Big Care Debate 2 –feedback report

January – April 2016

Prepared by: Simon Morgan, Head of Communications and Public Engagement

Contents

Section / Page
1.Introduction and summary / 3
2.The approach to public engagement / 4
3.Background / 5
4.In depth findings from the Big Care Debate 2 / 6
5.Responses from survey / 7
6.Opinions expressed in support group meetings / 13
7.Feedback from workshop exercises during CCG Big Care Debate 2 events / 14
8.Conclusion / 15
9.Next steps / 15
10.Recommendation / 16
11.Appendices / 16
  1. Introduction and summary

This paper presents an overview of the process of engagement through the Big Care Debate 2 and draws on the key themes that emerged.

Key Points from the Big Care Debate 2

  • Accessing GPs - Getting an appointment to see a GP was becoming increasingly difficult and there was a genuine concern amongst manyrespondents that access will be even more difficult as the size of the local population increases.
  • Staff attitude - there were some mixed views from respondents with some suggesting that they had a positive experience of staff – others less positive.
  • NHS 111- Nearly all of the people we spoke to said they were aware of NHS 111. Out of those who had used it, several mentioned they were concerned it was not suitable for their needs.
  • GP recruitment - Several respondents wanted to know how the CCG was supporting ways to address the shortfall in the number of GPs working across Colchester and Tendring.
  • Improved signposting to services - There was a favourable response towards having an effective signposting system in place that would allow patients and their families easy access to services, saving them time and wasted journeys. There was a feeling amongst some people in Tendring that a lot of services were Colchester centric.
  • Repeat prescriptions - One of the key themes around wastage related to automatic repeat prescriptions. Several respondents commented that too often medicines were over ordered – with some medication not being ordered at all despite clear instructions. The concept of the service was considered by several respondents to be excellent, but many people felt in reality it was not working as well as it should.
  • Stronger communication between departments - Many people spoke about the need for stronger communication between healthcare departments – especially in acute settings. There was a real sense that services were not speaking to each other which was having an adverse impact on patients.
  • Transportation - Transportation was a particular issue for many people – especially some elderly or frail members of the public who often found it a challenge to get to and from Colchester Hospital.
  • Excellence in services - Many respondents felt that while some concerns did exist, they had experiencedexcellent standards of service from the various health and social care departments across north east Essex.
  1. The Approach to public engagement

North East Essex CCG has been engaging widely with local communities in order to find out peoples’ views ontheir experiences of accessing services. The CCG wanted to find out perceptions on how the public thought communities could further support people to maintain happy and healthy lifestyles within their own neighbourhoods.We also wanted to find out about any instances of waste or duplication within the health and social care system that could be reviewed in the future. Key themes emerging from the Big Care Debate 2 will help shape the development of the Sustainability and Transformation Plan (STP). This will outline how services may be provided in the future to ensure they are affordable for the wider public across north east Essex and Suffolk.

Our approach

The CCG conducted its Big Care Debate 2 between the end of January and 30 April 2016. We spoke to 671 people and received 74 completed questionnaires (46 paper and 28 electronic). We also held two events of our own which received strong interest with around 130 people attending both meetings in Colchester and Clacton. Presentations were given by executive leads from the CCG as well as from Anglian Community Enterprise (ACE), Colchester Borough Council, Tendring District Council, Essex County Council and the Community Voluntary Services Tendring (CVST).

In addition, the CCG attended the 20 network groups and support meetings across north east Essex. These are listed in Appendix A at the end of this document.

Publicising the Big Care Debate 2

The Big Care Debate 2 was publicised through a number of ways:

  1. Repeated newspaper advertising on front pages of Gazette newspapers (at a heavily negotiated discounted rate);
  2. Widespread use of social media, promoting the events through our Twitter and Facebook channels;
  3. Through attendance at network/support group meetings (listed in Appendix A). Many chairs or organisers of these groups and meetings also conducted some awareness raising with their own members;
  4. Press releases were issued to the local media as well as uploaded to our website;
  5. Posters and leaflets were distributed and displayed within prominent locations across north east Essex including libraries, supermarkets, voluntary and community centres;
  6. News items in local newspapers and on Heart radio;
  7. Regular reminders issued through the weekly newsletters of the Community Voluntary Services (Colchester and Tendring).
  1. Background

The legal context

There are a number of statutory duties that outline the CCG’s duties which are described below. Over and above these, we are committed to involving and engaging patients and local communities on decisions about health services. The Big Care Debate 2 is an important element of this process of engagement.

The NHS Constitution

The NHS Constitution came into force in January 2010. It places a statutory duty on NHS bodies and explains a number of rights which are a legal entitlement protected by law.

