The Croydon Healthwatcher Blog takes a current issue that has come up either through our research or in response to changes in services and discusses this with reference to wider sources.
It’s a great way of getting to understand some of the challenges and how they might be responded to.
Life is what happens when you are busy making other plans
That famous line by John Lennon could not be truer when considering 2020 for health and social care system in Croydon. Back in January, we were told that the plans for a reorganisation of Clinical Commissioning Groups to larger groups would work for places like Croydon since it would cut administration and at least 90% of budget and decision-making would be delegated at Croydon level. We recorded the plans quite clearly in our South West London Merger discussions with the Croydon CCG.
Speed on six months and due to the impact of COVID-19, the planned model has been turned on its head. Rather than decisions being taken almost completely at Croydon level, or ‘place’ as the NHS likes to call it, a command and control procedure is in place, where much of the decision-making is being decided centrally at NHS England and then delegated to what was called STP (sustainability and transformation plan) level and now has been renamed ICS (integrated care networks) or as we understand it, South West London NHS.
For Healthwatch, this has put a new challenge to extend to our revised remit. Not only are we aiming to share analysis as soon as we can (see my previous blog in July), but now we have had to work out how we can best represent ourselves at this new South West London level since we are commissioned at Croydon level.
As mentioned before, all six local Healthwatches are working together to find a solution on how 1.2 million people who live in six quite different boroughs can be adequately represented and decision-making scrutinised. While this was important before COVID19 began, it has magnified now that it seems that more decision-making is happening at the South West London level, that at Croydon. We are doing our best to scrutinise what is happening and find a representative solution where the insight on services can inform our views on changes.
There are of course significant changes and challenges ahead: from digital services in both your local doctors, community services and for outpatients at hospitals, to managing services in those physical locations to protect people from COVID19 when they need to be in a physical location to get the care they need. Then there is the risk of an outbreak and how that can be handed. In all of this is it understandable that scrutiny, representation, insight and patient and service user involvement might be a secondary priority.
And yet positive things are happening. Croydon Health Services is outlining its plans for it People’s Experience, Engagement & Involvement Group, and the Integrated Care Network plus , delivering care at the neighbourhood mode has been launched in Thornton Heath (bringing health, social care and signposting in one location, both physically at Gillet Road and online). We provided insight about this planned change before COVID19, and we are having positive discussions with both about how they can best engage with their local communities and get patients involved.
Our challenge is how we support this. Another positive aspect of this is that Healthwatch is now one of the go-to organisations to provide insight. Indeed, we are being asked to provide more on several areas both within health and social cares and invited to more discussion As a result we are currently running surveys on the experience of residents in care homes, as well as asking family and friends what they think, and staff as well. We are also about the begin a survey tracking the experience of Croydon’s shielding service. All of this will help provider prepare and maintain a good service based on service user insight, in time for the autumn, which may bring new challenges.
We raised some months ago the issue of mental health and are pleased to be involved in a few discussions with commissioners on how we can provide relevant insight to help decision-making. Our Croydon College student-led project on mental health and COVID19 is now being analysed and I hope we will be able to share some insights in September which again will provoke discussion on how
services can meet needs.
Of course, this brings its own challenges in make priorities in what we want to focus on. While we have made our outline plan for this year, see last blog, we are now starting the process for the next one with our Annual Survey <see link>>. Please fill it in and give us your views on what we are doing and suggestions of what we can focus as we plan for the coming year. While we cannot predict what will happen (this year so much more than most) or plans can at least ensure we keep on track in representing the views, needs and ideas of you, the people of Croydon.
This year is going to be defined by the recovery of health and social care services in response to COVID-19. While it has had a massive impact for all involved, it has revealed some interesting insights into our use and expectations of services that can help define them in the future, as well as creating opportunities of real public involvement.
At Healthwatch Croydon, we are focused on delivering our services to you, the Croydon public, as best as possible. Reporting not just on the impact of COVID-19 but on raising other key themes that have come from conversations and insight, as well as an assessment of the changes taking place. Here is an overview of what we have done so far and plans for 2020-21.
Responding to COVID-19
Healthwatch Croydon have also had to respond to this change, with a revised mandate from Healthwatch England prioritising sharing patient experience more swiftly and increased signposting. All this happening when we are delivering the service from our homes.
Our response has been to ensure we could meet the challenge of producing reports that could be shared in stakeholders in a matter of weeks, rather than our usual months. Twice our record for getting a report compiled and shared with our stakeholders was broken.
