appendix 1: community connections list 51 appendix 1.1

APPENDIX 1: Community Connections List 51

Appendix 1.1: Bexley

BEXLEY

Category Organisation

Asian British Bangladesh Welfare Association

Black Caribbean Bexley African Caribbean Community Association

Carers Carers Support Bexley

Carers Bexley Mencap

Carers Bexley Moorings

Other Bexley Association of Turkish Speakers

Chinese Centre for Chinese / Vietnamese

Chinese Centre For Chinese and Vietnamese Speaking Elders

Christian Ark Christian Centre

Christian Avery Hill Christian Fellowship

Christian Christ Church

Christian St Pauls Church

Disabled (Physical) people Access Group (Bexley)

Disabled (Physical)people Arthritis Care

Disabled (Physical) people Bexley Association of Disabled People

Disabled (Physical) people Bexley Beavers Swimming Club for the Disabled

Disabled (Sensory) people Bexley Deaf Club

Disabled (Sensory) people Bexley SNAP

Disabled (Sensory) people Bexley Social Club for the Blind

Disabled (Sensory) people Deaf Centre Bexley

Gujarati Samaj Mrs Kokila Patel

Hindu Greenwich Hindu Temple (Mandir)

Hindu South East Hindu Association Lesbian, gay, bi-sexual and transgender people Bexley bisexual, lesbian and gay Group / BBLAGG Lesbian, gay, bi-sexual and transgender people Haven social group

Men Danson Park Men's Bowls Club

Muslim Association Bangladesh Welfare Association

Muslim Dr & Mrs Rashid

Muslim North West Kent Muslim

Muslim 70 Pier Road

Older People Age concern Bexley

Older People Bexley Borough Pensioners Forum

Older People Over 50's keep fit


BEXLEY


Older People Senior Citizen Lunch Group

Sikh Harbhajan Singh

Sikh Sikh Temple

Women Belevedere Asians Women Group

Women Bexley Bangladesh Women’s Association

Women Bexley Women's Aid

Women Women’s Institute

Young people BCVYO LIMITED

Young people Connexions Prospects

Young people Danson Youth Centre

Young people The Youth Awareness Programme Appendix 1.2: Bromley

BROMLEY


Asian British Asian People's Disability Alliance

Carers Asian People's Disability Alliance

Carers Carers Bromley

Chinese Bromley Christian Centre

Christian Bromley Parish Church

Christian Citygate Church

Christian Sureway Christian Centre

Christian Leung Shuen Wan Chinese Association & Social Club

Disabled Bromley Ablement

Disabled Bromley Autistic Trust

Disabled Bromley Mencap

Disabled Bromley Scope

Disabled Bromley Sparks, Room F36

Disabled Deaf Access

Disabled Disability Voice Bromley

Disabled Kent Association for the Blind

Hindu South East Hindu Association

Jewish Bromley Reform Synagogue

Lesbian, gay, bi-sexual and transgender people

Gordon House Association


BROMLEY


Men Out-Side-In

Muslim Southwark Muslim Women's Association

Old People Age Concern Bromley

Old People Asian People's Disability Alliance

Old People Biggin Hill Community Care Association (BHCCA)

Old People Mission Care

Other English as an Additional Language Support Service

Sikh Gurdwara Guru Nanak Darbar

Sikh The Sikh Temple

Women African Women's Welfare Group

Women Aperfield Womens Institute

Women GFS Platform Penge

Women Royal British Legion - Orpington Women's Section

Young People Beckenham Youth Voices

Young People Bromley Council for Voluntary Youth Services

Young People Bromley Youth Service

Young People Urban Saints - Youth Group

Appendix 1.3: Greenwich

GREENWICH


Asian British African Health for Empowerment and Development

Black African Asian Resources Centre

Buddhists The True Buddha School

Carers Greenwich Carers Centre

Chinese Christ Church

Christian Greenwich Chinese Association and School

Christian Greenwich Seventh-Day Adventist Church

Christian Greenwich United Church

Christian Greenwich Vineyard Church

Disabled (Sensory) people Breakthrough

Disabled (Sensory) people Greenwich Deaf Children's Society

Disabled (Physical) people Advocacy in Greenwich

Disabled (Physical) people Deptford Methodist Mission Disabled People's

Disabled (Physical)people Greenwich Association of Disabled People (GAD)


GREENWICH


Disabled (Physical) people Greenwich Disability Resource Centre

Hindu Centre Greenwich Hindu Temple

Hindu Shree Kutch Satsang Swaminarayan Temple

Hindu South East Hindu Association Lesbian, gay, bi-sexual and transgender people Metro Centre Lesbian, gay, bi-sexual and transgender people The Metro Centre

Men Bexleyheath & Belvedere Hockey Club

Men Erith Cricket Club

Men Greenwich Hockey Club

Men Greenwich Rugby Football Club

Muslim Charlton Mosque

Muslim Greenwich Islamic Centre

Older People Age Concern House

Older People Age Exchange Reminiscence

Older People Boyle House

Older People Contact the elderly

Other Somali Parents Network

Sikh Ramgarhia Community Centre

Sikh Woolwich Sikh Temple

Women Meditation Class

Women Mothers of Sexually Abused Children

Women Women's Centre

Women Womens Choir

Young people 14 - 19 Greenwich Youth Theatre

Young people Greenwich Young People's Council

Young people Woolwich Young Peoples Cafe Project Appendix 1.4: List of the organisations who nominated members to attend, by event

Nominating Organisations for Bexley Bexley LINk QEH UWM Rep Carer's Support/ Carer's Network The Youth Awareness Programme Greenwich Hindu Mandir, Plumstead Trust Diabetes UK Bexley Support Group National Childbirth Trust/ QMS Maternity Services Liaison Committee South London Healthcare NHS


Nominating Organisations for Bromley Abverbury Hill Christian Children and Family Centre Bromley LINk Health Link Membership Bromley LINk Stakeholder Engagement Group

Women's Institute

Bromley Sparks Unite (The Pensioner)

Nominating Organisations for Greenwich Greenwich Association of Disabled People (GAD) Multi-Faith Forum Greenwich LINK National Childbirth Trust Lewisham & Greenwich Home Instead Senior Care Queen Elizabeth Hospital User group Keep our NHS Public Somali Parent Group London & Quadrant Housing The Youth Awareness Program

Nominating Organisations for 3 Borough Event (General) Abverbury Hill Christian Children and Family Centre Action for Health, Education and Development

Diabetes UK Bexley Support Group

Bexley Council Greenwich LINK Bexley LINK Home Instead Senior Care Bromley LINK Multi-Faith Forum Bromley LINK Stakeholder engagement Group South London Healthcare NHS Trust Bromley Sparks The Youth Awareness Programme Carer's Support/ Carer's Network

Nominating Organisations for 3 Borough Event (W&C) Abverbury Hill Christian Diabetes UK Bexley Support Group Bexley Council Greenwich LINk Bexley LINk Multi-Faith Forum

Bromley LINk National Childbirth Trust/ QMS Maternity Services Liaison Committee

Bromley LINk Stakeholder Engagement Group South London Healthcare NHS Trust Carer's Support/ Carer's Network Unite (The Pensioner) Children and Family Centre

APPENDIX 2: Health Link – APOH PPI Process and Rationale Paper 56 Scoping Document

1. Purpose: Health Link has been commissioned to undertake patient and public engagement in the development of patient pathways arising from the implementation of A Picture of Health’s programme as part of a ‘comprehensive and inclusive patient engagement strategy’ in the implementation of the programme, recommended by the Independent Reconfiguration Panel (‘IRP’).1 The purpose of the work is to enable a broad sample of patients and residents of the four boroughs covered by the APOH programme to help shape the pathways so they meet patients’ needs and expectations as well as clinical requirements. 2. Success criteria for designing and delivering the involvement work and their rationale: We have identified 12 criteria for successful engagement in the APOH patient pathways emerge from legislation and guidance relating to patient and public involvement (‘PPI’)2 and from the documents and processes in APOH so far, as referenced below. Compliance Criteria: to comply with the legislation and guidance, involvement must be

1. Inclusive 2. Informed 3. Fit For Purpose 4. Transparent 5. Influential

Criteria to meet recommendations of the IRP Report 6. Effective 7. Meaningful 8. Comprehensive 9. Proportionate 10. Consistent (across all four boroughs and all services) 11. Valuable in achieving ‘a seamless service across primary, secondary, community

and social care, taking a whole systems approach.’

Criteria to meet recommendations of the Integrated Impact Assessment Report 12. Valuable in helping commissioners ‘understand the diverse needs of equality and

other groups before commissioning.’

