Medway Health Debate Feedback Report 2010

Medway Health Debate Annual Event Feedback Report November 2010

www.medwaypct.nhs.uk1

Medway Health Debate Annual Event Report Background NHS Medway’s programme of public engagement is branded the Medway Health Debate and aims to ensure that all of our engagement activity is co-ordinated and meaningful, is acted upon and informs commissioning decisions.

The Medway Health Debate is a cycle of engagement which includes public meetings, meetings with local community groups and organisations, drop-in sessions at public venues such as the Sunlight Centre and the Medway Health Debate survey online.

Commissioning managers also engage with patients and clinicians on specific subjects and involve them in the redesign of services. Medway LINk representatives and patients are involved in all of our Strategic Change Programmes.

The Medway Health Debate culminates in an annual public event. This year this event was held in partnership with Medway Local Involvement Network (Medway LINk) at the Corn Exchange on 26 October 2010. The Medway LINk is an independent network of local people and community groups working together to influence and improve health and social care services in Medway.

Feedback from our engagement programme, national and local surveys and Patient Advice and Liaison Service (PALS) and Complaints data, is taken to NHS Medway’s Patient Experience Network. This group ensures that public and patient feedback is co-ordinated and acted upon.

This feedback also directly influences the plans for future healthcare in Medway, set out in our Strategic Commissioning Plan and Annual Operating Plan and informs our Communications and Engagement Strategy.

The difference our engagement activity makes and the way people are influencing healthcare in Medway is reported in our Engagement Annual Report, available at www.medwaypct.nhs.uk/publications The people who use the NHS in Medway have invaluable first hand experience of health and social care locally. They help us develop, design and improve services for everyone in Medway. We couldn’t do it without them.

The Medway Health Debate annual event The event at the Corn Exchange on 26 October was publicised in the NHS Medway magazine Health Matters, on our website, in our e-newsletter “Growing Healthier”, and by personal invitation to everyone on the Medway Health Network as well as to a wide range of clinicians, partners and stakeholders.

More than 150 people attended. There were more than 30 third sector organisations and delegates reflected Medway’s diverse population.

The event recognised the importance of public involvement with speakers from Medway LINk and clinicians and patients talking about how they influenced commissioning decisions.

The theme of the event was how to get the best use out of limited public resources, while improving health outcomes and the experience of patients. For example by avoiding unnecessary hospital admissions by diagnosing and treating people earlier and by helping people to manage their own health better.

We asked people what they thought about healthcare locally, what should be prioritised and where money could be better spent. We wanted to know what we should stop doing and how we could support people to better manage their own health. We also asked people how they wanted to be involved in the planning of local services in the future.

The event was opened by NHS Medway’s Chairman Denise Harker. NHS Medway’s Acting Chief Executive Helen Buckingham and NHS Medway’s Director of Finance and Assurance Jonathan Bates gave presentations on the challenges and opportunities faced by the health economy in Medway, the importance of improving patient experience and outcomes and the need for a slimmer, more effective NHS. Brenda O’Neill, Terry Horobin and Neville Dack from the Medway LINk talked about the work of the LINk, how people could get involved and the difference it is making locally.

Optometrist Niall O’ Kane spoke about how public and patient engagement informed the development of the Primary Eyecare Acute Referral Scheme (PEARS). Joy Birdsey talked about how her Isle of Grain Disabled and Carers Group lobbied NHS Medway and brought a much needed Phlebotomy Pilot to the area.

The afternoon workshop sessions, facilitated by commissioning staff from NHS Medway, focused on specific service areas, how we are prioritising resources in

those areas and what progress was being made. We asked people if we were getting it right and if not, what should change. Some initial feedback was given on the day and was followed up with a full feedback report to every delegate.

The workshops covered the following subjects, the facilitators’ names are in brackets: • Urgent Care – (Helen Buckingham) • Public Health (Joint Strategic Needs Assessment) – (Dr Maggie Bruce and Karen Macarthur) • Long Term Conditions – (Simon Truett) • Stroke – (Pippa Barber) • Older People' s Services – (Jess Slater) • Mental Health – (Jane Wiltshire) • End of Life Care – (Errol Cordle) • Diabetes – (Heleen Tasseron-Ramanayake) • Personalised Health Budgets – (Victoria Nystrom Marshall and Noreen Hennessy) • Planned Care – (Tracy Bishop) • Cancer – (Dave Weaver) • GP Services – (David Selling) • Dental services – (Annie Godden) • Pharmacy Needs Assessment – (Anne Child) Workshop leaders described between three and five priorities for their areas over the coming year. Delegates were provided with information packs and asked to debate the current priorities in their area. Some of the workshops had specifically tailored questions to meet a specific consultation requirement, for example the Pharmacy Needs Assessment and Public Health’s Joint Strategic Needs Assessment but the majority of the workshops posed the following questions: 1. Do you agree with the areas we are focusing on, if not where should the focus be?

