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Healthwatch Islington Annual Report 2016/17

Our formal report on last year's activity

How well do local health and care services support the needs of people with autism?

We spoke with Islington residents with Autism Spectrum Condition, and with their families. We heard from 60 people in total. We were particularly interested in learning whether they thought that more could be done to make health and care services accessible.

  • people said that health and care providers (GPs, dentists, and hospitals) needed to be more flexible, rather than expecting autistic patients to be the ones to make adjustments.
  • many people reported difficulties accessing autism-specific services (speech and language therapy, occupational therapy, clinical psychology, CAMHS etc).
  • there's a need for better autism awareness amongst health and care professionals, particularly regarding autistic patients' communication needs.

Black and minority ethnic groups accessing services in Islington 2016/17

Diverse Communities Health Voice is a consortium of 10 Islington based organisations: Arachne Greek Cypriot Women's Group; Community Language Support Services; Eritrean Community UK; IMECE Women's Centre; Islington Bangladesh Association; Islington Somali Community; Jannaty; Kurdish and Middle Eastern Women's Organisation; Latin American Women's Rights Service; Healthwatch Islington (coordinator).

In this the second year of our community research 207 respondents gave the consortium their views on Pharmacy; Well-being; Accident & Emergency; Interpreting services; Referrals to specialist services

Phoning Adult Social Services: a mystery shopping investigation

People told us it was too hard to reach social workers by phone. We decided to investigate.

The Podiatry Foot Health Service

In Islington, community podiatry services are delivered by Whittington Health. In August and September 2016 we visited the seven health centres in Islington offering podiatry services, and talked to service users about their experiences. This report is based on their feedback, and that of the health centre staff to whom we spoke.

  • On the whole patients were positive about the staff and service.
  • However, 21 of the 33 patients we spoke to said that they had been waiting longer than they should have for their appointment.
  • The system by which appointment letters are sent out needs to be improved.

Emergency department, general practice, or pharmacy services?

A number of people use hospital emergency departments when they could be seen by a GP or in their local pharmacy. What factors influence how we decide where we need to be seen? We talked to Islington residents about their experiences. Our partners Every Voice and Manor Gardens Health Advocacy Service ran a series of focus groups on the same topic to ensure feedback from black and minority ethnic (BME) communities was included.

We found that across all groups there was some confusion about what constitutes a serious enough need for treatment at an emergency department. There was less awareness of what is on offer at local pharmacy amongst the participating BME groups. We've made two recommendations:
 
Recommendations
 

Home care: Stories from service users

Healthwatch Islington worked with two of the three local agencies to contact residents receiving council funded home care services. The user stories collected here offer a snapshot of what it is like for users receiving care and support, told in their own words.

Mental health day services: Islington Mind

The Enter and View team visited the three Islington Mind day services, jointly funded by Islington Council and Islington Clinical Commissioning Group. We chose to visit day services as these more 'preventative' community based social services appear to be under threat and vulnerable to funding cuts.

The Enter and View team undertook two visits to each Mind day service, the first being an announced visit in April and the second, an unannounced visit in May. We were particularly interested in seeing how how much say the service users had in how the centres were run.

Healthwatch Islington Annual Report 2015/16

Our formal report on last year's activity

  • Larger projects included our reseach into mental health services for young adults, and the health needs of black and minority ethnic communities who don't have English as a first language
  • We produced 12 reports with recommendations on how services in Islington could be improved
  • We provided information and support to 229 residents needing help to access services
  • Our cross-borough work to train volunteers with disabilities won us two national Healthwatch awards.

Revisiting the IHUB GP extended hours service

The IHUB is a new service. It runs out of three centres across Islington. It offers weekend and evening appointments and is open to anyone registered with an Islington GP.

In April we spoke to 53 patients using the service across the three centres. Of those, 48 said they would recommend it to friends and family. (This was a repeat of an exercise we had undertaken in November and December 2015.)

GP services for Islington residents in residential care

We spoke to care home residents, next of kin, and staff about their experiences of GP services that are delivered in the care home setting.

  • Generally respondents felt that the service was good.
  • The main issues related to communication between the home and the practice, and linking with other services, such as Out of Hours care and 111 (which some staff suggested were not as responsive).

