Key issues to accessing health and social care services in Tower Hamlets

Contents

Evidence	2

GP Access	2

Telephone systems	2

Online appointments	4

Access to prescriptions	4

Referrals	5

Access to services and information	5

Interpreters	6

Suggested improvements	6

Feedback from deafPLUS	7

Eastern European Community in Tower Hamlets	7

Social Services	8

Delays in getting a care package	8

Lack of communication	8

Older People	9

Carers	9

Women and children	10

Hospitals	10

Appointment process	11

Interpreters	11

Follow Up	12

Finding services	12

Training of staff	13

Mental Health	13

Next steps for Healthwatch Tower Hamlets	14

Evidence

The findings in this report are based on:

224 pieces of patient and user feedback relating to access to health and social care services collected from 1 April 2016 through a combination of:

direct Healthwatch Tower Hamlets outreach and engagement at our own events, Enter and View visits, at service providers premises, at community venues and over the phone (128).

NHS Choices feedback on GP Practices (73)

PALS and Complaints data from the Royal London Hospital (39)

The review of 14,572 comments from ‘I want great care’ on the Royal London Hospital, St Bartholomew’s and Community Services

Community intelligence gathered by voluntary and community organisations as part of the Tower Hamlets Community Intelligence Report 2016

Feedback from Healthwatch Tower Hamlets members, Advisory Group, Task Groups and Board.

Copies of all of the feedback and reports are available from Healthwatch Tower Hamlets.

GP Access

Of the 224 comments collected since 1 April 2016 87 related to GP services, of those comments 10 were positive and 51 were negative. Positive comments tended to focus on the quality of doctors and reception staff with an appreciation for being listened to, receiving good information, explaining care

and feeling involved in decisions.

Negative feedback focused clearly on two key areas.

Surgery telephone systems that prevented people from accessing appointments (41 comments)

The unavailability or long waits for appointments, particularly non urgent appointments (46 comments)

Telephone systems

The inability to access a majority of local GP practices by phone to book an appointment is causing patients wide spread frustration. It is common for patients not to be able to get through to a practice at all.

I have received three letters to remind me to book an appointment but there is never anybody to pick up the phone in this surgery.

I have been calling the health centre the whole day. A total of 25 calls I have in my mobile phone. No one has answered the phone in the whole day.

Or for people to have to wait between 30 minutes to an hour to get through on the phone line often only to be told that there are no appointments available.

The phone system is totally broken. It is usually impossible to set up an appointment by phone. It will literally tell you that there are no appointments with any doctors ever. (NHS Choices)

It seems to be common knowledge amongst patients that you need to phone the surgery first thing in the morning in order to have any hope of getting an appointment. This leads to a heavy number of calls at that time which exacerbates the problem further. For people who work it can be extremely difficult to arrange an appointment as they need to be traveling to, or be at work, at that time. It can also be a problem for parents who need to get children to school.

Many practices suggest people come down to the surgery first thing in the morning in order to access an appointment if they can’t get through on the phone. This can lead to long queues forming outside surgeries upwards to hour before they open with people standing in the cold when they may already have an existing health condition.

Trying to get an appointment with this surgery is like being involved in some horrible Kafkaesque nightmare.

1-hour queue for an appointment not practical - very difficult for people who work.”

Many GP practices have put in systems to ensure emergency and 48 hour appointments which have received both positive and negative comments with those who are able to come into the practice more likely to be able to access.

In order to access these appointments some patients are now saying that all their concerns are urgent which continues to put more pressure on the system as a whole and make it more difficult for genuine urgent appointments.

The triage or Doctor First call back system seems to work well with some patients who appreciate being able to confirm their self-diagnosis or course of action and therefore avoid a trip to the GP Practice. It can also help you to access an urgent appointment more easily. However some find it difficult discussing issues or expressing themselves over the phone rather than face to face. Others find it difficult to wait for a call back, if the Practice number is withheld people don’t recognise the call back, they’re at work and can’t discuss their health issues or they don’t have someone to interpret.

“You don’t want to go out in case they ring you and so you stay in the house all day.”

There is some feeling that this should not be a ‘one system fits all’ approach and that some groups should be given priority access e.g. older people, children with a learning disability. Unavailability or long waits for appointments

Once people have been able to reach the surgery, either in person or by phone, they are finding it difficult to access appointments. Waits are frequently four to six weeks for non-urgent appointments and in some cases people are told that there are no appointments available and that they need to call back every day to see if any appointments have been released. This can lead to significant delays in treatment and some patients have simply given up trying to get non urgent screening appointments.

