portfolio of documented outcomes 2013 - 2016 · (july 2016) 3. supporting mum: a report on patient...

Portfolio of Documented Outcomes 2013 - 2016

Updated December 2016

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This document aims to compliment Healthwatch Suffolk communications as a formal record of outcomes collated by the Healthwatch Suffolk team and subsequently communicated by the Information Services Team to the public. It will be updated on a quarterly basis with input from all staff and distributed.

More information about the work and outcomes recorded within this document is available from the following sources:

• Our reports website page: The following page lists all Healthwatch Suffolk reports currently available for download. That includes research reports, Enter and View visit reports and Annual Reports. The page also includes a brief description of our latest report and supporting video content: http://www.healthwatchsuffolk.co.uk/our-reports-2/

• Health Scrutiny Committee briefings: Produced in advance of each Suffolk HOSC meeting to update the committee on our ongoing work and items of mutual interest. These documents are available to download from the reports page on the website (see link above).

• Newsletters (Quarterly and MailChimp): All newsletters are available to download or views from our website. That includes all quarterly (8 or 12 page) newsletters and twice monthly MailChimp updates. Visit: http://www.healthwatchsuffolk.co.uk/about-us/newsletters/

• The website news listings: We will always aim to publish our outcomes and updates on ongoing work projects to our website news reel. All items are promoted on our social media platforms and within our MailChimp updates. View the news listings: http://www.healthwatchsuffolk.co.uk/news/

• The Annual Report: The Annual Report is a full account of our work, outcomes and impact across a given year. It is made available to a range of stakeholders as required by national regulations. You can download the latest Annual Report (in multiple formats) from the reports page on the website.

• YouTube: All of our videos are listed on the Healthwatch Suffolk YouTube Channel: https://www.youtube.com/channel/UCiaW9uHj8DIDItprWUuTAow

• Managers updates to the Healthwatch Suffolk Board of Directors: All managers provide an update to the Board on team outcomes and ongoing projects. These are available on our internal server.

• Toms Planner: This is online planning software used by the Information Team to monitor progress against all ongoing projects. Please speak with the team for details.

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Contents

“...for the first time, I actually feel valued as a person with something to contribute rather than someone who had no choice. I thank you Healthwatch for that. “

Project outcomes

List of reports (Research)List of reports (Annual reports)List of reports (Enter and View)

Hospital outcomes

Ipswich Hospital NHS TrustJames Paget University Hospitals NHS Foundation TrustWest Suffolk NHS Foundation Trust

GP outcomes

Other outcomes

Enter and View visit outcomes

North east Essex and east and west Suffolk STP

Feedback snapshot

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Pg. 4Pg. 5Pg. 5

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List of published reports:

The following projects have been completed and are available to download from the Healthwatch Suffolk website.

Visit: http://www.healthwatchsuffolk.co.uk/our-reports-2/

1. Supporting mum: A report on patient experience of maternity services in Suffolk (November 2016)

2. Lets Talk Mental Health - What did you tell us? (July 2016)

3. Supporting mum: A report on patient experience of maternity services provided by Ipswich Hospital NHS Trust (June 2016)

4. Young people’s views on mental health and wellbeing: A project with the Thomas Gainsborough School and Unity and Diversity

5. My999Story: What did you tell us? Full briefing (April 2016)

6. Stepping Forward: Our joint report with Suffolk User Forum (January 2016)

7. Inspiring progress: Improving mental health services for Black and Minority Ethnic (BME) communities in Norfolk and Suffolk (November 2015)

8. Evidence submission to the Health Select Committee inquiry on primary care services in England

9. Non-Emergency Patient Transport: Public Perceptions in Suffolk (August 2015)

10. Public perceptions and experiences of Wheelchair Repair Services in Suffolk (March 2015)

11. Public perceptions and experiences of Community Equipment Services in Suffolk (March 2015)

12. Public experiences of referral into mental health services (March 2015)

Project outcomes...31

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13. GP Services in Suffolk - Our report to the Suffolk Health Scrutiny Committee (January 2015)

14. Public Experiences and Perceptions of GP Surgeries in Haverhill (July 2014)

15. Public perceptions and experiences of being discharged from health and social care services

16. Health and Social Care Review - Our report on engagement activities in Suffolk (August 2014)

17. Public Perceptions and Experiences of Ambulance Services and NHS 111 in Suffolk (August 2014)

18. Your views about 111/Out of Hours Services in Suffolk (April 2014)

19. Mental Health Services in Suffolk: Our report to the Suffolk Health Scrutiny Committee (January 2014)

20. Proposal to establish a single centre for liver metastases resection (November 2013)

21. New Early Supported Discharge service for patients in Suffolk (November 2013)

Annual Reports

Three Annual Reports have been published to date for 2013/14, 2014/15 and 2015/16. All of the reports are available to download from our reports page in numerous formats.

Enter and View reports

List of all visit reports with date of visit included:

1. Chilton Croft Nursing Home (Sudbury) - July 2015

2. Davers Court (Care UK) - October 2015

3. Drummond Court (Bury St Edmunds) - December 2015

4. Hazeldell Residential Care Home - May 2016

5. Mildenhall Lodge Residential Care Home - September 2015

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6. Mills Meadow (Framingham) - March 2016

7. Woodfield Court (Stowmarket) - October 2015

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Patient experiences of GP practices in Haverhill (July 2014)

Following the merger of two local surgeries, the Haverhill Family Practice officially opened and is the new name for the practices formerly known as The Stourview Medical Centre and the Christmas Maltings Surgery.