Black and minority ethnic groups accessing services in Islington

Diverse Communities Health Voice is a consortium of 10 Islington based organisations: Arachne Greek Cypriot Women's Group; Community Language Support Services; Eritrean Community UK; IMECE Women's Centre; Islington Bangladesh Association; Islington Somali Community; Jannaty; Kurdish and Middle Eastern Women's Organisation; Latin American Women's Rights Service; Healthwatch Islington (coordinator).

The consortium works to get the voices of some of the most marginalised members of society heard by mainstream agencies. Islington Clinical Commissioning Group (CCG) asked the consortium to carry out community engagement work looking at: Hospital appointments and patient choice; GP services; Keeping fit and healthy. This report shares our findings.

Sexual health services

Healthwatch Islington commissioned local partners Community Language Support Services and Jannaty Women's Network to gather views from their clients on sexual health services.

Community Language Support Services assists speakers of community languages, especially refugees from east Africa and other Arabic speakers to access mainstream services. Jannaty supports women from a range of black and minority ethnic communities particularly across North Africa, the Middle East and Eastern Europe. 

  • Overwhelmingly respondents felt that information provided through local community organisations would be most helpful in promoting access to sexual health services

Access to primary care and social care services for Latin American Over 50s

We worked with the Latin American Women's Rights Service (LAWRS) and the Coalition of Latin Americans in the UK (CLAUK) to produce this report about the experience of their clients using services in Islington. Recommendations included:

  • Where possible, GPs could try and accommodate longer appointments when interpreters are needed. This would give patients time to ask the GP questions about their treatment, via the interpreter.
  • Medical and administrative staff should be trained about how to work with non-English speakers, migrants and people from other cultures in general. Training should focus on the particular challenges these service users face, and how to meet their needs most effectively.

Ophthalmology Services in Islington

Some eye care services can be provided closer to home, without the need to visit a hospital. With the help of the Thomas Pocklington Trust, we spoke to 51 local service users with experience of visual impairment services, via structured interviews or focus groups. We focused on what might give patients the confidence to use services in the community rather than in a hospital.

  • There was not a huge appetite for eye care services to be delivered in the community. Respondents valued the accessibility and familiarity of hospital eye care services. They also appreciated the quality of treatment, referencing the experienced staff and quality of equipment.
  • Respondents felt that community services would be better suited to minor ailments, screenings and tests rather than complex or urgent cases.

Mental health day services: The Recovery Centre Isledon Road

The Enter and View team visited the Recovery Centre Isledon Road, which is jointly funded by Islington Council and Islington Clinical Commissioning Group. We chose to visit day services as these more 'preventative' community based social services appear to be under threat and vulnerable to funding cuts.

This was an announced visit which took place in November 2015. We were particularly interested in seeing how how much say the service users had in how the centre was run.

IHUB GP extended hours service

The IHUB is a new service. It runs out of three centres across Islington. It offers weekend and evening appointments and is open to anyone registered with an Islington GP.

In November and December we spoke to 45 patients using the service across the three centres. Of those, 42 said they would recommend it to friends and family.

Mystery shopping: Healthcare Travel Costs

Healthwatch mystery shoppers phoned GP surgeries and visited local hospitals to see how easy it was to make a claim for reimbursement under the Healthcare Travel Costs Scheme. We found that the scheme was not well known or understood at the GP surgeries we spoke to, and not all hospitals made the claims process accessible.

  • GP reception staff in particular need to be informed about the scheme and when it might apply to patients using their services. Messaging should stress that the scheme is not just for hospital appointments, and is for patients on benefits or low income (rather than those with limited mobility).
  • Only University College Hospital included a prepaid envelope with their postal claim form. All hospitals should adopt this practice. This would ensure that patients on low incomes are not expected to pay postage costs when claiming reimbursement of their travel.

Care home visits, June 2015

Our Enter and View visits to Bridgeside Lodge Care Centre, Cheverton Lodge Care Home, The Highgate Nursing Home, and Muriel Street Resource Centre. Examples of our recommendations included:

  • Whilst we appreciate that technology isn't for everyone, all homes could offer WiFi as a cheap way of giving residents more choice and control over what they listen to and watch, what papers they read, and even the possibility of shopping. Bridgeside already offers this.
  • NHS commissioners to investigate increased waits for podiatry appointments.

GP online services in Islington

To gather local people's views on the online GP appointment booking service, we created a survey. We received 43 responses and our findings are shared in this report.

