author: yvonne davies, commissioning project manager, nhs lewisham ccg date: 4 october ... · 2019....

Review and redesign of interpreting and translation services in Lambeth, Southwark and Lewisham engagement plan

Author: Yvonne Davies, Commissioning Project Manager, NHS Lewisham CCG

Date: 4 October 2018

Version: 0.3

NHS Southwark CCG

Version Date Details/provenance/comments Author & contact details

Sent to

0.1 06/09/18 Yvonne Davies

[email protected]

LSL ITS engagement working group

0.2 19/09/18 Initial comments received and shared approach agreed.

Yvonne Davies

[email protected]


0.3 04/10/18 Key messages included Rosemary Watts

[email protected]


Southwark Engagement Advisory Group

Table of contents Proposal and purpose of engagement .................................................................... 3

Aims and objectives of engagement ....................................................................... 4

What do we already know ........................................................................................ 5

Previous Insight ........................................................................................................ 6

Equality Analysis ........................................................... Error! Bookmark not defined.

What do we need to know or design in more detail ............................................... 8

Equality Analysis ...................................................................................................... 9

Who we are engaging and key messages .............................................................. 9 Key stakeholders .......................................................................................................................................... 9

Key messages ......................................................................................................... 10

Resources required ................................................................................................ 10

Engagement activity plan ....................................................................................... 11 Southwark engagement activity plan .......................................................................................................... 12

Risks and mitigations ............................................................................................. 19 Estimated Cost ............................................................................................................................................ 20

Monitoring and evaluation ..................................................................................... 20

Decision making ..................................................................................................... 20

mailto:[email protected]



NHS Southwark CCG

Proposal and purpose of engagement

Why we are doing this

Lambeth, Southwark and Lewisham (LSL) CCGs currently commission an interpreting and translation service (ITS) to deliver interpreting and translation support to general practice across the three boroughs. In addition the service also offers ITS to dentists, optometrists, BPAS and Marie Stopes providers who are based in LSL. This activity is recharged to NHS England. The management and administration of ITS was transferred to Lewisham CCG on 1 July 2015 from NHS England. It was agreed at the time of the transfer that Lewisham CCG, who had historically always led for interpreting services, would take over the function. Lewisham CCG has since been the lead commissioner for the current service and manages it on behalf of all three CCGs. The current service offers a mixture of Face to Face (F2F), Face to Face British Sign Language (BSL), Telephone, Health Promotion clinics and written translation services. The service is delivered by multiple providers (including directly employed staff) each with their own contractual arrangements in place which are variable. Current arrangements are not sustainable either financially, operationally and contractually due to the multiple contracts in place therefore there is a need to commission a more streamlined service. LSL commissioners have outlined in their 2018/19 commissioning intentions the intent to review the existing LSL ITS service. Commissioners wish to undertake engagement in order to gain an understanding experience of current services in place from a service user perspective in order to shape how the service will look in the future.

Vision of where we need to get to

Commissioners across LSL aim to implement a more streamlined service model from the 1 April 2019 which;

o meets the needs of the local population requiring ITS

o guarantees high service user experience and satisfaction

o is operationally accessible for service users,

o offers high quality interpreting and translation services

o is delivered in a timely manner,

o is equitable to all service users for whom English is not their first language and/ or are sensory impaired

NHS Southwark CCG

o is contractually manageable with detailed reporting and monitoring systems in place

Timelines

Commissioners aim to undertake the engagement between October and December 2018

Aims and objectives of engagement

Aim

Undertake a level of engagement with both patients and healthcare professionals that book interpreting and translation services as service users as outlined in this paper in order to assist commissioners in making an informed decision about long term commissioning of ITS.

Expected Outcomes

o Understanding of current service user experience / satisfaction of current ITS across LSL to inform any new service model

o Gain an understanding of the health promotion clinics – how they operate, the benefits, the challenges

o Understanding of views from service users on how the service could look in the future

o Detailed engagement report providing an overview of all engagement undertaken.

How will we engage?