I would like to thank all those key stakeholders at the hospital, in primary care, in Croydon Council and in the voluntary and community sector, who have been open to all our reports, not just our recent COVID-19 responses. Our recommendations are being considered and we are also being invited to new conversations, where we can continue to influence and provide insight from you, the residents of Croydon.
Where to focus our efforts?
Our challenge is, and has always been, where we can focus our activity to have the greatest benefit. Should be proactively looking at areas where services, or the people they are there for, have been overlooked? Or reactive to the pace of real change taking place, which has now shifted gear with the recently published aims of recovery?
The answer, of course, is both. Things were already developing before COVID, with the further development of One Croydon and integrated care networks, an established, place-based leader for health and the merger of our local clinical commissioning group into a wider South West London NHS group. This creates opportunities for new ways of working, which need insight from the public. We are also aware that some people have not had their voices heard on services that mean the most to them and we will look to provide relevant insight where we can.
Our initial plans for 2020-21
Before COVID-19 began, we are looking to prioritise our work around four themes:
- Croydon University Hospital: As it has a large impact on Croydon residents and with the change taking place in response to the CQC inspections, we can provide relevant insight to support improvements.
- Mental health: We have received several reports about people’s concerns about access to effective mental health support.
- Primary and community health services: Ensuring continued conversation with residents to contributes to the major changes of One Croydon and the Integrated Care Networks+ implementation.
- Social care: Enable resident insight to inform decision-making on services in a challenging environment. It also addresses an imbalance in our focus in recent years.
In this new environment, we have used these themes to help consider new project proposals. Some of the ideas we are currently considering are as follows:
- The quality of support that shielded people have had and what they need going forward.
- The experiences of care home residents.
- Ensuring that the views of local people are considered in service redesign or review.
- Working with the other South West London Healthwatches and the NHS across to ensure that the views of local people are considered as the NHS recovery programme begins with proposals to make temporary changes permanent.
- Keeping informed about the impact of COVID 19 on BAME and learning disability communities and provide relevant insight to support services.
From what we have heard from discussions with key stakeholders, It is expected that this phase health and social care service recovery will exist well until next year, but within that time there could be significant developments and proposals in how services are delivered. We will be keeping a close eye on changes and will respond accordingly.
This may mean that some of the above ideas progress and others do not. Prior to undertaking any further projects, the board will complete the prioritisation matrix to identify which projects should be taken forward. This will be regularly published on our website in the coming months in response to decisions and developments, so you can see our rationale for taking projects forward.
Give us your views
Of course, we could not do any of this without the views we get from you, the people of Croydon. While we may not be able to meet you physically face-to-face, we will be running several surveys, online events, and other ways of engaging with us. We also offer a ring back service, so if you know someone not digitally connected who wants to give their views they can always call our hub to give their views or give their survey responses over the phone. Please call us and give us your views.
Keep well, keep informed and keep in touch.
How are Croydon residents are being affected by COVID-19?
Like many organisations, the coronavirus pandemic has affected how we do our work. As I mentioned in our video, we have adjusted our focus in line with Healthwatch England advice. Our priorities are now providing Croydon residents with the most up-to-date information and also to hear their views on experiencing services during this period.
Keeping well and keeping informed
Last week, we shared with key stakeholders our first report on the experiences of Croydon residents as a result of the wide changes due to coronavirus. The results of the first 63 people were interesting and wide ranging. In terms of information, most are relying on official national sources of information such as gov.uk and nhs.uk and the BBC, with local sources not being viewed as much.
This is interesting because later on residents clearly want to know about support which could be available here and so perhaps more focus is needed to promote local sources of information and ensure they are up-to-date. In response to this, we have produced our useful Frequently Asked Questions (FAQs) document which has been compiled over recent weeks. This downable guide developed in partnership with Croydon Voluntary Action will provide resident with useful information in one place. We will ensure it is updated every two or so weeks, as the situation changes.
Some Croydon residents have been significantly affected. These are some of the issues we have heard:
We heard that some residents were having difficulty getting food, due to a lack of delivery slots, problems in queuing due to a disability and being scared of people not abiding by the two-metre social distancing rule in supermarkets and on public transport. We know that community and voluntary services are working hard to support people, but the profile of these services needs better promotion. There is also confusion on who qualifies for assistance and who doesn’t and what support there maybe who are not the most vulnerable. People want to have their expectations met, and this needs careful and clear messaging.
There is confusion on whether people can visit their GP, and if they have specific long-term conditions can access their usual support at all. There are also those needing to access services such as emergency dentistry, ear syringing and podiatry which, while are not life-threatening, do affect quality of life if they are not resolved. Are these now available? I know our local NHS has provided more information this week on accessing GP and 111 for information, but clearly more information is needed. For example, I found out by chance in a meeting that emergency dentistry can be accessed via 111.