The practice operates from two buildings, Christmas Maltings and Stourview. The decision to keep both buildings open follows feedback received from a patient survey carried out when the merger was first announced. This includes information that we provided as part of our research regarding practices in the town to which 627 people responded.

One of our key findings was that a majority of patients expressed the view that they would like the merged practice to run from two sites in the town.

Health and Social Care Review (August 2014)

In the summer of 2014/15, we worked with the Suffolk CCGs to engage communities in discussions about how health and social care services could join up better to meet patients’ needs. The findings were combined with views from GPs, hospitals, out of hours and emergency care providers, community and social care teams as well as voluntary and community groups. Together they informed the Health and Social Care Review.

We agreed to compile the results of the engagement activity. Along with Community Action Suffolk and the Suffolk Coalition for Disabled People, we helped to identify events

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from which feedback could be gathered to ensure a varied response.

Two integrated care projects have since been launched (Connect) to take forward the common Integrated Care model developed within the Health and Care Review. This work has subsequently informed the ongoing development of the north east Essex and east and west Suffolk Sustainability and Transformation Plan currently hosted on the Healthwatch Suffolk website.

Our report about the East of England Ambulance Service NHS Trust and NHS 111 services (August 2014)

Following our joint project with the East of England Ambulance Service, it established a dedicated local champion working with NHS 111. This champion has was collating 111 reviews from staff via the data terminal in the vehicle, and these were sent to the Ipswich 111 team for them to review.

The Trust found that, on average, 70% of reviewed calls were considered inappropriate and would have benefited from clinical input. After the reviews took place, the referral rate, dropped from 13% to 10% (of calls answered by 111 that are referred to 999).

An additional outcome is that the 111 team assessed its call takers. Those with the highest referral rates were given master classes, which resulted in their individual referrals dropping by half. Harmoni (the provider) were also making an assessment as to whether the triage system could be enhanced to provide better questioning to reduce unnecessary referrals.

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Community Equipment Services (March 2015)

Service users asked for better communication regarding Community Equipment and Wheelchair Repair Services. As a result, Serco implemented Terms of Reference for communicating outstanding work orders. These detail the frequency and accountability for communicating with service users.

Patient experience of referral into Suffolk mental health services (March 2015)

Some service users reported that they had not been treated with dignity and respect by Norfolk and Suffolk NHS Foundation Trust staff. The issues raised were discussed with the staff teams concerned who were encouraged to be mindful that their interventions may be the first or only contact service users have with mental health services and this will influence their ability to engage with other services on their recovery journey

Improvements and standardisation of information for service users and carers included, a new Carers pack and two new information leaflets (one for adults one for children and young people) have been developed for GPs and other referrers to give to service users who are referred to AAT.

A Survey monkey encouraging service users to feedback on their experience of the service and also leave contact details if they would like to become involved in service development and planning was launched.

Information from the NSFT website on IDTs and other NSFT services was updated, printed and passed to service users being referred on following assessment.

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• Service users began to receive a copy of their assessment letter, which was shared with the referrer and the GP.

Transport to health care services in Suffolk (August 2015)

An early outcome was that Suffolk County Council agreed to establish a Health workstream of its Public Transport Forum, which led to the ongoing development of improved information for people about accessing transport services in the county to their healthcare appointments.

A lead within the NHS Ipswich and East and West Suffolk Clinical Commissioning Groups met with representatives from Age UK Suffolk with a view to updating existing information and to seek feedback from older people who are using the services. The aim was to ensure the information could be co-produced with local people.

Inspiring progress: Improving mental health services for Black and Minority Ethnic (BME) communities in Norfolk and Suffolk (November 2015)

The Trust took the following actions forward to improve it’s services:

• It will use insights from the project to inform training for staff including use of the video produced to support the report (click the camera icon overleaf)

• It will check that this training improves people’s experience of services.

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• It will measure whether people say services are more culturally sensitive.

• It will improve the way it publicises services to a wider range of communities.

• It will continue to run information seminars about mental wellbeing for the public and publicise these to BME and diverse communities.

• It recognises the importance of faith and belief and will commit to run more seminars for faith leaders on mental wellbeing.

• It will refresh its Spirituality Strategy (2013-2016) to include the insights of the project.

• It will hold another event in 2017 to tell people what it has achieved.

Stepping Forward: Joint report with Suffolk User Forum about the Norfolk and Suffolk NHS Foundation Trust (February 2016)

The Trust committed to open and transparent dialogue with Healthwatch Suffolk and Suffolk User Forum at a senior level to explore all of the issues raised in this report and other feedback both in terms of practical improvements and to increase staff awareness of the perspectives of service users.

The report was considered at a meeting of NSFT senior management. Additionally, the Trust also responded to the report as follows:

• NSFT acknowledge that, although the response numbers were relatively small compared to the number of people it offers support to, the findings are nonetheless significant and highlight important areas for it to focus on.

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• It committed to sharing the report with managers and frontline staff via their quality governance meetings, ensuring discussion, learning and reflection.

• To address the differing perceptions of what constitutes a “care plan” amongst service users, carers and mental health professionals, the Trust committed to explore the development of further information that it can send out to people who use its services and their carers. This would help people to know what to expect in respect of care planning and support from the Trust.