The Health and Social Care Act 2012

The Act sets out how the NHS will put patients at the heart of everything it does, focus on improving those things that really matter to patients, empower and liberate clinicians to innovate, with the freedom to focus on improving healthcare services.

It makes provision for CCGs to establish appropriate collaborative arrangements with other CCGs, local authorities and other partners, and it also stresses that CCGs must involve and consult patients and the public:

  • in their planning of commissioning arrangements
  • in the development and consideration of proposals for changes.

Big Care Debate 1

During 2014, the CCG ran its first Big Care Debate which gave people an opportunity to say how they would like health and social care to develop across north east Essex. There were a number of key themes that arose from this engagement which included:

  • Self care - taking responsibility for own care;
  • GP services – local people valued their GP practice and said it was usually their first point of contact;
  • Access to information and services – signposting to services using easy to understand language was important;
  • Prevention – clear information about how to stay fit and healthy;
  • Integration of services – There was a lack of frustration with the lack of joined up services.

The above themes were fed into the design process for the Care Closer to Home procurement in which the Anglian Community Enterprise (ACE) was appointed as the successful provider.

  1. In depth findings from Big Care Debate 2

Views on accessing GP services

The vast majority ofrespondents expressed concern that it was becoming increasing difficult to see a GP when they needed to access one. Many said it was a significant worry that appointments to see their practitioners were not available even when they had attempted to book a slot early in the day. Some respondents said they were concerned with the expected increase in the number of houses that are due to be built across north east Essex and the expected increase in the size of the local population. They questioned how the local health and social care system would cope ascommunities grow especially as it appears to be struggling at the moment. At least one person from each of the groups said a great deal of their own time had been wasted trying to book an appointment with their GP – with no success.

Views on signposting to appropriate services

Another key emerging theme from many respondents was the perception that clinical departments did not appear to communicate with each other. There have been suggestions there should be a specialist nursing team in place to triage those living with long term conditions. In addition, representatives from the Mind group in Clacton recommended that a signposting professional should be in post to help direct people to the most appropriate service according to their needs. This would save patients and their familieswasting time and energy in finding servicesto best support them.

Views on transportation

Severalrespondents spoke about the cost of travel between a patient’s home and hospital. The cost of using taxis was raised during a number of meetings and through questionnaires. One respondent highlighted that she had made six journeys between her home in Tendring to Colchester Hospital for various appointments. A taxi was used on each occasion at a cost of £60 per journey. One member of the Pensioner’s Forum in Holland on Sea pointed to a scheme in Exeter that involves a team of volunteer drivers taking elderly patients to and from hospital. This scheme worked well and allowed the community to support each other.

Views on equipment

There were fewer experiences that related to the use of equipment. However, onerespondent was told that the crutches she was given by a hospital department could not be returned. This was regarded to be a significant waste to the NHS. The respondent asked whether these pieces of equipment could be sterilised so that they could be returned to hospital, thus saving resource and money.

Views on repeating stories to healthcare professionals

There needed to be more effective mechanisms in place that saved patients having to repeat their story to clinical professionals. One representative from the Gateway Club said it would be ‘good to see the same doctor so not having to explain it all again.’ The same group said it would be beneficial for GPs and receptionists to appreciate that adults with learning disabilities may not understand the reason for waiting in a surgery.

Communication

One of the strongest themes that emerged through the Big Care Debate 2 was that communication between departments in some cases was poor. One respondent suggested more needed to happen to ensure a patient, who has undergone an operation, is made aware of arrangements they needed to make post discharge. The respondent felt that therewere too many assumptions made by hospital staff that patients understood what to do after they’ve been discharged from a ward environment.

  1. Responses from Survey

We received 76 written responses via our questionnaire. In addition we received many more comments through attending the support group meetings (please see Appendix A).

Question 1 (Please could you provide the first part of your postcode?)

We asked respondents to state the first part of their postcode in order to help us identify which area their experience related to. Out of those who did respond, the majority stated they resided in the CO15 postcode area of north east Essex (the Clacton area), followed by the C04 district (north Colchester area).

Postcode area / Number of responses
CO1 / 4
CO2 / 4
CO3 / 7
CO4 / 9
CO5 / 6
CO6 / 3
CO8-CO10 / 0
CO11 / 1
CO12 / 4
CO13 / 3
CO14 / 0
CO15 / 20
CO16 / 5
CM9 / 1
CM77 / 1
RM17 / 1
NO ANSWER / 1

Question 2 (Please select from below the word that summarises your experiences of NHS health/social care services over the past 12 months – ‘good’, ‘average’ or ‘poor’)

Respondents were asked to select a word that described their experiences of NHS health/social care over the past 12 months. 54% (40 out of 74) considered their experience to be either ‘excellent’ or ‘good’. No respondent considered their contact with services to be ‘extremely poor’, although many have made some suggestions for further improvement which are included later in this report:

Response / Numbers of respondents
Excellent / 5
Good / 35
Average / 18
Poor / 11
Extremely poor / 0
Not applicable / 5

Question 3 (Are there any experiences, either good or bad, that you would like us to know about and, if appropriate, do you have a view on how this experience could be improved?)

