationship with the CCG By stakeholder group Stakeholder group Base Got much / A little better Got much / A little worse 2% GP member practices 8 50% (9) 6% () 4 32% 36% 6 Health and wellbeing boards 2 00% (2) -% (0) Local Healthwatch/patient groups 6 83% (5) -% (0) NHS providers 5 60% (3) -% (0) 30% Other CCGs 5 80% (4) -% (0) 3 Got much better Stayed about the same Got much worse Got a little better Got a little worse Don't know Upper tier/unitary local authorities 4 75% (3) -% (0) Wider stakeholders 4 75% (3) -% (0) CCG comparisons Percentage of stakeholders saying got much better / got a little better Base 206: All stakeholders who say they have a working 44 Base 205: All stakeholders who say they have a working 48 Base 204: All stakeholders who say they have a working 46 Base national average: relationship with the CCG 836 Base CCG cluster: relationship with the CCG 689 Base CCG DCO: relationship with the CCG 28 9

29 To what extent do you agree or disagree with the following statements about the way in which the CCG commissions services? The CCG involves and engages with the right individuals and organisations when making commissioning decisions All stakeholders By stakeholder group 2 2 Stakeholder group Base Strongly / Tend to agree Strongly / Tend to disagree 6 3% 4% 2% 4% 4 3% GP member practices 9 68% (3) % (2) Health and wellbeing boards 2 50% () -% (0) Local Healthwatch/patient groups 6 67% (4) -% (0) NHS providers 5 80% (4) 20% () 44% Other CCGs 5 00% (5) -% (0) 20 Strongly agree Neither agree nor disagree Strongly disagree Tend to agree Tend to disagree Don't know Upper tier/unitary local authorities 4 75% (3) -% (0) Wider stakeholders 4 00% (4) -% (0) CCG comparisons Percentage of stakeholders saying strongly agree / tend to agree Base 206: All stakeholders 45 Base 205: All stakeholders 48 Base 204: All stakeholders 48 Base national average: All stakeholders 8244 Base CCG cluster: All stakeholders 697 Base CCG DCO: All stakeholders

30 To what extent do you agree or disagree with the following statements about the way in which the CCG commissions services? I have confidence in the CCG to commission high quality services for the local population All stakeholders By stakeholder group 4 Stakeholder group Base Strongly / Tend to agree Strongly / Tend to disagree 5 % 9% 33% 5 GP member practices 9 68% (3) 6% (3) Health and wellbeing boards 2 50% () -% (0) Local Healthwatch/patient groups 6 00% (6) -% (0) 47% 2 Strongly agree Neither agree nor disagree Strongly disagree Tend to agree Tend to disagree Don't know NHS providers 5 80% (4) 20% () Other CCGs 5 00% (5) -% (0) Upper tier/unitary local authorities 4 75% (3) -% (0) Wider stakeholders 4 00% (4) -% (0) CCG comparisons Percentage of stakeholders saying strongly agree / tend to agree Base 206: All stakeholders 45 Base 205: All stakeholders 48 Base 204: All stakeholders 48 Base national average: All stakeholders 8244 Base CCG cluster: All stakeholders 697 Base CCG DCO: All stakeholders 295 2

31 To what extent do you agree or disagree with the following statements about the way in which the CCG commissions services? I understand the reasons for the decisions that the CCG makes when commissioning services All stakeholders By stakeholder group 2 Stakeholder group Base Strongly / Tend to agree Strongly / Tend to disagree 0 4% GP member practices 9 63% (2) % (2) 22% 38% 7 Health and wellbeing boards 2 50% () -% (0) Local Healthwatch/patient groups 6 00% (6) -% (0) 36% 6 Strongly agree Neither agree nor disagree Strongly disagree Tend to agree Tend to disagree Don't know NHS providers 5 40% (2) -% (0) Other CCGs 5 00% (5) -% (0) Upper tier/unitary local authorities 4 75% (3) -% (0) Wider stakeholders 4 00% (4) -% (0) CCG comparisons Percentage of stakeholders saying strongly agree / tend to agree Base 206: All stakeholders 45 Base 205: All stakeholders 48 Base 204: All stakeholders 48 Base national average: All stakeholders 8244 Base CCG cluster: All stakeholders 697 Base CCG DCO: All stakeholders

