Talking, Listening & Working Together - feedback from the April workshop
The workshop was facilitated by Sally Czabaniuk, Engagement Lead with NHS North East Lincolnshire Clinical Commissioning Group (CCG) with the support of colleagues from partner organisations and Healthwatch North East Lincolnshire.
The slide set used at the session is attached.
We began with a short video - Strong, Integrated Care Systems Everywhere about the changes that are taking place nationally in the way that the NHS is organised.
Then Julie Wilson, Commissioning Lead with the CCG talked about the Humber and North Yorkshire Integrated Care System and what that would mean for us locally in North East Lincolnshire.
We want to make sure that local people and communities are engaged and involved in developing health, care and wellbeing priorities and plans. In our first discussion groups we looked at how people have their say now about health and care services, how you hear about opportunities to get involved and what you thought worked well.
We also asked groups to think about how we can find out what people whose voices we seldom hear need from their health and care services and how we can involve people from all parts of our community in the future.
We had 5 table top discussion groups, and this is what you said.
Ways that work well:
- University of third age – Interesting and fun activities but provides opportunity to share information, reduce loneliness, chance to feedback etc. Need to build relationship though and not just dip in and out
- Community groups – As above
- Emails to inform – All participants found out about this event by email. Can choose what to take part in or ignore but at least you know
- Emails - provided there is not too much information/ jargon/ acronyms.
- Face to face meetings, presentations, workshops
- CCG Community Forum has involved community members over many years
- Accord has been a great membership; it has been far more effective than similar memberships elsewhere in the region
- Digital engagement:
- Digital meetings have helped to improve awareness of engagement opportunities
- Digital engagement sessions on Zoom have been a good way for people to hear about the local NHS response to Covid
- People are getting used to online meetings:
- Although some people are less likely to speak up, than they would at a face-to-face meeting
- Digital medical consultations – there are pros and cons to this approach for different audiences
- Active Patient Participation Groups are a good way for patients to work with their GP practice, but this is not consistent across all practices
- Newsletters/communications from membership group such as Navigo and hospital trust
- Talking to staff health and care staff at hospitals, GP practices, mental health practitioners etc
Some things that don’t work so well
- Leaflets - nobody reads them
- Public meetings often use too many acronyms and make it feel inaccessible to lots of people
- Sometimes emails are irrelevant and should be sent in a more targeted way. For example, an older male may not want to receive information about maternity services.
Ways to involve people who do not speak up:
- Better use of GP app – Wasted opportunity when it’s just to order prescriptions. Could it be used for more feedback opportunities?
- Better use of social media
- 2 of 4 participants said they would have shared this event on social media
- Zoom events open up opportunities to get younger people/working age an opportunity to get involved
- Enabling people to join/engage in meetings digitally, without having to be seen or heard
- Remember that not everyone has access to technology and that some people get digitally overloaded. Must engage in many different ways- one way doesn’t suit all.
- Face to face – To get to people who aren’t on email, social media, not normally interested etc
- Keeping surveys ‘short and sweet’ with focus on specific areas. 2 or 3 questions maximum. If there needs to be more questions asked about other areas, there should be a separate survey
- Making opportunities accessible to those with other commitments
- Think about when meetings are held as well as where – evening meetings enable working people to attend
- Ensure information is simple and easy to understand - less jargon and acronyms
- Ensure we feedback to people who have been involved – what difference has their involvement made.
Face to face
- Going out into our communities and talking to people - go to where people are, don’t expect them to come to you
- Using community centres and other places which people go to already, utilising links with voluntary organisations
- Engaging with young people who have attended for Covid vaccines; using this as an opportunity to find out about their experiences
- Think about who is asking – sometimes people are more comfortable talking to VCS groups or volunteers rather than public sector staff.
- Placing an emphasis on co-production of services; involving service users & working with them – not doing to them.
- People will only engage when it's about something they care about or that directly impacts on them or their families
- Remember that often, a lot of people don’t want to be involved unless they have a complaint.
In the second half we put Talking, Listening and Working Together into practice to look at future plans for Diagnostic Services, things like X-rays, scans and other tests. Julie presented information about plans for a Community Diagnostic Centre for North East Lincolnshire which is part of a national initiative.
The discussion groups then looked at:
- Your experiences of being referred for tests
- What worked well and what would have made it better?
- What do we need to consider when designing new ways of delivering diagnostic tests?
Good experience of being referred for tests
- Routine blood test – Fast appointment, fast results, done in community not hospital so easier access and allowed to bring someone even with Covid restrictions
- Endoscopy, CT, MRI, bone scan, eye test – All positive
- Routine, regular testing for long term condition at GP practice – all straightforward with the right health care professionals involved and engaged with patient over period of time so they get to know you.
- There are cases where communication can work well
- Care is good
- PALS (Patient Advice and Liaison Services) & SPA (Single Point of Access) have provided good clarity on diagnosis/prescription.
What would have made it better?
- Between patients and provider
- Internal communication within and between providers
- Keeping patients informed of progress
- Waiting 3 years for results/ letters - not informed of results and often don’t know who will give you the results or how you can ask questions after you have received results
- Conflicting opinions from consultations, on the outcome of diagnostics
- Not knowing when you are going to find out outcome of scan or how and by whom – no information about timescales.
- Blood test – Seeing a GP in person, getting the right tests first time, unhelpful receptionist putting barriers in place, face to face appointment with the right person with the right knowledge
- Blood test at home – Having dementia support, explaining what’s happening. Didn’t complain as aware of NHS pressures
- MRI, CT, endoscopy, colonoscopy – Seeing a GP face to face rather than 3 telephone appointments with others, resulted in unnecessary tests, resulted in treating pain rather than ongoing cause. No trust now
- Being an inpatient and feeling well enough to go home but having to stay at hospital waiting for a scan
- Filling out lengthy forms for MRIs is a barrier for many people
- Prescriptions once diagnosed, are not always processed correctly (or the correct item).