2. What can people do to manage their own health better and what gets in the way of them doing that?

3. Involving the public and patients is crucial in designing health services.

What is the best way for us to involve you in the future?

4. Is there anything we are doing that is of limited value, and should be stopped?

The workshops were followed by a question and answer session. The feedback from all the workshops can be found in Appendix 1 of this report.

What is happening now?

This feedback has been added to the Delivering Health Together in Medway work programme which is discussed and actioned at the fortnightly progression group with progress reported to the Delivering Health Together in Medway Board.

This means the feedback will directly influence next year’s annual operating plan, Commissioning Managers will use this information to improve the commissioning of services in the future and the Patient Experience Group will link the feedback to other information we are receiving from surveys, PALS and complaints. We will also use the feedback to inform our Communications and Engagement Strategy.

You said, we did: How we will feedback This report covers all of the feedback from the day and has been circulated to all of the delegates with an invitation to anyone who is not already involved in The Medway Health Network to join.

The Medway Health Network is a virtual group of around 1,500 people we engage with to improve healthcare in Medway. We use it to keep in contact with the people who attend our events, write to us, call us or contact us through our engagement email address itsyournhsmedway@nhs.net We ask people what their interests are and send them targeted information of interest to them. We ask them to help us with consultations and surveys and we keep them up to date with what is going on locally through our e-newsletter “Growing Healthier”. The Medway Health Network is growing all the time as we develop our engagement activity.

Equalities Monitoring NHS Medway aims to be inclusive in all that it does and by monitoring who has been involved in our engagement activities we are able to identify groups which may not have found it easy to become involved.

This information enables us to make extra efforts to reach out to groups in different ways so that they find it easier to have their voices heard. The breakdown of delegates by ethnicity, age and gender is available in Appendix 2 to this report.

Representation by ethnicity showed a slightly higher percentage of people from different ethnic backgrounds than the Medway population as a whole. There were more women than men at the event compared to the Medway population. There was also a higher percentage of over 50 year olds than the Medway population as a whole.

Evaluation We asked delegates to fill in an evaluation form. The results were very positive with 98% of delegates happy or very happy with the event. See Appendix 2.

There were a number of questions regarding services run by partner organisations and the feedback about those services has been communicated to them. In future we will strive to get more representation from partner organisations and clinicians, in particular GPs, and we will address the under representation of working people.

We will do this by holding events at different times of the day and at different venues. We will also use different mediums to contact people, including through the use of digital media.

Appendix 1

Workshop Feedback Cancer Priorities 2010/11 • Prevention and Earlier Diagnosis • Acute Oncology • Inpatient Bed review • Radiotherapy • Living with and Beyond Cancer Do you agree with the areas we are focusing on, if not where should the focus be?

• There needs to be better promotion of bowel screening.

• Access to GPs put people off presenting. Opening hours of GPs also present a problem for working/busy people.

• Oncology services at Maidstone are excellent.

• Multiple appointments so that patients can be seen in one day.

• Health checks should cover Cancer as well.

• Family / genetic history should be better mapped – not just for breast cancer patients.

• Delays cause anxiety – needs to be better faster systems in place.

• Consistency is important factor - seeing the same GP good for patient, but also for GP so they have a familiarity with the case and the family history and genetics.

• Trainee GPs are unable to answer questions – supervision is needed.

• Men may not want to speak to female GPs – especially for prostate.

• Care and treatment is excellent in Medway.

• Important to be followed up on frequently – reassurance. Also with nurse specialists etc.

• Communication between healthcare professionals and departments.

• Living with and Beyond cancer is an important priority – people being able to access support when needed but managing your own health.

What can people do to manage their own health better, what gets in the way of them doing that and what support is needed?

• Address lifestyle issues.

• Cultural/Generational attitudes present barriers for different people making them less open to change.

• GPs need the right skills and knowledge as do patients to better manage their own health.

• Need to encourage regular screening – promotion about this.

Involving the public and patients is crucial in designing health services.

What is the best way for us to involve people in the future?

• Education in schools – targeting younger generations.

• Word of mouth feedback is good if accurate.

• Use community/ cultural groups to promote awareness.

• Have more direct campaigns (with shock tactics possibly?)

Dental Annie Godden, Head of Dental and Optical Team explained the areas of dental provision in Medway commissioned by NHS Medway and the importance of publicising the service so that members of the public are aware that NHS dentistry is available. The feedback from the group was the perceived idea that many practices left the NHS and became solely private therefore it is difficult to get an NHS dentist.

The questions for the workshop were:Are their any areas you feel the PCT should be focusing on?

• More communication so that members of the public are aware what services are available.

• Getting the message across that it is important to go to the dentist due to the impact on whole health.

• More emphasis on preventative advice and treatment in practices and other areas.

