BME Service Monthly Report June 2013

Use of Accident and Emergency Services
o  No of people engaged, with specific information on:
- Location of engagement / postcodes
- Age
- Gender
- Ethnicity
o  Key themes / issues raised from the engagement
o  Recommended actions /solutions to respond to the key themes / issues raised / Raw Data attached as a separate document > Pathways CIC _A&E Analysis June v.1
60 participants were engaged in their usage of Accident and Emergency services within Cheshire East.
Ethnicity data for participants
Postcode data for participants
Full breakdown per CCG:
South Cheshire 42%
Vale Royal: 12%
Eastern Cheshire: 46%
Of the 60 participants, 3 chose not to share their postcode details and referred only to the area in which they lived.
1 participant lived outside of the 3 localities (st7) however was currently visiting Macclesfield General at the time of
participation.
Age of participants:
Under 20: 4 20 to 35: 27 36 to 50: 18 51 to 65: 9 66 to 85: 2
From the data collection there appears no common themes between age, ethnicity, gender in relation to
the reason for attendance.
Attendance at A&E
Reasons for attendance at A&E included back pain, injuries, child related incidents, RTA amongst others. Although
Non-clinical information was ascertained from the participants, the responses to the reasons for their attendance
at A&E could suggest that over 55% of the conditions could have been sourced through alternative services, such
as back pain, cold and flu like symptoms, nose bleeds, sickness and diarrhoea. It was acknowledged by some
participants that A&E was their chosen service due to poor GP relationships, availability of appointment times
at surgeries, attitudes and general conduct of surgery staff and non-understanding of health services.
27% of the those that may not necessarily have required treatment at A&E, related to children and therefore
parents treated as an emergency.
In regards to attendance over a 12 month period, almost 70% of participants had used A&E once during the past
12 months, 28 % of participants had attended 2-5 times and 1 participant identified that they had used A&E up to
8 times during the past year. Reasons of this were due to strained relationship with GP following a breakdown in
communication and views of discriminatory treatment following a RTA last year.
Whereas it appears that almost all of participants were satisfied with the treatment, quality of care and general
service provided, it’s clear that there is a gap between service and perceived treatment / expectations of patients
and their conditions. One participant suggested that they felt racially discriminated against having attended A&E
having felt faint and felt that the support offered by both receptionists and nurses was inadequate.
Several participants complained that they had to wait for over 5 hours prior to consultation
in what they believed to be conditions / injuries that required immediate attention.
Additionally, a triage nurse was used to assess patients following registration in full view of other service
users and this was felt to have breached patient confidentiality.
Communication and provisions of interpreting appear to be a significant factor in participants commenting on
negative experiences. Due to communication / language issues, some of the participants felt that they were treated
inappropriately and that others without communication barriers were treated much sooner. As a consequence,
some felt this direct discrimination.
Choose Well Campaign
o  No of people engaged, with specific information on:
- Location of engagement / postcodes
- Age
- Gender
- Ethnicity
o  Key themes / issues raised from the engagement
o  Identified barriers faced to uptake of the Choose Well message
o  Recommended actions /solutions to respond to the key themes / issues raised / barriers faced / The BME Service has this month facilitated 22 Sessions engaging a total of 69 individuals from multiple BME communities across Cheshire East, in addition to sharing information with those participants of the A&E questionnaire.
Regular monthly activity has resumed as we continue to deliver sessions weekly at Eaglebridge Health Centre (SC) and Watersgreen Health Centre (EC) that are now directed towards Choose Well and accessing the right services. Social Inclusions Coordinators attend regular meetings with Shapla and Ocean in South Cheshire, the Gypsy and Traveller Community at sites in Winsford and Northwich, the Polish and Slovak church groups in Macclesfield, Northwich and Crewe. Choose Well information boards have been updated at regular drop in centres within South Cheshire to support BME communities in understanding / accessing the right services for conditions. Further work is underway with Age UK in East Cheshire to support elderly people from BME communities to support information and guidance of services, self care and wellbeing.