Many people simply default to A&E and the Walk in Centres as they know that they’ll be open and they’ll be seen. Some also believe they’ll receive a better quality service.

Just get yourself to the walk in centre or to A&E. Trust me it's better to wait a couple of hours in a queue than try to deal with this place when you're in a bad way.

Online appointments

Some practices seem to be operating effective online booking systems.

The online booking system works a treat and can usually get an appointment within a week (although usually only during work hours) - not sure why people are using the telephone in this day in age, apart maybe for emergency appointments only.

However these seem to favour those who know how they operate.

Do not try to get an appointment by phone - get an online login and login at exactly 08:00 to book an appointment

I’ve been trying several times a day for four days now to book an appointment online but there have never been any available. I don’t understand how the system works and if there are never any appointments online why did they encourage me to register.

There is a specific issue around access for people with learning disabilities who need to be able to see the doctor of their choice as quickly as possible, at an appropriate time of day (e.g. early appointment before the waiting room fills up) and not to be kept waiting for long periods.

Access to prescriptions

There seems to be an issue with accessing prescriptions and medication urgently if the GP is not available and the chemist is closed they are left with no prescriptions

48 hours to wait for repeat prescriptions. There isn’t any explanation for the wait. Sometimes you can’t help but run short. If you can’t get your prescription, you just have to miss your tablets. That’s dangerous.

For some patients who require regular medication they cannot gain access to it, due to the simple fact of chemists being closed on a weekend. If closed they are left with no prescriptions

No protocol in place for patients who have not been able to have their heart meds dispensed from Lloyds chemist because it is closed on weekends. Lloyds is being run as a commercial enterprise it should be open 24/7 hrs.

Referrals

There seems to be an issue with gaining referrals to other services from the GP’s with a range of issues around administration systems and processes between GPs and secondary care.

He told me he will post a referral to my home to see an eye specialist. I waited for two months and no letter has come through the post from my GP. I went back to my GP and he said a letter has already been sent to me. I said I have not received it and I doubt if the surgery sent me anything. He promised to send me another letter and it has been a month and I have not received anything. I think my GP surgery is slow and not very reliable. I will go back to my doctors and ask for another copy of my referral letter to be given to me in person. This I hope will speed up my referral and hopefully treatment for my eye.

Access to services and information

With ever changing policies and strategies on how to move services away from hospitals and increase patient self-management patients are becoming increasingly more confused as to where they should access care. There default position is often to go to the GP and if they can’t access their GP then to go to A&E. This is further exacerbated by the large percentage of the population who have English as a second language and who may also neither read nor write in their own language. As this process of change seems to be increasing in pace it is important to consider how information gets through to patients in order for them not only to keep pace with, but also to drive that change.

Many people access information on health services through GP practices, but many practices are overloaded with information and initiatives and are not geared up to deal effectively with information distribution. People need to see their local health centre as somewhere you can go when you have a minor urgent health care need. As one of our Healthwatch members said “when you’re ill you always think it’s urgent”. You don’t necessarily want to sit and wade through a leaflet on where you should go or who you should ring.

The Community Intelligence Report 2016 recommended that GP practices be a place people can go to access information about services that can help them to manage their health and wellbeing. For some people, however this does not happen as the GP is lacking in the knowledge.

Didn't feel that her GP had a very good awareness of epilepsy and keeps having to repeat the same information all the time or if it's a new GP she has to start from the beginning. She is more of an expert. She tried to start a group at the GP practice around info for patients but they seemed too reluctant to get it started.

Interpreters

The issue of Bengali and Somali speaking staff is still coming up as an issue but perhaps not as significantly as it has in the past. Concern is now more focused on older isolated people who may not have strong family networks around them where they wish to talk about issues of a very personal and private nature. There was a feeling that Bengali staff should also be able to interpret or speak in Bengali and a need for more Somali frontline staff.

It can take longer to access an appointment when and interpreter also needs to be booked and there seems to be a tendency for them to be cancelled more frequently. Again this can lead to long delays in treatment.

Bengali reception staff need to be Bengali interpreters. No family/personal feeling not there.

Elderly patients find it difficult to explain what’s wrong so more Bengali doctors are needed.

There continues to be a desire for more Bengali and Somali clinicians and ensuring local young people are attracted into health and social care professions at all levels.

We are seeing a change in language needs of the local community with the need for a more diverse range of interpreters required with new communities moving from Europe.

