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AGM draft minutes and Q&As

The draft minutes from our AGM in October, plus answers to many of the questions raised before and during the event can be found below.

Questions for Healthwatch Northumberland

Q:  My husband has multiple health conditions. Since March, paramedics have been called four times (via NHS 111/999 or GP). We have been told consistently that they would not take him to hospital, e.g. for a high temperature. Are paramedics instructed to routinely give this message, consequently deterring people from seeking help? We know from past experience when his breathing is normal for him, but cause for concern, and when he is deteriorating and likely to require intervention.

This whole experience leaves us feeling it is wrong to call for help. This is exacerbated by other consultations (GP and hospital) which feel ineffectual for a person with multiple comorbidities.

A: North East Ambulance Service said:

The staff who answer 111/999 calls are not routinely instructed to inform patients that they would not take him to hospital. Each individual is assessed in their own right and the context of their presenting symptoms. If an individual is identified as needing hospital access then we would recommended that. Where an individual can safely be transferred to hospital without ambulance intervention that will be recommended. This saves ambulances for those people where there is an absolute need to transport the patient with supported care on route.

During the period since March 2020 we have had different thresholds for answering calls depending on how severe COVID-19 has been. Things may change in times of high demand and depending on the changing government guidance as we learn more about the virus.

On some occasions we have advised people not to access hospital care, the outbreak of COVID19 meant hospitals may not be the same safe environment for people with weak immune systems as they were previously. In these cases, where care could safely and effectively be given at home that would be recommended.

Q: Why have mammograms for women over 71 been stopped with no indication of when they will start again. Newcastle Hospitals advised there is only a four month backlog.  I have booked a private appointment. Also have GP surgeries been told to stop advertising the service.

A: This question has been submitted to Newcastle Hospital Trust and we will publish the answer as soon as we have it.

Q: I have seen that Being Woman charity gives out devices to people to access digital services. Is this service only for black, Asian and minority ethnic people or can anyone in Northumberland also access their service to get digital devices. One of my acquaintances in Amble has one and she was guided to connect up to GP services.

A: Thank you for your feedback and query around Being Woman. If you are looking for support around digital skills or would like to have a device to access digital resources we recommend you get in touch with them directly, either through their website: www.being-woman.org.uk contact them on 01670 857167.

Live questions:

Q: Where would I find more details about the Healthwatch Northumberland vacancy? Will there be a link available?

A: Derry answered. Yes we will make the link to our website available after the event or you can email info@healthwatchnorthumberland.co.uk to find out more.

Q: Do you have a view about the recent Look North feature about designated care home dementia spaces?

A: Derry answered. This is a policy decision and we don’t have a view in advance of the patient/carer experience but we are keen to find out more and hear from people about this if it is implemented.

Q: Are there any Clinical Commissioning Group (CCG) plans to communicate the Primary Care Network plan to the wider community?

A: Derry answered. HWN is always keen on how issues, changes and developments are communicated to the wider service user group so we will put this to the CCG and publish the answer.

 

Questions for our guest speakers from Northumbria Healthcare NHS Foundation Trust, Dr Alistair Blair and Judith Stonebridge, Public Health Consultant

Q: How accessible is digital in healthcare for the visually impaired, and have they been consulted and involved in the planning on digital healthcare? In addition, a lot of self-care promotion is on digital and this adds to health inequalities.

A: Judith answered. This is a really important question and definitely needs to be considered. The pandemic meant a rapid change overnight and there wasn’t much time for engagement, but we are doing that now and are keen to work with Northumberland County Blind Association. A significant amount of appointments are by telephone rather than computer so this may help and face-to-face appointments are still available if appropriate. We are keen to be as inclusive as possible, not just with appointments but with materials too.

Alistair added in regard to the self-care resources that digital resources are in addition to existing materials. Nothing has been taken away, talking books and Braille resources are still available.

Q: Are there any hospital sites or GP practices providing virtual group clinics in Northumberland? There are many patients who attended face to face group clinics who are now isolated and unsupported because of Covid.

