NHS Kingston

Polysystem / Surbiton Hospital redevelopment

Stage 1 Consultation Report

1.Introduction

As part of a programme being led by NHS Kingston both to redevelop the Surbiton Hospital site and to deliver a new model of healthcare (referred to as a polysystem) across Kingston, NHS Kingston carried out a consultation to engage with key internal and external stakeholders and with the public.

Following approval from Kingston Council's Health Overview Panel in August 2009, NHS Kingston held an informal public consultation between 1st September and 30th November 2009.

The topic of consultation was “Better care systems and Surbiton Hospital site redevelopment” and the aim was to gauge initial responses to the key principles behind NHS Kingston's plans.

A further pre-planning application consultation (for the Surbiton Hospital redevelopment) is planned in 2010 when NHS Kingston will consult on more detailed proposals for redeveloping the hospital site.

This report details the processes used to gain opinion from members of the public and from non-clinical stakeholders. The process used / results gained from engagement with clinical stakeholders will be dealt with in a separate report.

2.Consultation methodology

In order to explain the principles behind the new model of healthcare being proposed for Kingston (referred to as a polysystem) - and the proposal to build a polyclinic on the Surbiton Hospital site - the following activities were arranged and information produced to inform stakeholders and the public about the plans.

  1. Stakeholder group meetings with healthcare professionals, local council staff, councillors and local community group representatives were held in July and August 2009. At these meetings, NHS Kingston sought guidance and recommendations for how best to proceed with the consultation. A further staff and stakeholder consultation meeting was also held on 6th October. A separate consultation meeting for staff and carers from the South Bank House, Mental Health Trust facility on the Surbiton Hospital site was also held.

  1. Two A4 information leaflets were produced (see Appendix A):
  • a 4 page leaflet entitled "Bringing better care closer to the community" explained the key principles, aims and objectives which would underpin the development of new services in four Kingston neighbourhoods.
  • a double sided leaflet entitled "Surbiton Hospital site redevelopment" explained NHS Kingston's intentions to redevelop the hospital site and dealt with key questions and concerns previously raised by councillors and the public about possible uses for the site.
  1. Public meetings were arranged in each of the four neighbourhood areas of Kingston, from 1.30pm-2.30pm and 7.30pm-8.30pm as follows:
  • Maldens & Coombe - Weds 7th Oct. – Christ Church, 91 Coombe Road, New Malden
  • South of the Borough - Tues 13th Oct. – St. Mary’s Centre, Church Lane, Chessington
  • Surbiton - Weds 21st Oct. – Surbiton Hospital, Ewell Road, Surbiton
  • Kingston Town - Weds 28th Oct. –United Reform Church, 14 Eden Street, Kingston

Edward Davey, MP for Kingston and Surbiton, chaired the meetings and Clive Nattrass, Polysystem Programme Director, gave a presentation that explained NHS Kingston's intentions for the programme, in context with the wider Healthcare for London initiative around polysystems.