- Confusing telephone booking systems – difficult to make changes to appointments
- For wheelchair users there are significant accessibility issues. Most departments do not have a hoist meaning that certain tests cannot be accessed. Being taken to certain tests in an ambulance as a wheelchair user is a horrible and traumatic experience that puts you off getting diagnostics because of the trauma. A great section of the population is being ‘cut out’ because there is no hoist; and staff do not know how to deal with people with additional needs
- When a potentially hereditary/genetic condition has been identified in a family – the process for getting the recommended tests to diagnose if this is present in relatives is not consistent in all areas.
Things to consider when designing new ways of delivering diagnostic tests – what is important to get it right for patients and their families
- Patients/ carers need to be able to park for free, consider that people may have large vehicles for transporting wheelchairs etc.
- Signage and information about how to get there is important
- Must have good public and community transport links - lack of dial a ride and village buses, cost of taxis etc are a barrier
- Making better use of existing transport fleets that Partner organisation have – such as mini buses
- Car parking – to include disabled parking, take into account size and type of vehicle being used by the patients (e.g. height restrictions)
- Must have accessible drop-off points into the Centre.
Access in the building
- Accessibility for all, not just considering disabilities but also considering push chairs etc. Be inclusive!! Be accessible, not just in terms of how people can get there but also how accessible it is inside the building. Wide doors, hoists and other necessary equipment.
- Doorways and navigation within the building – signage
- Involve patients with access needs in the planning of the lay out of the premises (inside and outside)
- Having a meet and greet service at front of house to welcome people and help people get to where they need to be
- Comfortable waiting area with somewhere to get tea/coffee/water
- Private (sound proof) consultation rooms
- Help/information for people about services may help them deal with diagnosis or treatment plan – especially where people may have had bad news.
- Opportunity to refer people into other services in the community.
- Right test at the right time
- Timely access - number one priority must be access to fast testing and results
- Face to face appointments first with right practitioner so right tests are given
- Continue community-based testing
- Bloods should be possible everywhere. Sending disabled people to different departments when they could be done at the same place would make a big difference
- Can certain diagnostic tests be done at a person’s home to avoid the trauma of going to the hospital or different care settings. It is not easy for everyone to get to appointments and can be very distressing for people with certain conditions
- Consultants on site to provide advice to patients
- One stop session for diagnostics – having a consultant for condition X at the CDC one day per month, to provide advice to patients and diagnosis. Streamlining the wait for diagnosis
- Additional areas of screening, above and beyond the minimum NHS requirement for Community Diagnostic Centres
- Self-referral for some diagnostics
- Accessibility- communication barriers. Some people struggle to get through to the right place on the phone because of difficult to navigate automated telephone systems.
We all agreed that all the areas covered were priorities to take forward when planning the development of the Community Diagnostic Centre for North East Lincolnshire.
Questions, comments and follow up
“It is difficult to find out information in one place about what support is available for older people”.
“Can Patient Participation Groups (PPGs) be more involved with all of these changes?”
The PPGs will be key partners. In future sessions we are going to look at how PPGs and other groups will be part of the Partnerships Community and Service User network and influence the work of the Partnership.
“Is there a way to make an anonymous complaint at a GP practice because many people are concerned that if they complain it will affect their future treatment?”
General comments can be passed on anonymously to practices via suggestion boxes and if there isn’t one, speak to the CCG PALS team who can make a note of the comments and action as required. However, if it is a complaint about a specific thing that the patient has experienced then complaints in their nature need to be investigated and this would mean that it would be essential that the details of the case were provided so that the investigation could take place.
“Why does nobody ever think of visiting a pharmacist?”
Pharmacists are key parts of health systems. There are also new roles within primary care to support with demand. One of the new roles are ‘clinical pharmacists’ who have a key set of specific skills to help patients with medicine management and lots of other things. As a CCG, our communications team share lots of messaging via different means about the benefits of visiting a pharmacist.
“Why do we have a national issue to access GP face to face appointments? There are campaigns in the media encouraging people to talk to their GP if something in their body doesn’t feel right and most people find this laughable as it is so hard to access a GP appointment”
Throughout the pandemic, GPs have continued to be open and seeing patients. At the outset of the pandemic, the triage first system was put in place. This is an approach we have been trying to work towards for some time but it became necessary to work this way during the pandemic. However, if people need to be seen by a GP, there are appointments available. It may be that certain problems can be dealt with by a different clinical professional like a nurse or a clinical pharmacist or one of the other new roles mentioned previously but if there is a clinical need to be seen by a GP then people are being seen.
Please speak to the CCG PALS team to discuss this with us and with your consent, we will look into this.
PALS is a confidential service and can be contacted by:
Telephone: 0300 3000 500 (Calls to this number are charged at local rate from a landline or mobile number)
Writing to: Customer Care Team, North East Lincolnshire CCG, Municipal Offices, Town Hall, Grimsby, DN31 1HU
We have arranged for a member of the CCG PALS team to attend the next two workshops to be on hand to hear people’s comments, compliments and complaints.
We hope you enjoyed this workshop and hope you will join us again. To help us to improve these sessions we would appreciate it if you could complete the attached evaluation.
It is important to us to know whether we are supporting or providing services fairly to all groups of people, and we would appreciate it if you could complete this survey - the questions are intended to help us to find out about that. The information you give us will be kept confidentially and stored securely and will only be used to monitor the fairness and effectiveness of our service delivery and employment practices. No personal information which can identify you, such as your name or address, will be used in producing equality reports. You do not have to complete this form or some of the questions if you do not want to and it will not affect your access to services or how we treat you.