Being social isolated now…
This is really taking a toll on residents: from missing the social aspects of work or volunteering; to being distanced from friends and family and feeling trapped and lonely. Some are even concerned that they may die without being able to say goodbye. We believe that there needs to be some practical support to alleviate the isolation, including inexpensive ways for people to connect be it WhatsApp, Zoom, Skype or even a straight-forward phone call. Helpful information to support mental health could also be included.
…and the longer–term impact?
As we move forward out of lockdown, it is clear we are going to need more mental health support. While local services set up to support people during lockdown have done much to support physical needs, the mental and emotional ones are clearly going to be around for sometime after. These early comments should serve as a taste of things to come. What are service providers planning now to ensure demand for support to be met? It’s likely that things will not go back to how things were before.
Challenging finances and families
Not unsurprisingly financial concerns were high on people’s minds with concerns about lack of work, pay, benefits and paying rent. Children and families have been affected, adjusting to home schooling which can be difficult if you do not have reliable broadband. Some families all together in cramped locations with parents out of work, and limited access to green space, as well as missing friends.
These again only contribute to some further stress and impact on mental health state. Differing information on how and where to get support only makes this more complex. Clearer, accessible information is need to show how people can get support.
While much of this has been mentioned at a national scale in media and parliament, it is useful to hear the particular issues of Croydon residents – and this is only the start. What we have heard so far is from the first 63, since then we have received nearly 200 more responses, which we are analysing for our second report in a few weeks’ time. This survey will continue throughout this time, so we will be able to see how you, as Croydon residents, feel about all the local initiatives taking place and hear how they impact you as we move to the next phase, whatever and whenever, that may be.
During this time, you can be sure that Healthwatch Croydon will ensure your voices are heard with those who can make the changes. Indeed, our first report has already had responses from key stakeholders and we plan to provide more.
We cannot do this without your views though, so please keep in touch by filling in our survey and telling us your experiences good or not so good – we need to know, or you can call our number or email us.
Keep well, keep informed and keep in touch,
Healthwatch Croydon Manager
You may have heard that Croydon’s NHS organisations are proposing and planning changes to the way they work. There is in fact so much change going on it is hard to keep up, and that is said by someone working in the sector. How it must come over to you as Croydon residents I am not quite sure. So, here is my perspective to help you understand what’s going on.
The Long term Plan influences all
In January, NHS England created their Long Term Plan. At over 120 pages it is a weighty document, but has an ambitious vision particularly towards integrated care and population health, individual plans on key conditions including cancer, cardiovascular disease, stroke, diabetes, respiratory disease and mental health and a focus on digital to deliver services.. You can read a digest by the Kings Fund here. To deliver this, structures need to change as well, so the development of Primary Care Networks and Integrated Care Networks have been proposed to deliver this (see more below). For these networks to be adequately supported, NHS England and NHS Improvement have proposed that CCGs merge together to streamline commissioning (buying and planning) arrangements and release resource to invest in these new networks at a more local neighbourhood level.
So how is this changing things in Croydon? Firstly, there is the development of the Health and Care Plan. This has been developed by the One Croydon Alliance which is made up of representatives of the NHS Croydon Clinical Commissioning Group (CCG) who plan and buy health services for Croydon, Croydon Health Services NHS Trust (hospital and community services provider), South London and Maudsley NHS Foundation Trust (mental health services provider), the GP collaborative (which represents nearly all Croydon GPs) Croydon Council, and Age UK Croydon and is the blueprint for delivering services in the borough. You may have seen an iteration published for discussion in May which we as Healthwatch Croydon encouraged contribution of views to. I am glad to say our comments were taken seriously and we hope the final version will reflect resident’s points when it is published shortly. This plan holds to the principles laid out in the national Long Term Plan and indeed anticipated many of them as it was being devised in advance.
One of the core structural changes to enable this plan to succeed are the establishment of Primary Care Networks (PCNs) where local doctors collectively work together to deliver services at a neighbourhood area. While each GP practice will hold a direct contract with NHS England and NHS Improvement, the idea is that GPs work together at the neighbourhood level which they define as between 30,000 and 50,000 people. These wil be part of Integrated Care Networks, where other NHS organisations, local councils and the voluntary sector work with local doctors to deliver services at the local neighbourhood level.
