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Eye care costs

Eye care costs

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New research from Healthwatch England reveals costs of additional eye care services are likely to deter some people from visiting opticians altogether.

An estimated 50% of sight loss is avoidable. That’s why it’s vital that people can have their eyesight tested regularly and get the help they need if there is a problem. Yet new research from Healthwatch England found that costs associated with visiting opticians are deterring those on the lowest incomes from getting regular eye tests.

An online survey was carried out asking about people’s eye care experiences between July and September 2024. 14% of people who responded to the survey had avoided eye care due to cost in the last two years.

People who described themselves as ‘not at all comfortable financially’ were much more likely to say they avoided going to opticians than those who were financially very comfortable (39% vs 3%). Lack of awareness of the financial support available may also contribute to the high rate of people avoiding eye care.

Additional costs may put off patients

As people face rising eye care costs and lack of financial support, many high street opticians, which are private businesses, increasingly rely on generating income through offering services in addition to eye tests.

The survey found that of those who had attended an eye test in the last two years, 72% had experienced staff offering additional services at a cost. This practice has made some people reluctant to visit optician services at all. Those who said that opticians had offered them additional paid services were twice as likely to say they had avoided getting eye care in the last two years compared to those who had not experienced this.

84% of the respondents to the survey were eligible for free eye tests. However, as the results of the survey show, many people eligible for financial support for their eye care may find it difficult to afford additional costs. They may put off getting eye care because they are concerned about being pushed into paying for products or services they can’t afford.

Healthwatch England set out the following steps to protect people from the rising impact of eye care costs:

  • The Department of Health and Social Care should review support for the costs of NHS eye care for those on the lowest incomes.
  • The Government and the NHS should consider a targeted communications campaign through direct channels to low-income eye care patients.
  • The primary eye care sector should have clear guidelines for how staff should assist those on lower incomes without affecting their confidence in seeking care.

If you would like to tell us about your experiences of accessing eye care, please get in touch.

Eye care waiting times

Eye care waiting times

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New research from Healthwatch England has revealed people’s eye health often deteriorates while they wait a long time for specialist eye care.

They are calling for greater use of high street optician services, including optometrists working in optician services, to help cut waiting times.

Responses from 1,051 people currently waiting for specialist eye care appointments suggest that the vast majority (85%) of people support the idea of optometrists being able to refer patients without seeing a GP first. Over 65% are comfortable with them helping to monitor and treat eye conditions.

An optometrist’s role is to detect defects in vision, signs of injury, ocular diseases or other abnormalities. Optometrists often work alongside other professionals in primary eye care, supporting people with a range of eye problems and referring people for specialist care.

Expanding their role and responsibilities, such as being able to treat patients for a greater range of conditions, would help more people with the most serious eye conditions to be identified and referred for specialist care earlier.

The survey, which asked people to share their experiences of eye care between July and September 2024, found many people struggled while waiting for specialist care:

  • Of those currently waiting, 70% said they noticed some deterioration in vision.
  • People currently waiting for eye care reported that long waits affect their ability to continue their hobbies, 75%; mental health, 69%; ability to work, 52%; and relationships, 36%.
  • The most common type of support people reported needing was ‘knowing who to contact for further information’ about their care. However, only 14% of people said they knew who to contact.
  • Only 4% said they had been given advice and information to help them with day-to-day activities, such as working.

Eye care is the busiest outpatient speciality in the NHS in England, and with an ageing population, demand is set to grow further. According to NHS statistics, last December nearly 600,000 people were waiting for specialist eye care, a third of whom had been waiting more than the 18-week target set by the Government.

And getting referred for specialist eye care may be a long process for some. Of those currently waiting, almost a quarter (22%) had to have multiple appointments before being referred.

Healthwatch England calls for optician services to take on more responsibility for managing people’s eye care and referring them for specialist treatment to help cut waiting times. Additionally, actions such as those proposed in the Optometry First model are needed to improve communications and support for people waiting for eye care.

Read the full report at the Healthwatch England website

If you would like to tell us about your experiences of eye care services please get in touch.

Improving patient discharge

Improving patient discharge

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From hospital to home: Improving patient discharge

Every winter, the NHS is under pressure to free up beds. However, getting hospital discharge wrong can harm both patients and services. Healthwatch England looked at what people have told them about leaving hospital, and the lessons the NHS can learn to improve the support patients get.

In 2023, Healthwatch England’s research found worrying problems with people’s experiences of hospital discharge. People said the NHS didn’t give them proper support or information. Two years later, a review of people’s experiences of hospital discharge indicates that many of the same problems are still occurring.