The Pathways: There are 3 types of pathway: 1. The Local Pathways - on Out of Hospital Care which will vary by borough. 2. The Generic Pathways affecting the population in general, on

a) Urgent care and acute medicine (same day discharge) b) Urgent Care and Acute Medicine (inpatient) c) Elective Surgery d) Daycase Surgery e) Emergency Surgery f) Trauma Surgery

3. The Targeted Pathways affecting certain population groups, on

a) Maternity b) Gynaecology c) Children and Young People

1 IRP Report Advice on Changes to the Distribution of Services between Bromley Hospitals, QEH Greenwich, QMH Sidcup and University Hospital Lewisham & Associated Development of Community Services 31.03.09. 2 S 242 Health Act 2006 and Real Involvement Statutory guidance Department of Health October 2008

APPENDIX 2: Health Link – APOH PPI Process and Rationale Paper 57 Scoping Document

The Local Pathways will be addressed in four local Events, one per borough (10). The Generic Pathways and the Targeted Pathways will be tackled in morning or afternoon simultaneous sessions at a South London conference. There will be a plenary session between the morning and afternoon sessions at the conference to consider overarching themes (1,2,8)

Recruitment: unlike public consultation, engagement does not require large numbers of people but rather a broadly representative sample so that the different types of people who may be affected by what is being planned are being meaningfully involved (3,6,7,8,9,10). To achieve this, we will use the following sampling approach: 1. Develop a Community Profile of each borough made up of the following data per Middle

Super Output area (1,7,12): a. age b. ethnicity c. gender d. disability e. deprivation

The first 3 are statutory equality groups and the last is important for health inequalities because of the association between deprivation and health.

2. Invite residents through GP practices using an form which tells us their postcode,

demographics and GP practice, so we can: � map demographics of participants against the relevant borough profile � use postcodes to check that participants give us a broad geographical spread across

the borough concerned � map the GP practices of participants so that we have a constituency of people for

future involvement who could get involved in future through Patient Participation Groups, contributing a legacy of consultation capital at the most local level aligned to practice based commissioning. (3,5,6,7)

3. Develop a Community Connections database of community organizations supporting:

� the statutory equality groups not covered in the demographics against whom it is unlawful to discriminate in services or processes: - lesbian, gay and bi-sexual people - people of either gender or reassigned gender - people with a religion or belief

� groups who are traditionally underrepresented in engagement such as refugees, travelers or people with mental health problems (1,2,3,8,12).

4. Invite representatives from these Community Connections organizations to bring the

perspective of those whom they support to the events (6,7,8,11). This type of event is by definition unlikely to attract traditionally under represented groups, whose views will need to be directly obtained through outreach meetings at a later date.

5. A gap analysis to compare workshop participants with the overall Community Profile, to

inform future outreach involvement work.

APPENDIX 3: Materials Issued 58 Appendix 3.1: Letters - General

Dear Director

The way the NHS delivers services in your area is changing....

Health Link is an independent, not for profit social enterprise working to give the public a say in the health service. The NHS in Bexley, Bromley, Greenwich and Lewisham has been working on a reform programme for the local NHS called a picture of health. The programme has commissioned us to hold events with local residents to gather ideas on how local health services should be provided as a result of recent decisions under a picture of health. An information sheet is attached giving more details. Your organisation has been chosen as somewhere we could recruit local residents to attend the following consultation events:

� Hospital Care: A conference to discuss how hospital services, such as urgent care and planned or emergency surgery, should work across the boroughs after the changes, to be held on 27th July from 10-2pm at a venue in Southwark.

� Care outside Hospital: A local event to discuss where and how services in the community, should be provided after the changes, details of which are shown on the attached flier.

Both venues are accessible by public transport and have disabled access. Refreshments will be provided. We would be grateful for your help in passing the application packs to those who use or work in your organisation, so they can apply to us for a place at one of the Events. The application form may be completed:

� online at www.health-link.org.uk or www.apictureofhealth.nhs.uk; � via the freephone number 0808 909 8582 (24 hours) or; � in hard copy & returned in the freepost envelope provided.

We will make a gift of £20 to each person who is accepted and who participates at the Event. If you have any queries do not hesitate to ring Daryl Gallagher on 020 7254 1582. We look forward to hearing views of those whom you support on how these changes should work for them. Elizabeth Manero, Director

APPENDIX 3: Materials Issued 59 Appendix 3.2: Letters - Women’s & Children

Dear Director

The way the NHS delivers women’s and children’s services in your area are changing....

Health Link is an independent, not for profit social enterprise working to give the public a say in the health service. The NHS in Bexley, Bromley, Greenwich and Lewisham has been working on a reform programme for the local NHS called a picture of health. The programme has commissioned us to hold events with local residents to gather ideas on how local health services for women and children should be provided as a result of recent decisions under a picture of health. An information sheet is attached giving more details. Your organisation has been chosen as somewhere we could recruit local residents to attend the following consultation events:

� Women’s and Children’s Hospital Care: A conference to discuss how women’s and children’s hospital services should work after the changes, to be held on 28th July from 1- 4pm at a venue in Southwark.

� Women’s and Children’s Care outside Hospital: A local event to discuss where and how women’s and children’s services in the community should be provided after the changes, details of which are shown on the attached flier.

Both venues are accessible by public transport and have disabled access. Refreshments will be provided. We would be grateful for your help in passing the enclosed application packs to those who use or work in your organisation, so they can apply to us for a place at one of the Events. The application form may be completed:

� online at www.health-link.org.uk � via the freephone number 0808 909 8583 (24 hours)or; � in hard copy & returned in the freepost envelope provided.

We will make a gift of £20 to each person who is accepted and who participates at the Event. If you have any queries do not hesitate to ring Daryl Gallagher on 020 7254 1582. We look forward to hearing views of those whom you support on how these changes should work for them. Elizabeth Manero, Director

APPENDIX 3: Materials Issued 60 Appendix 3.3: Information Sheet

A Picture of Health Information Sheet, FOR MORE INFORMATION PLEASE CALL HEALTH LINK ON 0207 254 1582 or email us on

[email protected]

Will you share your ideas about local healthcare?

You may have heard that hospitals in your area will be changing. The aim is to use NHS

resources better and offer patients safer, more modern care in these hospitals:

� South London Healthcare trust based at

- Princess Royal University Hospital, Farnborough

- Orpington Hospital

- Queen Elizabeth Hospital, Woolwich

- Queen Mary’s Hospital, Sidcup

� Lewisham Hospital

The NHS in Bexley, Bromley, Greenwich and Lewisham has been working on an

improvement programme called “A Picture of Health”.

Local people, Councils, NHS staff and the Secretary of State for Health have already

commented on the plans. Now, before the changes go ahead, we want to make sure

we get the details right - so we are asking for your views.

Where are we in the process?

The diagram below shows where we are in the process and the red arrow shows where

this piece of work comes in the process.

Getting your input into how the new services will work

Your local NHS has asked an independent organisation, Health Link, to involve local

people in the next set of decisions. They will be hosting meetings with local people, to

gather your ideas on the way that patients get their care under the new arrangements.

These ‘routes’ that people follow through the NHS system are called ‘patient

pathways’. For example, the patient pathway for someone needing surgery would be

from the GP, to a hospital and home to finish recovering.

We want to make sure the new pathways work well for patients. By coming to the meetings and sharing your experiences, you can help us with this. We’d also like to

INFORMATION SHEET

APPENDIX 3: Materials Issued 61 Appendix 3.3: Information Sheet

A Picture of Health Information Sheet, FOR MORE INFORMATION PLEASE CALL HEALTH LINK ON 0207 254 1582 or email us on

[email protected]

involve you in monitoring the new system once it is in place, to make sure it works well for patients.

What has been decided already?

The plans reflect important trends in modern medicine. People with the most serious problems need quick access to senior doctors and advanced technology. These scarce resources need to be together in one place. Yet where the risks are lower, people are best treated closer to home.

In line with this thinking, complex and emergency care will be concentrated at Princess Royal University Hospital, Queen Elizabeth Hospital and Lewisham Hospital. Minor injuries, routine care and some outpatient services will be the new focus at Queen Mary’s Hospital in Sidcup.

What is left to decide and what difference can you make?

The next stage is to decide how the new system will work. We need to think about:

� How can we improve patient’s experience of new health services?

� What information will people need to find their way round the new system?

� How can we improve how hospitals, GPs (family doctors) and social services work together?

The meetings are taking place before decisions have been made about how these services will operate – so there is time to influence and improve how they will work for you and for the benefit of other local patients.