My999Story briefing (April 2016)

The briefng was shared with the CQC to inform its inspection of the Trust. It was also made available to Local Healthwatch in the East of England. The CQC made use of the data to inform its overall understanding of the experiences people have when accessing services provided by the Trust.

This was the most significant source of patient experience submitted to inform the CQC’s view of the service and was quoted throughout its final inspection report.

Thomas Gainsborough School project: Young peoples views on mental health and wellbeing

Overall, pupils were dissatisfied with their PSHE lesson content and wanted the school to run mental health awareness workshops. An outcome has been that staff and students at the Thomas Gainsborough School have now received mental health awareness training from Suffolk MIND, which will go some way to

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addressing this important need.

Importantly, the work was held in high regard by Suffolk County Council and led to the development of a new funded project called “My Health, Our Future”; the purpose of which will be to form a part of the EWB2020.

The project will help schools to identify the needs of pupils in respect of mental health and wellbeing so that steps can be taken to increase support and promote healthy psychological development. Pupils will have the opportunity to talk about their views on mental health and wellbeing and about how their school could improve its approach to maintaining the wellbeing of pupils.

Let’s talk about mental health briefing

In early July 2016, the CQC inspected the Norfolk and Suffolk NHS Foundation Trust for the second time. Healthwatch Suffolk was keen to ensure that a good body of evidence could be presented to the CQC on patient and carer experience.

This report was produced to inform the latest inspection of the Norfolk and Suffolk NHS Foundation Trust following a brief campaign.

The experience of new mums and their birthing partners in Ipswich Hospital NHS Trust (June 2016)

An immediate outcome from the report about Ipswich Hospital NHS Trust was a change in policy that will see the partners of women who are having their babies at the hospital having the option to stay overnight.

Whilst partners have always been welcome to

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stay during labour and birth, Ipswich Hospital have now extended this offer so that partners can stay overnight before labour and after their baby has been born and will be offered a reclining chair, blanket and pillow to make them comfortable. Previously, they needed to leave at 9pm, which meant that anyone whose baby was born in the evening could only spend a short time with mother and baby before having to go home.

Other outcomes from this report included:

• Increased patient involvement in birth planning: Whilst the hospital provides information about where people can have their baby, our survey suggests that people often struggle to distinguish between choice of place of birth and their birth plan. The hospital teams will therefore work on ensuring women and their partners have more opportunities to discuss these subjects during their pregnancy. The “Birth Options Clinic” is now in place and led by a Consultant Midwife for women who need more detailed discussions about developing their birth plan and their choice of birth place.

• Effective communication about who to call and when: The hospital says it has received positive feedback from parents about its dedicated “Community Midwifery Hotline”, which provides improved access to an experienced midwife Monday to Friday (8am until 6pm). It has told us that it recognises the need to improve its offer of information and will review the content on its website about how to contact the maternity unit and in what circumstances

• Ensuring adequate information is available for mums and their birthing partners:

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The hospital is undertaking a complete review of its website information and social media activity. We have offered to provide input into scoping what additional information services users would like to have available. The Trust will also review its antenatal education provision and an offer of Hypnobirthing classes has been made available to all patients.

• The content of antenatal classes: We found that 46% of the mums and 37% of the birthing partners who took part in our survey stated that they did not feel antenatal classes equipped them for labour. The hospital has therefore agreed to review the classes including what content is included and also its support to the team of midwives who provide the classes.

• Keeping people informed of their babies progress: Whilst most respondents told us they had received an update on their babies progress within 15 minutes and were positive about the care on the neonatal unit, the hospital is aware that sometimes this does not occur for a variety of reasons. It will therefore explore use of an i-Pad link and cot camera so that parents can see baby and communicate with a named nurse if they are unable to be at the bedside (e.g. following a Caesarean Section).

• Information about potential emotional changes post birth: The hospital has informed us that a perinatal mental health midwife has recently started to work at the Trust, which will enable training to be provided to all midwives on supporting mums and their birthing partners more effectively. The hospital will also be working with stakeholders on an approach in Norfolk

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and Suffolk to improve what is offered, the information and support available.

The experience of new mums and their birthing partners in hospitals across Suffolk (November 2016)

This has been an important project as there is a lack of engagement research both locally and nationally (in the whole of the UK) for birthing partners to share their experiences of the maternity pathway. It is for this reason that our local hospitals have genuinely listened to the views expressed and told us about the changes they are making to improve services for new parents across the county.

Things like:

James Paget University Hospitals NHS Foundation Trust

• The development of a task and finish group that will pilot a system whereby birthing partners can be offered the opportunity to stay in the hospital overnight to support mum. This will include the criteria for opt in and out, safeguarding issues, facilities/support given and a contract of behavior.

• Ensuring all community midwives have access to new smartphones and are trained in their use to improve communication with parents. The hospital will also conduct a survey to understand what patients need from such contact and follow this up six months later to assess improvement.

• Making sure every woman and birthing partner is offered a documented appointment to generate a birthplan. An audit of birthplan completion will be

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completed in 2017 to check this is happening.

• Producing written information that will help people to make informed choices about where to have their baby.

• Making sure that new parents have the chance to ask questions at every antenatal contact and that this is documented.