A: Alistair answered. We need to separate group support, group education and group consultation. At present none are happening because it hasn’t been possible to get multiple people on to a secure platform. Zoom doesn’t meet the secure standards of the NHS. We’re looking into how group support and education could be delivered but it is harder to provide group consultations as there are issues with confidentiality. There is no way of knowing whether someone is recording the session. However, there are definitely opportunities here.

Q: What about increasing digital engagement and capacity building to facilitate digital engagement, especially those most at risk of poor health outcomes?

A: Judith answered. She said this is an issue which was discussed pre-Covid and inspired her to think about how people experiencing financial difficulties might not differentiate between letters in plain white envelopes from the NHS and elsewhere. There are plans to try to understand why people are not coming to appointments and what is preventing access. The pilots for the community hubs should help people develop digital skills. The Trust is also trying to make the language clearer on any letters sent out and will keep looking at data to help make improvements.

Q: Younger people might find digital engagement difficult if home is not a safe place or in cases of domestic abuse. How sensitive are services to these issues and how will it be addressed?

A: Alistair answered. There is a higher rate of mobile phone ownership and usage among young people. This is quite empowering as it is easier to make a quick call away from home rather than attend a face-to-face appointment which may be difficult if living with a controlling person. There are ways which people can signal over video if they are being threatened. The greater worry is that there are people who aren’t accessing health services at all.

Q: I recognise the value of digital consultation but it is still necessary to have face-to-face appointments. Can you reassure people digital appointments are not going to be the poor relation?

A: Alistair answered. If you need to examine someone you can only really do that by physical contact. People shouldn’t think of remote consultation as second class. It’s often just as good for information and sharing as face-to-face and the same amount of time for the clinician. It’s about choosing the right tool for the job.

Q: What about those practices who don’t have video links? Is connectivity in GP practices an issue?

A: Alistair answered. 90% of remote consultations are over the phone and all practices have phones. Every practice is also wired up for video consultations. Connectivity is more of a problem at the patients’ end. Sometimes image quality can be quite poor on video so texting a photo can be clearer.

Q: Is Northumbria Healthcare willing to look at the confidentiality agreements regarding virtual group clinics? There are many examples of virtual group clinics with confidentiality agreements templates in place.

A: The Trust is in discussions with Attend Anywhere (the system we use for virtual consultations) and they have confirmed they are planning to introduce a module for group consultations.  They are hoping to have something in development this year with a plan to introduce next year.  We are also looking into Microsoft Teams to see if this could be an option.  We would be interested to see an example of one of these confidentiality agreements and what platform is being used.

 

Healthwatch Northumberland AGM 21 October 2020 draft minutes

NHS 111 Northumberland

NHS 111 ‘Call-First’ FAQs

You may have heard or seen in the news that NHS England is currently trialling a new ‘call-first’ approach, which encourages people to contact NHS 111 before going to A&E. To support this, 111 call handlers should be able to book people directly into appointments with alternative services or give people a pre-booked time to attend A&E to avoid overcrowding in departments.

Healthwatch England has produced this FAQ guide jointly with the Royal College of Emergency Medicine which outlines how the new approach should be working and common questions people may have surrounding it.

Emergency Departments (A&Es) are there for all and everyone in their time of need. They are the frontline care service we turn to when we’re experiencing a critical, life threatening health problem or have had a serious accident.

We want all patients to receive the best possible care in a safe and timely way, but too often people are kept waiting in their A&E. Many patients who go to A&E could be treated more appropriately, and often more quickly by another service within the NHS.

Which is why the NHS is asking patients to call 111 first. By calling 111 first patients can potentially avoid waiting unnecessarily in a hospital waiting room and find the service that is right for their needs.

Calling 111 first may also help to reduce pressure on parts of the health service that are overstretched by redirecting patients to services that are ready and available for them, helping make the NHS better for all.

The coronavirus pandemic has also made clear that we need to change the way we all access urgent and emergency care, to help reduce the risk of infection.
Here we outline what those changes are and answer some of the frequently asked questions about what these changes mean for patients.