What will happen at the meetings?

We will ask what you think about patient pathways including:

� Urgent care, including A&E � Planned surgery

� Care for medical conditions � Day Surgery

� Maternity � Emergency surgery

� Gynaecology � Care for Children & Young People

We may also cover patient pathways for all types of care that will not be provided in hospital, including:

� Care in care homes � Therapies such as physiotherapy

� District nurses � Care for dementia

Where will the meetings be?

The attached form shows dates, times and locations of the meetings.

What should I do next?

Please complete the form and send it to us at the FREEPOST address shown indicating which meeting you would like to attend. You may attend both if you wish. You may also access the form online on

www.health-link.org.uk or www.apictureofhealth.nhs.uk

62

HAVE YOUR SAY ON THE NHS EVENT APPLICATION FORM

Bromley Central Library, High

YOUR CONTACT DETAILS Your Name: .....................................................................................................................

Address: ..........................................................................................................................

.......................................................................................................Postcode: .................

Telephone: ............................Mobile (if any): ...................................................................

Email (if any): ..................................................................................................................

Do you have any Special Requirements for attending the Meeting?

Dietary Needs: .......................................................................

Other Needs (e.g. disabled access, language interpreter, signer, crèche) please specify:

..............................................................................................

If you have been nominated by an organisation, what is the name of the organisation?

.................................................................. Organisation’s Postcode .................

Send this form to Freepost RLXR-EUYS-KEAH, 62 Beechwood Rd. E8 3DY; or

Apply on the 24 hr Freephone number:

For sessions on services for patients in general on 0808 909 8582

For sessions on services for women & children on 0808 909 8583; or

Apply online www.health-link.org.uk or www.apictureofhealth.nhs.uk

ONCE WE PROCESS YOUR FORM, WE WILL SEND YOU DETAILS OF THE VENUE AND MAP

Which borough do you live in? Bexley �� Bromley �� Greenwich ��

Which event would you like to attend?

(All events cover services for patients in general as well as women’s and children’s services). If you wish, you may apply to go both to your Local Event on Out of Hospital Care (starting at

6pm), and the 3 Boroughs Event on Hospital Care (daytime).

Bromley Local Event at Bromley Central Library on 15th July ��

Bexley Local Event at Beth’s Grammar School Bexley on 22nd July ��

Greenwich Local Event at Forum at Greenwich on 28th July ��

3 Boroughs Event at Avonmouth House at Elephant & Castle on 27th July ��

ABOUT YOU

To help us make sure that we invite a broad range of local residents, please tell us:

Your Gender Male � Female �

Your Age

16-29 � 30-44 � 45-59 � 60-74 � 75 and over �

Your Ethnic Group

White � Mixed � Asian or Asian British � Black or Black British � Chinese � Other (please specify)....................................

62 Beechwood Rd London

E8 3DY

63

FREE LUNCH! £20 GIFT FOR REGISTERED PARTICIPANTS

CRECHE PLACES AVAILABLE CRECHE AVAILABLE

YOUR HOSPITAL

SERVICES

ARE CHANGING...

HAVE YOUR SAY

62, Beechwood Rd.

London E8 3DY 0207 254 1582

www.health-link.org.uk

WHAT ARE YOUR IDEAS ON HOW THE CHANGES SHOULD WORK?

How should the new A & E & urgent care work? What if you need medical care as an outpatient? Suppose you need admission as an emergency? What if you need an operation? What happens if you need gynaecology treatment How should the options on having a baby work?

What about the new services for sick children?

Avonmouth Hse, 6 Avonmouth St. SE1 6NX (Elephant & Castle/Borough)

27th July 2009 Topic timetable: 10.30-2.30pm - services for all

1-4.30pm - women’s & children’s services

To registerTo registerTo registerTo register: Call: 0207 254 1582 :or 0808 909 8582 (all services) ; or 0808 909 8583 (women’s & children’s services); or Online:www.health-link.org.uk

APPENDIX 4: Recruitment Schedule 64

STREET FACE TO FACE RECRUITMENT

Borough Location Event Date

Bexley Bexleyheath town Centre – Charity Shops, Dentists, Pharmacies, opticians

3 Boroughs & Bexley Local

17.06.09

Bexley Bexleyheath Aldi 3 Boroughs 26.07.09

Bromley Bromley Town Centre - Dentists, Pharmacies, opticians

3 Boroughs 17.06.09

Bromley Orpington Town Centre – Charity shops, menswear shops

3 Boroughs 24.07.09

Greenwich Woolwich Town Centre - Dentists, Pharmacies, opticians

3 Boroughs & Greenwich Local

17.06.09

Greenwich Greenwich Town Centre - Herbalist, Physio-therapist, Charity shops, opticians, pharmacies


17.06.09

Greenwich Greenwich Town Centre - General 3 Boroughs & Greenwich Local

18.07.09

Greenwich Woolwich Town Centre - General 3 Boroughs & Greenwich Local

20.07.09

Greenwich Woolwich Job Centre Plus 3 Boroughs & Greenwich Local

24.07.09

Greenwich Woolwich Job Centre Plus 3 Boroughs & Greenwich Local

24.07.09

Greenwich Odeon Cinema, Greenwich Village 3 Boroughs 25.07.09 Greenwich

Woolwich Town Centre – Mothercare, Spec Savers, McDonalds

3 Boroughs & Greenwich

26.07.09

Greenwich Thamesmead Aldi 3 Boroughs 26.07.09

RECRUITMENT IN NHS PREMISES

Bexley Queen Mary’s Sidcup A & E 3 Boroughs 17.06.09 Bexley Queen Mary’s Sidcup A & E 3 Boroughs 22.07.09 Bexley Queen Mary’s Sidcup A & E 3 Boroughs 24.07.09 Bromley PRU A & E 3 Boroughs 17.06.09 Bromley PRU A & E 3 Boroughs 22.07.09 Bromley PRU A & E 3 Boroughs 24.07.09 Bromley Beckenham Beacon Health Centre 3 Boroughs 24.07.09 Greenwich Queen Elizabeth A&E 3 Boroughs 17.06.09

Greenwich Queen Elizabeth A&E 3 Boroughs & Greenwich Local

22.07.09

Greenwich Queen Elizabeth A&E + Women’s Health


24.07.09

MAILOUTS ACROSS THE SECTOR SRG Members 1 1 E 6.07.09 Local Authority Councilors 1 1 E 6.07.09 NCT 3 3 E 7.07.09 MSLC 3 3 E 7.07.09


BROMLEY (15th JULY)

Category No.

letters/posters No. Packs G WC G WC

D/S/E Date

Equalities & Carers 57 0 171 0 S 2.07.09

GP practices 5 5 20 D 2.07.09

GP practices 10 10 40 D 3.07.09

GP practices 37 37 D 3.07.09

GP practices 6 6 48 48 D 7.07.09

LINk 1 1 E 6.07.09

Princess Royal Hospital 24 24 D 2.07.09

Residents Associations 39 39 E 10.07.09

TUGS 16 0 16 0 S 6.07.09

TOTAL 195 109 335 210 849

BEXLEY (22nd JULY)

Category No.


D/S/E Date

Equalities & Carers 39 117 S 8.07.09

GP practices 38 152 152 S 9.07.09

Patients 200 200 Via PCT

15.07.09

Queen Mary’s Sidcup 20 1 50 50 D 9.07.09

Women’s & Children’s grps

8 24 S 8.07.09

TOTAL 305 1 543 202 1051

GREENWICH (28th JULY)

Category No.


D/S/E Date

Equalities & Carers 33 99 S

GP practices 60 240 240 S 10.07.09

Queen Elizabeth Woolwich 12 10 12 8 D

Women’s & Children’s grps 7 21 S

TOTAL 105 17 351 269 742

Total packs (information sheet & application form) 1910

Total posted letters 732

Total recruitment visits 26


RECRUITMENT THROUGH LOCAL AUTHORITIES AND PCTS Organisation Activity Date

Bexley LA Text messages and emails sent out to approx 130 individuals

23.07.09

Bromley LA Information placed on website and staff intranet 23.07.09

Bexley LA Information placed on website and staff intranet. Awaiting confirmation of further activity

23.07.09

Greenwich LA Agreed to put information on website. Awaiting confirmation of further activity

24.07.09

Bexley PCT Emailed and asked to forward information on. 24.07.09 Bromley PCT Emailed and asked to forward information on. 24.07.09

Greenwich PCT Emailed and asked to forward information on. Arranged a member of staff to ring around to drum up support

24.07.09

In addition: All LINks hosts spoken to Follow up calls to all those who we mailed. Results logged in a picture of health/recruitment and mailing/contacts by borough for both Greenwich and Bexley

APPENDIX 5: Materials For Workshop 67 Appendix 5.1: LATEST UPDATES FROM APOH

The latest from

A picture of health

The A picture of health (APOH) programme aims to significantly improve the delivery of health services

for, and the health and well being of, more than a million people in Bexley, Bromley, Greenwich and

Lewisham.