32 To what extent do you agree or disagree with the following statements about the way in which the CCG commissions services? The CCG s plans will deliver continuous improvement in quality within the available resources All stakeholders By stakeholder group 4 Stakeholder group Base Strongly / Tend to agree Strongly / Tend to disagree 9% 2% 3 GP member practices 9 58% () 6% (3) 0 22% 29% Health and wellbeing boards 2 50% () -% (0) Local Healthwatch/patient groups 6 00% (6) -% (0) NHS providers 5 40% (2) 20% () 38% Other CCGs 5 00% (5) -% (0) 7 Strongly agree Neither agree nor disagree Strongly disagree Tend to agree Tend to disagree Don't know Upper tier/unitary local authorities 4 50% (2) -% (0) Wider stakeholders 4 75% (3) -% (0) CCG comparisons Percentage of stakeholders saying strongly agree / tend to agree Base 206: All stakeholders 45 Base 205: All stakeholders 48 Base 204: All stakeholders 48 Base national average: All stakeholders 8244 Base CCG cluster: All stakeholders 697 Base CCG DCO: All stakeholders

33 To what extent do you agree or disagree with the following statements about the way in which the CCG commissions services? The CCG effectively communicates its commissioning decisions with me All stakeholders By stakeholder group 3 Stakeholder group Base Strongly / Tend to agree Strongly / Tend to disagree 7% 2% 3 GP member practices 9 58% () 6% (3) 0 22% 29% Health and wellbeing boards 2 50% () -% (0) Local Healthwatch/patient groups 6 83% (5) -% (0) NHS providers 5 60% (3) -% (0) 40% Other CCGs 5 00% (5) -% (0) 8 Strongly agree Neither agree nor disagree Strongly disagree Tend to agree Tend to disagree Don't know Upper tier/unitary local authorities 4 50% (2) -% (0) Wider stakeholders 4 00% (4) -% (0) CCG comparisons Percentage of stakeholders saying strongly agree / tend to agree Base 206: All stakeholders 45 Base 205: All stakeholders 48 Base 204: All stakeholders 48 Base national average: All stakeholders 8244 Base CCG cluster: All stakeholders 697 Base CCG DCO: All stakeholders

34 To what extent do you agree or disagree with the following statements about the overall leadership of the CCG? The leadership of the CCG has the necessary blend of skills and experience All stakeholders By stakeholder group 2 Stakeholder group Base Strongly / Tend to agree Strongly / Tend to disagree 6 3% 4% 2% GP member practices 9 68% (3) % (2) 44% 20 Health and wellbeing boards 2 00% (2) -% (0) Local Healthwatch/patient groups 6 00% (6) -% (0) 36% NHS providers 5 80% (4) -% (0) 6 Other CCGs 5 00% (5) -% (0) Strongly agree Neither agree nor disagree Strongly disagree Tend to agree Tend to disagree Don't know Upper tier/unitary local authorities 4 00% (4) -% (0) Wider stakeholders 4 50% (2) -% (0) CCG comparisons Percentage of stakeholders saying strongly agree / tend to agree Base 206: All stakeholders 45 Base 205: All stakeholders 48 Base 204: All stakeholders 48 Base national average: All stakeholders 8244 Base CCG cluster: All stakeholders 697 Base CCG DCO: All stakeholders

35 To what extent do you agree or disagree with the following statements about the overall leadership of the CCG? There is clear and visible leadership of the CCG All stakeholders 5 2 2% 4% % By stakeholder group Stakeholder group Base Strongly / Tend to agree Strongly / Tend to disagree GP member practices 9 68% (3) 5% () 44% 20 Health and wellbeing boards 2 00% (2) -% (0) Local Healthwatch/patient groups 6 00% (6) -% (0) 38% NHS providers 5 80% (4) -% (0) 7 Other CCGs 5 00% (5) -% (0) Strongly agree Neither agree nor disagree Strongly disagree Tend to agree Tend to disagree Don't know Upper tier/unitary local authorities 4 00% (4) -% (0) Wider stakeholders 4 75% (3) -% (0) CCG comparisons Percentage of stakeholders saying strongly agree / tend to agree Base 206: All stakeholders 45 Base 205: All stakeholders 48 Base 204: All stakeholders 48 Base national average: All stakeholders 8244 Base CCG cluster: All stakeholders 697 Base CCG DCO: All stakeholders