Mental health services for young adults

50 young adults from a range of vulnerable backgrounds gave us their views on mental health, and the mental health support services they would find most useful. 21 more young adults were trained by Healthwatch to go out and conduct those interviews.

  • We recommended that more support be delivered in community, rather than institutional settings.
  • Support should not be delivered in isolation, but holistically; combined with social activities, advice, guidance and advocacy services.

Experiences of Integrated Care

We carried out phone interviews with Islington service users who have experienced integrated care through Multi-Disciplinary Team pilots. These pilots are aimed at more intensive users of services. The model seeks to bring together professionals from primary care, community services and social care to deliver 'person centred' care. This ensures that patients don't fall into the gaps between services, and avoids the duplication that comes when those responsible for different areas of a person's care are not working together.

Annual Report 2014/15

Our formal report on activity in 2014/15.

  • Larger projects included our our investigation into the provision of interpreting services at GP practices, and our work on NHS complaints
  • We produced 11 reports with recommendations on how services in Islington could be improved
  • We provided information and support to 226 residents needing help to access services

 

NHS Complaints Insight

We carried out some work on local complaints processes in Islington. This included mapping the existing ways in which patients can complain. We were also asked to gather the views and experiences of local people who had made or tried to make a complaint to find out what worked well about local processes and what could be improved.

Customer Service in GP reception areas

In 2014 Islington Clinical Commissioning Group arranged customer service training sessions for reception staff within GP practices. Healthwatch Islington mystery shoppers then visited practices to measure the impact of the training.

Experiences of the Integrated Care Ageing Team Service

We carried out interviews with residents, relatives and staff in local care homes. The aim of the research was to find out about users' experiences of the Integrated Care Ageing Team (ICAT) service and how residents (and where appropriate relatives and carers) had been involved in their treatment, and in conversations about their end of life care.

Interpreting services in GP practices

Feedback through Healthwatch Islington's out-reach work with voluntary sector organisations andresidents (including non-English speakers) in 2013/14 highlighted that GP practices in Islington may not be consistently providing interpreting at reception and for consultations. So Healthwatch Islington decided to gather further evidence. This report shares our findings.

Care Home Visits, 2014

Our Enter and View visits to St Ann's, Highbury New Park, Lennox House, and Muriel Street Resource Centre.

Mystery Shopping GP Complaints

Mystery shoppers visited GP practices in Islington in January 2014 to see if their was clear information provided on how to make a complaint. Seeing that there was often no information available, or that information was out of date, Healthwatch Islington produced new guidance for the practices to display. We repeated the mystery shopping in October 2014 to see what improvements had been made. This report shares our findings.

Raising Adult Safeguarding Alerts in Islington

Healthwatch Islington decided to carry out some research with a small number of voluntary organisations to identify how the process of raising an alert, and the subsequent contact from the Access Team, works in practice.

Carers Week 2014

During Carers Week, local partners Centre 404 and Islington Carer's Hub (both members of our Steering Group) invited us to host stalls at two of their events and gather the views of carers. We asked carers to talk to us about what makes services harder to use, for them as carers. We asked them to tell us about what things were working well and how services which are more difficult to access could be improved.

Care.data event, July 2014

A report on the meeting hosted by Healthwatch Islington to share information about the care.data scheme.

Healthwatch Islington Annual Fair, June 2014

A report on the discussions about local health and social care that took place at the Healthwatch Islington annual fair.

Gathering Views and Providing Information, May 2014

Findings from our outreach and signposting work.

Annual Report 2013/14

The formal report on our first year of work in Islington.

Refugee Forum Event Report, March 2014

New NHS structures and refugee and migrant community health needs: Islington Refugee Forum was keen to ensure that local refugee community organisations were aware of the changes that have taken place within health care services.They also wanted an opportunity to engage with NHS providers. The event was hosted by Healthwatch Islington.

Experiences of Deaf service-users in local hospitals, March 2014

Deaf service users raised a range of concerns about experiences in local hospitals, these included a lack of staff understanding about being Deaf; a lack of interpreting available to service users even following a GP referral that highlights this need, a lack of information about whether an interpreter will be at an appointment ; and one example in which a patient felt that the interpreter used may not be suitably qualified to interpret.