Feedback from drop in sessions per locality
Eastern Cheshire
·  Little if any information on how to access / register with GP’s
·  Accessing A&E is only option as cant register with GP
·  No language appropriate support available on local CCG website – Information has been shared with those that were engaged
·  Access to services becomes limited when required during working hours
·  A&E offers a 24 hour service
·  No knowledge of other services
·  Did not know that pharmacists could provide support other than to give medicine
South Cheshire
·  Had used Choose Well information following instruction by Social Inclusion Coordinator however when contacting NHS Direct they referred through to GP, GP could not facilitate an appointment for up to two weeks and therefore went to A&E for treatment
·  No relationship with GP / not registered due to lack of information and negative comments from family and friends. One participant identified that the GP asked for them to arrange their own interpreter for the next appointment
·  Understanding the role of pharmacists
·  Cultural response / behaviours – have always used A&E
·  Knowledge of services and how they can support patients. No understanding of Choose Well
·  Suitability of communication / language appropriate materials
Vale Royal –
·  Understanding of local services and how / who they support. Communication within the community as to changes in national services had led to confusion
·  Accessibility due to work
·  Cultural Awareness – accessed services as directed by partner
·  Suitability of materials
People’s choice in accessing services is often decided upon the impact of past experiences, not just necessarily within Cheshire, also outside of the UK. The BME service is communicating Choose Well at almost every opportunity when engaging communities, through drop in sessions, focus groups, one to one support sessions. Communication is a significant barrier, not just from patients trying to access service, but for those that hold negative experiences within services. At a recent South Cheshire drop in session, the participants had initially started to identify positive experiences within services, however the positives were soon clouded by the negative responses of others of which then influenced negative comments from those that had initially had ‘good’ experiences. GP’s and receptionist were identified as one of the most significant influencers of negativity towards health services; waiting for appointments, poor communication, little if any respect / dignity shown by reception staff towards patients or their community. Those engaged in sessions generally felt that their experiences when attending A&E were much more positive therefore informed their decisions for future support. Several participants have commented that on the occasion they had contacted NHS direct they were referred to hospital because the GP’s were not accessible, therefore if that was common practice, then why is there a need to waste further time speaking with NHS Direct, when that time could be used waiting at A&E
Prior to delivering Choose Well information sessions, almost all that we have engaged had little knowledge of the support pharmacists can offer.
Other objectives – Maternity / Smoking / Screening / Elderly People
o  No of people engaged, with specific information on:
- Location of engagement / postcodes
- Age
- Gender
- Ethnicity
o  Key themes / issues raised from the engagement
Recommended actions /solutions to respond to the key themes / issues raised / Tulip Sessions are continuing on a weekly basis at Eaglebridge Health Centre and have scheduled in regular sessions at Victoria Children’s Centre in Northwich. Tulip has enabled mothers with young children an opportunity to access health and wellbeing support for themselves and their children through support of a health advisor and linking in with Health Visitor teams. We have been working with Health visiting teams in Vale Royal in developing relationships and attaching Tulip to their attendance at the Victoria Children’s Centre. We have agreed a provisional programme to support attendees in both Vale Royal and South Cheshire that is inclusive of Physical and Mental Health, Wellbeing, the impacts of Welfare Reform, Moving into employment. The format will consist of a rolling 5 week programme with concentrated support sessions. This programme is now being delivered
There have been 8 Tulip sessions facilitated during July with 13 attendees from BME communities, 15% of attendees were from white – European ethnicities, further engagement work is currently being undertaken with other BME communities to identify barriers and encourage attendance. We are using the data we collect from usage of A&E to support parents with young children to consider alternative services / understand self care and treatment of conditions for infants through Choose Well.
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In regards to elderly people (Eastern Cheshire) a further engagement meeting is pencilled in for early July with Age Uk and the 50+ network to identify further opportunities to engage BME communities in a collaborative approach from all organisations.
We are currently developing plans with the 50+ network in how the BME Service can support their healthy lifestyle event in October.
Asset Mapping
o Table of identified community assets with specific information on:
- Name
- Description
- Location
- Target audience
- Contact details
- Frequency of meetings (if applicable)
- Services offered (if applicable / Data is continually being obtained and database updated regularly from engagement with BME communities. In line with Service Level Agreement a full documented database will be shared with the Clinical Commissioning Groups at the end of July.
Patient Experiences
o No of patient stories produced on film with specific information on:
- Location
- Age
- Gender
- Ethnicity
o  Type of service commenting in (acute hospital, primary care, community provision, mental health etc)
o  Positive or negative experiences / Videos continue to be collected with clients / communities on what services are accessed and what were the participant responses.
We are currently collecting patient experiences on why they access the services they do, what services are they accessing and their responses to service delivery with a specific focus on Accident and Emergency, knowledge of services, primary, secondary and acute and collaborating with Choose Well.
3 case studies have been attached to this report.

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