Health Promotion Clinics

o Attend a selection of clinics ensuring that there is a cross section across the three boroughs, language and service provider

o Engage with the service users, clinic hosts and interpreters

o Questionnaires/ informal conversations

Current experience and proposed service model

o Liaise with known groups of communities where English is not their first language or for those who are sensory impaired

o Known patient groups

o GP member forums

o Questionnaires/ informal conversations

NHS Southwark CCG

What do we already know Population Profiles across LSL (JSNA)

Lambeth, Southwark and Lewisham (LSL) are located in south east London which has a diverse and mobile population, with extremes of deprivation and wealth. LSL are also ranked amongst the 15% most deprived local authority areas in the country and has a younger population than the national average. The three boroughs all have a very mobile and ethnically diverse population with over 100 different languages being spoken in each borough. The growth in population across LSL means extra demand for services, ranging from GP practices, pharmacies and sexual health clinics. It is crucial to understand where the bulk of this growth will be to plan effectively and the continuing diversity must also be considered when planning and commissioning services. Commissioners need to be aware of languages to keep service accessible and to make services increasingly equitable it is crucial to be aware of the inequalities that currently exist. A more detailed population profile is available upon request.

Service Activity

A review of LSL ITS activity for 2017/18 was undertaken. The following provides a high-level summary.

➢ The following table provides a summary of booking by type for each CCG.

CCG F2F BSL TEL Health

Promotion TOTAL

LAMBETH 3625 205 8192 715 12737

LEWISHAM 944 182 5057 350 6533

SOUTHWARK 5033 235 4942 51 10261

TOTAL 9602 622 18191 1116 29531

➢ Telephone bookings are the most utilised resource and equates to 62% of all bookings across the 3 boroughs. F2F = 33%, Health promotion clinics = 4% and BSL = 2%

➢ The highest number of requests was for telephone support which also utilised the most hours making it the most cost-effective means of support.

➢ Request by booking type varies across each CCG o Lambeth has the highest number of health promotion clinics (64%) and

Southwark has the lowest (approx. 5%)

NHS Southwark CCG

o Southwark utilise the highest number of total hours despite not having the highest number of bookings. This is a result of high volume of F2F bookings and low telephone bookings.

o Lewisham’s preferred booking type is telephone interpreting and requests for F2F is 4-5 times less than Southwark and Lambeth.

o F2F BSL bookings across the 3 boroughs are comparable.

Examples of best practice / NHS England recommendations

The current LSL model identifies with other service models implemented at both a local and a national level in terms of the types of support provided to patients for whom the majority favour a mixed model of telephone, F2F, BSL and a range of written services. We currently part meet the recommendations outlined in the NHS England Principles Framework for commissioning Interpreting and translation services however it is evident that there are also current gaps in the existing service provision.

Previous Insight Southwark

Healthwatch Southwark report, March 2016

1. In one week in March 2016, Healthwatch Southwark phoned all GP sites in Southwark (then at 44) stating that their neighbour was registered and needed a GP appointment but they didn’t speak much English and asked whether they could request an interpreting service.

2. Of the 44 sites contacted, 35 said that they could offer an interpreting service. Of these, 15 mentioned telephone interpreting only, six mentioned a face to face interpreter only and eight practices mentioned that they could provide both. Nine practices explained that they book double appointments when using an interpreter. seven practices specially mentioned Language Line. Eight practices said that they could not provide an interpreter and six of these suggested bring along a family member / friend.

3. Healthwatch also asked those practices who stated that they could provide interpreters (35) whether interpreters were available to help with registration at the practice. Eight said they could. 26 said they could not – of these 12 suggested bringing a family member / friend to help.

4. Healthwatch recommendations to the CCG from the report are below: 4.1 All receptionist staff to be given training and information about interpreting

services to ensure consistent messaging and equal access for patients across Southwark. They should be supported to understand the importance of offering interpreting services.

4.2 All GP reception areas to clearly display information about interpreting offers for patients and details about Language Line.