  1. An A5 flyer entitled "Personalised care, closer to home" was used to publicise the events (see Appendix A).
  • This contained a high level summary of the plans, details of the public meetings and a request form inviting people to register their interest and to be sent further information.
  • 36,000 copies were distributed via the Kingston Guardian and 18,000 copies via the Kingston Informer. (Taking into account some overlap in distribution, it is estimated that over 45,000 homes were reached, equating to 57.7% of the 78,000 homes in Kingston). 1,000 copies were also distributed to doctors' surgeries, residents associations, libraries and community groups.
  • This format and distribution method was selected to reduce the cost of producing and distributing large information packs to a potential uninterested audience. Using the local papers a wide distribution was achieved at a fraction of the cost (1/5th) of a solus distribution.
  1. Posters advertising the public meetings were also sent to libraries, community centres and doctors surgeries (see Appendix A).
  2. A unique website was created for the polysystem programme to enable fast, easy access to the relevant information about the programme and consultation via a direct web address featured on all printed materials.
  • Updates were published explaining what a polysystem is, about the public meetings, and about GP and pharmacy meetings.
  • Comments fields were included in each update, allowing people to publicly respond to the articles.
  • Site visitors were also invited to "submit a question" to the polysystem team via a simple contact form.
  • The polysystem team responded to 14 individual comments and enquiries submitted via the website.
  1. Press releases were sent to the local media and an item was written for the news desk of the local radio station (Radio Jackie). Articles appeared in the Surrey Comet and Kingston Guardian on 9th + 11th September, 19th September, 7th October, 29th October and 30th October and the Kingston Informer on …. ; and on the front page of the Kingston Council's Health Bulletin in October. The Health Bulletin goes to all borough councillors, key local health organisations, the local media and appears on the Council's public website at (See Appendix A).
  2. Letters (see Appendix A), leaflets and questionnaires were sent to 600+ local community representatives, associations and organisations and to 98 people who registered their interest via the flyers.
  1. Questionnaires - 11 questions on a variety of healthcare topics and practical aspects of the Surbiton Hospital site redevelopment - with a variety of open ended and more directive questions seeking people's views (see Appendix A).
  1. Throughout September and October, NHS Kingston representatives also attended 4 x Royal Borough of Kingston Council Neighbourhood meetings and 1 x Health Overview Panel meeting - all of which were held in public, to brief attendees (councillors and public) on the plans. Flyers and leaflets were distributed at these events.
  1. Information about the polysystem programme and consultation was also made available at NHS Kingston's public Annual General Meeting on 28th September; its town centre Health Fair on 22nd October and a Patient Participation Group meeting in November.

Consultation reach and response

  • 45,000 homes (approx. 58%) sent high-level information.
  • 700+ local community representatives, organisations and interested individuals were sent more detailed information.
  • 128 individuals attended 10 consultation meetings (8 x public meetings, 1 staff / stakeholder meeting and 1 x South Bank House staff and carers meeting).
  • A further 380+ individuals were reached via 5 council meetings (held in public); an NHS Kingston public board meeting; a stand at an NHS Kingston Health Fairand a patient participation group meeting.
  • A total of 104 questionnaires were returned (approx 8.6% of the 1,200 sent out / made available at meetings).
  • The results of various qualitative ‘Needs Assessments’ with seldom heard groups have also been incorporated.

3.Feedback results

  1. Responses by area
  • Questionnaire responses

By far the majority of questionnaire responders resided in the Surbiton area. This was to be expected since half of the consultation was focused on the changes to be made in that area, in the form of redeveloping the Surbiton Hospital site. See Figure 3.1.

Figure 3.1

  • Meeting attendance

Similarly, attendance at meetings varied greatly by area, with 23 people attending in Kingston, 15 in Maldens + Coombe, 65 in Surbiton and 8 in the South of the Borough.

Figure 3.2

  1. Feedback about healthcare services and professionals

When questionnaire responders were asked an open question about what they would most like to see NHS Kingston doing, in light of the proposals, to improve local healthcare - the most popular responses were:

  • for more tests, treatments, ‘hospital-like’ and community services to be available in Surbiton / other suburbs (26%);
  • more out of hours care (12.5%);
  • and more choice / flexibility / helpful reception staff in regard to when and how appointments can be booked (9.6%).

See Figure 3.3.

Figure 3.3

When asked an open question about which elements of the current healthcare service they most liked and wanted NHS Kingston to preserve when developing the new care systems, the most common answers were:

  • easy access to good GPs (19.2%);
  • caring, high quality staff, esp. personal relationship with GP (18.3%);
  • and the current services - and in some cases also previous or expanded services - found at Surbiton Hospital (9.6%).

See Figure 3.4.

Although 28.8% of responders declined to answer this question, this is in-keeping with the fact that many other questions were also omitted by some responders - and the fact that some only filled in a small proportion of the questionnaire - reflecting the fact that many people only wished to convey their views about certain subject areas.

Figure 3.4

When given a list of possible areas for improvement and asked to rate which were "very important", "important" or "not important" the most popular choices for "very important" were:

  • to be seen by the most appropriate healthcare professional (66 responders / 63.5%)
  • for the phone to be answered at all times between 8am-6pm (65 responders / 62.5%).