NHS 111 Call-first Frequently Asked Questions

1. What is happening?
To ensure that patients get the right care as quickly as possible, save people long waits in A&E, and ensure emergency departments don’t get too crowded, patients are being asked to call NHS 111 first before going to their A&E – except in absolute emergencies. NHS 111 will advise patients on whether they could be better and more quickly served in a different care setting such as an Urgent Treatment Centre. Some areas are trialling booking appointments at A&E via 111 to help patients save time waiting if their issue is less urgent.

2. Why is this change being made now?
This is how we think emergency care should always be accessed, but it is really important that this becomes the norm now we are living with COVID-19. To support social distancing in A&E, we need to make sure A&Es really are for emergencies only, and sometimes patients waiting in A&E may be better served elsewhere, such as their General Practice. This means A&E departments are more crowded, putting patients at greater risk of COVID-19 and making it more difficult for staff to look after patients well. Social distancing in A&E may mean that some people have to wait outside or in their car until it is safe for them to come into the department.

To prevent this, the NHS wants to support as many people as possible to be seen quickly by other services that may be more appropriate for the needs of certain patients. This is why we’re asking patients to call NHS 111 before going to their Emergency Department.

3. What should I do if I have an emergency?
If you have an emergency, call 999 immediately or go straight to your Emergency Department (A&E). If you have a health issue that is not an emergency please contact your GP, call NHS 111 for advice or visit 111.nhs.uk. If you go to your A&E, you’ll be assessed on arrival but if the clinician thinks you should be seen elsewhere, you may be asked to phone NHS 111 and/or be directed to an alternative service.

4. Can you give me an example of an emergency and a non-emergency?
Emergencies include:
• loss of consciousness
• acute confused state and fits that are not stopping
• chest pain
• breathing difficulties
• severe bleeding that cannot be stopped
• severe allergic reactions
• severe burns or scalds
• stroke

If you think you are experiencing any of these it is vital you go straight to your Emergency Department or call 999.

Examples of non-emergencies would be earache or knee pain. While these may be uncomfortable you are unlikely to be in any danger and could be treated more appropriately somewhere other than you’re A&E. For these types of issues contact your GP, call NHS 111 or visit 111.nhs.uk. If your issue is urgent but not life-threatening – like a sprained ankle – calling 111 and getting a pre-booked appointment to attend A&E can save you a long and uncertain wait in the department, allowing you to wait in the comfort of your own home until the Emergency Department is ready to see you.

5. Will I ever be turned away from an A&E department?
No-one experiencing a medical emergency will ever be turned away – you will always be treated urgently if your condition is severe or potentially life-threatening.
If your condition is not life threatening or could be treated more appropriately or quickly elsewhere you may be asked to call 111 from the hospital. By asking those with less urgent issues to call NHS 111 first for assessment rather than going straight to their A&E, we aim to save patients time and get them the care most appropriate to their needs. You could be directed to a more appropriate service or one that can see you sooner. You may also be able to wait at home and avoid a long wait in a busy Emergency Department.

6. When I call 111, who am I speaking to and are they clinically trained?
NHS 111 services are managed slightly differently in each region, but most are run by ambulance services. You will speak to trained professionals who will either be or have direct access to healthcare clinicians, and who will be able to expertly assess the urgency of your condition or illness. They will direct you to the appropriate service, book you an appointment if needed, and/or tell you what to do next.

7. My NHS 111 always sends me to A&E. Why can’t I save myself the delay and just go straight there?
In 2018, only one in ten callers to 111 was advised to visit A&E. NHS 111 can often provide health advice over the phone, or book you an appointment at an alternative service that is available. This will save you time. If you are told to go to an A&E, you will be booked in and staff at the hospital will be expecting your arrival.

8. Will I receive an appointment more quickly if I have a more urgent health need?
Yes, patients are always assessed and prioritised based on the urgency of their need.

9. If I call 111 and they say I need care from a non-emergency service, will they be able to make an appointment for me?
This varies by location, but one aim of the call-first approach is to ensure it happens more. If 111 can’t make you an appointment at an alternative service immediately, they will direct you to the best service to meet your needs.