• Reducing waiting time for specialist dental treatment and treatment under general anaesthetic.

• Training carers in oral health.

• Pensioners should be offered a free dental examination.

Is there anything we are doing of limited value that should be stopped?

• School screening. (Note: School screening has stopped this year as 2 years ago the requirement for positive consent became necessary. Since then the uptake for school screening has been very low and of those parents that do give consent most of their children already receive dental care.)

What can people do to manage their own health better and what gets in the way of them doing that and what support is needed?

• It was agreed that parents should be made aware of their responsibility for their children’s health.

• More oral health education.

Involving the public and patients is crucial in designing health services.

What is the best way for us to involve people in the future?

• The group felt that more communication is needed and it was suggested that this could be through newspaper advertisements and group visits by the Oral Health Promoter.

Diabetes Priorities 2010/11 • Pathway development – continuing our joined up approach • Patient Education • Healthcare professional education Points raised: • Lack of knowledge about services available.

• Clarification on courses available from GPs. • More awareness needed of the podiatry service.

• Better communication about what patients can do to manage their condition e.g. eat little and often.

• Move towards personalised care planning for diabetes, agreeing diet etc to fit in with the patients’ lifestyle instead of just handing out leaflets on food that can be eaten.

• Patient education on how patients can still live their life whilst managing their condition.

• Group communication sessions to give patients support and tailor made sessions to help patients.

• Up to date training for GPs. • Diabetes Specialist nurse available at GP surgeries.

• Make use of Pharmacies for advice.

• As Diabetes cannot be seen or felt patients need encouragement and help to manage their condition before it gets worse.

• More campaigns on prevention of diabetes.

• Education throughout school.

• Education and awareness for parents.

• Diabetes support group - mix socialising with education e.g. patient support groups with cakes that are for people living with diabetes, use of existing community groups such as church, Asian community centre etc.

• All leaflets and posters should be available in different languages especially as one of the biggest risk groups are Asian people.

• Medway is a deprived area so the importance of diet is paramount as healthy foods generally cost more.

• Give all patients a copy of the balance magazine from Diabetes UK. • Support groups should be at different times and venues so available to all.

• Better communication between services.

• Minimum standard for Health Care Professional/GP/Nurse.

• Early education to prevent diabetes and making people aware of what can happen if the condition isn’t properly managed.

• Personalised care plan – make diabetes work for your lifestyle.

• More awareness of what can happen if condition isn’t managed.

End of Life Care Priorities 2010/11 • Developing a Single Point of Access with a rapid response out of hours service.

• End of life register.

• Improve access to bereavement services.

• Provide education to staff, carers, families and the wider public on end of life care.

• Sustain the use of the Liverpool care pathway within the acute sector further implementation in nursing homes.

Background The Medway End of Life Care strategy mirrors the national strategy and remains a national priority. People in England are living longer with longer term conditions, so approaching the end of life can be a prolonged period of time. It is essential to ensure that people approaching end of life and those who are caring for them are treated with dignity and respect.

To ensure that service and care provision improves it is essential that resources are not duplicated or wasted and are in the right place at the right time.

Feedback • Participants were uneasy about the concept of ‘balancing the books’ in relation to end of life care.

• Who is best placed in the community to co-ordinate care when approaching end of life? There is only one chance to get it right for each individual. If the person is in hospital this will be the consultant, but they should also be talking to the patient’s GP. • Investment in staff training is needed - Care support workers, Doctors and GPs need training to raise awareness of end of life care, improve service coordination and create communication strategies to ensure more efficient use of resources.

• It would be less wasteful if medication prescribed to a patient nearing the point of death was regulated to a quantity relating to the remaining period i.e. not a three months supply when only a couple of weeks are foreseen to remain.

Single Point of Access (SPA) Availability of a service where a single call will ensure that people are immediately directed to the most appropriate service to manage their particular crisis. This will help by: • • • •

Reducing anxiety in times of crisis.

Enable effective coordination of services.

Ensure effective use of resources.

Facilitate ease of access.

Single Point of Accesses are being developed nationwide, giving access to a range of end of life care support agencies (voluntary sector organisations e.g. MacMillan, Marie Curie, Rapid Response and also GPs, hospices etc).

It would be accessed via a single phone number. After the initial call establishing the service required by an end of life individual/carer, the SPA would assess and arrange the appropriate service to that individual/carer. A call to 999 would also access this service, if appropriate. The aim is to improve the outcome for the end of life individual, by providing greater co-ordination, better communication and more continuity of care.

In Medway this service will go live on 1 January 2011.

Participant response • Full support was given to this concept.

• The need for effective publicity to reach the people that need to access the service is essential.

• It is essential that knowledge of the availability, purpose and accessibility of this service is consistently understood and promoted amongst staff dealing with people requiring end of life care (and their carers).