One Croydon had anticipated these new structures and so the Croydon Health and Care Plan already meets these expectations and can move swiftly to delivery. This creates the opportunity for health services to be delivered to better meet local people’s needs, but the devil is in the detail. We are in discussions with the CCG and Croydon Council in helping to define where and how patient representation and involvement is placed within these new structures, as they are set up. We plan to take on some insight work working with One Croydon partners later in the year which will influence these new structures.
Meanwhile Croydon Health Services NHS Trust and NHS Croydon Clinical Commissioning Group have agreed a joint working partnership in May of which you can read more about here. They are still separate organisations and will remain so but have created joint committees-in-common to work together on issues such as quality, planning and finance. The CCG will still hold the planning and buying function but will work closer as a unit with the hospital and community services trust. The benefit is that it reduces the impact of the buyer-provider split which has existed for about 20 years, where one part of the system bought the service from another. As I understand it lot of administrative time was spent between the two organisations negotiating with each other when they could have been working together. A good example of this is quality which is now headed by a Joint Chief Nurse, rather than two directors in each organisation. Their performance will still be assessed by committees with independent non-executive directors, wider joint committees and of course NHS England and NHS Improvement. It is intended that a committee-in-common will become the core Croydon committee responsible for delivering Croydon’s hospital and community health services, working with the wider One Croydon Board which is about health and social services and has a remit beyond just health. I have been assured that Healthwatch Croydon will have a place on this committee to ensure independent patient and resident representation is included.
If all of this was not enough, Croydon CCG is proposing to merge into one South West London CCG, also known as an Integrated Care System (ICS). This has been seen as potentially controversial since it could be seen as a shift of power away from Croydon. Having had a number of discussions with key people involved, this is something that has been mandated by NHS England and Improvement, but how it is delivered is down to the local CCGs to decide. In South West London, the importance of ‘place’ such Croydon is seen as important by the leadership who want to delegate as much money and therefore power to the place, reflecting that Croydon, Richmond, Kingston, Sutton, Wandsworth and Merton are very different boroughs with different needs. All other areas of England are going through the same process but not necessarily with the same delegation as South West London. In some cases, more resources will held more centrally at the ICS level.
Of course, for Healthwatch Croydon, this provides both challenges and opportunities. Challenges in that some aspects of the new organisational structure will mean we have to define Healthwatch representation at a South West London level. I can assure you we are exploring ways to ensure that all Healthwatches in South West London can work together effectively to support representation at this level. In terms of opportunities, we have already confirmed representation on all the key Croydon organisations from the CCG Governing Body to Croydon Health NHS Trust Board, as well as Health and Wellbeing and Health and Social Care Scrutiny and One Croydon Transformation, as well as now being invited to contribute to a number of subgroups around proactive health and quality.
It should be remembered that our role is to influence, using our independent insight, to help those delivering services to remember the patient in the decision-making. We cannot do what we do without you and your views. So, get involved, challenge us with your ideas and views and together we can help make services in Croydon accountable to resident’s needs and also feed that back at a South West London level.
Gordon Kay, Healthwatch Croydon Manager
Working with the Croydon Healthwatch Team provided me with invaluable skills and knowledge. Most notably, one of the skills I had developed from this experience was the ability to approach citizens and ensuring the “15 seconds” of their attention was enough for them to proceed with asking for their opinion on Croydon’s health service. Another skill I had developed from this experience was listening and expressing people’s ideas, as well as taking notes to ensure their view was fully represented. The awareness of how government funding is divided up for the different health services was interesting to find out because it provided a better explanation for the reason some services perform better than others. The beautiful thing about Healthwatch is that it accepts our medical services are not perfect, and they wish to improve things by using the voices of the people as navigation to better medical services in Croydon. Although, it was quite upsetting to hear some of the stories told by the people I was speaking to, and I could tell they were extremely hurt from their experience with health services – I hope that by spreading awareness of Croydon Healthwatch more people can know their feedback is valued and that services such as Healthwatch need to know these things so that more can be done to protect these people. It was truly an honour to work with the Croydon Healthwatch team, they were very kind and a joy to work with, they treated me as though I was a part of the team and valued the contributions I had given throughout the day.
Thank you for the experience,
Press release: 23 December 2020
Shielders said that overall service was good, but communication could
have been better and some organisation more consistent.
Friends and family had big role to play in supporting people.
Mental health support is needed, particular for those who live alone.
Croydon COVID-19 shielders shared their experiences on first lockdown to help deliver
better services for the second one, because of insight led by Healthwatch Croydon, which
is published today.