APOH began in 2005 when the NHS in outer south east London identified the need to reorganise how

local health services were provided. Over the next couple of year, an extensive amount of analytical work

was undertaken in the areas of clinical redesign, finance, capacity, human resources, estates, and

impact assessment, to identify exactly how services could be changed for the better. Then, in 2008,

APOH ran a public consultation to gather feedback from local people about the proposed changes.

On 8 May 2009, following a review of the programme by the Independent Reconfiguration Panel (IRP),

the Secretary of State for health (SofS) published his decision on the future of APOH, giving the green

light for the changes to go ahead.

The changes to be implemented under APOH will ensure the local NHS can provide better, safer and

affordable healthcare services in local community settings, and from the four largest hospitals in our area

– the Princess Royal University Hospital in Farnborough (PRUH), Queen Elizabeth Hospital in Woolwich

(QEH), University Hospital Lewisham (UHL), and Queen Mary’s Hospital in Sidcup (QM

The four acute sites will each have:

� urgent care centres, that will treat many of the current A&E patients;

� outpatients services;

� assessment services for children and older people; and

� day-case surgery (where the patient does not stay overnight).

The differences between acute services under APOH will be:

� QMS will specialise in planned surgery and become a base for many community healthcare

services. It will have a 24-hour urgent care centre, midwife-led birthing unit (MLBU) and

paediatric ambulatory care service, but will not have an A&E or children’s inpatients;

� PRUH, QEH and UHL will become specialist emergency centres with 24-hour A&E, maternity

units and children’s inpatients; and

� UHL will also provide some planned surgery.

APPENDIX 5: Materials For Workshop 68 Appendix 5.1: LATEST UPDATES FROM APOH

For more information about APOH Visit www.apictureofhealth.nhs.uk

Email [email protected] Freephone (please leave a message) 0800 321 3579

Latest update – July 2009

� Clinical redesign workstreams are finalising new service models and redesigning

patient pathways, through engagement with clinical colleagues and patients

� Clinical engagement included a recent series of workshops where service models

were presented to doctors, nurses and midwives in the areas of acute and general

medicine, surgery, children and young people, women’s services, for feedback

� A series of public and patient engagement events, from 15 July, to gather feedback

from patients about any issues they foresee when APOH implements the changes to

services, and how they think these issues could be resolved

� Business planning work continues alongside the clinical redesign work, with financial

and capacity analysis currently being refreshed. The service models proposed by the

clinicians are also being assessed against financial and capacity sustainability.

� Estates development planners have been appointed and planning work is underway

across all acute sites

The acute changes will be supported by more services being provided in the community, closer to

patients’ homes. These services will include, but not be limited to:

� ante- and post-natal care

� home births

� paediatric ambulatory care (‘walk-in’ assessment and treatment services for children)

� community matrons

� medical assessment services

� intermediate care (for short-term stays and treatment out of hospital)

� rehabilitation (for patients post-hospitalisation)

� day care facilities (for treatment such as intravenous chemotherapy)

� screening (for cancers and other illnesses)

� health support services (stop smoking, obesity programme, alcohol interventions etc)

� support for, and management of, long-term conditions (e.g. diabetes, cardiac, stroke

and chronic obstructive pulmonary disease)

� ophthalmology (eye care)

� oral surgery

Now the challenge is to drive forward the implementation across multiple care pathways and in four

boroughs, and ensure that all of the benefits promised by the programme are delivered.

APPENDIX 5: Materials For Workshop 69 Appendix 5.2: WHAT DO WE MEAN BY.....?

An independent not for profit organisation

62, Beechwood Rd E8 0207 254 1582 www.health-link.org.uk

OUT OF HOSPITAL: locations other than district general hospitals (such as Queen Mary’s Hospital at Sidcup), which are ‘closer to home’ for more patients. These might include health centres, GP surgeries or larger centres like Northumberland Medical Centre. URGENT CARE CENTRE: A walk-in service staffed by GPs and nurses who can treat patients with urgent, but non life-threatening conditions. Up to 60% of patients who currently use A & E actually only need this level of service. There is already an Urgent Care Centre operating at Queen Mary’s Sidcup.

INTERMEDIATE CARE: This care may be provided in intermediate care beds (such as the 14 bedded Step UP Step Down Unit at Queen Mary’s Sidcup), or to patients in their own homes by the Virtual Ward team. Led by a team of nurses, with cover by a GP and support from specialist rehabilitation therapists, the Step-Up Step-Down ward supports patients who need rehabilitative care without the intensive acute input required on a regular hospital ward. At present, its main focus is to support patients referred from the community who do not need an acute admission to hospital, but do need some nursing support over a 24-hour period. Patients likely to benefit include those who are physically frail, disabled or who are recovering from recent illness or injury.

A ‘Virtual Ward’ is currently running in North Bexley and there are plans to expand these across the borough. In virtual wards patients receive high levels of care but in their own homes. Nurses, GPs, therapists and social offer the level of support a patient’s condition dictates - a mixture of phone calls and visits, running from 8am to 8pm.

LONG TERM CONDITIONS: Conditions that people have over the long term and which cannot be cured. In addition to advice on prevention, patients need ongoing support and treatment for these conditions. Long term conditions prioritised in Bexley include diabetes, coronary heart disease and Chronic Obstructive Pulmonary Disease or COPD. Estimates for numbers for Bexley residents with these conditions (figures from the London Health Observatory and Bexley Care Trust Annual Public Health Report) are: � Diabetes: 8,500 (3.7%). � Coronary Heart Disease: the single most common cause of death, causing 18% of

deaths in under 75s in Bexley � COPD: 9200 (4.2%)

MATERNITY CARE OUTSIDE HOSPITAL: home birth will be an option. Antenatal and postnatal services will be provided in some Children’s Centres, some large GP surgeries and health centres, by community midwifery teams, who will also provide ‘shared care’ with GPs for some women. Up to 1,100 women having babies in Bexley are considered to be unlikely to need a doctor at their delivery (Bexley Care Trust Commissioning Strategy Plan 2008-2013) and might consider the choice of a home birth or birth in a midwife-led unit, subject to advice from midwives and obstetricians on whether they are suitable for this type of birth. Currently home birth rates (2007) in Bexley are 2.1% per year compared to 7% in the catchment of Kings College NHS Foundation Trust at Southwark. PAEDIATRIC AMBULATORY CARE: walk in assessment and treatment services for

children.

APPENDIX

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Appendix

5.3

: Purp

ose

of Event

PURPOSE OF THIS EVENT

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APPENDIX

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Appendix

5.4

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a M

ap E

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APPENDIX 6: Verbatim Views 72 Appendix 6.1: Verbatim tables from Bexley Event

BEXLEY LOCAL EVENT Participants indicated how confident they were about the planned changes. No one expressed full confidence. The great majority (19 people) indicated a serious lack of confidence. 2 people did not entirely lack confidence, but were close to doing so. 4 people were a little more confident, but were still closer to lacking confidence than to having it. The comments are summarised in the table below:

TABLE ONE - CONFIDENCE THAT APOH PLANS WILL BENEFIT PATIENTS

Clinical services, resources, issues Non-clinical services,

resources, issues

Positive views Less convenient, but might be better care.

-

Reservations, concerns, doubts

Cuts in services.

A rushed process, lack of clarity, lack of opportunity to influence. Concern about not knowing what is happening. Confusion and concern over Lewisham. Transport.