End of Life Register The register ensures that people can be identified early so that they can get the right care, at the right time, in the right place. When treating a patient with an end of life condition a GP will talk to the patient about subjects such as where they would prefer to die (hospital, home, hospice…) and whether they would like to be resuscitated. The GP, with the patient’s consent, will record the patient’s decision on an End of Life Register. This record will be accessible to the emergency, health and social care services, to ensure that each individual receives the best and most appropriate care at the right time.

Participant response: Need to ensure all agencies/people delivering care have access to the End of Life Register.

Improved access to bereavement services End of life care is not just about looking after the dying, but also about ensuring that sufficient counselling support services are available for those left behind. It is the intention to improve access to bereavement service and to provide a less variable standard of service.

Education to staff and carers • “People don’t like to talk about death.”

• Raise awareness and educate the public in enable easier conversation between GPs, patients/carers etc about end of life care and choices.

• There is a concern that on occasions, families of patients approaching end of life are not aware of how close to death that family member is.

Sustain use of the Liverpool Care Pathway (LCP) The LCP is a document to help carers and doctors ensure the right intervention is given at the right time in the last days and hours of a person’s life. The LCP helps to ensure a more comfortable death, supporting both the patient and the family/carer, ensuring that: • • • •

the patient is an a quiet room which is easily accessible to family members cardiac pacemakers are switched off no blood samples are taken no x-rays are taken

Issues raised • • • •

•

Family/carers accessing transport e.g. bus services, can be a problem – for example in the early hours of the morning.

Access to faith services when at point of death e.g. if not an active faith member.

Disjointed process when an end of life individual is transferred from hospital to a home for palliative care.

Often medication provided on discharge is limited and not the full range that was being administered prior to discharge affecting continuity of care and comfort of the person.

Certification or verification of death – after discharge from hospital, if a GP is not seen prior to death, the police and coroner become involved in the post-death procedures causing emotional distress for those left behind.

GP Services Do you agree with the priorities we are focusing on, if not where should the focus be?

• Doctors talk to the carer/ parent of disabled people, not the patient there need to be better communication. They need to see the individual and not the disability.

• Improve training of health professionals.

• Listen to the patient – patient choice e.g. medications. Often the GP will not let the patient finish before they diagnose.

• When the patient is a young child, and a parent is present, it is acceptable to address the parent who can give a more accurate account of the problems.

• When a disabled adult and their parent or carer attends with them, the GP addresses the parent or carer rather than the disabled person. This is wrong and there needs to be better training to stop this happening.

• GP training – no patient/group engagement.

• Access to appointments when you need it. Non urgent should be seen “within a few days.”

• Lack of choice regarding getting a referral - but then there is a cost implication • There needs to be a quicker diagnosis and referral.

• Mental Health – GP training needs to improve. We need to access people at home who have unfamiliarity with medical services.

• GP opening hours – out of hours not just a telephone number.

• Medway on Call Care (MedOCC) provides a good service.

• Cross referrals – patient access and transport issues with this.

• Annual leave cover – inform PCT to discuss and get approval to continue.

• GPs need to be aware of referring to new services.

• Stock control of drugs within GP surgeries, especially flu jabs, there is frustration caused when things are unavailable when it suits the patient.

What do you think about our approach to support quality?

• Like the Quality Outcomes Framework (QOF) approach of publishing GP scorecards, it encourages transparency.

• Will GP quality remain the same once white paper reform takes place?

• Change of address – lack of vacancies at other GP practices.

• GPs need to accept new patients.

• Complaints about GP – where can patients go for help or advice?

• NHS vs. Private – NHS doctors can get the diagnosis wrong or there is a lack of diagnosis.

• Why is there inconsistency – some GPs have long waiting times, others have short waiting lists. Appointments are gone by 8am. Other practice staff make for a better/ worse experience.

How do you want to be involved in the future?

• Should be focusing on the specifics of GP training and patient involvement.

• Questionnaires should be used. We can consult and engage with patient groups.

• Patient leaflets and information written by patients in conjunction with the NHS and not supported by GP surgeries – could we work with the Local Medical Committee.

Long Term Conditions Priorities 2010/11 1. Intensive Case Management.

2. Personal Care Planning.

3. Redesign Chronic Pain Management.

4. Implement Lung Improvement Strategy.

The majority of people in the workshop had experience of Long Term Conditions either as a patient or a carer.

Do you agree with the areas we are focusing on, if not where should the focus be?

• Generally a good set of priorities but what happens if your condition falls outside their criteria. (Note: It was explained that they had not set priorities based on disease specifics and priority 1 and 2 incorporated all diseases.)

• Many patients who do not receive care, especially children with ME (Myalgic Encephalopathy) and chronic pain management.

• Not very clear what personal care planning means – I’m happy being involved with my care – others are not. Who decides my care? Is it the GP, me, or in conjunction with one another.

• Today’s workshops were good, but is it worth it as the PCT is going – will anybody take our views on board.