36 To what extent do you agree or disagree with the following statements about the overall leadership of the CCG? I have confidence in the leadership of the CCG to deliver its plans and priorities All stakeholders By stakeholder group 3 Stakeholder group Base Strongly / Tend to agree Strongly / Tend to disagree 5 2% 7% % 7 38% GP member practices 9 68% (3) 5% () Health and wellbeing boards 2 00% (2) -% (0) Local Healthwatch/patient groups 6 00% (6) -% (0) 42% 9 Strongly agree Neither agree nor disagree Strongly disagree Tend to agree Tend to disagree Don't know NHS providers 5 60% (3) -% (0) Other CCGs 5 00% (5) -% (0) Upper tier/unitary local authorities 4 00% (4) -% (0) Wider stakeholders 4 75% (3) -% (0) CCG comparisons Percentage of stakeholders saying strongly agree / tend to agree Base 206: All stakeholders 45 Base 205: All stakeholders 48 Base 204: All stakeholders 48 Base national average: All stakeholders 8244 Base CCG cluster: All stakeholders 697 Base CCG DCO: All stakeholders

37 To what extent do you agree or disagree with the following statements about the overall leadership of the CCG? The leadership of the CCG is delivering continued quality improvements All stakeholders By stakeholder group 2 Stakeholder group Base Strongly / Tend to agree Strongly / Tend to disagree 7 6% 4% 2% 2% 36% 6 GP member practices 9 63% (2) 6% (3) Health and wellbeing boards 2 00% (2) -% (0) Local Healthwatch/patient groups 6 00% (6) -% (0) 40% 8 Strongly agree Neither agree nor disagree Strongly disagree Tend to agree Tend to disagree Don't know NHS providers 5 80% (4) -% (0) Other CCGs 5 00% (5) -% (0) Upper tier/unitary local authorities 4 50% (2) -% (0) Wider stakeholders 4 75% (3) -% (0) CCG comparisons Percentage of stakeholders saying strongly agree / tend to agree Base 206: All stakeholders 45 Base 205: All stakeholders 48 Base 204: All stakeholders 48 Base national average: All stakeholders 8244 Base CCG cluster: All stakeholders 697 Base CCG DCO: All stakeholders

38 To what extent do you agree or disagree with the following statements about the overall leadership of the CCG? I have confidence in the leadership of the CCG to deliver improved outcomes for patients All stakeholders By stakeholder group 4 Stakeholder group Base Strongly / Tend to agree Strongly / Tend to disagree 4 9% 2% GP member practices 9 74% (4) 6% (3) 9% 40% 8 Health and wellbeing boards 2 00% (2) -% (0) Local Healthwatch/patient groups 6 00% (6) -% (0) 40% NHS providers 5 60% (3) -% (0) 8 Strongly agree Neither agree nor disagree Strongly disagree Tend to agree Tend to disagree Don't know Other CCGs 5 00% (5) -% (0) Upper tier/unitary local authorities 4 75% (3) 25% () Wider stakeholders 4 75% (3) -% (0) CCG comparisons Percentage of stakeholders saying strongly agree / tend to agree Base 206: All stakeholders 45 Base 205: All stakeholders 48 Base 204: All stakeholders 48 Base national average: All stakeholders 8244 Base CCG cluster: All stakeholders 697 Base CCG DCO: All stakeholders

39 To what extent do you agree or disagree with the following statements about the clinical leadership of the CCG? There is clear and visible clinical leadership of the CCG All stakeholders 4 3 2% 7% 2% 9% By stakeholder group Stakeholder group Base Strongly / Tend to agree Strongly / Tend to disagree GP member practices 9 68% (3) % (2) Health and wellbeing boards 2 00% (2) -% (0) 5% 23 Local Healthwatch/patient groups 6 00% (6) -% (0) 3 29% NHS providers 5 60% (3) -% (0) Other CCGs 5 00% (5) -% (0) Strongly agree Neither agree nor disagree Strongly disagree Tend to agree Tend to disagree Don't know Upper tier/unitary local authorities 4 00% (4) -% (0) Wider stakeholders 4 75% (3) -% (0) CCG comparisons Percentage of stakeholders saying strongly agree / tend to agree Base 206: All stakeholders 45 Base 205: All stakeholders 48 Base 204: All stakeholders 48 Base national average: All stakeholders 8244 Base CCG cluster: All stakeholders 697 Base CCG DCO: All stakeholders