TABLE TWO - MAKING INTERMEDIATE CARE WORK (Group 1) Rank Main category Issues within main category

More District Nurses District Nurse – well trained What will happen if the District Nurse cannot make a diagnosis? Does she call a doctor or send the patient to hospital? Care given in the home by fully trained staff 24 hours a day Well trained staff and staying at home for treatment

1 Well trained at home

Intermediate care should be in the home if possible District Nurses to be attached to a GP

2 District Nurses 24 Hour Cover Good communication Should be publicised to older people Communication with local Doctors 3

Better Communication

Promote intermediate care. A lot of people still aren’t aware. Perhaps TV commercials to promote Funding issues: i.e. NHS v Social Care need to be clearer

4 Funding Medical equipment funding (often Patients need facilities at home) More community nurses needed

5= More Staff More members of staff working part of intermediate care Medical equipment funding

5= Medical equipment Responsible for all patient equipment - nurse

7 Continuity and Continuity of care – a nurse that I know



confidence

TABLE THREE - MAKING INTERMEDIATE CARE WORK (Group 2) Rank Main category Issues within main category

To remember the patient comes not to be pushed aside because you have a golf point in half an hour One to one with the Doctor for care at home To get help when needy at home And to be heard from the Doctor for your home Reasonably easy access to medics when necessary Occasional home visits by medics if necessary Services to meet(?) demand, not too late Social Services stores 24 hrs Transport for patients to get to rehab etc Remember patients’ needs first – they shouldn’t be rushed

1 The patient comes

first

Remember patients are frightened of what can happen, and listen to them in their time Education of patients to ensure they understand that they will receive the same standard of care they have received in hospital More District Nurses Ensuring staff are properly trained Enough District Nursing/Community Nursing Teams Rehab centres Physiotherapy and other support services The knowledge it exists and is available to all age groups

2

Enough trained staff

Consistent and regular home visits by qualified and/or experience staff Joint working between medical and social care services Consistency from the care team Make sure GP has full details (up to date) before and after discharge Health work and social services work is not a job that can be done on strict hours – both need to finish job, and not have EU regulations

3 Good working

practice

More respect from staff at Doctor’s. Not to be turned away What precautions are necessary so that illness doesn’t get worse Remember patients need explanations in simple language Structured advice from medics re best way of recuperation Who to contact if urgent help is needed? Get the information to the public Important for patients to know who to complain to, and get answers in language

4 Good honest

communication and information

If you have any complaints or you wish to make any suggestion, who should you contact?


TABLE THREE - MAKING INTERMEDIATE CARE WORK (Group 2) Rank Main category Issues within main category

Get the information known – during admission to patient and carers

5 Cost to patients Who pays? – patient or Social Services

TABLE FOUR - HELPING TREATMENT AND SELF-MANAGEMENT WORK BEST FOR PATIENTS WITH LONG TERM CONDITIONS (Group 1)

Issues Educate people about their condition Holistic services Links with people with other conditions Good access to other support services Regular home visits Community nurses working with people in the community Communication for check-ups Consistency with appointments – not changed Good communication from your doctor One point of contact in the community Good coordination between services Liaising with the voluntary sector If self-managing you must have support Good information – helpline Good information sharing between services

TABLE FIVE - HELPING TREATMENT AND SELF-MANAGEMENT WORK BEST FOR PATIENTS WITH LONG TERM CONDITIONS (Group 2)

Issues Access to Cardiac Nurse Specialised staff for specialities, e.g. dialysis Cardiac Nurse to have medical history Availability of Occupation Therapists, Physiotherapists etc Skills in communication from Doctors and Nurses to Patients Staff trained in long term conditions in all schools, eg. To give injections - Diabetic Effect of hospital changes on children with long term conditions Break down the fears of chronic conditions in school Specialist care – no dilution Adults and children to be treated individually and separately Diabetes 2 – to have enough blood strips Involving family as carers – to support the patient End of life planning

TABLE SIX - MOVING TO AN URGENT CARE CENTRE AT QUEEN MARY’S WITH NO A&E Reservations, Concerns, Doubts

Capacity and A&E a concern. How many extra ambulances will there be? Where will people go to A&E after changes?


TABLE EIGHT – MAKING ANTENATAL CARE AND POSTNATAL CARE WORK WELL FOR WOMEN

Rank Main category Issues within main category Support for mobile population Early pregnancy - ?Miscarriages, ?Ectopics More GP check ups Where will women be scanned in early pregnancy – will GP surgeries be doing it? Local appointments with known teams of midwives Mental health support – continuing More midwives in the community to give adequate postnatal support

1 Quality of Care

Support for breast feeding or bottle feeding Choice of close by/local places for scans Will women experience the same level of care regardless of postcode ‘Choice’ midwives More information about choices for place of birth Homebirth: choice/information should be given to all

2 Choice

Prenatal care Women should be informed of 3 Cs: choice, care and continuity More parenting classes Early pregnancy - ?Miscarriages, ?Ectopics

3= Information

Cessation of smoking Are there enough midwives to provide all care to women? Will women expect same level of care regardless of postcode? Recruitment of experienced midwives Retention of midwives

3=

Staff

Local appointments with known team of midwives

TABLE SEVEN - URGENT CARE CENTRES – WHAT NEEDS TO BE DONE TO HELP PEOPLE KNOW WHERE TO GO AND WHEN?

Suggestions Consistent national messages Clear patient focussed messages about services provided Clarity for people with long term conditions Opening times People need to be told what an Urgent Care Centre is, what it offers Need to know what the difference is between Polyclinics, Urgent Care Centres and GP surgeries Information in GP surgeries Through patient participation groups Letters to all households with explanation Translation into other languages Needs to start before change happens


TABLE NINE - MAKING HOME BIRTH WORK WELL FOR WOMEN AND BABIES Rank Main category Issues within main category

Better care from GPs during labour at home More time at antenatal appointments to talk to Midwife about want you want for birth If you could rule out every maternal and foetal complication, then home birth would be wonderful Less infection with delivery at home Knowing there are plenty of ambulances and paramedics

1 Quality and

safety

Getting the NHS to pay for an independent Midwife if NHS cannot provide home birth Bath and (?) mood light music Safe facilities in the home Facilities at home for birth should good The right height bed

2 Facilities

Pain relief More time at antenatal appointments to talk to Midwife about what you want for birth Confident and competent Midwives More ambulances and Paramedics Getting NHS to pay for an independent Midwife if NHS cannot provide home birth More Midwives

3 Staff

More Midwives in teams working together so that mother knows Midwife. More information on home birth

4 Information Mum’s choice

GRAFFITI BOARD – BEXLEY EVENT APOH stated Lewisham was included but now gone back to London area. What compensation do we get (hospital wise) in Bexley? Concerns about finances 6,000 marched and no action taken Rename ‘virtual Ward’ to Home Care Kidbrooke – what’s happening? Jo M – to respond to Kidbrooke query We can communicate to people about UCC’s through council magazines Concerns about too much change Freedom passes start later – time of event Why Elephant and Castle for the 3 events? Lack of community services Concerns about process – not hearing / being consulted Cleanliness at Queen Mary’s

APPENDIX 6: Verbatim Views 77 Appendix 6.2: Verbatim tables from Bromley Event

BROMLEY LOCAL EVENT Participants indicated how confident they were about the planned changes. At the extremes, one was very confident (get seen quickly), one was not at all confident (plans were very complex). Another was fairly seriously lacking in confidence. The remaining five were around the middle, slightly more confident than not. The comments are summarised in the table below:

TABLE ONE - CONFIDENCE IN APOH PLANS

Clinical services, resources, issues Non-clinical services,

resources, issues

Positive views

Instead of waiting hours you will get seen quickly. Overall it is a good plan to have different hospitals specialising. Good to have services together.

-


Very complex to consider.

Geographical concerns – a big area with transport difficulties – it is difficult to get to services without a car.

TABLE TWO - MAKING INTERMEDIATE CARE WORK Rank Main category Issues within main category

1 Good ongoing personal

service

Phone calls to patients, e.g. from doctor to patient. Work one-to-one. Help with old people more so they feel safe. Doctors and staff to help people with aftercare. Language and communication skills for care staff.

2 More help at home

Home help. Household help. More help for everyone who needs it. Keep people in their homes. Language and communication skills for care staff. Calls – e.g. doctors phoning patients.

3= Working well between

services

Sufficient quantity and quality. Communication between PCT and Social Services. Coordination of services Tpt etc. Support to help people deal with difficult things. Financial – not necessarily provision of money, but help, support etc concerning finance.

3= Good communication of

what’s available

Make sure patients understand options/services/ support that are available. Publication of what’s available.

5= Make use of good

technology

More technology to monitor at home, e.g. heart condition. SOS help button.

5= Good consultation Consult patients when planning new services and changes to the service


TABLE THREE - HELPING TREATMENT AND SELF-MANAGEMENT WORK BEST FOR PATIENTS WITH LONG TERM CONDITIONS

Main category Issues within main category

Support for carers Support for carers. Advice for carers.

Communication with patients Good communication with people. Make sure people understand the options available. Clear, jargon free diagnosis and advice.

Resources to support

Appropriate and experienced support. Reliable equipment. Provide people with tools for self management. Sufficient resources to support people.

Good support from and for staff

Support must be continual. Good staff training to help people. Good staff hygiene.