• Withdrawal of pain service has caused problem – people with chronic pain still need the service - worrying – causes concern.

• Need to diagnose long term conditions earlier and identify needs • Link telehealth to the consultants.

• Two years ago the PCT got money for respite for carers, do they still get it?

• Not enough nursing homes.

What can people do to manage their own health better, what gets in the way of them doing that and what support is needed?

• Longer GP appointments.

• Access to better information.

• Family relatives, carers all being educated on condition.

• Education – patients need to know about their own condition and consultants and other health professionals should be managing their own condition. GPs should play a part in this and allocate more time to speak with their patients. On the flip side of this, some people don’t want to be educated.

• Professionals should know more about rare conditions or have access to information pertaining to a condition.

• There needs to be more back up care and proper care packages in place as those currently in place rarely work.

• Family/ relatives and carers need to be informed and educated in order to support relatives.

• More information needs to be available to let them know what organisations are there to help them.

• Respite should be considered when looking at any strategy.

Involving the public and patients is crucial in designing health services.

What is the best way for us to involve people in the future?

• More done for carers/ relatives, and at the planning stage.

• There needs to be two way communication between all parties.

• Consider mental capacity of individual patients / nursing staff/ all health workers being trained in mental capacity act. They don’t know the individual carer/patient.

Is there anything we are doing that is of limited value, and should be stopped?

• How do you choose services to suspend? Others agreed.

• It’s great to have these health debates, but what is the point as everything is going to change when the PCT goes. (Note: It was explained that NHS Medway is working on a commissioning strategy that will involve GPs and we would expect would inform GP commissioning) • One patient had had five letters about flu jabs, one would have done and it would have been better to make your own appointments on site - it saves the letter and the admin time and waste of paper.

• Sending letters to people that are irrelevant – smear test letter when patient has had a hysterectomy.

• Reduce health checks to bi-annually. Quicker diagnosis – quicker referral (check database to see if presented with same condition more than 3 times) • Unnecessary follow up appointments.

• Reduce number of staff in out patients.

Mental Health Live it Well Strategy Priorities: i. Built coalitions between all elements of public services, the voluntary sector, and the independent sector that focus on collaborative endeavour and shared enterprise to improve mental health and wellbeing. ii. Lessened the stigma, discrimination and unhelpful labelling attached to mental ill health and those using mental health services. iii. Reduced the occurrence and severity of common mental health problems, particularly by targeted actions to improve wellbeing for more of those people at higher risk. iv. Demonstrably improved the life expectancy and the physical health of those with severe mental illness, and demonstrably improved the recognition of mental health needs in the treatment of all those with physical conditions and disabilities. v. Reduced the number of suicides. vi. Ensured that all people with a significant mental health concern, or their carers, can access a crisis response service at any time and an urgent response within 24 hrs - and that service contact points are more local. vii.Ensured that all people using services are offered a personalised service, giving them more choice and control over the shape of support they receive wherever the care setting is. viii.Delivered better recovery outcomes for more people using services, with care at home as the norm. ix. Ensured that more people with both mental health needs and drug and/or alcohol dependency (dual diagnosis) are receiving an effective service.

x. Delivered effective mental health services for offenders and those anywhere in the criminal justice system.

Is there anything we are doing that we could be doing better?

• GPs need to be better trained in Mental Health awareness, someone who is depressed won’t go to GP, let alone read a self help book.

• Promotion of changes in service delivery is needed.

• Care where needed and access for hard to reach groups (NHS Medway is looking at how to access hard to reach groups and trying to bridge gaps in services for example outreach in homeless centre).

• People having issues accessing appropriate services, for example disabled and vulnerable people.

• Higher rates of mental health problems in offenders, can’t visit services.

• The voluntary service KCA offering some satellite services.

• Need better links with primary care.

• Need to ensure GPs are properly trained as they do the referrals.

• Work in partnership with GPs as medication involved.

• Primary care level – no services at all.

• Much information online, but lots of people can’t access this. What alternative methods are being explored?

• No good assessing without follow up.

• If a client misses two appointments, you are knocked off the list and nothing happens until they commit suicide.

• How do you access isolated people in their homes?

• Mental health teams not turning up, now signpost to Medway and Swale Advocacy Partnership (MSAP) and the Police.

What can people do to manage their own health better, what gets in the way of them doing that and what support is needed?

• Support carers and they will keep client healthy. Carers need to be encouraged to support each other, need to create networks.

• Catching problems early saves money.

• People are aware of self referral to services, but choose and book doesn’t include mental health services.

Involving the public and patients is crucial in designing health services.

What is the best way for us to involve people in the future?

• Mental health patients don’t access services and need to be empowered.

• When informed, GPs are very proactive in making referrals.