As a result of the COVID-19 pandemic, Croydon Council were required to lead the delivery
of shielding services for over 8,000 residents. Healthwatch Croydon, the local resident’s
champion for health and care services, ran a survey from August to October 2020. They
wanted to find out the views of shielders including their experience of shielding, how
effective the Council’s actions had been in providing information about services, whether
shielders needed extra services beyond those initially suggested. They also wanted to
know their experience when shielding has been paused, including the use of telephone
and video consultations.
The experience of those using shielding services in Croydon due to COVID-19, published
today presents the following findings and recommendations. These were shared with
Croydon Council in October before second lockdown which enabled services leaders to
make changes to improve services for shielders based on their views.
The vaccine is finally here and we can now release to you the FAQ’s and information packs for you to download and read. The majority of your questions can be answered via the link below.
Hi everyone, this Wednesday we will be hosting an online event via a public Facebook group to talk about the upcoming reconfiguration of Epsom, Sutton and St Helier Hospital and how this will affect Croydon residents.
Link to NHS information: https://improvinghealthcaretogether.org.uk/consultation/
Event till start at 15:00 pm.
Join the Facebook group here: https://www.facebook.com/groups/168640154080171/
The NHS is currently conducting a review into the NHS’s non-emergency patient transport services (NEPTS) this is ultimately to find out how well the system is working and how it can be improved. Complete the survey here.
One of the roles of Healthwatch is getting views from the seldom heard and hard-to-reach and the one group that sums this up is Croydon’s youth. You may not be aware that Croydon has the largest under 15 population of all London boroughs with 22% of the population. This means 84,000 people who rarely get to have their say on services.
The reasons for this are not unusual. Firstly, most are in schools or family settings where it is difficult for us to access, compared with individual living independently. Secondly, since we tend to focus on conditions, and since most are lucky in good health, we don’t tend to come across them. Although mental health in children and young is now becoming a bigger priority, as it services for those with learning disabilities.
Two weeks ago, my week was bookended by two great opportunities to meet under 15s. At the South West London NHS Health and Care Plan event, I got to facilitate a table of Tudor Academy pupils from New Addington, and then Healthwatch Croydon participated in Youth Takeover day where we showed seven youths what we did and encouraged them to undertake outreach with us asking residents their views on services.
The young children aged 10-12 at the Health and Care Event, not only sung at the start of the event as part of their choir but stayed the whole morning to give their views on how health services could be changed or improved to meet their needs. There was literally a factory of ideas with tens of post-it notes on different ways that people could take control of their health and also get the services they need. There was a big emphasis on reducing isolation, learning about healthy eating and lifestyles and a focus on mental health and wellbeing. These articulate youngsters presented their views at the end of the session, and are a real credit to their school and their community.
I was inspired by their positivity and problem-solving focus. Having a chat with the Deputy Head of the school, she explained the community focus the school had. They run mother and baby groups to help raise the profile of the school but at the same time help with social isolation, which shows the roles that other organisations beyond health centres can give. With so many schools in Croydon, could they not be funded to provide services? Especially as they connect with children and young families on a daily basis for 39 weeks of the year, not to mention after school and holiday clubs.
Hats off the Clinical Commissioning Group for building a good relationship with the school as well. As a result, they are very open to engagement as a result and Healthwatch have been invited to visit the school and gain views from parents and children alike.
On Youth Takeover day, we took seven 11-17 year olds, on two rounds of outreach at London Road Medical Centre, where they met social prescribing staff as well as patients. In the afternoon, we did a similar tour of the hospital main reception where we gained many comments on service, and where they also got to meet the new Interim Chief Executive of Croydon Health Services, Matthew Kershaw. Many of the teenagers found the process both interesting and challenging, having to do much active listening.
For us it was a good opportunity to hear their views on services as well, which were a little less forthcoming. It seems that many do not use services that much, leading us to think about how health and social care services can engage with this part of the population. Interestingly, many few used other services such as youth clubs, but they did all attend school, so maybe that is the approach that commissioners and providers need to focus on if they want this group to engage. Other ways maybe through some council projects. Indeed, we had some useful conversations with the Youth team at Croydon Council, about working with the Young Congress and networks of young people to gain their views.
With so many challenges both around physical but also mental health, it is important that their voice is heard. After all, they are the future generation for Croydon and engaging them now, will ensure they are active citizens in the future, contributing to discussions on building better services for all.
On Wednesday 28th November, Healthwatch Croydon had the opportunity to visit Croydon University Hospital new Emergency Department. The new A&E is a complete overhaul from the previous department and includes a new state of the art technology as well as well thought logistical patient pathways, clearly, there has been a lot of thought put into the best way to improve efficiencies for Healthcare professionals and also the comfort of the patients who will be using the service.