• A review of the content of parent education classes including a proposal to identify how the classes can be improved to help women and birthing partners be better prepared for the birth of their baby. The format of the new classes will include opportunities for women and birthing partners to meet and share their experiences.

• A re-design of birth planning documentation will include options for emergency support so that new parents are clear about their options.

• A leaflet about pain relief will be made available in different languages.

• Post birth emotional changes for women and birthing partners will be included in the information offered to new parents upon discharge from the hospital.

West Suffolk NHS Foundation Trust

• A review of the possibility to introduce overnight stays for birthing partners. The hospital currently considers this on a case by case basis, where individualized needs have been identified. In response to this report, from October 2016, the hospital extended its visiting hours for birthing partners to 09:00 – 21:00 hours.A review of the antenatal appointment structure.

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• Ensuring staff attend internal sessions on delivering service excellence.

• Monitoring patient feedback to ensure all communication between professionals and patients/birthing partners is understood.

• A review of parent education will commence in or before January 2017 to check that course content is appropriate and that adequate information is provided to new mums and birthing partners during the antenatal period.

• Support to explore with stakeholders, the possibility of a social platform through which birthing partners can network and connect.

• Consider how the process for informing new mums and birthing partners about the health status of their baby whilst on the neonatal unit could be improved.

• The development of an information leaflet regarding the potential expected emotional changes in the few weeks after the birth in themselves and their partner.

National Maternity Review

As part of the role out of Baroness Cumberledges “Better Birth” reports, the Local Maternity Systems (LMS) were asked to formulate plans .

Sue Arrowsmith (Deputy Director of Nursing ,Quality and Patient experience) said that she would forward our reports to the clinical network leads so that the Maternity Accountable Officer could ensure our findings are incorporated into the Ipswich and East Suffolk LMS future planning.

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Hospitaloutcomes...

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The following pages list all of the outcomes recorded about the Ipswich Hospital NHS Trust. West Suffolk NHS Foundation Trust and James Paget University Hospitals NHS Foundation Trust. They have been acheived predominantly through the sharing of service user feedback about the services.

All Suffolk hospitals

Maternity services

In November 2016, our project about the experiences of new mums and birthing partners encouraged all three acute hospitals to make changes that will improve support for local people. See from page 17 for more details.

Stroke patient survey

In February 2016, we designed a patient feedback survey for the acute stroke wards at West Suffolk Hospital and Ipswich Hospital. The hospitals wished to standardise their feedback for comparative purposes. The survey was implemented in April 2015.

Ipswich Hospital NHS Trust

Complaints handling at Ipswich Hospital NHS Trust

Through involvement on an Ipswich Hospital Task and Finish Group in 2014/15, we were able to influence the creation of a new policy on complaints handling.

Improved environment for young people

In January 2015, Ipswich Hospital identified that it could improve its services for children and young people by featuring more fun and child-friendly decoration on a newly decorated ward. This was identified from a joint engagement event.

Sickle Cell and Thalassemia support in Suffolk

In 2014/15, concerns identified in our Black and Minority Ethnic and Diversity Group about a lack of information and support for Sickle Cell and Thalassemia in Suffolk resulted in a number of improvements for patients at the Ipswich Hospital NHS Trust:

• Service users were invited to attend an Ipswich Hospital Board meeting at which three actions were agreed to address issues including the desire to develop a Sickle Cell care pathway from primary care to acute hospital treatment.

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• The placement of an alert on patient notes.

• A drive to increase staff awareness and training.

• Public Health Suffolk incorporated recommendations to improve services within its needs assessment for groups at risk of disadvantage. This includes the desire to improve access to services through primary care and the continued improvement of services within acute hospitals.

• Feedback from patients indicates that maternity care and maternity screening has improved in general as a result of increased awareness amongst staff.

• Ipswich Hospital launched a Paediatric Sickle Cell clinic to connect parents and patients in a relaxed environment.

Service User Feedback 2014/15

Comments raised with Ipswich Hospital NHS Trust in 2014/15 resulted in a number of outcomes including:

• Comments regarding the poor attitude of staff on a certain ward were addressed.

• Signage within the Eye Clinic

was checked as appropriate following a walk around by the Patient Experience Team.

• Following a concerning comment about care within the Trusts maternity services, issues were raised with staff and midwife rounding was introduced across all maternity wards.

• Patients awaiting transport were experiencing delays on discharge and appeared unclear about when it would arrive. The Trust said it was working with the ambulance service to address the imbalance between the prioritisation of discharge transport and outpatient transport.

• We had comments from carers because they were not kept informed of their relatives appointments. The hospital reviewed its administration system and, with the help of its Caring for Carers Group, was able to successfully test the system to ensure carers receive information about appointments as well as patients.

• The hospital removed an information leaflet about healthy eating and diabetes from its website and subsequently reviewed its format and content. This followed feedback from us on the basis of service user

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feedback to state that the leaflet contained inaccuracies.

• We received feedback that described the care somebody suffering from end-term cancer had received on one of the hospital wards and indicated this person had not received good care. The feedback indicated the person had been left in pain and that no one had answered call bells on the ward for pain or to use the toilet. The comment also highlighted that staff had shown little kindness or compassion and that the person had been left without fluids for long periods. The following learning points and actions for ward staff have been identified:

• To conduct a weekly audit to ensure call bells are being answered in a timely manner to provide assurance that bell answering is not unduly delayed.

• Consider referral to psychiatric liaison team for any patient with long standing mental health needs and ensure that the consideration is documented.