Why safe hospital discharge matters

When the NHS correctly discharges patients from a hospital to their homes or another care facility, it can aid their recovery and free up beds for new patients. But for this to happen, hospitals are supposed to ensure that patients:

  • are medically fit to leave the hospital
  • have the information they need
  • have any care and support they need in place
  • are involved in the planning.

However, getting the discharge process wrong causes problems for both the patient and services. If patients are discharged too early without proper support, they may have to be readmitted to a hospital or seek help from GPs or pharmacies.

Meanwhile, delays in discharging medically fit people create issues for new patients needing beds, leading to longer wait times in A&E and treatment in corridors until beds are available.

The importance of being involved in plans

NHS guidance on hospital discharge states that the NHS should support patients and their relatives and carers in making fully informed decisions about the care and support they receive on discharge from a hospital, where appropriate.

However, people have told us about not being involved in discharge planning and the inappropriate decisions this can result in. Examples include:

  • Hospital staff taking patients with dementia at their word when they say they don’t need support at home.
  • Relatives not being consulted about moving patients to care homes when care packages were already in place.
  • Hospitals assuming relatives could care for patients on discharge or transport patients home without checking first.

The consequences of poor timing

NHS discharge guidance states that people should be discharged to the right place, at the right time, with the proper support to maximise their independence and lead to the best possible outcomes.

However, we have heard about people leaving hospitals without everything in place. People have told us the NHS has discharged them:

  • Before seeing a consultant
  • Before being properly diagnosed
  • Without any follow-up care in place
  • Without medication or information about how to manage at home.

As a result, some people experienced severe consequences, including further medical complications. In some cases, the NHS had to readmit people to the hospital.

In other cases, people described their discharge as delayed as they had to chase up the hospital for information on self-care and medication or because they were waiting for social care. This can have knock-on consequences.

The importance of clear information

People have told us about being given poor or limited discharge information on how to cope once at home and how to care for themselves. We heard about:

  • Information that was inappropriate to their needs or made outdated assumptions.
  • A lack of or limited information on administering medication by injection or changing catheters.
  • Discharge letters that gave inaccurate information about someone’s condition.

The impact of a good experience

Research from Healthwatch Oxfordshire found that people value support and care from health professionals, good communication, being involved in decision-making, and effective follow-up and aftercare.

Positive stories about discharge care include:

  • Appropriate and helpful information on how to care for themselves.
  • The post-discharge support they need, including equipment to help cope at home and visits from community teams.
  • Support from voluntary organisations, including a home visit on the day of discharge.

Steps that will improve hospital discharge

Current winter pressures and the high demand for hospital beds result from multiple factors affecting NHS and social care teams. However, several steps could help ensure more people have a safer hospital discharge experience.

  1. Follow existing guidance: NHS England’s next Urgent and Emergency Care Recovery Plan should ensure that Integrated Care Boards (ICBs) ensure that services follow existing hospital discharge guidance.
  2. Review secondary care workforce: ICBs should also focus on workforce solutions in secondary care.
  3. More resources for social care: The government has announced plans to review social care challenges. However, in the short term, more resources are needed to ensure that councils and providers have the necessary staff, skills, and resources to support individuals in living independently.
  4. Better data on hospital discharge: To ensure people are not rushed out of hospital when they’re not ready and that processes are working for patients, we are calling on the NHS to restart the collection of daily emergency readmissions data and publish this data monthly. Minimum standards on transport waiting times and post-discharge contact times should also be introduced.

If you would like to share your experiences of hospital discharge please get in touch.

A pain to complain

A pain to complain

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A pain to complain: new research from Healthwatch England

Healthwatch England has shared a new report which looks at some of the barriers people face when making a complaint about NHS healthcare.

Read the findings and recommendations

Key findings

Very few patients complain

Almost 24% said they had experienced poor NHS care in the past year. Yet more than half (56%) of people who experienced poor care took no action, and fewer than one in 10 made a formal complaint.

Low confidence stops people acting

Of those who didn’t make a complaint after poor care, 34% believed that the NHS wouldn’t use their complaint to improve services, 33% thought organisations wouldn’t respond effectively, and 30% felt the NHS wouldn’t see their concern as ‘serious enough’.

A poor complaints experience is common

Over half (56%) of people who made a formal complaint were dissatisfied with both the process and the outcome of their complaint.

Falling investment in support to help people complain

The budget allocated to councils to arrange statutory NHS complaints advocacy for local people has declined by more than 20% over the last decade.

People experience long waits for responses

On average, integrated care boards (ICBs) took 54 working days to respond to complaints they handled as commissioners of NHS services. Response times ranged from between 18 and 114 working days.