Next were:

  • to get an appointment the same day as you call (52 responders / 50%)
  • to be offered a range of appointment times between 8am and 6pm (52 responders / 50%).

The majority of responders rated it "important" to:

  • receive test results in a day or two rather than a week or two (46 responders / 44.2%)
  • to be offered evening and weekend appointment times (38 responders / 36.5%) - although 27 responders (26%) thought this not important.

To have a health centre to close to where you work rather than where you live was rated as "unimportant" by the majority - 42 responders / 40.2%, although many of these did state that they were retired. See Figure 3.5.

Figure 3.5

When asked directly about how NHS Kingston could improve the availability of healthcare staff, the most common response was that the current system works well or works okay (18.3%). The next most frequent suggestion was for out of hours services to be improved (13.5%) including the provision of a manned phone. See Figure 3.6.

Figure 3.6

Again a high proportion of responders chose not to answer this question, although since many felt the services worked well it is likely that others who declined to respond also saw no need for improvement.

When offered a range of service areas that "could be provided by a polyclinic or polysystem in your area" 40.4% of responders wanted urgent care; 35.6% wanted diagnostics; 29.8% wanted minor procedures and 24% wanted long term conditions. See Figure 3.7.

Figure 3.7

From the list of services that could be provided by a polyclinic or polysystem, the ones that people most wanted to see being improved were:

  • More urgent care to relieve Kingston A+E (18.3%)
  • More diagnostic appointments + faster results (15.4%)

Other proposed improvements made between 3 and 9 times (in order of popularity) included:

  • Minor procedures closer to home / at GP surgeries
  • Improve dentists (esp. more NHS + for disabled)
  • Improve access to physio / osteopathy
  • Out patients
  • Health information + advice (inc. social services)
  • Better / more joined up care for young and old
  • More community nurses / home visits
  • Better use of chemists / on site / ajoining GPs
  • Opticians / opthalmic services
  • Happy with services
  • Improve long term conditions

See Figure 3.8.

Figure 3.8

From the public meetings 3 generic questions about healthcare services arose:

(many more are covered in the specific sub-sections which follow)

Surbiton / * How will the changes affect patient choice? Will patients be able to choose which hospital they go to?
* Do we know statistically what the community will need in the way of services, not just what people think they need? We have an ageing community and I am keen that what we get will serve us going into the future.
Maldens + Coombe / * Would it be possible to bring some specialists out of the hospital to practice in the community? Or will this mean they spent too much time travelling?
  1. GP services

People who responded to the questionnaires were asked a range of both open-ended and more directive questions about GP services. The responses showed a number of interesting trends. Of all service areas, GPs and doctors were the most frequently mention aspect of healthcare - but this is reflective both of the fact that much of the questionnaire did focus on this aspect of primary care - and that GPs and doctors are the front line service provider and usually the main experience people have of the health service. (See Figure 3.12, page 13.)

In response to open-ended questions, the most frequently made comment about GP services stated that easy access to good GPs was the most important thing for NHS Kingston to protect when developing the new care systems - with 19.2% of responders making this unprompted comment. See Figure 3.4 (page 6).

It was also evident that people were happy with the number of GP services available locally, as this was the 2nd lowest option selected (just 2.9%) when offered GP services among a list of possible services to be provided closer to home. See Figure 3.7 (page 7).

In response to both open-ended questions, and more directive questions, many people wanted better flexibility of appointments. When asked how improvements that could be made to healthcare services generally, the 3rd most popular suggestion was for more choice / flexibility / assistance in how and when appointment bookings could be made - with 9.6% of people asking for this in response to an open question. See Figure 3.3 (page 5). When asked directly about how GP appointment bookings could be improved, the most common answer was for more options for advanced bookings - 17.3%. See Figure 3.9.

Figure 3.9

Some specific suggestions for how to improve appointments bookings were:

"more options for advanced bookings"

"book appointments in advance not just on the day"

"there are not enough appointment slots available to book a few days or weeks in advance"

"stop having to book at least 2 days ahead or ringing before 8am for same day appointment"

However, 11.5% of responders also felt that the system for appointment bookings already works well, or works okay. GP surgeries that were mentioned positively were Oakhill x 4, Central x 4, Merritt x 2, The Groves x 2, Kingsdown, Chessington Park, Brunswick, Berrylands, Grays and Orchard all x 1.