Coordination between services

Good communication between services. Coordinated services reducing waiting times.

Support for those who can’t manage at home

Support for those who can’t manage at home

TABLE FOUR - URGENT CARE CENTRES - INFORMATION FOR PUBLIC Topic Suggestion

Suggestions on what needs to be done so people know where Urgent Care Centres are, when they are open etc.

Simple pamphlet showing: (a) exactly where to go (b) phone numbers to call in various circumstances for advice,

information or intervention (c) relevant transport information on the pamphlet (d) clear explanation of the service and distinction from GPs and A&E (e) examples of types of conditions for which Urgent Care Centre is

appropriate (f) clear information about whether any age groups are excluded (e.g.

children under 2)

Information pamphlet should be distributed by: (a) being readily available in doctors’ surgeries, libraries etc. (b) being delivered to houses by the NHS, not in free newspapers,

which are often thrown away

Information and the pamphlet should be provided to: (a) NHS Direct (b) St John’s Ambulance (c) Red Cross (d) Public events (e) Community and faith groups (f) Advocacy and support organisations such as Mencap (g) Professionals working in the community (e.g. Health Visitors,

Midwives) (h) Services such as Preschools


Possibility Urgent Care Centre becoming a substitute for GP out-of-hours services (e.g. MDoc) Relationship of Urgent Care Centre to Rapid Response.


TABLE FIVE - MAKING ANTENATAL CARE WORK WELL FOR WOMEN

Rank Main category Issues within main category A name rather than a number. Personalisation. Excitement, joy. Seeing the same person. Understanding people’s circumstances. Time to talk. Time to talk re birth plan/visit hospital. Ability to choose midwife for birth.

1 Personal care

Opportunity to change midwife if not happy. Flexible hours in case of work. If scans in hospital, help in costs of getting there. Home antenatal appointments.

2 Flexibility and convenience

Local access. Explaining t staff if people’s circumstances change.

3 Administration and handover Good handover of notes between areas if mother moves.

TABLE SIX - MAKING POSTNATAL CARE WORK WELL FOR WOMEN Rank Main category Issues within main category

Respect. Consistent, evidence based advice. Understanding of mother’s wishes – breast feeding.

1 Quality of care

Short waits. Plenty of contact. Flexible hours. Short waits. Close to home/at home. Help with costs to get to appointment.

2 Access to services

Personal home visits.

3 Prompting mothers

Contact us when injections required.

Crèche facilities in case of older children. 4 Facilities

Changing facilities.


TABLE SEVEN - MAKING HOME BIRTH WORK WELL FOR WOMEN AND BABIES Rank Main category Issues within main category

Care in emergency. Facilities to care. Monitoring equipment. Where you live.

1= When things go

wrong

Birth plan when things go wrong. Time to discuss and ask questions. Good information about prep. Support for mother. Encouragement.

1= Personal care

Help with birth plan – time. Enough midwives round the clock. Medical team. 3 Staffing

Helpful staff in transfer. 4 Labour Pain relief, choice of.

Quality of home. 5=

Personal circumstances Where you live.

Formula milk. 5= After birth

Support for breast feeding.

GRAFFITI BOARD – BROMLEY EVENT Adequate and ongoing training + support for care workers working in the community Seeing notes afterwards Reassurance of being in hospital No jargon Health visitors for the elderly Cleanliness Terminology of intermediate care

APPENDIX 6: Verbatim Views 81 Appendix 6.3: Verbatim tables from Greenwich Event

GREENWICH LOCAL EVENT Participants indicated how confident they were about the planned changes. 12/42 participants were very confident about the changes. 10/42 participants where undecided about the changes and 19/42 participants were not confident at all about the changes. The comments are summarised in the table below:

TABLE ONE - CONFIDENCE THAT APOH PLANS WILL BENEFIT PATIENTS

Main category Clinical services, resources,

issues Non-clinical services,

resources, issues The changes might be for the better

Services will improve

It makes sense for hospitals to specialise

Previous Knowledge that it works

Positive Views

Neo natal care and MLU Planning Need further information Depends on whether its being monitored

Consultation process Reservations,

concerns, doubts

Been decided on financial needs not clinical needs


Being 100% sure they are ready to leave hospital No Limit on stay Free on NHS not S.S

1 Clinical needs

Is there a proposed limit on how long the patients stay Staff are fully trained Rehabilitation Key worker assigned to each patient to co ordinate all aspects of care

2 Quality of care

More fun and activities Cut down on waiting time Homely so feel comfortable Move efficient equipment/furnishing Comfy seats Things to entertain them (i.e. TV)

3= Good Facilities

Light rooms Who is responsible in making decisions on who goes where Effective communication between hospital & intermediate care Good communication between doctors and patients Interpreters available for consultation

3= Information and communication

A personal NHS contact not website or phone lines



Close liaison with the doctor for care Information given to patients about what is happening Longer Visiting hours Frequent visitation from friends and family

5

Patient well being

Online system 8.30-7.30 Close to home Home assessment Prep for going

6 Good re-integration

Local services

TABLE THREE - MAKING INTERMEDIATE CARE WORK (Group 2) Main category Issues within main category

Staff Client Awareness of services Care will be quick immediate care fast medication Share care have a good team Confidence Not long waiting Helpful and understanding To be local Welcoming environment Team of specialist staff Early assessment

Services

Planned care Social care Post hospital monitoring emergency care i.e. afterwards After care

Planned care Family friends support Friendly people Support

Support Transport Link assistant

Transport Easy transport

Clear communication Explain the treatment in easy words not jargon

Wellness Healthy balanced food


TABLE FOUR - HELPING TREATMENT AND SELF-MANAGEMENT WORK BEST FOR PATIENTS WITH LONG TERM CONDITIONS (Group 1)

Rank Main category Issues within main category Ongoing advice

Advice and your rights Welfare rights, benefits (social) rights Access to specific support groups

Support Ongoing support To be informed if classified as disabled Choice of Hospitals Understanding of the patient by the professionals Answers to questions on your condition To be informed if classified as disabled Choice of Hospitals Understanding of the patient by the professionals Answers to questions on your condition Honesty about your prognosis A treatment plan Understanding that blue badge holders need access to hospital transport Quick medical report and correspondence between Gps and benefits Not having appointments council

What patients want from the professionals

How are you monitored long term


Issues Good Training for Patients Holistic care Key worker Good Housing Improvements to your home Group activities/group support Training to understand your disease and cope with it Confidence on Diagnosis Services that talk to each other Good relationship with GP Good support from your GP Emergency support system Continual Contact Information about condition Transport Outside activities Feeling of improvement Agricultural and gardening Need to know who to go to in an emergency Patients need to be trained on their condition Expert patient system Assurance



Issues Access to counselling Home visits Voluntary groups to support Support Groups Sufficient financial support for patients

TABLE SIX - URGENT CARE CENTRES – WHAT NEEDS TO BE DONE TO HELP PEOPLE KNOW WHERE TO GO AND WHEN?

Suggestions Where the services are What help is available Chart of services How to get to services Contact number for advice How to complain Bus routes Choosing where to go

Content

What services are being provided In community groups Social services Libraries All providers Places of worship Job centres schools Internet Council At Greenwich Forum At your GP Local Supermarkets Pharmacists House to house leaflet drop In hospitals

Where

In the community Verbally at GP Consultations Picture format for those who cannot read Different Languages , Braille and audios How to access it Waiting times

How

Times


TABLE SEVEN - MAKING ANTENATAL CARE AND POSTNATAL CARE WORK WELL FOR WOMEN

Rank Main category Issues within main category Further information about birth choices Information Throughout pregnancy Information about benefits pregnant women are eligible for ( antenatal and post) Face to face information about and care as leaflets are at times forgotten More Scans during pregnancy to reassure mothers to be (or sound scans-heartbeat) Choice of place of care Antenatal care for mother and the baby Proper information Post natal info about if your baby becomes unwell e.g. blocked nose

1 Information

Follow up from midwives Continuity of care Continuity of care before or after birth Continues care by one midwife/ or team antenatal to post natal period Women should be given one midwife who will provide help and care (antenatal and post natal) To have the same midwife or small group of midwives throughout pregnancy and after birth More midwives and support workers

2 Continuity of Care

Continuity of care in antenatal and post natal care. This will be a better experience for women and more efficient for practitioners and midwives. More involvement More care Ongoing infant feeding support (not just in 1st week) More access to health history of women where the UK is not birth country to maximise good outcome of birth Offer Free English Language Teaching for women so they can benefit better from health services. More Crèche facilities More friendly midwives More time for full explanation ( including interpretation) More support for the post natal women when discharged from hospital so quickly Peace of mothers mind and in the home Working with community very closely