Suggested improvements

Not surprisingly the most common suggestion for improving access to GP services is to increase the number of GPs and other practice staff. This would improve the number of available appointments together with the quality. There is a feeling that there is not enough time during the doctor consultations with patients required to book another appointment- having to go through the whole process again. There is also a suggestion of more training for people on phones.

Training of reception staff needs improving such that they have the knowledge to answer queries on the phone.

Understanding that there are restraints on space in many practices, it would be beneficial to have a dedicated information area within practices. This could move the focus away from GP Practices as just providing curative medicine but more as Health and Wellbeing Centres where people can get health and social care advice similar to a Citizen’s Advice Bureaus but for health. This might include a computer set up for people to easily access the joint directory website with the same information also available at Ideas Stores and across community centres and organisations.

Some further suggestions made by Healthwatch members are:

Ensure that GP Surgeries and frontline staff know where to get the right treatment and provide quick clear information on how to access the right service including making online appointments.

Provide visual information in community, health group sessions, tagged on to ESOL, luncheon clubs, in the Post Office queue etc.

Produce more visual education on different illness and where to go, e.g. DVD, advert, on TV.

More awareness on community channels (Bengali channel) or GP surgeries.

Support community health guides and community health champions to get the right information into social networks where it can be circulated among families and friends.

Develop a local NHS Direct number with Sylheti and Somali speakers be established and every household be provided with a fridge magnet with the phone number on. It could function a bit like NHS Direct but with the knowledge of local Health Centres, their opening times, where the walk in centres are, after hours services, third sector groups etc.

Feedback from deafPLUS

deafPLUS have particularly noted

A lack of access to BSL interpreters. This can cause:

confusion

delay in diagnosis

lack of understanding of treatment plan and how to take medication.

unable to explain any allergies/previous medical history

General lack of deaf awareness amongst medical staff

Looking at computer and talking.

Generally not being deaf aware = making appointment stressful for deaf patient and leaving patients unsure of their diagnosis.

Unable to book appointments as many require telephone bookings

Doctor’s calling out patient names when time for appointment and they don't hear this thus have missed their appointment.

Not making written format easy to understand (e.g. appointment letters, referral letter, treatment plans, etc.) Some deaf people need things such as above written in an easy clear format OR in BSL format.

Lack of specialist health services for deaf people E.g. mental health services specifically trained in dealing with mental health issues in deaf people

The Deaf Community is facing constant difficulty with telephone appointment booking systems, verbal prompts when their doctor is ready to see them, and rarely have a clear understanding of their diagnosis and treatment.

Eastern European Community in Tower Hamlets

DASL’s research into the health care needs of people from Eastern European communities found that 40% found the registration process for GP’s was complex and lengthy, some waiting months before they were informed that they had been successfully registered. Some people interviewed felt that a lack of adequate identification (e.g. passports, birth certificates, NIN cards, etc.) was a barrier to accessing health care and registering with a GP practice. Concerns were raised by one professional agency that when a person is trafficked or endured forced labour, very often they flee without any documents or identity.

Most stated that language was the biggest barrier with 77% saying this caused problems when trying to access health care along with the second being homelessness with 45% saying they experienced problems.

Women who had been pregnant said they were unaware of any ante natal care or what they could access in the way of pregnancy support, ante natal classes, activities or follow up care during pregnancy. One woman stated that she felt alone and frightened and didn’t know where to turn for help.

Recommendations

Registration at health care practices is explained or accessible in written information in EEC languages, or alternative information about where people can go if they are not eligible to register with a particular practice.

Information about health care services for people from the EEC be available in accessible formats (language, electronically via websites, literature in accessible venues), specifically Polish and Russian. Extend the hospital telephone translation into English, Bengali and Polish & Russian

Translation be available for pregnant women at every stage of pregnancy – including written information about stages of care.

Some organisations are already putting into practice ways to improve access to health care for their service users, lessons and good practice should be shared across the sectors.

Training for health care professionals on the intricacies of the EU regulations and health care in the UK for EEC.

Social Services

Delays in getting a care package

Through our preliminary work around hospital discharge, feedback direct to Healthwatch and through the Older People’s Reference Group we are picking up potential significant concerns regarding delays to care packages being put in place and to undertaking assessments. This is leaving patients and their family and carers very distressed and uncomfortable with no, or not enough, care.

My sister has been hospitalised for the past two months. She hasn’t been bathed and is very uncomfortable. She is emotionally stressed and the nurses have said she is ready to go home. Her social worker hasn’t organised a care package for her and is never available. The social worker is never available and there is a dispute over who will be paying for the services she receives. They say the equipment needed isn’t suitable for her but I’ve told her mattress and bed has been delivered. I don’t know what to do, I’ve taken two days off to sort this out and bring her home.