10. What if I can’t contact NHS 111?
91% of calls to NHS 111 are answered within 60 seconds. You can also use NHS 111 online. If you have an emergency, you should call 999 or go straight to your Emergency Department. If you do not have the means to contact 111, go to your Emergency Department  and they will have facilities for you to do this. You can also contact your GP.

11. If 111 directs me to a non-urgent service, but the service tells me to go to A&E, will I be seen more quickly?
If a health professional believes that your condition has become or is becoming urgent, then you may be directed to your A&E, where you will be prioritised according to your condition. However, it will depend on the circumstances and the urgency of your medical need.

12. If I turn up at A&E and I haven’t called 111, will I need to wait longer?
Depending on your condition, you may be asked to call NHS 111 on arrival. They will assess whether you could be more appropriately treated elsewhere – and potentially more quickly. You may be given an appointment time at your GP or A&E. This will save you waiting unnecessarily. If you are directed elsewhere and choose to wait for treatment at you’re A&E, you may end up waiting longer. However, if you are seriously ill or injured you will of course be seen as quickly as possible.

13. What happens if I turn up to A&E and they tell me to call 111, but 111 then tell me to go to A&E?
This shouldn’t happen but in the unlikely event that it does you will be further assessed at your A&E and treated in a timeframe appropriate to your needs.

14. Do I need to call NHS 111 if I arrived at an A&E in an ambulance?
No, the triage and assessment by a paramedic provides a higher level of care than you would get by phoning NHS 111. If you are brought to the hospital by an ambulance, this means that the ambulance staff thinks you need further help. A&Es have always prioritised the treatment of patients who arrive by ambulance, as these people are sicker.

15. If I call 111 and they give me an appointed time to attend the A&E what will happen if I can’t get there on time?
Please do try to stick to your appointment time. Being late has a knock-on effect on the treatment of other patients, and your own care – Emergency Departments are very busy places and you may have to wait longer as a result of being late. However, what happens if you are late will depend on the severity of your condition, local policies and how busy the A&E is.

16. How far ahead of my pre-booked appointment will I need to turn up?
It is important to turn up on time as being late has a knock-on effect but arriving early does not mean you will be seen before your allotted time. We would advise checking in no more than 15 minutes before your appointment.

17. What happens if someone gets a booked appointment for A&E but doesn’t show up? Will someone check that they’re ok?
We expect all departments that book-in patients to have systems in place to assess whether a follow up is necessary. It is particularly important that vulnerable patients or those at risk of abuse who miss appointments are checked up on.

18. Will anyone else other than 111 be able to book me into A&E (e.g. GP practice etc)?
No, but your GP may tell you to go to your A&E if your needs warrant it.

19. What if I go to A&E and am advised to go to a different service but I still want to wait there and be seen?
You will be seen but you might to have to wait longer. You may find that you will be seen quicker by going to the other service.

20. What if my condition changes while I’m waiting at home?
This depends on the change in your condition; if you become seriously ill, call an ambulance, otherwise call NHS 111 again.

21. How do I cancel an appointment made by 111?
If you no longer need your appointment, please call NHS 111 to cancel it. Someone else may be able to use your timeslot.

22. If I’m told not to go to A&E, where else might I be directed to?
This will vary locally depending on what is available. You may be directed to a pharmacist, your GP, A&E or given advice on how best to self-care if your call advisor thinks you are safe to do so. You may also be directed to an Urgent Treatment Centre. These are facilities you can go to if  you need urgent medical attention, but it’s not a life-threatening situation. If you are unsure about what service is right for you, call NHS 111.

23. I have a complicated ongoing medical problem that is looked after by the hospital. When I get ill, I normally go straight to the A&E and they call the specialist to come and see me. Should I carry on doing this?
It might be better for you to try and contact the specialists that look after you before you come to the Emergency Department. Some patients with complicated medical problems need to be looked after in places other than the Emergency Department, particularly if they are vulnerable to infections. Obviously, if you are extremely ill, you should call an ambulance.