• To discuss with the palliative care team and acute pain team the need to introduce a different pain assessment tool for palliative patients or

those with complex needs which is more sensitive.

• To liaise closely with visiting professionals so they are aware of the treatment plans and any complexities which may exist.

• To ensure that all staff are practicing at all times according to the trusts values and behaviours

General feedback following engagement in November 2016

In November 2016, patients mentioned that things had been well explained to them by staff but on occasions they received mixed messages. People were being told that something would happen by one staff member and then being told something different by another. They also raised that there was a lack of communication between the hospital and external services and that a couple of patients had been moved late in the evening/ early morning.

The Matron will take all issues back to the team so that they are more mindful of the information given to patients plus that they have a raised awareness of the impact on patients. She has clarified that it is possible that they as staff get mixed messages about next steps and that they don’t move a patient

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late at night unless there is a clinical need for a patient being admitted needing a bed and that the decision is made by the hospital coordinator or manager on call and not the ward.

James Paget University Hospitals NHS Foundation Trust

Informed patients

In October 2014, we received commentary about James Paget Hospital to suggest that a person was not adequately informed about a particular procedure. The person also seemed unaware of choices available to them. We were pleased that the hospital took action in response to the feedback, which we hope will improve the experience of patients in the future:

• The head of the department was asked to ensure that all staff are aware of the potential for causing distress to patients if processes are not followed with compassion.

• The hospital reviewed practice and procedures for obtaining patient consent and recognised that it has the responsibility to provide patients with information they need.

• It reviewed the information that it provides.

• Negative comments regarding patient discharge from us were incorporated into mandatory training to inform learning at the hospital.

Keeping patients informed when waiting inside the hospital

Following one of our engagement visits in October 2015 to the James Paget University Hospital, patients in A&E told us that it would be better to have information about the anticipated waiting times they faced so that they could judge how much time was available for drinks or to use the toilet and to keep friends and family better informed.

The Service Manager responsible for A&E at the hospital, looked into our feedback. There is a TV screen monitor that should display the anticipated waiting times direct from the Emergency Department Information System. Unfortunately, on the day we visited, this was not switched on.

The feedback highlighted this error and indeed, the requirement for staff to be more vigilant in their daily checking processes to ensure the screen is activated. The Service Manager escalated this to the relevant staff responsible for the daily checks to ensure that this will be actioned to improve the patients experience by keeping them well informed at all times.

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West Suffolk NHS Foundation Trust

Improving care for people who have a learning disability

In 2014/15, we received feedback from a concerned mother about the West Suffolk Hospital which indicated a vulnerable adult had not received good care. There were problems with her sons care in the hospital, the interpretation of his medical notes and matters concerning the maintenance of his dignity. The patient had been visibly upset with his treatment, which was an unusual behaviour for him.

The Trust took a number of steps to improve the experience of all vulnerable adults that use its services.

Sam Bower (Deputy Chief Nurse) said:

“We were saddened to hear of this experience and viewed this feedback as an opportunity to improve the care we provide to this group of patients. So we could understand more of the experience we asked that the family write to us with more detail.

“As soon as we received this we were able to implement specific actions targeted to address the issues raised. This has included additional training in ward

areas and additional support to patients, families and carers from specialist staff. With the support of Healthwatch this family were able to tell us why the care we gave did not meet the specific needs of their son. We apologised for this and have taken steps to change practice.”

Improving support for carers and patients at the end of life

Carers of patients within West Suffolk Hospital will receive more support after we raised concerns about feedback regarding the care for patients at the end of life and the support available to carers.

The hospital will now support its staff to identify carers earlier. This includes:

• Placing envelopes in outpatient areas containing support information.

• Updating information contained in carer packs, which was added to the carer’s webpage on the hospital’s website.

• Further family carer awareness training was delivered to wards to emphasise the benefit of packs for carers.

• Carers champions were nominated across wards and departments.

• The detail of the case we raised with the hospital was used as a

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learning tool for staff training.• As a result of our letter and

other episodes of poor communication between the NHS West Suffolk Clinical Commissioning Group and West Suffolk Hospital discharge planning team, a daily teleconference was established to discuss all cases awarded continuing healthcare funding and waiting for care packages to be started or care placements to be found. This improved communication between the discharge planning team, patients and their families and carers.

• The hospital reviewed how it could improve continuity of care for unplanned admissions to Oncology by focusing on whether patients admitted to the Macmillan Unit could bypass the emergency assessment unit to be admitted straight to a medical ward.

• A poster was developed as a reminder for patients to contact the Macmillan Unit (MACU) if a patient becomes unwell.

With regard to end of life care within the Trust, an action plan that was in development prior to our contact with the hospital, highlights the following outcomes:

• A new end of life care champion was identified for ward F7.

• Focussed staff training sessions

are planned regarding end of life care issues and the referral process.

• An end of life care review was completed on ward F7 in March 2016.

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GP outcomes...

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GP outcomes...

NHS England

In July 2014, NHS England told us that our reports were of immense value in providing feedback and information against which it can gain a fuller understanding of primary care services.

• A Practice was reminded about the importance of disability awareness after your comments highlighted a potential gap in staff training.

• A Practice made adjustments to the timing of appointments to improve patient experience.

• A Practice reviewed room layout because concerns were raised that intimate examinations were being made awkward by obstacles in the room.

• NHS England discussed the current rationale for GP time provision across two sites (the public had perceived an imbalance) and planned to work with the practices to make adjustments where the need for change could be evidenced.

Constable Country Rural Medical Practice

During the year 2014/15, we were contacted by the Capel St Mary Parish Council, which was concerned by the response it was receiving from its local practice

(Constable Country Rural Medical Practice). Attempts by the Parish Council to discuss and resolve these issues with the Practice and its Patient Representative Group had proved unsuccessful.

With our influence, we were able to arrange a joint meeting to explore the concerns in detail and agree how things could be improved for the local community. Since this point we have been working with the Practice to engage patients and implement actions that include the recruitment of volunteers to a newly established Patient Representative Group (now widely recognised as a marker of good practice to improving engagement at the practice).

Most recently we have been instrumental in helping the practice to improve its patient care and move out of special measures.

Pete Keeble (Practice Manager) said

“Following our CQC inspection in March this year we held an open evening for patients with the objective of sharing our plans for the future and recruiting a new PPG which would enable us to fully engage with our patient base and understand their needs. Healthwatch supported us at the event and manned a PPG recruitment stand.

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“Nearly 50 patients expressed an interest and were subsequently invited to the practice one evening where 13 core members were elected. Healthwatch helped us with the election process and with establishing the structure of new PPG, including drafting terms of reference. Since then, the PPG has met on half a dozen occasions, initially bi-weekly and more lately monthly. We have open discussions about how to take the practice forward and a shared objective of improving not only the service we deliver to patients but also the environment in which our staff work. Healthwatch continue to offer advice and an independent view which helps to manage expectations.

“Engaging with patients to understand their frustrations and needs is key to improving the service we offer. Healthwatch has helped us by holding a number of engagement events where they ask patients a number of questions to gauge their experience and understand the detail of when events went well or not so well. By repeating the exercise, say on a six-month basis, you can quickly get an indication of whether the steps you have taken to address problems have had the desired impact. A Healthwatch engagement exercise earlier in the year identified that access was still our primary issue. We worked on this over the

summer months and in September, aided by the PPG, we put in place a new appointment system designed to address the problem. Feedback from NHS Choices and FFT to date is very encouraging. Further Healthwatch patient engagement exercises will provide a much more detailed understanding of which specific elements of our new system have worked well and which elements will need to be tweaked further.”

Care Quality Commission

We have worked closely with the Care Quality Commission to help it plan CQC inspections of Primary Medical Services. We worked together to ensure the voice of patients was heard in relation to their feedback on GP practices in Suffolk.

Hawthorn Drive

A GP practice in Ipswich arranged staff training to help its clinical staff engage patients more positively. The Hawthorn Drive Surgery agreed to implement the training following comments submitted to us via our Feedback Centre.

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Other outcomes...

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Early Supported Discharge Services for stroke patients

In September 2014, the provider for this important service was announced as Norfolk Community Health & Care NHS Trust (NCH&C).

Prior to the procurement exercise we had asked local people to submit their views on how the service could best deliver effective care. As a result, changes were made to the specifcation for the service, particularly in relation to individualised care plans, training and support for carers which was strengthened.

Norfolk and Suffolk NHS Foundation Trust

Crisis care

In 2013/14 and prior, issues about a lack of support for people in a mental health crisis were raised jointly by Healthwatch Suffolk and Suffolk User Forum following the receipt of many negative comments from service users.

In 2014/15, we continued to challenge the Trust about the need for 24/7 call recording and monitoring which had not been implemented.

The Chair of the Norfolk and Suffolk NHS Foundation Trust confirmed

that delays with recording calls out of office were resolved. To support this, additional training and supervision was rolled out to increase customer service and help Trust staff to manage difficult telephone calls.

The implementation of this service meant that the Trust could monitor how staff handle calls and learn from this but also, from its perspective, evidence abusive and inappropriate calls as well as call volume and response times.

Student nurse observations

A comment about the administering of depot medication at a specific clinic led to the Norfolk and Suffolk NHS Foundation Trust reminding staff that patients should be made aware of their right to refuse observation by student nurses.

Depot medication is used to treat some types of psychotic illnesses. In this case the person was being given the injection in an intimate area and felt embarrassed by the presence of student nurses. Staff had not checked that the person was happy to be observed.

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East Coast Community Healthcare

Following a complaint endorsed by us, Community Nurses from East Coast Community Healthcare were reminded to assess a patient in a full and robust manner before making the decision to ask them to attend a clinic instead of receiving home visits.

Orthotics Services

Local Healthwatch in England have highlighted that people are being affected by a lack of access to orthotics services. Orthotics help to improve quality of life by reducing pain, keeping people mobile and independent and preventing more invasive and expensive interventions like surgery, amputation or the need for social care.

NHS England issued a call for local commissioners to improve how orthoses are provided to people, alongside a suite of guidance and resources to help them do so. As a Local Healthwatch, we welcomed this report, which followed work undertaken as a result of concerns raised by our wider national network.

We contacted our local commissioning groups in Suffolk to ask them to respond to the recommendations with any

improvements they can make for people accessing the services in Suffolk. We are pleased that NHS Great Yarmouth and Waveney Clinical Commissioning Group has responded to state that it has been reviewing the current service provided to patients against the guidance. It is in discussions with the provider of orthotics services (James Paget University Hospital Foundation Trust) and is developing a service specification that will take account of the recommendations set out in the new guidance.