• Should be training head teachers and teachers in the signs of mental health to help identify people earlier

• Explain services available in a clear way. How would the general public know what step 1, 2 or 3 is? (NHS Medway is in the process of developing a leaflet on what steps mean and how they are accessed) • People often have low reading skills and a mental health issue, how is information getting to them?

• People often turn to church, any work around involving them? (Community development workers talking to churches to educate about mental health issues.)

• Four mental health workshops across Kent and Medway run by LINk couldn’t get mental health services to attend. Kent and Medway NHS and Social Care Partnership Trust (KMPT) need to go out and talk to people.

Older People Medway Joint Health & Social Care Commissioning Strategy for Older People Priorities 2010/11 • Managing Long Term Conditions.

• Preventative Services.

• Managing Dementia.

• Managing Admissions to Hospital and Residential Care.

• Personal Budgets for Health & Social Care.

We have published an Older Peoples Plan and a Joint Commissioning Strategy for Health and Social Care which sets out our five key priorities. Of these five, where should our main focus be?

Coming through nursing homes, there are a lot of Chronic Obstructive Pulmonary Disease (COPD) problems and people with Long Term Conditions and these need to be better managed.

Personalised health budgets are a good idea if managed properly and if people are able to manage their own budget with their carers. There needs to be sufficient training and support. Monitoring of these budgets is also very important. As we have an increasing percentage of our population which falls into the older peoples category there need to be better preventative services to reduce the burden on the NHS as people grow older with Long term Conditions.

GPs do not always look after older patients and tend to put it down to growing older in general when there can be real issues there.

Managing residential nursing homes and care homes should be done properly.

GPs need to be aware of other services, like dementia advisors, to signpost to other services.

Case management is important, especially if we are to see an increase in Personalised Health Budgets.

Workshop 2: Personalised Health Budgets shouldn’t be forced on people. It is an additional worry for older people to manage; they just want someone to tell them what their options are and to advise them on the best option. They can only manage their own budgets if they have good information provided to them. There is too much to this process.

This is a form of means testing; there is a finite amount of money. What happens if you have a number of conditions? The good thing about the NHS now is that everybody pays into it and those young people hopefully do not need to use it for a long time, while the older people at the other end of the spectrum get to use it and it provides equal access to all.

What can people do to manage their own health better, what gets in the way of them doing that and what support is needed?

We should not be relying that heavily on GPs. Nurses know patients well and could use that knowledge to make an assessment about whether a patient needs to go into hospital. GPs should listen to nurses. GPs might worry that it is a risk to leave older people at home on their own. Nurses are more sensitive to family needs and won’t send to hospital if it can be managed at home. Nurses want and need more responsibility to advise on patient care. GPs need better signposting to community teams.

Use internet to raise awareness for individuals to help manage their own health.

Better thought needs to be given to discharge policies, because Older People are often discharged in the middle of the night, meaning they incur lots of costs around taxi fares and may be well enough to be discharged, but not well enough to go home.

GPs are a bottle neck. Patients are often afraid to go back again and again to see them. Care homes should be able to refer directly to community services, rather than go through the GP. We need a map of services which sets out what services are out there, not just for GPs. Workshop 2: We need to promote health checks more to over 55s. Healthier people will be less of a burden to the NHS in the future. Could organise coffee mornings to present awareness sessions.

Involving the public and patients is crucial in designing health services.

What is the best way for us to involve people in the future?

There needs to be comprehensive information about services for older people.

How much influence do carers and older people have on services that are provided?

Voluntary sector has not been maximised to provide services.

Need to provide plain English information, especially with regards to personalised health budgets and avoid jargon.

Need to target those who are falling through the net. This comes with community.

Knowing your neighbour and checking in on them.

Could there be an initiative with the benefits office to provide information? There are often long queues there and so this is a good time to target people.

We need to better support and involve carers. What help is there for them?

Should GPs be looking out for the healthcare of the carers as well? All doctors know who their patients are, but not their carers. There is supposed to be a carers register – but is this up to date and how can we maximise this information?

How are we involving carers in care planning? Carers are rarely noticed.

Workshop 2: You need to think carefully about organising events for older people.

They won’t come out in winter, or in the evening, they do not like the towns in the evening.

It would be a good idea to get someone to come and talk about Personalised Health Budgets to community groups, so they better understand the process and do this several times so it sinks in. Design this information session in co-operation with community group leads so it suits target audience.

Voluntary sector tries to disseminate information but we need to find out the fundamental reasons why people are not accessing services.

You need to communicate with people via their own communities. For example, send information to care and residential homes, and sheltered accommodation.

Older people access the cinema in the daytime.

RAINara (Active Retirement Club) and the 442 Club offer socialising opportunities for Older People – tap into this, healthier lifestyles. Use information tools like The NET (magazine) and Action Forum.

Pharmacy Needs Assessment Do you think there are any needs that we have missed?

• No needs have been missed in the group’s opinion and Pharmacies are very accessible.