Watch our online AGM and Review of the Year

Thanks to everyone who came along to our online AGM last week. We hope you enjoyed hearing about our work over the last 12 months, and also from our guests from Northumbria Healthcare NHS Foundation Trust, who spoke about accessing healthcare via digital means, assuring quality of consultations, and what the future holds.

The event can be viewed below. There is still time to ask a question – about our work, about digital access to services, or anything to do with local NHS and social care services. Get your questions to us by 30 October; we will publish all questions and answers here in the next few weeks.

 

Healthwatch Northumberland AGM and Review of the Year 2020

 

Mental health summary report

In our Annual Survey 2020, mental health services was the second most chosen area where people thought we should focus our attention in the coming year. Mental health services had a high dissatisfaction rating – of those that use them 79 people said they were dissatisfied with mental health services (54%) – this was the only time more people said they were dissatisfied with a service than said they were satisfied with it. Respondents told us about a wide range of issues they had with mental health services.

People felt there could be more local mental health services
Respondents specifically mentioned Berwick Infirmary, where they felt there could be more mental health services. Respondents also called for more mental health services for autism in Hexham and Haltwhistle.

Responses from patients and staff alike highlighted a need for more resources to be put into mental health services
Patients told us there is a lack of mental health emergency beds and trained psychologists, and described Talking Matters Northumberland (TMN) as a stretched service. They also told us there is an increased demand for mental health services and that there needed to be more support for men at risk of suicide, as well as for young people. The Community Mental Health Team (CMHT), TMN, Cumbria, Northumberland, Tyne and Wear NHS Trust (CNTW) and Children and Young People’s Services (CYPS) were specifically mentioned by patients and staff alike as services that would benefit from more resources.

 

Healthwatch Northumberland Mental Health Services Report 2020

Quarterly Report April to June 2020

As the independent champion for people who use health and social care services, Healthwatch Northumberland listens to what people in Northumberland think about the services they have used. We act on what people are saying, sharing their views with those who have the power to make change happen. We also help people find the information they need about services in their area and record this as ‘signposting’.

People who use health and social care services tell Healthwatch Northumberland about their experiences throughout the year. This report shares a summary of the feedback collected from April to June 2020.  This period was during the national Covid-19 lockdown and we had stopped all face to face engagement and started to work in different ways. The next report will cover July to September 2020.

This quarter we received feedback and enquiries from:

  • Telephone calls, emails and social media (92%)
  • Postal surveys and feedback forms (4%)
  • Talking to people at online engagement events (2%)
  • Through a third party (2%)

Areas of Focus

We are open to all feedback about health and social care services. Responses to our Annual Survey helped us to identify a specific areas of focus which we are prioritising in 2020/21.

Mental Health Services, especially for children and young people

Covid-19 has meant changes have been made to health and social care services. Patients and carers’ experiences and signposting requirements are likely to have been different during this time.  For this reason we have also chosen to focus on any feedback we receive which is related to Covid-19 and these changes.

We are also working to hear more from people in area of the county we hear from less, particularly in south east Northumberland.

Aims

The report shows:

  • Who Healthwatch Northumberland is hearing from
  • What people are saying and the general sentiment of comments
  • What people are experiencing – what is working well and where there are areas for improvement?

Feedback

Between April and June 2020, we received feedback from 47 people. We signposted 13 of these people to services and provided information or advice to eight people.

This report explores who Healthwatch Northumberland is hearing from across the county, presenting a summary of general respondent demographic information. Demographic information shared includes location, gender, age, and whether the respondent is sharing their own health and social care experience or speaking on behalf of a friend or relative.

We also look at the general sentiment of comments, with specific reference to the service type (e.g. primary care, secondary care, mental health, social care), as well as whether the feedback relates specifically to quality of care or access to services. Service category, for instance whether the comment refers to a GP surgery or acute care, is also explored alongside the sentiment of feedback. 

Read the report for April to June 2020

Our Review of the Year and AGM

Our Review of the year and AGM will take place online on Wednesday 21 October, from 2.00pm and 4.00pm. Find out about our work and how we made a difference to people in Northumberland over the last 12 months.