The recommendations were also considered by the east and west CCG Executive to decide on whether this is an area to review in the future. The guidance will be referenced in service specifications in order to ensure the incumbents managing the Musculoskeletal system are aware of the learning opportunities.

Sexual Health Clinics in Suffolk

We asked Public Health Suffolk to review the practice within a sexual health clinic of using pink and blue forms for patients that corresponded with the patients gender. We were concerned about the potential impact of this on patients from the transgender community as the forms are used as part of medical examinations.

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The Provider has raised the issue internally and it will be resolved by the introduction of Electronic Patient Records which is currently being rolled out. The Provider has also been in discussions with the Terence Higgins Trust about delivering transgender training to staff, as a result of our feedback and feedback it has received from patients who are transgender.

Sharing Information about local care services

Working together in Adult Social Care - Information Sharing:The Care Quality Commission published a briefing that shows what can be achieved by Local Healthwatch, the Care Quality Commission (CQC) and other partners working together to improve adult social care services.

It contains many good, practical examples of working together that may be helpful to thousands of people who are members of Local Healthwatches around the country.The briefing highlights that Healthwatch Suffolk and CQC are participating members of Suffolk Adult Services Information Sharing Meetings and considers it a marker of good local practice.

Changes to IVF and MVA services

Governing Body members of NHS Ipswich and East Suffolk and West Suffolk Clinical Commissioning Groups decided to defer decisions on proposals to reduce access to IVF services and re-focus services delivered to marginalised and vulnerable adults.

Almost 1,400 pieces of feedback were received from the public (many obtained by Healthwatch Suffolk in support of NHS events).

Accessible information

We supported Healthwatch Surrey to produce a toolkit for our national network of Local Healthwatch. It explains what the NHS Accessible Information Standard is and how they can hold others to account.

The toolkit has been produced with support from NHS England, Healthwatch England, The Alzheimer’s Society, Surrey Coalition of Disabled People, Sight for Surrey, NHS Coastal West Sussex CCGs, Barchester Healthcare and Cranleigh Medical Practice.

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Improving services through safeguarding vulnerable adults

In 2015/16, we received feedback that a deaf blind person was receiving poor treatment within their care home. The feedback we received indicated that staff within the service were not able to communicate with the individual and that their post and phone messages were not being communicated. The person was unaware of what was being said about them during doctors visits because an interpreter was not available.

We were informed that the care home concerned is now receiving support and training to enable their staff to communicate with all residents including those with additional support needs.

East of England Ambulance Service NHS Trust

Following media coverage in May 2016, regarding unmarked vehicle leasing by the East of England Ambulance Service NHS Trust (EEAST), Andy Yacoub (Chief Executive of Healthwatch Suffolk) spoke with Chris Hartley (Director of Communications for EEAST).

Andy was made aware that the Trust Remuneration Committee would discuss the policy at its next

meeting and the Trust would also be benchmarking the policy against those of other ambulance Trusts.

Chris Hartley committed to keeping Healthwatch Suffolk updated on developments and passed on Healthwatch Suffolk’s offer of being involved in any review of this policy should this happen.

Gluten free foods on prescription

We consider that there was a lack of notice and consultation about the changes that has made the transition to coping without NHS support more difficult for some patients in the county. Furthermore, we believed the CCGs did not take sufficient steps to properly inform patients about alternative diet options.

Upon receipt of negative feedback, we contacted the CCGs to engage them in a discussion about the issues raised. From this, we were able to help the CCGs identify that some patients had not been notified about the changes, how they could seek support or challenge the decision against their own individual circumstances. The situation was resolved.

As a result of these proposed policy changes and others in the recent past, we asked commissioners to form an Equality Impact Board,

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which they have implemented. The purpose is to ensure that the likely impact of proposed changes in policy on members of all communities in Suffolk is adequately assessed.

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Enter and View outcomes...

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Chilton Croft Nursing Home in Sudbury (July 2015)

This visit was announced. The provider has submitted an action plan outlining improvements made following the visit, including:

• A clearly documented rota will be in place to evidence the out of hours management cover available to the home.

• The management team has continued with the development of a more clearly defined model of social activity.

• Improvements made to care planning review and involving residents in the process.

• The homes training administrator has worked with Suffolk Brokerage to develop its internal staff training. It will deliver formal dementia awareness training for all staff.

Mildenhall Lodge Residential Home in Mildenhall (September 2015)

This visit was announced. The provider (Care UK) has submitted an action plan outlining several improvements made following the visit.

• It will implement a keyworker system that benefits the residents in the home. It will advertise this information to

the residents and relatives by putting up this information in residents rooms.

• It has confirmed that there are now plans in place to improve the current environment on the dementia suite to include appropriate colours, corners of interest, sensory items and themed areas.

• Some residents have said that they do not like to use the lift to the cinema room. The provider has now covered the mirror in the lift as this was thought to have been an issue for some residents. It will also look into hosting movie events in a more accessible location.

Davers Court in Bury St Edmunds (October 2015)

This visit was not announced. The provider (Care UK) responded to our request for information following receipt of complaints. It had conducted an investigation and reported the following improvements:

• Reports of dirty pads being left in residents rooms will be addressed by a daily walk round conducted by the housekeeper and manager. We are pleased to hear that this will ensure all rooms are at a standard that should be expected before the residents

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leave their room to take part in activities or to visit the dining area. We are also pleased to hear that staff have been made aware they must not leave dirty pads on the floor and hope that this advice will be adhered to in future.

• That teams will be more vigilant to check catheter bags are emptied more frequently.

• We recognise the difficulties of care staff working with residents who may be challenging and were encouraged to learn of work with families to try to achieve the best outcome for the resident.

• We were encouraged to hear that Care UK has recognised the poor quality of housekeeping as noted by us and by complainants. It is pleasing to hear that steps are being taken to appoint a full complement of housekeeping staff.

• The provider also noted further specific areas of improvement with regard to closer general monitoring of food and fluids charts and more direct supervision of staff.

Woodfield Court in Stowmarket (October 2015)

This visit was announced. The provider (Stowcare Ltd) has

informed us that some points raised will be explored including recommendations regarding menu choices and home decor.

Drummond Court in Bury St Edmunds (December 2015)

The E&V team entered a room marked reception, however there was no bell to ring. It was unclear how a visitor arriving after office hours would gain entrance. A bell has now been fitted to both the office door and the reception window.

The complaints procedure will be issued to all families in response to feedback from relatives, who told us they were not aware of a complaints procedure.

Our visit also influenced the implementation of IT facilities that will enable people to work across the services at Drummond Court more effectively than at the time of our visit. The provider has also told us that all managers now spend one day of their week working alongside their staff teams.

We asked that, where residents have difficulty reaching alarm pull cords, consideration should be given to finding an alternative means of alert. The provider told us that it will review the pull call system to ensure that it meets the

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needs of people it supports. The provider has reinforced the importance of the ongoing need to monitor and inspect the cleanliness of all houses. It is also setting up an activities committee involving staff and people supported to look at the organising of activities throughout the year for service users and families, should they choose to attend.

Leopold Nursing Home in Felixstowe (February 2016)

The provider has responded to the recommendations made within our report outlining a number of actions taken to improve the service. This includes ensuring steps are taken to improve safety measures (e.g. fire safety signage and tidying loose cables away).

The provider has committed to monthly premises audits through which it is making improvements to decor and ensuring improved maintenance of the building.

Mills Meadow Care Home (March 2016)

One of our recommendations was that the good practices observed in the ground floor dining room could be duplicated in the first floor dining room to improve the mealtime experience for those

residents.The provider responded to state that mealtimes are different for residents located upstairs because the Dementia Unit is located downstairs. The provider is aware that service provision for residents located upstairs is a little task orientated and has taken steps to address this.

Friars Hall Nursing Home (June 2016)

The provider has responded with a specific action plan as follows:

• The provider is exploring the possibility of signage for private areas that it make it clear that care is in progress to protect people’s dignity.

• The manager will ensure that staff are fully aware of appropriate room layout to avoid chairs being placed against the walls. They will use photographic support to achieve this.

• The staff team were unaware of the NHS Accessible Information Standard. They will now ensure all information is made available in a larger font and will explore the implementation of dementia friendly signs throughout the home.

• To achieve a high standard of dementia care, the provider will explore a number of décor and

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maintenance solutions such as the installation of grab rails in corridors, signage and changes to paint colour.

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Local health and care leaders have been working together to develop plans that seek to ensure the future of our local NHS and social care services. These are called Sustainability and Transformation Plans (STP). They will show how local services will evolve and become sustainable over the next five years.

There are two STP areas that cover Suffolk. One for north east Essex, west and east Suffolk and another separate area for Norfolk and Waveney.

How are we influencing this? As a key partner involved with the development of the STP in the county, we have helped to establish a strong communications and engagement workstream.

It is through involvement with this element of the STP that we have worked to establish a page in November 2016 with information about the north east Essex and east and west Suffolk Local Health and Care Plan (STP) on our website. People can use the page to

feedback their views on the early plans. Visit: http://www.healthwatchsuffolk.co.uk/neesuffolkstp/ To date, we have been able to act as the independent voice of reason and clarity at the strategic steering group. We continue to be engaged in developments and will have the opportunity to influence specific change projects that develop out of the STP work. This includes the developing partnership between Ipswich and Colchester hospitals.


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A snapshot of feedback...

550+ comments logged as part of our research projects.

4,406Individual comments recorded from people using

health and social care services in Suffolk

341 services rated by people using our online Feedback Centre.

People have rated services in Suffolk with 4 out of 5 stars on our online Feedback Centre. Many people rated the quality of care provided highly.

Whilst people are generally positive about services, there is significant variation in ratings.

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Additional statistics on the way...

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All queries about this document including suggested revisions or additions, should be directed to the Information Services Team so that adjustments can be made as soon as possible.

All outcomes are as reported to Healthwatch Suffolk by providers or commissioners of local health and social care services. They are true at the time of record but may change over time as a result of external influencers (e.g. changes to the provider of the service, reduced funding or Government interference).

Our annual reports contain much more detail about the full range of work we are involved with including networks, forums, the Suffolk Information Standard, community engagement activity and other partnerships. Visit our reports page on the website to download the latest report.

Getting in touch:

Tel: 01449 703949Email: [email protected]

Address:

Freepost RTTY-CEUT-LCRHHealthwatch SuffolkUnit 14, Hill View Business ParkOld Ipswich RoadClaydonIpswichIP6 0AJ

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