Are there any particular services you would like to access through the pharmacies in your area?

• Medication user reviews (MURs) are not offered proactively.

• Increase access to Methadone supervision in Pharmacy. Pharmacies need to advertise services more clearly.

• Increased access for needle exchange.

Are the pharmacies in your area open at the right times?

• General consensus was that pharmacies are open at the right times.

• Pharmacies had slightly longer opening hours in line with extended GP hours.

Planned Care Do you agree with the areas we are focusing on, if not where should the focus be?

• Focus should be on waiting times; this could be aided by sharing of appointment times between receptions. Appointment schemes are in the process of being looked at now.

• Patient questionnaires are carried out (in Grain) for services, e.g. Phlebotomy.

Rather than queue have an appointment system, regardless of where you are registered. System in third week is working well.

• Phlebotomy: You need one person taking the blood to deal with acute patients.

Priority needs to be given to fasting patients, people’s working hours etc. You could go from five days to three, but with more GPs, even if you are unregistered there.

• Encourage more GPs to get involved to help the system run smoother.

• Planned care for mental health, transition from mental health.

• Services within Primary Care to being discharged, need to know where to turn.

• Implement “floating support” access to services.

• Effective research. E.g. knee replacements. Recovery process improved by moving rather than being immobile.

• Choose and book is great for when there are appointments – not ok for people without transport.

• Could there be such a thing as automated telephone appointment reminders?

What about text messaging?

• Moving services out of the hospital and into the community is good but not always possible – especially if specialist equipment is necessary so the options are limited.

• Why is phlebotomy being focused on? (Note: It was explained that a number of complaints were being received about it.)

• Additional practices for GPs to provide a service in the community without needing to be registered to that GP. • Finance - money goes to whoever carries out the service. It will save the NHS money by freeing up services and moving them to the community.

• Care closer to home makes services more accessible to all in the community if you spread services more between GPs, health centres and hospitals.

How can we raise awareness of projects we are currently undertaking?

• Currently poor communication. Emails are instant, so why is there this problem of communication?

Involving the public and patients is crucial in designing health services.

What is the best way for us to involve people in the future?

• Need to think through pathways creatively.

• “patient diary” feedback. Changing professional’s perception of care.

• Carers struggle with the issue of data protection within a hospital setting.

Is there anything we are doing that is of limited value, and should be stopped?

• Cut down on duplication.

Public Health Involving the public and patients in our Joint Strategic Needs Assessment (JSNA) is crucial in making sure we get the right priorities. What is the best way for us to involve people in the development of this JSNA? • Qualitative research done by others.

• Undertake our own Qualitative research from areas such as Phlebotomy clinics, the Sunlight Centre and tap into faith groups.

• Employees and places of work, with special emphasis here on men’s health.

• Work with LINks to gather information for the JSNA Consultation.

• Use health trainers. 6 employed by the Sunlight Trust for consulting the population.

Who do we need to make sure we include?

• LINks/Age Concern.

• Social clubs.

• Men’s working clubs.

• Young people and children – Hold events around 6th form times and schools • Conservative club and local labour party.

• Link with University of Greenwich and other major organisations in Medway.

• Harder to reach groups – using groups that other partners already have links with. Important to ensure the population is truly represented in the consultation.

• Big companies like EDF Energy (use carbon management work.)

• Integrated offender management team (data) – Hard to reach.

• Job Centre data/ employment.

• Universities.

• Faith groups.

• Eastern European groups (Medway Ethnic Minority Forum) community interpreters included.

• Children’s centres.

Information from the last JSNA was used to inform our NHS Medway strategic goals. What do you think are the key needs in Medway now that we need to investigate as part of the new JSNA? • “Spend the money on the young” Great concern that young children will bear the burden of recession.

• Men’s health.

• Ask health professionals (including health trainers) on the ground • Unemployment.

• Current Strategic goals.

• (Micro needles - increased self management.)

• Technology – telephones.

• Priority – self management of care.

• More communication between all partners.

• Young age group – Smoking – to fit in “cool.”

• Teenage pregnancy – social norm.

Stroke Priorities 2010/11 • Seven Day Transient ischaemic attack (TIA) Service.

• MRI Scanning.

• Introduction of Telemedicine.

• Monitoring Hypertension through GPs. Do you agree with the areas we are focusing on, if not where should the focus be?

• Seven Day Transient ischaemic attack (TIA) Service is very important so that stroke can be prevented.

• Important to focus on prevention as well as treatment. Follow ups from GP important – some GPs are good at follow ups and some or not, this need to be the same across the board.

• Need to educate people about stroke and importance of people understanding the symptoms and how to deal with them.

• NHS Direct needs a link to specialists e.g. Stroke Specialists. Doctors should make patients more aware of the importance of blood pressure checks and the reasons why high blood pressure contributes to stroke.