Lack of communication

Another issue is the lack of communication between the different professionals involved in a patients care.

Currently has a care package in place. She had a call from a social worker to say that they wanted to make an appointment for a short term assessment of her care. A couple of weeks later another social worker called to make an appointment to undertake a long term assessment. Shortly after that she had a call from the Occupational Therapist who wanted to assess her physiotherapy needs. She felt that at the least they should be talking to each other and sharing information. Ideally they should all come around together along with other people involved in her support and that they should do the assessment together. She can talk to them about what she thinks she needs.”

Poor communication with client. Social worker confused of the needs of the patient. Reception staff ask too many questions. Bouncing from one professional to another. From 2016 I am struggling with my son’s care because the LDS did not complete the paper work on time, so I am able to access respite for my son. Some error with the payment not paid to the respite centre, so they blocked my access to book.

Older People

Over the past 12 months there have been various consultations with the Older Peoples Reference Group concerning social care services both with Council officers and Healthwatch Tower Hamlets. Some of the key issues that have come up through those consultations are:

Not knowing how to get a social care assessment. People are not aware of the emergency service social worker team. There was an instance where neighbours were constantly monitoring and supporting an older person who was suffering frequent falls.

Not knowing that you’re entitled to social care support and not knowing the system. They understand how to access health but not social care. Unaware of after care and enablement and whether they are entitled to it.

With the introduction of a charging system some people may be put off and assume that they’re not entitled to anything.

A sense that the information that is available is online and not accessible by a large proportion of the older population.

There should be more information/leaflets available at GP practices and at the hospital. Put something in East End Life and post directly to older people. Integrated Care Programme should focus more on social care. Care Coordinators should have a greater focus on accessing social care services.

Carers

A number of the Community Intelligence reports touched on issues relating to carers

Health service information should be targeted at women as they are the primary health and caring providers in families.

Important health messages promotions should include partnerships with grassroots services that are able to engage with women from communities that are poorly served by current services including carers. Priority must be given to those from particularly disenfranchised communities such as those of Somali heritage who rely on oral traditions of communication and have limited reading, digital and English language skills.

Health messages should be promoted through TV channels and touch screens at GP services in appropriate community languages so as to reach disenfranchised women and families through a range of approaches.

The CCG and Healthwatch should continue to work in partnership with small organisations to undertake further research into the changing needs of the borough’s most vulnerable women and carers so as to support them in maintaining good health for themselves and their families and dependents.

The views of parents of children with Special Education Needs and children themselves need to be listened to on how services could work better together to improve the quality of their care.

Women and children

Engagement undertaken by the Asian Women Lone Parent Association found that the biggest challenges faced in trying to help women and their children to be healthy and well were in relation to access and support services including getting their children into a good school, support to find a job/volunteering, knowledge and support to access local exercise services for themselves and their children.

Stress was a common challenge but over half did not know where to go to access mental health services. The recommendation was to look at a holistic programme that addresses all the needs of the women impacting on their mental and physical health. Stress is significant factor in their lives so looking at activities that will help alleviate this would be key.

Hospitals

In January 2016 Healthwatch reviewed 892 comments on services at the Royal London of which 219 related to access.

Reviewing the most recent comments the following arears still seem to be issues.

Appointment process

There seems to be an issue with gaining the hospital appointment once the GP has referred you.

Hospital appointments take too long to be booked. Especially when you are being referred via GP's.

Hospital appointments are very late, especially when your appointments have been referred by GP.

Booking hospital appointment after being referred by GP can be very difficult. It's really hard to get through to them, because lines are very busy. They take long to answer the calls. Sometime you have to call back the next day to book appointment. More staff should be employed at the central appointment line.

The online booking system was not user friendly. I tried to change the time of my appointment and the outcome was an appointment was made at another hospital (Whipps) without my knowledge.

We have had some difficulty trying to ascertain if the number of postponed and cancelled outpatient and surgery appointments is continuing to be a problems but it is still appearing in the patient comments.

My appointments were cancelled on several occasions and were never given an apology for that; also, I waited 45 mins before being seen.

However there does seem to be some distinct improvements in some clinical areas that hopefully can be replicated in other areas of the hospital.

Very fast appointment after GP referral. Good "one visit clinic system." Appointments tend to be regular and organised.