Having had a full tour, we think the new department is truly magnificent. This wonderful new building cost more than £21m to construct and has been designed by the hospital’s doctors and nurses to create the best environment in which to care for our community.
This is a great new facility but we need to be sure we only use it when we need emergency care so that staff can focus on those who really require their expertise at this busy time of the year.
That means that we all need to think about how to choose the right services for our health and care needs this winter and why I have pledged to become a Croydon NHS #WinterChampion.
If you do need to visit the new Emergency Department at Croydon University Hospital, then you will notice a big difference from the old facilities. It is 30 percent bigger than the hospital’s previous Emergency Department and has rooms with doors for every patient, rather than curtained cubicles, for better privacy and dignity.
There are two separate waiting areas for children and adolescents. There are also two mental health liaison rooms offering private and appropriate spaces where nurses can assess people who need specialist care, plus a dedicated Children and Adolescent Mental Health Service (CAHMS).
In addition, the Emergency Department includes a new 24/7 Urgent Treatment Centre with six consultation rooms and a treatment room where people with more minor ailments can be looked after by qualified staff, all of which are well signposted from the clear and open entrance of the new department.
The departments are set out so that patients are able to feel at ease throughout the experience, with navigational infographics on the walls of each consultation room, throughout all sub-departments in the building such as the Urgent Treatment Center and children services.
The main A&E department waiting rooms are designed with atmospheric orange artwork to help improve the atmosphere of the department, and the Children’s A&E, has incorporated the use of soft natural lighting to improve comfort for these more vulnerable groups. Children’s A&E has incorporated into it an interactive playroom with a soft play area including some more age-appropriate games with the installation of a games console.
It is not only patient experience with has been well thought out, each room has a wall mounted tablet which is linked up to the nurse’s station, pictures will be transmitted in real-time to ensure that the status of the patients is known centrally and more efficiently, making use of time more efficiently for healthcare professionals.
So, if you feel unwell, don’t wait for it to get worse because expert health advice is available at your local pharmacist for minor ailments, or you can book an appointment with a GP during their extended hours of 8am-8pm, 7 days a week.
You can also phone NHS 111 to speak to trained staff and clinicians about immediate health concerns. NHS111 is available 24 hours a day and is free to call from landlines and mobiles or you can visit www.nhs.uk or search #StayWellThisWinter on social media.
I am so pleased that we have such wonderful facilities and a wide range of different emergency and urgent care services for our community as we head into this busy time of year.
We all have a part to play in looking after our health and choosing the right service, so I hope everyone will help the NHS to help us this winter.
By Gordon Kay, Healthwatch Croydon Marketing Officer
Last month, we were contacted by a Croydon Grandmother who told us her story of what happened when her grandchild had a suspected fracture.
Being aware that the Purley GP Hub, would be the nearest and most relevant place to go, they went there. Previously, the Minor Injuries Unit was always nurse led and residents were told that this was the reason they could not access the x-ray facilities. Now the Hub was GP led, it followed that the xray facilities would now be accessible.
They waited for an hour and half before seeing a GP who suspected it may be fractured and suggested she go to Croydon University Hospital’s Urgent Care Centre as they could x-ray it. When the grandmother suggested there were x-ray facilities at Purley she was told that they were not available for this type of injury. So finally she went to East Surrey Hospitals A&E department and got the care for her granddaughter there, which meant another three- mile journey and more delay in getting treated.
Whatever people may feel about a service, nobody should have to wait over two hours in pain and have to see one specialist who then tells you to go somewhere else. Isn’t this the opposite of an integrated minor injuries service that is supposed to take the pressure of A&E?
This story raises two big issues one about buying of services that an x- ray facility exists that cannot be used and the other about poor signposting and communication of existing services.
Buying of services
We investigated further the pathway. Why is it that there are x-ray facilities at Purley GP Hub, but on this occasion they could not be used? Croydon Clinical Commissioning Group (CCG) told us that all GPs have the power to refer an x-ray at Purley but these are for injuries considered more serious, such as a chest injury.
We were advised that patients with injuries considered less serious should go to go directly to Croydon University Hospital. In short, while an x-ray facility exists it is only used in certain situations and there is no requirement to x-ray for suspected fractures at Purley.
To the public this is clearly a confusing proposition. The reason for this is that this was not an essential option in the recommissioning of urgent care services that concluded in 2016.
While the issue was discussed in the reprocurement process, the decision was taken that in order to meet the ‘right place, first time’ requirements for treatment, x-rays for minor injuries would be performed at the Urgent Care Centre at Croydon University Hospital.