4.3 Reception staff to offer a double appointment when an interpreting service is requested.

NHS Southwark CCG

4.4 When Southwark CCG review interpreting services in primary care, they should seek to understand why this service is not always offered to patients, monitor the use of this service, and engage with GPs about use of Language Line.

4.5 Invite Language Line to present on what their service offers and how to use it at Practice Managers Forum meetings, Practice Nurses Forum meetings and through GP Protected Learning Time.

4.6 Healthwatch Southwark will continue to inform residents, and voluntary and community sector organisations that support them, about what they can expect from GP services in relation to interpreting services.

4.7 Healthwatch Southwark will carry out this check again later to see if information provided by surgeries improves

Southwark CCG engagement

1. Anecdotal information has been received at engagement events by people who use BSL about the difficulties about availability of BSL interpreters and associated difficulty of accessing same day or next day appointments.

2. The deep dive into the 8 – 8 service as part of the Equality Delivery System highlighted the fact that interpreting services are not available out of core hours.

Lewisham

Healthwatch Lewisham provided the following intelligence about the interpreting service:

• People born deaf may have low literacy skills and especially require the presence of a Sign Language interpreter. Alternative methods such as using pen and paper to communicate in writing or typing using computers may depend on the individual’s literacy skills and may not be suitable.

• The research uncovered that deaf people in Lewisham face difficulties with interpreting services. There was a lack of clarity around whether accessing an interpreter was a patient’s responsibility or if it should be arranged by a provider. We also found that when deaf people visit various services they simply don’t know how to book interpreters.

• Many people with additional communication needs may not have the confidence to assert their needs or ask for help. Many may not be aware of patient choice or have access to relevant information. It is therefore vital to ensure easy access to information and the information to be clear, concise and in accessible formats.

• Deaf participants often need to book an interpreter when they book an appointment, however they are not always sure this has been arranged. Our recommendation would be for Sign Language interpreters to be booked routinely for patients that require them, with confirmations sent to patients for their reassurance. If an appointment has been cancelled due to a lack of an interpreter, it would be helpful to fast –track another appointment.

NHS Southwark CCG

• Deaf participants are frustrated with waiting times when they book an interpreter as well as the amount of time it takes for interpreters to turn up at booked appointments. It has been reported that some participants experience long waiting times (approximately an hour) for an interpreter to turn up despite the appointment having been booked for a particular time in advance.

• Many deaf participants, especially those living independently, feared finding themselves in an emergency situation or needing to see a medical professional urgently. The research uncovered that almost half of the participants were not aware of what to do in case of an urgent need or an emergency. Some were not sure if they could access an interpreter in case they needed to book an urgent appointment or if they needed to use A&E department but were unable to communicate with staff.

• Deaf participants suggested that widening the availability of technology such as video interpreting would be helpful.

• A few deaf participants praised The Jenner Practice and Lee Road Surgery for being very compassionate, deaf aware and a ‘model of excellence’. Wells Park Practice was also praised for being supportive to patients.

What do we need to know or design in more detail Commissioners need to work with engagement leads to draft and develop key engagement work required to determine what is required and resources required to achieve it.

The following needs to be considered when drafting questionnaires/ questions for each relevant stakeholder group;

Service user experience and satisfaction

- What ITS services they have accessed (F2F, telephone, BSL, health promotion etc.)

- What worked well (booking process, timeliness, personalized etc.)

- What didn’t work well and could be improved

- Suggestions

Health Promotion clinics

- What clinics they attend

- Why they attend the clinics

- What do the clinics offer that their GP practice does not offer

- What works well

NHS Southwark CCG

- What doesn’t work well and could be improved

- suggestions

Shaping the Service

- Gaining views on other ways of delivering the service

- Understanding views on what is acceptable in terms of accessibility and timeliness of booking appointments

Equality Analysis An initial equality analysis screening has been carried out which indicates a full equality analysis is required.

Who we are engaging and key messages

Key stakeholders

Stakeholders Interest & Influence

Engagement level Approach

Health Overview and Scrutiny Committees

High Influence and

High interest

Actively engage and involve

• OSC trigger template

• Briefing

• Attend meeting

Patients High Influence

and High interest


• Known community groups

• Health promotion clinics

• Patient groups/ focus groups

• Questionnaires

Staff High Influence

and High interest


• Questionnaires

• Meetings

• Letters

GP Practices High Influence

and High interest


• Questionnaires

• Member forums

Dentists/ Optoms/ BPAS/ Marie Stopes

Low influence and

Low interest

Actively engage / keep informed

• Questionnaires

Healthwatch High Influence

and High interest

Actively contribute to the engagement and / or communicating messages

• Meetings

• Engagement intelligence

Health promotion clinics (Practice hosts)

Low influence and

high interest Actively engage

• Questionnaires

• Informal discussions

ITS providers Low influence

and high interest

Actively engage • Questionnaires

• Informal discussions

NHS Southwark CCG

Known Community groups / advocates

High influence and High interest

Actively contribute to the engagement and / or communicating messages

• Meetings

• Engagement intelligence

Key messages NHS Lewisham Clinical Commissioning Group (CCG) is working with NHS Southwark and NHS Lambeth CCGs* to review the interpreting and translation service for patients in GP surgeries, dentists and opticians.

The interpreting and translation service helps people communicate with their doctor or nurse if they do not speak English. Southwark/Lambeth/Lewisham is a richly diverse area, with patients from numerous cultural and ethnic backgrounds who rely on this support to access healthcare.

The service helps by providing interpretation via the telephone, with a face to face interpreter or with a British Sign Language (BSL) interpreter. It is not a health advice service. The service is confidential as you would expect from your GP surgery.

We want to hear the views of people who use the interpreting and translation service, particularly those who speak the most used languages. In Southwark these include Spanish, Vietnamese, Portuguese, Mandarin and Cantonese. We want to understand people’s experience of the service and whether it meets their need. We know that lot of other languages are spoken across Lambeth, Southwark and Lewisham and all languages requested in the last two years have been met by the current service.

The Healthwatch organisations in Lambeth, Southwark and Lewisham have provided useful feedback on the service over the last two years, and we will continue to work with them as part of this review. We will also be meeting with community groups and other organisations to help understand people’s views and experiences of the service.

The review will take place from October 2018 and a report will be written in January 2019, with proposals about how the service will look in the future.

* CCGs buy, monitor and plan health services for local people. This is known as commissioning. They are responsible for making sure that local people get the most accessible and effective healthcare services possible. The CCGs need to make sure that the services we commission meet the needs of our patients, are good quality and offer value for money.

Resources required • Engagement support across LSL to provide guidance to commissioners on the

development of the engagement plan and support implementation accordingly.

• Interpreting & Translation support to implement engagement with service users (interpreters should not be from existing providers) and to translate materials such as leaflets and questionnaires

• Healthwatch - provide intelligence, provide guidance, knowledge and support if required. Requirements to be determined.

NHS Southwark CCG

• Materials – printing, posting, collation, report writing. Electronic questionnaire development etc.

Engagement activity plan The interpreting service is delivered across the three boroughs therefore CCG commissioners agreed that a collaborative engagement plan is required in order to affectively review the current service model and contractual arrangements in place.

Recognising that access to and utilisation of interpreting services varies significantly in terms of preferred booking type (F2F, Phone, BSL etc.) and by requested language due to population profiles, each CCG undertook a mapping exercise to determine their local engagement requirements.

Each CCG has developed an engagement activity plan which focus on proactively contacting the speakers of the top five languages as well as identifying group so speaker of other languages. The draft Southwark engagement activity is overleaf:

Southwark engagement activity plan

Community groups

Engagement activity

Audience/ stakeholder

Purpose Messages / questions

Where When Lead Resources / materials needed How being promoted

Latin American Group

Latin American users of GP services

To promote review and understand current experience

Pembroke House

Elena Felices, Latin American Community Co-ordinator, Advising London

TBC Engagement leads

Primary care leads

• Questionnaires (paper /elec)

• Translation

• Presentation pack

• Information leaflets

Via the group

Latin American Women’s Rights Service / FULA



Stone’s End Day Centre

Tamya Bustamante, LAWRS

[email protected]


Primary care leads


• Translation



Via the group

Latin American Disabled People’s Project



Unit 7 - 42 Braganza Street Kennington Enterprise Centre SE17 3RJ

Jonh Marulanda-Garzon at [email protected]


Primary care leads


• Translation



Via the group

Portuguese Speakers Community Centre

Portuguese speakers and users of the service


1 Othello Close SE11 4RE

020 7820 8666


Primary care leads – Lambeth?


• Translation



Via the group



NHS Southwark CCG

Southwark Vietnamese Chinese Community

Vietnamese users of GP services


Troy Town? Unclear where they meet?

020 7277 5425


Primary care leads


• Translation



Via the group

Vietnamese Women’s Group

Vietnamese users of GP services


Bellenden Centre

020 7277 8642


Primary care leads


• Translation



Via the group

Southwark Vietnamese Chinese Community

Vietnamese, Mandarin, Cantonese speakers / users of GP services


Alpha Street. Thomas Carlton Centre?

020 7635 0022


Primary care leads


• Translation



Via the group

Vietnamese Mental Health Service

Vietnamese, Mandarin, Cantonese speakers / users of GP services


Jack Shieh

[email protected]


Primary care leads


• Translation



Via the group

Southwark Deaf Forum

BSL users of GP services


Disability Resource Centre

Kabir Kapoor

Samba Coker


Primary care leads


• BSL interpreters



Via the group

https://www.google.co.uk/search?source=hp&ei=e9uoW8boBMLSa4LMsKgD&q=Vietnamese%20community%20groups%20Southwark&oq=Vietnamese+community+groups+Southwark&gs_l=psy-ab.3..33i22i29i30k1.11757.20381.0.20541.41.37.1.0.0.0.288.3077.29j5j1.35.0....0...1.1.64.psy-ab..5.36.3075.0..0j35i39k1j0i131k1j0i67k1j0i131i67k1j0i20i263k1j0i22i30k1.0.cNXWdyZwqmA&npsic=0&rflfq=1&rlha=0&rllag=51467373,-69938,278&tbm=lcl&rldimm=3766511845943774494&ved=2ahUKEwiZroWC1dPdAhWKy4UKHWjKCAIQvS4wAHoECAYQFw&rldoc=1&tbs=lrf:!2m1!1e3!3sIAE,lf:1,lf_ui:2


NHS Southwark CCG

Southwark Day Centre for Refugees and Asylum Seekers

Generic To promote review and understand current experience

Copleston Centre

Pauline Nando

[email protected]


Primary care leads


• Translation



Via the group

Southwark Refugees Community Forum


Sumner Road

020 7703 4046


Primary care leads


• Translation



Via the group

Southwark Cyprus Turkish Association

Turkish users of GP services


Old Kent road

020 7701 7375


Primary care leads


• Translation



Via the group

Bengali Women’s Group

Bengali users of service


Rockingham Community Centre

020 7403 9888


Primary care leads


• Translation



Via the group

Health Promotion Clinic

User of serv ice


Lister Primary Care Centre


Primary care leads

•

Locality PPGs

Generic To promote review and understand

Blackfriars Settlement

Cambridge House

7 November

13 Nov

Engagement leads


• Translation

Via email list


NHS Southwark CCG

current experience

Primary Care Lead



Pensioner’s Forum


Southwark Pensioner’s Centre

TBC Engagement lead

Primary Care Lead


• Translation



Via the group

Forum for Equality and Human Rights in Southwark

VCS providers of services across diverse groups

To promote review and understand any issues their users have

Presentation 11 Dec Engagement lead

Primary Care Lead

• Presentation Via the group

CCG engagement mailing list

Generic To promote review and understand any issues their users have

Narrative and link to website

October • Narrative

• E survey

E mailing list

Healthwatch Southwark bulletin

Generic To promote review and understand any issues their users have



• E survey

E mailing list

Wider stakeholders

Engagement activity

Audience/ stakeholder

Purpose Messages / questions

Where When Lead • Resources / materials needed

How being promoted

NHS Southwark CCG

Practice Managers Forum

Practice managers


St Giles Surgery 1 November Primary Care Lead

• Briefing


As part of regular meeting

GP locality meetings

GPs To promote review and understand current experience

Surrey Docks Health Centre

St Giles Surgery

25 October Primary Care Lead

&

Director of Integrated Commissioning

• Briefing

• Presentation


Practice Nurse Forum

Nurses To promote review and understand current experience

InSpire Centre 30 October Primary care Lead

• Briefing

• Presentation


GP federations / 8 – 8 providers

Managers and GPs


Meeting / briefing Primary Care Lead

• Letter

Local Medical Committee

To inform Meeting / briefing Director of Integrated Commissioning

Primary Care Lead

• Briefing

• Presentation


NHS Southwark CCG

GP bulletin

GPs, PMs, To promote review and understand current experience



• E Survey

2017/18 activity

SOUTHWARK F2F

TOP 10 LANGUAGES

1 Spanish 2834

2 Vietnamese 269

3 Portuguese 237

4 Mandarin 229

5 Cantonese 159

6 Turkish 149

7 Polish 134

8 Tigrigna 105

9 Romanian 101

10 Bengali 101

1. The practices with the highest use of face to face interpreters in 2017/18 were:

• East Street surgery (906)

• Hurley at Lister (803)

• Camberwell Green (682)

• Princess Street (640)

• Old Kent Road (457)

2. The most used languages for telephone interpreters during 2017/18 were:

NHS Southwark CCG

Language LAM LEW SOUTH TOTAL

SPANISH 3500 1183 2350 7033

PORTUGUESE 1266 260 259 1785

MANDARIN 231 897 488 1616

POLISH 486 218 98 802

VIETNAMESE 148 438 197 783

ARABIC 383 227 130 740

TURKISH 142 339 162 643

CANTONESE 151 185 211 547

SOMALI 362 89 77 528

FRENCH 160 128 67 355 •

3. The practices with the highest use of telephone interpreting in 2017/18 were:

• Concordia Parkside (591)

• Manor Place Surgery (578)

• Penrose Surgery (455)

• Sternhall Lane (398)

• Villa Street (352)

• Hurley at Lister (292)

5 There were 235 British Sign Language (BSL) face to face appointments in general practice during 2017/18 as follows:

• Princess Street (35)

• Aylesbury Partnership (32)

• Surrey Docks (26)

• Blackfriars Medical Practice (12)

• Bermondsey Spa (11)

NHS Southwark CCG

Risks and mitigations

There is a risk that the scheduled engagement will take longer than anticipated impacting on the overall delivery for the commissioning of any new service models required resulting in a delay to any procurement required / new contracts commissioned. This would have a financial impact into the next financial year 2019/20

LSL Interpreting Service

3 3 9

1) working group in place and aware of the risk. Each CCG to raise accordingly with internal teams 2) Each borough to adopt mitigating approaches to reducing cost pressure i.e. target practices who use high F2F and increase use of telephone 3) Engagement plan being drafted and finalised in order to identify full level of engagement required 4) procurement advice to be sought in advance with regards to timescales should it be required and factored into the delivery plan.

6

Estimated cost To be confirmed

Monitoring and evaluation The Lambeth, Southwark and Lewisham working group that has been established will monitor the engagement.

Evaluation Report: An evaluation report providing an overview of the outcomes of the engagement will be produced. The report will cover all aspects of engagement undertaken as part of this review. XX will be responsible for drafting the report.

Lewisham CCG will provide oversight of the engagement taking place and be responsible for keeping LSL colleagues updated with progress

Decision making CCG Decision Making For information

Lambeth Primary Care working group EEC Group

Southwark Primary Care Commissioning Committee

EPEC Committee

Lewisham Primary Care Commissioning Committee

Patient and Public Reference Group

author: yvonne davies, commissioning project manager, nhs lewisham ccg date: 4 october ... · 2019....

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