A general lack of communication seems to be felt

My son's scan results were supposed to have been sent from hometown. I called this morning and it was confirmed as done. When we arrived at the appointment there were no results available for consultant to view.

Interpreters

It is clear that there is a definite issue with regards to the language barrier.

Bengali people are treated really poorly and badly. She recounted a story of a midwife and the mistreatment. Midwives do not listen and the baby was born on the ward. Patient couldn’t speak English. The nurse said…you Bengali people have babies every year, why you crying?'”

Booking a translator before your appointment to see a GP or go to the hospital is very difficult because there aren’t enough translators available and they are fully booked”

During our Enter and View visit to Ear, Nose, Throat (ENT) Outpatients they estimated around 40% of ENT patients are not seen as a result of them not having the necessary interpreting support, this is resulting in unequal access issues and having an impact on delaying patients in receiving treatment/medicine or necessary valuable medical advice.

Case study from deafPLUS

Client RD fell ill at deafPLUS during one of our bingo sessions. RD has asthma and is a diabetic. She also smokes and has poor general help. DeafPLUS staff called an ambulance and RD wanted our volunteer JN to accompany her as they are also friends.

Upon arriving at the hospital, the nurses started talking to JN expecting her to interpret for RD. JN is hard of hearing herself and explained that they needed to book a qualified interpreter and that she was only there as a friend.

The nurses refused to book an interpreter and kept talking to JN to relay the information over. At the end, JN texted deafPLUS and we immediately went over to the hospital and talked the procedure through with the nurses. An interpreter was booked for the next day and deafPLUS had no option but to stay to interpret in the meantime with no medical training or knowledge which put the client at significant risk and disadvantage.

Follow Up

There seems to be a mixed comments concerning follow up appointments

Good follow - up cure - friendly and attentive staff.

Operation was great. The services and care are not joined together. Follow appointments have been difficult to get and to chase. This patient was meant to get an appointment after 4 weeks and it has now been 6 weeks and he hasn’t heard anything.

I was seen on time and attention was given and the follow up appointment was immediately issued to me at the reception.

This year I had an echo which was fine but the follow up appointment with a consultant was not there.

Finding services

Although this seems to be a rather superficial issue, there does seem to be a problem with regards to finding the actual service department leading to people missing appointments and finding it very challenging to get a new one.

The signs in the hospital are not clear as people/service users are not aware of the lifts and seem to be lost. The signs need to be more visible and clear. More information will also be good such as voice recognition as people with partial sight may find it hard.

The lift is very hard to use and some people say they don’t know how to use them.

I did find it hard to find the clinic initially though - as my letter said to come to ultrasound on the first floor - but the hospital signs do not mention ultrasound at all.

Training of staff

There is a general view that the staff require more training

Training of reception staff needs improving such that they have the knowledge to answer queries on the phone.

Mental Health

The Healthwatch Tower Hamlets Mental Health Task Group has identified as one of its priority areas the need to improve access to work opportunities for people with mental health issues and is co-developing a project with users, ELFT and the Department of Work and Pensions.

Many people have said they could have avoided lower level mental health problems if they had had someone to talk to and there seems people would prefer not to access overly structured support. Employing more people with lived experience within services

Length of wait to see a Psychologist

I was referred by my GP to see the Psychologist. It took me eight weeks to get this appointment.

Access to out of hours’ crisis support

The opening hours of the ‘crisis’ phone is not good, there is no one there in the evenings and weekends to answer the phone, sometimes I feel really awful in the weekends, but there is no one to talk to. (Deancross Personality Disorder E&V- 16th March 2016)

Not enough signposting of local support group services to service users

I would like to know more about activities that I can take part in, I get bored and need things to do…currently no one here is telling me where I can go to participate in other activities (Three Colts Lane CMHT- 29th June 2015)

Next steps for Healthwatch Tower Hamlets

As a result of the feedback that we have gathered above Healthwatch Tower Hamlets is in the process of developing a number of projects within in our work plan for 2016/17.

A series of enter and view visits to eight to ten GP Practice’s (2-3 in each Locality) in Tower Hamlets to review access to GP services. Working in partnership with the patients, CCG, CQC and the GP Care Group.

Our Mental Health Task Group is developing peer researchers who will undertake outreach to discuss access issues regarding mental health users.

To use Healthwatch England’s Social Care Toolkit to help local us to find out to what extent delays in social care assessments, package arrangements and reviews are a concern for local people.

Work with the Healthwatch Tower Hamlets Young Peoples Panel to identify the key issues impacting on access to health and social care services for young people. To agree project by end of September 2016.