What can people do to manage their own health better, what gets in the way of them doing that and what support is needed?

• Better relevant advice on the end of the phone. People’s experiences of the service are mixed. If they have a bad experience they will not use the service again.

• Communicating with patients whose first language is not English can be a barrier. Need to find ways of making links with these people – suggest greater contact with the Stroke Association.

• Educating people about stroke is very important to help people manage their own health better and help prevent Stroke.

• Encourage people to visit their GP – roll out of Health Checks to under 75s.

• Encourage use of blood pressure checks at home. Blood pressure may be raised when visit doctor so more realistic blood pressure readings may be better.

• Important to emphasise importance of regular checks.

• Very important to improve communication between hospital and GP for follow up care.

• Changing types of medication from one brand to another is not good and can give different side effects.

Involving the public and patients is crucial in designing health services.

What is the best way for us to involve people in the future?

• Hold events out of hours to get better range of people. LINk events are often held out of hours.

• Medway Matters is good, but not everybody reads it.

• Use lots of different media e.g. TV, radio, newspaper, leaflets, possibly evening surgeries to get feedback from patients.

Is there anything we are doing that is of limited value, and should be stopped?

• LINks – lots of paperwork received and some not of much value – waste of funds.

• Encourage use of email.

• May not need to personalise letters etc, e.g. invited for flu jab as this would save money.

Urgent Care Priorities 2010/11 • Avoid unnecessary Emergency Department attendances and acute admissions • Ensure anyone who does need to attend the Emergency Department, or be admitted, is treated as quickly and effectively as possible and discharged with the right support.

Do you agree with the areas we are focusing on, if not where should the focus be?

• The introduction of Paramedic Practioners is a good step forward- – they can treat some patients and not send them straight to the emergency department.

• Extended learning for paramedic staff about Paramedic Practioners would also be useful. paramedic response providers • Raise awareness of walk-in centres and pharmacies • Patient care plans should be set when a patient starts treatment at hospital and should continue to ensure that care is provided at the end when the patient leaves hospital • Improve and link up with mental health and social services at emergency department

What can people do to manage their own health better, what gets in the way of them doing that and what support is needed?

• Better communication in plain English and pictorial – patients can be confused about A and E messages. They need to be clearer • Improve education of 999/ NHS Direct call handlers so they don’t just refer to emergency department Involving the public and patients is crucial in designing health services.

What is the best way for us to involve people in the future?

• Better advertising/ education for young people.

Event Evaluation

Appendix 2

How satisfied were you with:

Very happy/happy

the booking process and pre-event organisation (%) the organisation of the day (%) the venue and facilities (%) the quality of the catering (%) the presentations and discussions (%) the information you were provided with (%) the amount of time given to ask questions (%) The overall event (%)

91% 95% 96% 94% 92% 90% 93% 98%

Equalities Monitoring: Ethnicity North African Middle-Eastern Any other Total Arab or Arab British Black Caribbean Black African Any other Total Black or Black British Bangladeshi Indian Pakistani Any other Total Asian or Asian British British Irish Any other Total White White and Asian White & Black African White & Black Caribbean Any other mixed background Total Mixed Chinese Eastern European Any other ethnic group Total other ethnic group Undisclosed

Percentage

0% 3% 2% 5% 3% 3% 85% 3% 88% 2% 2%

0% 3%

Neither Happy or Unhappy 5% 5% 4% 5% 8% 10% 1% 2%

Unhappy/ Very unhappy 4% 1%

6%

Age Under 18 18-25 26-30 31-40 41-50 51-60 61-70 71-80 80 and over Gender Male Female

Percentage 1% 6% 3% 6% 12% 17% 20% 23% 12% Percentage 34% 66%

It’s your NHS Make your experiences count Find us

Get involved

NHS Medway Fifty Pembroke Court North Road Chatham Maritime Chatham Kent ME4 4EL

Share your opinion and help us make services better for you. email: itsyournhsmedway@nhs.net phone: 01634 335173

01634 335020

Patient Advice and Liaison Service (PALS) PALS is here to help when you need health advice, have concerns or don’t know where to turn. email: pals@medwaypct.nhs.uk freephone: 0800 014 1641

Customer Care Listening and acting on your comments, compliments or complaints. email: nhsmedwaycomplaints@nhs.net freephone: 0800 014 1634

Medway Local Involvement Network (LINk) This guide has been produced by NHS Medway.

Information in it can be made available in other formats and languages on request to itsyournhsmedway@nhs.net or by ringing 01634 335173

The Medway LINk is your local independent network of local people and community groups working together to influence and improve Medway’s health and social care services. The LINk provides a forum for concerns about service provision and quality, and works with those who plan and run services to bring about real change.

Why not join the LINk and help shape local services? email: info@kmn-ltd.co.uk phone: 01303 297050 website: www.themedwaylink.co.uk

1 www.medwaypct.nhs.uk