As the Secretary of State for Health and Social Care says ‘People should have phone or video consultations with their doctors unless there is a clinical reason not to’, and that there had been a ‘hugely positive’ response to virtual appointments during the coronavirus pandemic, we will also have guest presenters talking about technology in NHS and social care services. We’ll explore how the coronavirus crisis has accelerated the move to online appointments and consultations, what has worked well and not so well, and what we can expect in the future.

You can ask a question in advance or at the Q&A session in our webinar.

Join us if you can!

Register for the Healthwatch Northumberland Review of the Year

Northumbria Healthcare logo

Non-essential hospital visits suspended

From Northumbria Healthcare NHS Foundation Trust:
Due to the rise in cases of coronavirus in the community, non-essential visiting is to be suspended in hospitals across Northumberland and North Tyneside, with effect from midnight, Thursday 17 September 2020.
Northumbria Healthcare NHS Foundation Trust has taken this difficult, however important, decision to protect its patients and staff.Until further notice, visiting will only be permitted in the following circumstances and PPE must be worn:

  • For patients who are receiving end-of-life care or are terminally ill and in the late stages of their illness
  • For birthing partners in maternity units
  • For parents or legal guardians in the children’s unit
  • For long-stay patients and those with dementia or where best interest decisions or exceptional clinical/social matters are being discussed, at the discretion of the nurse in charge

Women can bring their birthing partners when attending 12 or 20-week scan appointments.

This move comes as tougher restrictions are announced for the seven local authority areas in the North East, including Northumberland and North Tyneside.

iPads will continue to be available on wards to facilitate ‘virtual’ visiting and friends and relatives will be able to stay connected to loved ones by ringing the trust’s patient line on 0191 293 4306, available Monday to Friday 9am to 5pm or sharing pictures/photos via In addition, patients can make unlimited phone calls to UK landlines and mobiles free of charge via bedside units.

Anyone attending an outpatient or diagnostic appointment or for a minor injury, urgent care or in an emergency at hospitals in Northumberland and North Tyneside is asked to do so alone, unless they need to be accompanied by a carer, to reduce footfall. People attending hospital sites are being reminded to wash their hands at the basins when entering and leaving, wear a face covering and maintain social distancing.

Marion Dickson, executive director of nursing, midwifery and allied health professionals at Northumbria Healthcare, said:

“In light of the increased numbers of cases of coronavirus across Northumberland and North Tyneside, we simply must take action now to protect our patients, staff and local communities.

“Suspending non-essential visiting is a difficult decision to make however, given the current situation in our communities, it is the right one if we are to reduce the spread of coronavirus in our hospitals and take care of our most vulnerable patients.

“As nurses, we know the positive impact seeing and hearing from loved ones can have on a patient and we would urge families to make use of the methods we have in place to facilitate virtual visiting and staying connected.

“We had tremendous support from our communities when we had these visiting restrictions in place previously and we would appeal to them again for their co-operation at this difficult time.”

The trust is also reminding people to:

  • Follow advice on https://www.nhs.uk/conditions/coronavirus-covid-19/if they have symptoms and not to attend A&E or hospital sites for a Covid-19 test.
  • Keep your distance and follow rules on social distancing – please stay apart 2 metres from others where possible. If it isn’t – one metre with mitigations such as a face covering.
  • Do not mix with people from outside your household or support bubble
  • Wear a face covering – especially in enclosed public spaces when social distancing can be difficult or when you are in contact with people you would not normally meet. This includes when you are using public transport, car sharing and using taxis. Please remember to wear a face covering if you are attending health care settings such as a hospital, clinic, GP surgery or pharmacist.
  • Keep those hands extra clean – wash hands for 20 seconds and often. Use soap and water to wash your hands or use hand sanitiser. It is especially important to do this when you
    • get home or into work
    • blow your nose or sneeze
    • eat or handle food or drinks

The main symptoms of coronavirus are:

  • a high temperature
  • a new, continuous cough
  • a loss of, or change to, your sense of smell or taste

If you have symptoms, you are advised to get a test and stay at home. For more information visit www.gov.uk/coronavirus