Long term conditions survey, March 2014

The Department of Health defines a long term condition as 'a condition that cannot, at present be cured; but can be controlled by medication and other therapies'. Examples
include diabetes, heart disease and chronic obstructive pulmonary disease. We asked 37 local residents with these conditions how they felt about the support they received.

Information on making a complaint about your GP service, January 2014

In December and January our team of mystery shoppers visited the 37 GP surgeries in the borough to check if there was clear information available on how to make a complaint. Here is what we found.

Home Care Services January 2014

A survey looking at the care people receive in their own home. Interviewing started in earnest in September, mainly in Day Centres and continued until December 2013. The research also included a focus group.

Urgent Care, Children and Young People, November 2013

This piece of work carries on from Healthwatch Islington’s visits to the Angel Medical Centre and Urgent Care Centre at Whittington Hospital. Healthwatch Islington worked with Islington CCG’s Participation Officer for Children and Young People to contact local young people and ask them for their views.

Enter and View Urgent Care, November 2013

Healthwatch Islington's Enter and View team visited the Angel Medical Centre and Whittington Health’s Urgent Care Centre in September 2013. We spoke to 48 patients in total.

Older People Leaving Hospital, July 2013

Healthwatch launch report, April 2013

Report from the launch event of Healthwatch Islington

We've helped get free WiFi access for care home residents and visitors

Wifi symbolWhen Healthwatch volunteers last visited care homes in 2015 we noted that Bridgeside Lodge had a WiFi network available for residents and visitors. Whilst technology isn’t for everyone, we recommended all homes could offer WiFi as a cheap way of giving residents more choice and control over what they listen to and watch, what papers they read, and keeping in touch with relatives. Healthwatch has continued to press for this change and since March this year three more homes have made free WiFi available.

We've made it easier to contact social workers by phone

We'd heard anecdotal reports that it was hard to reach social workers by phone. We decided to undertake some mystery shopping and build up a picture of what was happening. We asked for a list of all social workers and called them randomly over a two week period. The exercise uncovered long waits for calls redirected to Business Support. We made a number of recommendations, including that callers should be able to leave messages for social workers more easily. Our recommendations were followed, and the experience is much improved (We mystery shopped the service again a few months later to make sure). In the words of one service user, 'It’s less stressful now because you know you’ve at least left a message. Also, if I call after 7pm calls are free so it prevents us from having to make such expensive calls like before.'

We've ensured fairer access to weekend and evening GP appointments

It is now possible for Islington patients to see a doctor in the evening or on the weekend. The service was originally offered out of three GP centres (or hubs). Healthwatch found that a disproportionately large number of patients using the service were from the practices where the hubs were based. In other words, the 33 GP centres that did not serve as hubs were less likely to refer their patients to the service. As a result of our work, there is now a clearer contractual requirement that the provider of the IHUB service takes action to ensure that non-referring GP practices refer their patients to the service.

We made it easier for care homes to contact their GP practices

We went into local care homes to find out what residents, next of kin, and staff thought of the GP service provided to residents. We found that although the service was valued, it could be difficult to contact the GP outside of scheduled visit times. Those care homes that had a direct line for their GP did not have this problem, but very few homes had been provided with one. As a result of our work, Islington Clinical Commissioning Group now insist that a direct telephone number and email is provided. It's been introduced as a requirement in the operational agreement between each GP provider and home.

Healthwatch Islington wins national award for volunteering

The work of our volunteers, and our approach to volunteering, was celebrated as the best in the country at the Healthwatch network awards in June. Our project on mental health services for young adults and our ongoing partnership with 'Help on Your Doorstep' (where staff and volunteers go out door knocking on local housing estates to offer support and learn about residents' needs) were singled out for particular praise. Read more.

We made the Healthcare Travel Costs Scheme more accessible

We wanted to find out how easy it was for patients on low incomes to reclaim their travel costs. Not all local hospitals made the scheme easily accessible, and none of the GP practices we spoke to knew that their patients could receive this support. We shared our findings in December 2015. There was an immediate change of policy at Moorfield's Eye Hospital. A few months later the Whittington followed suit. Islington Clinical Commissioning Group then contacted all GP practices, emphasising that the scheme was not just for hospital appointments. We also worked with Healthwatch England to convince NHS Choices to change the information on their website to make it clearer who could benefit from the scheme.

We listened to Islington residents who are cared for at home

We worked with Islington Council and two local providers, to reach some 600 people receiving council funded care in their own homes. We provided signposting to those that needed it, helping with enquiries about how individual contributions to the costs of home care were calculated, and giving out complaints information. We also carried out phone interviews, gathering some great feedback on people's experiences of home care which we published and shared with commissioners this summer.

More GP practices in Islington are now offering interpreting

The work we began nearly two years ago, to increase the use of interpreting services in our GP practices, is beginning to show results. Overall the number of bookings in the last six months has increased, and more practices are offering interpreting. Islington Clinical Commissioning Group have told us that our involvement has really helped them to prioritise this work and expand the monitoring of usage rates. We've also produced EasyRead guidance in Arabic, Greek, Spanish and Turkish about getting interpreting support at the doctors.

We showed which services were most important to local people

We are giving a voice to those whose first language is not English

We are the lead partner in a successful funding bid made with 9 local black and minority ethnic organisations. It is the first time many of our partners have received funding from health service commissioners. The project partners represent communities who can't be reached through usual forms of engagement due to language barriers, or residency status, and diverse other factors. The funding is allowing these organisations to run focus groups with their members, to give much needed feedback to commissioners on issues including hospital appointments, GP access, and public health.

We worked with other Healthwatch to engage the Deaf community

Healthwatch Islington and 12 other London Healthwatch delivered a project with the British Deaf Association to identify, train and engage London’s Deaf community in monitoring the quality of health and social care services.

The project partners held an event, ‘Skilling up for Deaf Inclusion', to disseminate findings from Enter and View visits to three London A&E departments, share what they learnt and celebrate the success of the volunteers. We also identified challenges facing Deaf residents in accessing services in London and made recommendations on increasing inclusion for Deaf people. The work has received national recognition.

We helped to improve conditions in care homes in Islington

We made eight enter and view visits to care homes last year, speaking to more than 60 residents and members of staff. We noticed that in some care homes, gardens were in a state of disrepair. We also noted that not all residents were satisfied with the range of activities on offer. Islington Council agreed to follow up with the providers, and ask for more access to outdoor space for residents. They also carried out Tree and Garden Surveys at each care home. At Muriel Street the front and rear gardens have been extensively pruned and tidied, and the manager is obtaining permission to re-landscape the gardens completely. Kissing it Better, a charity that works with patients and their carers, has been funded to set up new intergenerational activities in the homes.

We've helped people who are isolated or have restricted mobility

In June 2014 we partnered up with Help on Your Doorstep, a local service that connects with people who don't have the confidence or resources to access services themselves. Healthwatch outreach staff accompany the Help on Your Doorstep team twice each month, knocking on doors to talk to residents about Healthwatch and to hear about their needs. This means we are able to help people who are isolated or have mobility issues, people most in need of social care services in particular, who we would be unable to reach through other means. We've knocked on nearly 2,000 doors on some of the most disadvantaged housing estates in the borough. Door knocking has very quickly become the most important source of referrals for our signposting service.

We've made a difference for individuals in Islington

We've handled 226 requests from people needing help to access health and care services in the past year. One patient had been incorrectly advised that they would be discharged if they were unable to attend a physiotherapy appointment at the Whittington they had been given at very short notice. Our intervention led to staff at the Whittington being retrained. We helped another to report her dentist for negligence. That dental practice was then investigated by the Dental Council and required to take action to improve their services. When we resolve problems for individuals, it can lead to changes which improve services for everybody.

We identified the strengths of an existing service

We went into care homes to find out how the service provided by the Integrated Care Ageing Team was viewed. We learned that residents and relatives valued the way this team managed difficult conversations about end of life care. As a result Islington Clinical Commissioning Group has decided that these discussions will be more systematically delivered and monitored, to make sure this strength isn't lost as the service expands out of care homes into the wider community. Our report on the service was picked up, and shared more widely, by the King's Fund, the national think tank that helps shape health and social care policy and practice.

We've helped raised standards of care in local hospitals

At the Whittington we've helped to improve discharge procedures for elderly patients, particularly with regard to follow-up care. We also secured the introduction of ear plugs and eye masks on wards to help patients sleep. Our work on behalf of Deaf patients has seen new training programmes brought in at the Royal Free, vibrating buzzers introduced at University College London, and a clear commitment from both hospitals to always let Deaf patients know whether a British Sign Language interpreter has been booked ahead of their appointment.