Humber Acute Services Programme - Humber and Wolds Rural Action - Targeted Engagement with Hard to Reach Groups

We Asked

You to share your experiences when accessing care in hospital, the good, the bad and the indifferent, and to share any ideas or suggestions on what we could do to make your experience better in the future. 
Over the 18 workshops held across the Humber between February -October 2019, 192 people attended in total, representing various different 'seldom heard' groups.

These groups included; carers, people living with a mental health condition, homeless, people living with learning difficulties, LGBTQ+, children and young people and gypsy and travellers. 

Conversations were framed around the four key challenges faces by the local NHS:

1.  Quality of care - the quality of care a patient receives can vary depending on where and when they are treated
2. Healthcare is changing - more patients could be treated out of hospital, closer to home. This would free up beds for those patients who really need to be in hospital. 
3. Workforce - Despite efforts to recruit, we still struggle to find and keep all the doctors and nurses we need. 
4. Finance -  Demand and costs of providing care is rising faster than available funding. 

The full findings of the report are available here

You Said

Challenge 1 - Quality of Care
Generally you received excellent care within hospitals with nursing teams playing a key role in "lifting spirits"
However, some concerns were raised around the quality of care some patients received, particularly around personal hygiene, for example, having to wait long periods of time to be able to have a shower and brush their teeth. 

You want care and treatment plans to be developed with the needs of the patient and their carers at the centre.
You said that you would like better communication in relation to end of life care to ensure patient's wishes can be granted earlier, also you said staff need to have a better understanding of the Mental Capacity Act 2005 to ensure patients receive the most appropriate care for their needs. 

You sometimes miss appointments because of lack of access and high parking costs.
Generally, people told us that they were happy to travel to receive care, however some people told us they often miss appointments because they simply cannot afford to travel to a hospital or pay the parking fees, especially when appointments are delayed, or they don't have access to public transport. 

There are some simple changes we can make to make the environment more inviting and accessible.
Some examples provided included the use of  visual aids and simple language to improve signage, making it easier to navigate around the building/hospital site. Increase provision of toilets, in particular the locations of accessible toilets. Quiet, comfortable spaces for people to wait in who find being around people triggering. 

You said that ineffective communication is having a negative impact on your patient experience and needs to be addressed.
Communication challenges and some gaps that still exist between different parts of the health and care system are impacting on some patients’ experiences of care. Examples provided included how nobody gets back to you when you contact them and personal details are sometimes not updated on the system so letters get lost and appointments missed. 

Don't make assumptions that we understand what you are saying.
Concerns were raised regarding equality and diversity. Some people felt that there was an assumption that everyone could see, hear, write, be fully able-bodied and able to fully understand what was being said to them.  For example, there was an expectation for a deaf person to use the phone to book an appointment and for them to hear their name being called at the clinic

Challenge 2 - Healthcare is changing
You could see the benefits of having some services provided outside of a hospital, closer to your home.
By having services closer to home it would reduce travel costs and travel times meaning you would be more likely to attend your appointment, there would however need to be better public transport links established. Carers also told us this would be beneficial as the constant travelling to appointments can be very stressful. You did however, raise concerns as to how local services would work, especially when there are already significant workforce issues. 

You recognise technology can sometimes be used to help provide follow-up care
You said you can see a place for technology in supporting the delivery of ongoing healthcare, and the use of virtual/video appointments can be beneficial to some patients as it eliminates the need to travel to appointments. However, some felt virtual appointments were often a waste of time as no physical examination could be undertaken. Others also raised concerns around the difficulty some patients may face with digital appointments, for example stroke patients, patients with mental health issues, or patients living in rural areas with poor connectivity. 

You would like to see better out of hospital support in the community.
Providing services outside the acute hospital setting and into the community was considered extremely important to you with vulnerabilities such as Mental Health, Learning Disabilities, Dementia, Drug and Alcohol issues. Having locally based community services that where available generally and at times of crisis was seen important to you. For example, Learning Disabled people would like to have more access 24/7 to specialist nurses and/or Epilepsy Clinics to prevent A&E visits. There were very strong views that some people being treated in the acute hospitals should be able to access an alternative environment safeguarding other patients and staff. 

 

Challenge 3 - Workforce
You recognise that there is significant workforce issues and understand the challenges faced by the local NHS to recruit and retain staff

The following were some factors identified by you as to what makes  a career in health less attractive; The cost of medical degree progammes and student loans accrued whilst learning which need to be re-payed once earning; Long shifts and pressures to fill gaps on rotas; Staff leaving the NHS to work for the 'Bank' as there is more flexibility and better T&Cs. Proposed solutions included; reintroduce bursary schemes; more emphasis on a healthy work-home life balance, including flexible working patterns and improved hours of work; Better training and career development opportunities. 

 

Challenge 4 - Finance
Generally, the public have a good understanding of the financial issues faced by the NHS. 

You agree there is a need to review current service provision and delivery in an attempt to reduce costs.

There was recognition that changes in service delivery and cost (or savings) in one part of the system often had a knock-on effect to another service or part of the system. There is also a belief that there are too many managers and not enough investment in the medical workforce. The following suggestions are some made by you on how the NHS could save money; missed appointments should incur a cost; listen more to the workforce on where efficiencies could be made; recycling unopened medication instead of disposing of it. 

 

We Did

Next We Will
Remain in contact with the groups and provide regular updates on progress.

Ensure that the feedback and data captured from this crucial engagement is considered and informs any future decision making as to what the future for health and care in the Humber could look like in the future.