3 Interpersonal

More Team work Better antenatal More post natal care 4 Quality of care

To be listened too postnatally 5 Support and Home

Good environment at home having space to talk to


TABLE SEVEN - MAKING ANTENATAL CARE AND POSTNATAL CARE WORK WELL FOR WOMEN

Rank Main category Issues within main category midwife Support for new mother i.e. where can she get help Peace of mind at home Healthy food Medical care Good environment More regular home visits by the midwife Services close to home Choice of place of care Early access to maternity services i.e. teenage mothers

6 Interpersonal

More involved with your midwife

TABLE EIGHT - MAKING HOME BIRTH WORK WELL FOR WOMEN AND BABIES

Rank Main category Issues within main category Confident , competent midwives to support women and babies Experienced midwives with good back up services

1= Staff

Health care professionals to know about home births A lot of information on what you need and what will be provided by the midwife Reassuring mums and encouraging them to have home births Information and experience can help in home births More acceptance of, and support for home births by all HCPS involved in maternity More acceptance of, and support for home births by all HCPS involved in maternity Overall nationally home birth rate is 2%. In the Netherlands in it is 30%

1= Information

Contact in case of a emergency Regular visits from one experienced midwives Regular visits after birth from midwife to check on mother and baby

3 Extra Services

Contact in case of emergency during and after birth Would never consider having the baby at home. Will be away from all the facilities that are available at the hospital in case of an emergency.

4 Fear

Scared to have a baby at home

5 Interpersonal You need to have build up a good relationship with midwife and have supportive partner.


GRAFFITI BOARD – GREENWICH EVENT

Understanding and caring Better staffing!! Patient info shared Easy access Longer visiting hours, better staffing, more efficient equipment/furnishings Make service more EFFICIENT Will GPs shift their responsibilities towards urgent care centres? Online system Trust between doctors and patients More enthusiastic staff so they don’t feel alone

APPENDIX 6: Verbatim Views 88 Appendix 6.4: Verbatim tables from 3 Borough Event

1. THREE BOROUGHS EVENT

TABLE ONE - A&E and URGENT CARE Topic Suggestions

House to house communication Easily stored information Good information to all Bexley and surrounding community Fridge magnets Healthcare professionals to give out information about changes all the time Better public information What is actually happening? More suitably qualified staff

What will make change from A&E to UCC at QMS work well for patients?

Added implication of swine flu Dedicated phone lines No 0845 numbers – free phone Not too many phone numbers 999 for urgent cases Human beings at end of phone How do we know what service to use? Clarity about names and functions Good telephone triage Minimum journey times No pay and display at A&E

What will make Accident and Emergency work well for patients?

Pay on exit for car parking Definition of urgent care Minimum journey times Adequate transport (incl LAS) No delays Sufficient capacity in the system Effective triage at first point of contact Seeing the right clinician at first visit Qualified staff 7 day access to a GP

What will make Urgent Care Centre work well for patients?

A relaxing environment in hospital and ambulance 2. EMERGENCY SURGERY AND MEDICINE What are the key issues for patients at the stages 2a to 2d after the changes?

TABLE TWO A – BEFORE YOU GO INTO HOSPITAL Rank Main category Issues within main category

Deciding whether to go No criticism for decision 1= Deciding you need help

Acting quickly Smooth handover of problem Clear messages Carer/friend’s knowledge

1= Communication

Avoiding confusion


TABLE TWO A – BEFORE YOU GO INTO HOSPITAL Rank Main category Issues within main category

Knowing who to call Patient is consulted on decisions No criticism for decision 3 Patient centred process

Relaxing environment Where to go Making the decision on where to go Getting there

4 Where to go

Acting quickly

TABLE TWO B – WHEN YOU ARRIVE AT HOSPITAL Rank Main category Issues within main category

Quick attention Good diagnosis Quality of diagnostics

1 Customer service

Customer service generally Communication with family Patient is consulted on the decisions Staff sensitivity to patient’s state of mind

2 Patient centred

Customer service generally Finance – car park charges

3 Parking Parking and dropping people off

TABLE TWO C – WHILST YOU ARE IN HOSPITAL Rank Main category Issues within main category

Confidence in treatment (effective) 1 Treatment

Help with feeding Being kept informed Sympathetic staff 2 Customer service

No mixed wards Visiting hours Distance of visiting 3 Visiting

Cost of visiting Communications with outside Cost of communication with outside 4 Communication

Use of own mobile phone

TABLE TWO D – WHEN YOU LEAVE HOSPITAL Rank Main category Issues within main category

Social care 1 Support for you

Personal circumstances 2 Patient feedback Patient invited to feedback on treatment etc.

3= Access Follow up appointments at QMS/local Ongoing treatment Follow up appointments 3= Completing the care

After care (medical)


3. PLANNED SURGERY AND MEDICINE

What are the key issues for patients at the stages 3a to 3d after the changes?

TABLE THREE A – BEFORE YOU GO IN TO HOSPITAL Main category Issues within main category

Clearly documented social service involvement – named individuals Good information about what is going to happen Private vs NHS Impact of dementia on patients and carers How long will I stay? Two way planning process – choice Post-op therapy Availability of ITU beds Choose your hospital Will the surgery solve the problems Last minute cancellation Pre medical assessment Home assessment, for e.g. knees and hips and where I am a carer/parent Details about what is going to be done Priority re-appointment if your surgery is cancelled

Topics discussed

Poor provision of care for people with diabetes Effect of change on public transport facilities Right people treated in the right places Where am I going to go?

Top topics from discussion

Effect on staff

TABLE THREE B – WHEN YOU ARRIVE AT HOSPITAL Main category Issues within main category

Bed availability Parking spaces for patients and visitors Appropriate parking for drop-off and ‘settling in’ Timings for meals etc. Appropriate admission times – patient centred Visiting time information Who is the key contact for patient Good waiting areas To be shown around Medical notes and information available Wheelchairs for those who need them Treated with dignity and respect by all Information about complaints procedure Information about patient’s rights Interpreting services available including sign language

Topics discussed

Emergency carer cover to be ‘truly’ 24/7 Not familiar with area Top topics from

discussion Notes not keeping up


TABLE THREE C – WHILST YOU ARE IN HOSPITAL Main category Issues within main category

Less jargon from consultants Be treated as a human being No discrimination Being treated better Timing of consultant visit Sufficient medication at right time Travelling time and distance for visitors Separate male/female toilets Further work needed at QM to cope with change Sheets changed more often Dedicated single sex wards Dedicated nurse(s) Be involved in your care plan No MRSA or other infections Help with feeding Availability of ITU services Food should reflect culture and taste

Topics discussed

Meals should offer better choice (fruit) and vegetarian options Lack of ITU at QMS Top topics from

discussion Further work at QMS to make it fit for purpose

TABLE THREE D – WHEN YOU LEAVE HOSPITAL Main category Issues within main category

Records transferred back to GP Better discharge procedure Improved communication – include nurses Transport for people if they need it More information on post-hospital services and post-op care Better staff help on discharge Follow ups Leave hospital with appropriate medication Good communication between different services Double check that discharge is appropriate Provision made for patient requirements at home Point of contact with people who looked after you

Topics discussed

Better Communications with District Nurses Coordination of after care Transport links

Top topics from discussion

No change until new system in place


4. PAEDIATRIC AMBULATORY SERVICE

TABLE FOUR A - BEST WAYS OF PROVIDING INFORMATION TO THE COMMUNITY ABOUT THE NEW PAEDIATRIC AMBULATORY SERVICE

Ways of providing information Communication across ALL sections of the community Share more information with ordinary people People in places of worship, schools, clinics, groups GP patients Mothers and pregnant women Children Parents and carers Leaflets and posters (in different languages) Information on fridge magnets Local press Radio and children’s TV advertisements Facebook As booklet of local services Verbally by health professionals etc. Area performance league tables Story board GP – when anyone registers Health Visitor Midwives give every new mother the information Hospitals and Doctor’s surgeries Children’s Centres Schools, including in classes and on notice boards Children’s Information Centres Churches Libraries Youth centres Supermarkets Pharmacies Mothercare etc. Playgroups Civic Centres Coffee shops Child health centres Local clinic Good leaflet to every household


Your child is seriously unwell and you are taking him/her to the new ambulatory paediatric service. What would make this service work well for you?