We asked people to highlight any experiences they felt could be improved. The following key themes were suggested by respondents:

  • Access to GPs - Many respondents said they felt frustrated at not being able to book an appointment with their GP. One respondent suggested there should be later opening times at GP practices.
  • Staff attitude - There were some mixed views from respondents with some suggesting that they had a positive experience of staff (very kind, very busy but attentive). However there were other responses that highlighted the issue of a negative attitude (some receptionists and nursing colleagues). One respondent also suggested that staff needed to be more proactive in ensuring that their patients are given adequate levels of food and water while in hospital.
  • Condition of buildings - Comments were received on the standard of the estate – with one respondent praising Colchester and Clacton hospitals and the Walk in Centre as ‘greatly improved’. There was also a call from a respondent that there should be better access for disabled people in healthcare buildings.
  • Referrals - Some respondents felt they were confused and often lost in the referral process, often having to speak to a number of different people to get their query resolved. Respondents said this caused them anxiety and wasted their own time. There were also suggestions about the cost associated with sending letters out to patients advising them of rescheduled appointments. One respondent highlighted their appointment was rescheduled five times and referred to the cost and time with sending ambulances for transporting the patient.
  • Medication wastage - There have been repeated comments from respondents about wastage associated with prescriptions. One person highlighted they had wasted their own money to pay for GP prescribed eye drops, only to be told by an eye specialist that they should not be using the medication.
  • Test results - Availability of test results in written form could be further improved. One respondent suggested that this should not be verbal.
  • A&E and urgent care treatment - Treatment for an elderly lady who suffered a fall was handled promptly. Similar experiences at the Minor Injuries Unit at Clacton.
  • Communication - Among many respondents there appeared to be poor communication between the GP and Colchester Hospital. One respondent suggested people with long term conditions should have access to a specialist nursing team either by email or phone so that the patient could receive advice when needed.
  • Travelling to Colchester Hospital - One respondent said travelling to Colchester for urgent treatment is too far. Clacton Hospital should be used to alleviate some of the pressure and to allow patients to be treated closer to their home. Several people called for a new hospital to be built in Clacton.
  • Waiting times - Often these were too lengthy and in one instance, a patient who experienced pain associated with arthritis had to take out private treatment after she was advised of a 12 week waiting time.

Question 4 (If you have used NHS health/social care service recently, how would you rate each of the following areas? Respondents were asked to select a rating of ‘Good’, ‘Average’ or ‘Poor’).

  • Timeliness – whether they were seen on time;
  • Courtesy – were they dealt with in a courteous way by staff;
  • The standard of information provided to them;
  • They way different services interacted with each other to provide them with a seamless service.

Respondents were asked to rate their experience out of ‘Good’, ‘Average’ or ‘Poor’. The following scores were noted from the completed questionnaires:

Good / Average / Poor
Timeliness / 27 / 32 / 7
Courtesy / 42 / 18 / 4
Standard of information / 28 / 30 / 3
Ways services interacted with each other / 12 / 23 / 21

Question 5 (During your contact with NHS health/social care services, do you believe there were any areas of waste or duplication that you came across that could be stopped?)

We asked respondents whether they came across any areas of waste or duplication during their contact with services that could be stopped. The following responses were received:

  • Duplication in paperwork referring and re-referring patients across services/departments. Perhaps more multi-disciplinary team and cross organisation/sector meetings would benefit both NHS teams and patients;
  • More regular review of repeat medications and reduce the amount of meds prescribed;
  • Stop employing expensive agency staff and "overtime" payments;
  • Reduce the number of letters, especially those confirming appointments and make better use of phones, emails and texts;
  • Ambulances kept idle as a result of poor handovers;
  • Too many leaflets in doctors’ surgeries;
  • The cost of people accessing inappropriate services (for instance A&E when it is not a life threatening condition;
  • Explaining problems to nurse, and then repeating this to the doctor.

For a list of additional responses, please see Appendix B

Question 6 (Did you feel that any of your time was wasted?)

We also asked respondents to give their views as to whether any of their own time was wasted. Attending appointments they regarded as ‘unnecessary’ which resulted in little outcome for the patient emerged as a continuing theme. Withinthis, there were a number of different issues respondents gave views on (for instance time, inconvenience and cost in attending the appointment). There were also a couple of suggestions to make it easier for patients to access appointments – including the idea of extended opening times of GP practices and running weekend services. Below are the some of the responses we received: