Lobbying Your Local CCG 101.
All the CCG's I've had contact with through work (essentially the old Avon authority, now broken up into Bristol, South Glos, BANES and Somerset) have a list of conditions and diseases that they consider to be both expensive and patient-manageable. These typically include asthma, epilepsy and diabetes (all kinds) but may also include immunisation, HIV and so on, depending upon how your CCG functions.
Because complications of these first three conditions are so expensive (when you factor in hospital admissions and community nursing costs), can have life-changing impacts on people who have them, and can often be managed by patients with some pro-active intervention and education, CCGs tend to consider them in their own categories and will discuss them separately. Thus you'll sometimes see a 3-month spate of asthma plan education courses being advertised, or epilepsy awareness and support groups or a push to get diabetes on every GP's agenda.
With all that in mind, diabetes (whether type 1, 2 or otherwise) is considered to be the most expensive and avoidable of all 3, with both children's and adults commissioners giving it regular table time during meetings. It's one of the few things they actually do exercise authority over GP's for (you'll be surprised but GPs are relatively independent of their local CCG, for too many reasons to explore now) so the CCG can direct GPs, through incentives or co-planning or whatever, to change their approach somewhat (a good example of this is the increased take-up of the flu jab).
This means that commissioners can inject funds into local health networks - hospitals, community nursing, GP surgeries - to increase specific interventions and improve specific pathways. But they don't do it lightly and only after an evidence-based discussion that looks at all areas of their authority's performance. Which means if you're hoping to persuade your local CCG to fund your Libre, you've got to demonstrate why it would ultimately save
them money while improving health outcomes for your area
and decreasing pressure on local services.
You've got to know how and where to lobby and build a business case for it.
Your CCG is directly answerable to your local Health and Wellbeing Board, which is made up of a collection of agencies including local council, commissioners, voluntary organisations and Healthwatch. Healthwatch is the public's way in to the Health and Wellbeing Board (unless you're connected to a voluntary org that has a chair at the table, then you lobby them directly).
For more info on Health and Wellbeing Boards:
https://www.kingsfund.org.uk/projec...Ob3T3nMy7j7V04-1CtUcDTuKZ__9_QahoCcw0QAvD_BwE
On this page:
http://www.healthwatch.co.uk you can find your local Healthwatch group and their contact info. Their role is to be the public voice at the H&WB, and they will work thematically through the year. So maybe for the first quarter, they'll be looking at mental health, the second will be hospital inpatient experiences, the third could be the quality of local care homes, who knows. Their choice of theme will be directly influenced by the local orgs they work with and the people who have been in contact with them. So the more people contacting them about a particular issue, the more they'll take notice.
During that quarter, the issues raised by their theme - concerns, local issues, individual stories - will be raised as issues at the H&WB meetings, so put on the commissioning and political agenda. They have the ability to ask some very tricky questions, demand answers and then follow up if those answers are not forthcoming. In fact, their statutory reach is surprisingly long. Your local Health and Wellbeing Board should hold public meetings at least once a month and their minutes should be publicly available, which means you should be able to look back through previous meetings and see when diabetes was last discussed. Some H&WB keep diabetes, asthma and other "expensive preventables" constantly on their agenda, regardless of other issues.
While you can contact Healthwatch at any time with any concern, comment or agenda, your voice - and therefore your need - will be amplified if your issue fits in with what they've picked for their current theme. It's also possible (if you're organised and there's a few of you) to persuade them to change their theme - so if self-management of diabetes - including the availability of the Libra - isn't in their immediate schedule when you first contact them, it's possible to get them to change it.
It's totally possible to get the need for Libre local funding in front of your commissioners very quickly - even before Christmas. But you'll have to do a little legwork in your area first.
- Contact any local diabetes groups and see if you can find support or whether anyone else is also campaigning for the same thing. It's just easier if you all work together, and you're more likely to get traction on your issue if the council / CCG is only having to respond to one group of people with one set of well-thought-out questions and points.
- Look for the archived minutes of previous Health and Wellbeing Board meetings, probably on your Local Authority website somewhere, and research when diabetes was last on the agenda.
- Find your local authority's current Health and Wellbeing Strategy (may also be called a vision, priorities or any number of shiny things). Frame your issue within the points it makes. For example, here's Bristol's:
https://www.bristol.gov.uk/document...+to+2019/e8e8ab69-ca50-4eab-85d4-2753cf1255d6
So I could easily argue that a CCG-funded Libre program hits 3 core values there (prevention, self-management, community voice), without even going through the blurb above it.
- Get some facts and figures together. Your CCG is required to post annual health updates giving key facts and figures for your area, and diabetes should already be firmly near the top of their agenda, so info should be nice and clear.
- Contact your local Healthwatch, find out what their current and next few topics are. Tell them why you're working on this, what it means to you. They may be able to link you in with others with similar goals.
- Don't take it personally, don't be cynical, don't be impatient. The type of change you're hoping to make requires a lot of people making a lot of decisions and that takes both time and evidence. But if you prepare well and present yourself not as an adversary but as an advocate, you're more likely to win key people over to your way of thinking.
Good luck! If you need me to give advice, read anything, help in any way drop me a PM. Even if it's a couple of hours on Skype helping you find your local resources, count me in
Sock x