TABLE FOUR B - MAKING THE NEW AMBULATORY PAEDIATRIC SERVICE WORK WELL FOR PATIENTS

Ways of making service work well Where to take the sick child? Do I have to decide where to take my child? New choice for QMS catchment Maintaining a flexibility of choice for parents Welcoming atmosphere Waiting area suitable for children Better understanding of children of all ages Seen as soon as possible To be given an idea of how long to wait Effective triage Good communication with parents/carers Effective sharing of patient information Continuity of care Efficient transfer and transport arrangements 5. HAVING A BABY 5a You are having a baby and are considered SUITABLE FOR MIDWIFE LED CARE. What would make the stages of pregnancy work well for women, their partners and their babies?

TABLE FIVE A – MAKING STAGES OF PREGNANCY WORK WELL FOR PATIENTS Stages Issues

Aim at same midwife throughout Knowing your midwife Midwives doing scans and blood tests Booking appointments in the community Antenatal appointments – convenient times and locations Full information Understand risks - how would we know about the baby’s health without the risk of having a miscarriage in early pregnancy? What are the risks about having a miscarriage?

EARLY PREGNANCY

Explanation of why I was considered low risk – difference between low and high risk? Antenatal appointment – more time with midwife Good antenatal classes (in community) Regular checks Any complications referred Drugs – choice Equipment - explanations Good communication

MID TERM

Comprehensive notes


TABLE FIVE A – MAKING STAGES OF PREGNANCY WORK WELL FOR PATIENTS Stages Issues

Empathy, understanding circumstances Home help – what’s available? Counselling and involvement of Dad 1-to-1 care: midwife with me all the time Midwife throughout labour Baby and mother very safe What if they don’t turn up? Communications – good levels Good documentation and observation Complementary therapies More water birth facilities Hydraulic pool therapy Emotional support Music therapy

LABOUR

Facilities for partners!! Double check baby’s health on discharge Better care for ill children After birth care Extra postnatal support Choice of having more postnatal visits Help with postnatal depression Facilities for partners

ON DISCHARGE

Give mums help on how to bring up baby 5b. You are having a baby and are considered likely to NEED CARE IN AN OBSTETRIC UNIT. What would make the stages of pregnancy work well for women, their partners and their babies?

TABLE FIVE B – MAKING STAGES OF PREGNANCY WORK WELL FOR PATIENTS Main category Themes within main category

Pre-conceptual care I want to see midwives as well as a doctor Understanding the risks Understanding what the doctor is saying to you Understanding about what is going on with the pregnancy and what is going to happen Full information from early on to discharge Fears of emergency Medical notes obtained early Early booking for high risk women Infections Easy access to multi-disciplinary teams, e.g. diabetes

EARLY PREGNANCY

Personal mental health To be treated as an individual – not just ‘labelled’ in a high risk category MID TERM Good mental health services

LABOUR 1-to-1 care – midwife with me all the time


TABLE FIVE B – MAKING STAGES OF PREGNANCY WORK WELL FOR PATIENTS Main category Themes within main category

Midwife throughout labour Visiting hours for dads extended Comfortable, peaceful environment even if lots of intervention necessary To be treated with dignity and respect Quiet room for couples with sad outcomes Better care for mums and babies Clinician with diabetes expertise during weekend Help with baby at home – baths, feeds Give mums help how to bring up baby Helping new mums with breast feeding – how to … Not making you feel uncomfortable with choices – breast feeding Excellent, consistent breast feeding support Full support for single parents, what’s available?

ON DISCHARGE

Quiet room for couples with sad outcomes

GRAFFITI BOARD – 3 BOROUGH EVENT (General) Where do Bexley Patients go? Distances for Bexley Patients to travel. ‘Standby’ ambulances at QMS. Audit of number of Patients going to A & E and then back again. Which hospitals do Patients from Bexley go to? GP should be responsible to get hospital notes We have no trust in the authorities. Our fight is with the politicians. Concern about closure of QMS. Bexley is losing out. Nobody in favour Today’s comments will not reach the masters.


GRAFFITI BOARD – 3 BOROUGH EVENT (Women’s & Children)

Parent’s can decide to call GP if they wish to first

Support with/after injuries/illness for single parents with no support at home

To be able to get GP to do call visit if needed What is happening with Beckenham Beacon – minor injuries unit?

Inconsistency in applying policy Cleanliness in all hospitals Clarity on consent guidelines Capacity in maternity units All healthcare staff need to know Capacity = Staff, beds. Posters in libraries Discharge to be PT control. c/s not 2 days Advert in local newspapers Pay on exit parking Letter from Pre-school Accountability – who is accountable? Feed Starving Patients Need spiritual support in hospitals Use plain English not ‘Triage’ Please do not close Barnard health centre A lot of people find consultation a bit much by late afternoon. Don’t suppose those remaining will get a bonus though?

Boris Johnson’s restrictions on freedom pass use is causing chaos and discrimination

Consolidation of the public is always a surprise and a chaotic experience

Post code lottery for preventive child screening (e.g. Ophthalmology)

Query about Ophthalmic screening etc for children

A fierce opinion re mixed words emerged – but without any real democracy, discussion; a forced consensus.

APPENDIX 6: Verbatim Views 97 Appendix 6.5: Evaluation Summary

PARTICIPANTS EVALUATION OF EVENTS

EVALUATION

Clear Purpose

Facilitation Venue Materials Food

Bexley Out of Hospital Care Event Excellent 10 6 8 2 13

Fair 1 1 2 2 1

Not Good 5 0 1 0 0

Bromley Out of Hospital Care Event Excellent 3 4 5 3 6

Fair 4 1 2 1 0

Not Good 0 0 0 0 0

Greenwich Out Of Hospital Care Event Excellent 14 13 7 8 7

Fair 5 0 1 2 0

Not Good 0 2 5 0 2

3 Boroughs Event Excellent 29 27 29 21 27

Fair 5 4 2 9 4

Not Good 0 0 0 0 0

Comments from 3 Boroughs Event:

� “Felt public was at least listened to. Even if they couldn’t do anything.” � “Not sure of purpose fully until I got here.” � “Would love to be informed about future events via email.” � “The day was very informative. Good participation. Well done.” � “Printouts to take away. Air Conditioning wind!” � “A Challenging & Stimulating day. Some frustration RE Q.H.H Closure obvious

solution – to me that is barred” � “A morning or afternoon session on its own might be enough for one day.” � “Thanks for the Crèche - otherwise I could not have come.”

COMBINED SATISFACTION RESULTS FOR ALL EVENTS Voting by stickers

Excellent Fair Not good Totals

Number % Number % Number % Number Clear purpose 56 72 17 22 5 6 78

Facilitation 50 85 7 12 2 3 59

Venues 49 79 7 11 6 10 62

Materials 34 83 7 17 0 0 41

Food 53 91 3 5 2 3 58

APPENDIX 7: Demographic Breakdowns 98

The tables below show the demographic breakdowns of those attending each event. The expected number is the number of people would be expected in that category if the attendees were to match the demographic profile of the borough. The numbers are based on the 2001 census.

DEMOGRAPHIC COMPARISON – BROMLEY LOCAL EVENT ETHNICITY AGE

NUMBERS NUMBERS Actual Expected Actual Expected

White 8 7 16-29 1 2

Mixed 0 1 30-44 2 2

Asian or AB 0 1 45-59 0 2

Black or BB 0 1 60-74 4 1

Chinese/ Other 0 1 75+ 1 1

GENDER Male 3 4 Female 5 4

DEMOGRAPHIC COMPARISON – GREENWICH LOCAL EVENT ETHNICITY AGE


White 23 35 16-29 11 12

Mixed 0 1 30-44 6 15

Asian or AB 3 3 45-59 9 9

Black or BB 12 5 60-74 10 6


No Answer 7 No Answer 9


DEMOGRAPHIC COMPARISON – BEXLEY LOCAL EVENT

ETHNICITY AGE


White 23 26 16-29 2 6

Mixed 0 1 30-44 5 8

Asian or AB 2 1 45-59 6 7

Black or BB 1 1 60-74 6 5


No Answer 2 No Answer 2


APPENDIX 7: Demographic Breakdowns 99

DEMOGRAPHIC DATA ON PARTICIPANTS – 3 BOROUGHS EVENT ETHNICITY AGE

NUMBERS NUMBERS

General Women & Children

General Women & Children

White 19 16 16-29 4 3

Mixed 0 0 30-44 2 1

Asian or AB 9 11 45-59 9 8

Black or BB 2 1 60-74 10 9


No Answer 1 No Answer 3 4

GENDER Male 16 13

Female 15 17

appendix 1: community connections list 51 appendix 1.1

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