The problem was that this has not been clearly or effectively communicated. Indeed Healthwatch Croydon only found this out after being sent a link by the CCG to a set of questions about the reprocurement process published deep within the CCG website.
Lack of effective signposting
As our research into GPs which is being published this week shows this is indicative of a system that is confusing the public. Indeed our research at hubs showed that whilst the majority of people we spoke to are happy with the quality of service provided, a clear majority were also unclear as to what was provided and where.
When hearing this grandmother’s account, we feel that she should at least have been informed at Purley Hospital on arrival that they did not deal with suspected fractures, and that it may be better for her and her granddaughter to go directly to Croydon University Hospital, rather than waiting for a GP assessment. A basic triage facility would have identified the potential injury and advised accordingly. It is an obvious assumption to make that a service with an x-ray unit, will conduct x-rays and if this isn’t always the case, then at a minimum the communication of this needs to be improved. This is even truer for Purley which used to have a minor injuries unit.
Croydon is not unique in these circumstances. Only last month, NHS England published guidance on what non-hospital based centres should be offering from 2019 see Urgent Treatment Centres – Principles and Standards July 2017.
On page 4 it talks about the public being confused by a mix of walk-in centres, minor injury units and urgent care centres, with a confusing variation in opening times and what diagnostics may be available. It is even refers to x-ray facilities but still refers to their use in some cases and later on page 8 at the recommendations makes only desirable plain x-ray facilities available, uses the number of people using the service as an deciding factor.
So what can be done?
Firstly, there needs to be better communication of the quickest, most effective pathway for people with different injuries and conditions to take when they arrive. This starts with effective triaging at GP hubs. By having trained professionals such as GP and nurses on the front desk, they can make swift assessments and decide whether you need to stay at the Hub or go somewhere else.
Secondly, a review of the demand for x-ray services needs to be made. The reason to make this decision was based on research by the CCG back in 2015. Well perhaps demand has changed, or maybe they need to look at cases for using the facilities when dealing with more vulnerable groups such as children.
Finally, much stronger and wider communications of which services are available where and how, which are easily accessible by phone call, mobile and print advertising, so that whatever age or background, a person genuinely gets to use to the ‘right place, first time’.
It is time to end this ‘snakes and ladders’ approach to an essential service, we should all be able to get care at the right place as swiftly as possible. After all, isn’t this what the reprocurement of urgent care services was all about?
By Gordon Kay, Healthwatch Croydon Marketing Officer, 6 July 2017
The concerns and needs of carers is usually an area long overlooked by policy-makers and NHS providers. While the focus is on those being cared for, carers sometimes get missed out in the system, as some of our reports on hospital discharge in 2016 suggested.
Did you know that according to Croydon Carers Information Centre, there are 33,000 carers in our borough? Yet it has one of the lowest carer Health Check take up rates of all London Boroughs with just over 1 in 20, 5.4% of the eligible population being offered a Health Check. The Croydon Carers Strategy 2011-2016, noted that while carers often neglect their own health and wellbeing, Black Minority Ethnic (BME) carers in particular faced additional difficulties of stereotyping and social inclusion.
The 2011 report Half a Million Voices noted that BME carers provide more care proportionally that White British carers, which puts them at greater risk of ill health, loss of paid employment and social exclusion. These are, of course the same issues as White carers, the difference is that they also have to deal with cultural barriers, stereotyping, language difficulties, which further enhances the exclusion. Some BME groups also suffer more exclusion that others with Bangladeshi and Pakistani carers particularly challenged.
At the local level, the London Borough of Croydon’s Carer Engagement 2017 report, which surveyed carers in the borough, had responses from 59% white carers and 24% BME, yet the population in Croydon is 54% BME, 46% white. The report proposed that future engagements should therefore seek responses from BME community to ensure better representation.
IRISS Insights, who specialise in enhancing the capacity and capability of the social services workforce, suggested in their report, Improving Support for BME Carers that there is little guidance concerning the needs of BME carers. Part of the issue is the difficulty in obtaining accurate information about the size and nature of the BME carer population. Census questions identifying BME carers have existed since 2001. This has made a difference, but underreporting is high, due to language barriers, concerns on immigration status, or a perceived suspicion of sharing data with the State.
Carers UK research suggest BME carers are more likely to struggle more financially, be more likely to be caring for a sick or disabled child aged 20-24 (which reflects long-term caring responsibilities) and be more likely to be caring for someone with a mental illness. As a result, carers have had restricted access to education, employment and, when in work, promotion.
Ethnicity data has improved significantly since the 2010 Ethnicity Act made a legal requirement for health and social care providers to collect data. This UK-wide data has revealed that Indian, Pakistani and Bangladeshi groups report a poorer experience than White British people. But it is not clear where in the system they are experiencing unfair or inequitable treatment.