40 To what extent do you agree or disagree with the following statements about the clinical leadership of the CCG? I have confidence in the clinical leadership of the CCG to deliver its plans and priorities All stakeholders 4 3 2% 7% 2% 9% By stakeholder group Stakeholder group Base Strongly / Tend to agree Strongly / Tend to disagree GP member practices 9 68% (3) % (2) Health and wellbeing boards 2 00% (2) -% (0) 49% 22 Local Healthwatch/patient groups 6 00% (6) -% (0) 3% NHS providers 5 60% (3) -% (0) 4 Other CCGs 5 00% (5) -% (0) Strongly agree Neither agree nor disagree Strongly disagree Tend to agree Tend to disagree Don't know Upper tier/unitary local authorities 4 00% (4) -% (0) Wider stakeholders 4 75% (3) -% (0) CCG comparisons Percentage of stakeholders saying strongly agree / tend to agree Base 206: All stakeholders 45 Base 205: All stakeholders 48 Base 204: All stakeholders 48 Base national average: All stakeholders 8244 Base CCG cluster: All stakeholders 697 Base CCG DCO: All stakeholders 295 3

41 To what extent do you agree or disagree with the following statements about the clinical leadership of the CCG? The clinical leadership of the CCG is delivering continued quality improvements All stakeholders By stakeholder group 2 4% 4 9% 6 Stakeholder group Base Strongly / Tend to agree Strongly / Tend to disagree GP member practices 9 47% (9) % (2) 36% Health and wellbeing boards 2 00% (2) -% (0) 0 22% Local Healthwatch/patient groups 6 83% (5) -% (0) NHS providers 5 60% (3) -% (0) 29% Other CCGs 5 00% (5) -% (0) 3 Strongly agree Neither agree nor disagree Strongly disagree Tend to agree Tend to disagree Don't know Upper tier/unitary local authorities 4 50% (2) -% (0) Wider stakeholders 4 75% (3) -% (0) CCG comparisons Percentage of stakeholders saying strongly agree / tend to agree Base 206: All stakeholders 45 Base 205: All stakeholders 48 Base 204: All stakeholders 48 Base national average: All stakeholders 8244 Base CCG cluster: All stakeholders 697 Base CCG DCO: All stakeholders

42 To what extent do you agree or disagree with the following statements about the clinical leadership of the CCG? The clinical leadership of the CCG is delivering continued improvements to reduce local health inequalities All stakeholders By stakeholder group 3 3 7% 2% 7% 5 33% Stakeholder group Base Strongly / Tend to agree Strongly / Tend to disagree GP member practices 9 42% (8) 2% (4) Health and wellbeing boards 2 50% () -% (0) 24% Local Healthwatch/patient groups 6 83% (5) -% (0) NHS providers 5 60% (3) -% (0) 27% Other CCGs 5 00% (5) -% (0) Strongly agree Neither agree nor disagree Strongly disagree 2 Tend to agree Tend to disagree Don't know Upper tier/unitary local authorities 4 50% (2) -% (0) Wider stakeholders 4 75% (3) -% (0) CCG comparisons Percentage of stakeholders saying strongly agree / tend to agree Base 206: All stakeholders 45 Base 205: All stakeholders Base national average: All stakeholders 8244 Base CCG cluster: All stakeholders 697 Base CCG DCO: All stakeholders

43 To what extent do you agree or disagree with the following statements about the way in which the CCG monitors and reviews the quality of commissioned services? I have confidence that the CCG effectively monitors the quality of the services it commissions All stakeholders By stakeholder group 6 Stakeholder group Base Strongly / Tend to agree Strongly / Tend to disagree 2 4% 3% 33% 5 GP member practices 9 68% (3) 5% () Health and wellbeing boards 2 00% (2) -% (0) 5 % Local Healthwatch/patient groups 6 00% (6) -% (0) NHS providers 5 60% (3) -% (0) 38% Other CCGs 5 00% (5) -% (0) 7 Strongly agree Neither agree nor disagree Strongly disagree Tend to agree Tend to disagree Don't know Upper tier/unitary local authorities 4 50% (2) 25% () Wider stakeholders 4 25% () -% (0) CCG comparisons Percentage of stakeholders saying strongly agree / tend to agree Base 206: All stakeholders 45 Base 205: All stakeholders 48 Base 204: All stakeholders 48 Base national average: All stakeholders 8244 Base CCG cluster: All stakeholders 697 Base CCG DCO: All stakeholders