The next most common suggestion for improvement was better phone access / answering to be provided, with 8.7% of responders suggesting this. Other areas for improvement suggested were: the introduction of internet bookings, improved receptionist approach / attitude, more staff needed as appointments were hard to get, a walk-in or sit-and-wait service (to fill missed appointment slots), email bookings, and to speak to people not machines. See Figure 3.9.

Many people also wanted regular access to a known GP with 9 responders (8.7%) mentioning this as being important when asked for other general ideas for improvement (see Figure 3.10) and a further 10 other references (9.6%) being made to the GP relationship throughout all of the questions. See Figure 3.10 below.

Figure 3.10

From the public meetings, 23 questions about GP services arose:

Surbiton / * Are all GPs in the area supporting the plan?
* Will the new system provide a better out of hours service?
Maldens + Coombe / * Will the local GPs – including Brackendale – be involved? Are they obliged to be a part of the polysystem?
* I have my GP’s mobile number. I don’t want the new polysystem to change my access to my GP.
* My GP practice is only small. In the new polysystem, will I be sent to another GP who is further away?
* How will GPs receive payment for different services under the new system? Won’t it be so complicated that we'll need more accountants to work it out?
* Will the new system be creating much larger GP practices? For example if several small practices move into one larger premises?
* GP practices in New Malden should work collaboratively to share specialist services and equipment so that patients can be referred between practices if one offers a service that another does not – instead of referring them to the hospital.
* GPs should work together to provide a better out of hours service and also to provide an improved urgent care service so that urgent treatment that does not require a trip to hospital can be treated more locally. This would reduce wait times at Kingston A&E.
South of the Borough / * There is a problem with the Gosbury Hill surgery site. If we don’t want to move to a GP-led clinic, can we keep our own doctors? I don’t think all the practices should move in to one building.
* Can we have a better GP out of hours service – especially at weekends?
* Whilst we are happy for more services to be brought into the neighbourhood, and for GPs to work together to solve issues of providing more services, where continuing care is a concern we do not want people to become anonymous. Quality care in those situations can only be done where a patient is known by the GP or other service provider. We need to ensure continuity. Mistakes can be made when a person is never seen by the same person twice.
* Is it feasible that one of the Chessington GP practices could move into the new Surbiton polyclinic?
Kingston / * How easy will it be to get to the GP practices? I am a patient at Oakhill and it is not easy to travel to.
* Will GP surgeries be open on Saturdays? Will the out of hours service generally be improved?
* Which organisations are being consulted on the project? Are there any GPs being consulted?
* At the Labour Party conference it had been announced that boundaries would be scrapped for GP practices. How will this tie in with the polysystem?
* What will happen to the personal GP service I currently receive at the Brunswick surgery when it becomes part of the polyclinic? Will they lose the individual element that makes their service so good?
* Should GPs have to invest in new facilities and moving together in new locations? A new clinic at Kingston Hospital could be a problem. Shouldn’t GPs sort out problems with the existing service rather than getting a new facility?
* Patients have loyalty to their own GPs. Will they want to go somewhere where they will see a GP they don’t know?
* Do we know what proportion of GPs will move to run their surgeries from a polyclinic and what proportion will stay as they are?
* If a person is registered to another GP practice, could they still be seen by GPs providing primary care at Kingston?
* The proposal is for a very collaborative, co-operative model of health care. But how will this work on top of the existing competitive model? There are financial incentives for GPs to bring more activity to their practices. Will they really be sending patients to other practices?
  1. Community nursing (district nurses, health visitors, midwives, therapies, end-of-life care)

6.7% of questionnaire responders mentioned community nursing as something they wanted to move closer to home (3.8%) or to be improved (2.9%) - one of whom wanted community nurses available for longer hours. See Figure 3.7 (page 7) and Figure 3.8 (page 8).