Where research has taken place, the key issues were language barriers and knowledge of services and cultural challenges. For example, in Bengali, Gujarati, Urdu and Punjabi there is no word that translates to ‘carer’, so the role may not be recognised or perceived as a role that needs support. There are also concerns that NHS services could not meet cultural and religious needs, so services were not taken up.
While Healthwatch Croydon is here to represent the views and experiences of all Croydon residents, we do also have a duty, in law, to gain the views of those least represented. BME carers clearly fall into this category, particularly where we have a population that is 54% BME.
This area of work is clearly under-researched and has many contradictions. Therefore, the focus of the first of our in-depth research reports in 2017-18 will focus on asking BME carers about their experience of using Croydon’s GP services, to see if their needs are being met.
It is important that anyone irrespective of background gets the neccessary support they need. In a borough with such a rich diversity of people, services need to be able to respond to all service users wherever they come from. The aim of this report, will show any barriers to access and therefore guide NHS buyers in delivering services that give BME carers the support they need, but we cannot do it without the views of BME carers.
If you are a BME carer, come and share your experience at by filling in our survey by 21 July or contact our Community Engagement Manager, Geraldine Bolam on 020 8663 5632 or firstname.lastname@example.org for a one-to-one chat. We can only influence change with your experiences.
By Gordon Kay, Healthwatch Croydon Marketing Officer, 5 April 2017
Recent decisions by Croydon CCG, to close Foxley Lane women’s mental health unit and to cease assisted conception (IVF) services despite public engagement resulting in substantial opposition to these cuts, raise two important questions for me. Firstly, what power should patient have to influence decisions on healthcare and secondly what is effective engagement and how does it differ from consultation?
The NHS Constitution states that a citizen we have the right to be involved, directly or through representatives, in the planning of healthcare services, the development and consideration of proposals for changes in the way those services are provided, and in decisions to be made affecting the operation of those services.
Section 242 of the consolidated NHS Act 2006 and 2012 Health & Social Care Act places a duty on NHS trusts, CCGs & strategic health authorities to make arrangements to involve patients and the public in service planning and operation, and in the development of proposals for changes.
While the legislation defines that patients and public need to be engaged it does not define effective models of how this should be delivered. So, what is a good example of engagement?
David Gilbert of InHealth Associates, a specialist consultancy that helps NHS organisations deliver better patient and public engagement suggests proposes an engagement cycle. At each stage, patients and the public have a role to play in services.
What is interesting about this cycle is that is looks at getting public, patients and communities involved right at the beginning.
It focuses on five stages:
- Working with communities (of geography and of interest) to identify needs and aspirations
- Working with the public (as citizens and taxpayers) to plan and transform services
- Working with patients and carers to design services and improve quality and safety
- Working with patients and the public to procure and contract services
- Working with patients and carers to monitor services and share learning.
This engagement cycle isn’t very new, it has been adapted and tested by dozens of CCGs and NHS organisations across the country. Utilising this model is more likely to result in the public feeling valued, trusted and in a position of influence, the commissioner understanding that they have reliable data, and the backing of the public in their decision-making. And with the right commitment, it could happen here in Croydon.
Which takes us back to the Foxley Lane and assisted conception decisions. Had the CCG sought public engagement right at the beginning of the process, instead of consultation towards the end, the public may have gained a greater understanding of the complexities and this might have helped the CCG in terms of trust. The same decision may have been made, but at least the public would have been engaged in the process and had some ownership of it.
That is not to say that this kind of public involvement does not happen in Croydon. A Healthwatch Croydon volunteer was recently part of the procurement panel for the new urgent care services contract. The insights he gained as well as the input he gave shows what can be possible. What’s more he feels, that he contributed to this shared decision. An example of the CGG doing with its service users not too its service users.
Another positive example of this, is the commitment given by Croydon Council’s public health team to work with HWC in involving teenagers in the service design of sexual health services in the borough. based on the recommendations of our research report. We need to see more of this kind of public engagement but earlier in the decision-making, and it is not just the CCG, but at the two NHS Trusts and with the Council. Public engagement is not rocket science.
This discussion is even more important when you consider that there are due to be major changes to health and social care in Croydon as a result of the South West London Sustainability and Transformation Plan. Now more than ever is the time to consider real engagement, particularly when the changes to services are substantial and predicated on hard financial decisions to be made. So, when are the commissioners are going to take up the challenge of the engagement cycle and engage with the public as true partners?
The benefits could be transformational for all concerned.