The NHS is not effectively learning lessons

NHS organisations do not effectively capture the right data about who makes complaints, do not welcome complaints or fail to fully demonstrate learning from complaints. There is little national oversight and accountability over the complaints process.

Healthwatch England’s recommendations
  • Make the complaints process easier for patients and their families to navigate
  • Monitor and improve the performance of organisations that handle complaints
  • Develop a culture of listening to and learning from complaints

Read more on the Healthwatch England website.

If you would like to talk to us about a health or care service you have used as a patient or a carer, please get in touch.

Cervical screening my way

Cervical screening my way

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In 2023, NHS England set a target to eliminate cervical cancer by 2040. It’s an admirable but challenging goal, set against declining levels of uptake by women of cervical screening over the past 20 years.

In response, Healthwatch England launched research to investigate why some women are hesitant to go for screening, to make recommendations to policymakers on how to improve uptake and to help meet the elimination goal.

Key findings

  • The top reasons for hesitancy among respondents were worries about physical discomfort, embarrassment at undressing in front of healthcare professionals and a belief they didn’t have to go because they weren’t currently sexually active.
  • Women felt NHS information describing the purpose of cervical screening was good/clear (78%), but fewer (58%) said it explained Human Papillomavirus (HPV) the leading cause of cervical cancer.
  • Some women didn’t receive accessible or translated information to enable them to understand the invitations and make an informed decision about attending screening.
  • Most women (81%) who’d attended screening previously said staff treated them with respect. However, only a third (33%) felt they’d been able to ask staff for practical changes that could make them feel comfortable in appointments.
  • There was strong support (73%) for home testing – currently being considered as an option by screening experts – if it was offered free on the NHS.
  • There are major gaps in national data on the diversity of women who attend cervical screening.
  • In-depth interviews with women provide examples of innovative practices that improve uptake among diverse women.

Recommendations at a glance

Recommendations to policymakers include calls for:

  1. NHS England to investigate solutions to ensure that disability and ethnicity data about people attending screening can be captured, analysed, and published alongside regional and age uptake data in the future. This would allow for a more comprehensive picture of uptake among diverse groups.
  2. NHS England to address the gap left by the closure of Jo’s Cervical Cancer Trust (the only charity and national helpline dedicated solely to cervical cancer), with high-profile promotion of alternative, trusted sources of direct support and information for women.
  3. Screening providers to ensure they train and enable admin and screening staff to meet their responsibilities regarding accessible information and adjustments to care.
  4. Screening providers, working with local Healthwatch, to seek feedback from their local communities to understand views on booking methods, appointment times and preferred locations for drop-in clinics. Services should adapt access accordingly to help increase uptake.
  5. NHS England to introduce an NHS-branded Trauma Card, based on a Healthwatch Essex initiative for affected women to bring to appointments.
  6. Subject to the results of NHS-commissioned research on the safety and effectiveness of self-screening, the NHS should adopt self-screening as an alternative option offered to all women nationally who would prefer it. Instructions for their use should be co-designed with women.

Read the full report and recommendations

If you would like to leave feedback about cervical screening or another health or care service please get in touch.

Healthwatch England on the NHS strikes

Healthwatch England on the NHS strikes

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Government and unions urged to find resolution to strike action

Healthwatch England response – 20 December 2023

Five organisations representing NHS leaders and patients have jointly written to the Chair of the Council of the British Medical Association (BMA) and to the Secretary of State of the Department of Health and Social Care stating concerns about the on-going industrial action within the NHS.

The organisations, including Healthwatch England, Age UK, NHS Confederation, National Voices and The Patients Association, are seriously concerned about plans for industrial action set to take place between 20 and 23 December, and for a further six days in early January 7am on 3 January to 7am on 9 January 2024.

Collectively the organisations are calling on both Government and the BMA to get back to the negotiating table, believing that further strikes would be a major blow for the service already grappling with record waiting lists, winter pressures and the financial fall out of previous industrial action.

In the first week of December there were already 13,000 patients – many older people – waiting to be discharged. Strike action in the run up to Christmas could see these numbers increase, leaving patients stranded in hospital over the holiday period despite being medically fit for discharge.

Over the course of 2023 we have seen more than 1.2 million operations and appointments cancelled and £1.4 billion spent by NHS organisations, including on additional staff costs, as they have sought to keep essential services running.

Meanwhile, waiting lists have increased by 510,000 from 7.2 million in January to 7.71 million in October 2023. These lists have already impacted on the health of patients, families and carers while they wait for essential treatment or struggle to access the on-going support, they need to manage health conditions. And, it is most disadvantaged communities and vulnerable patients who pay the highest price for disruption and delays.

Despite the best efforts of hard-working NHS staff, the organisations are concerned that it will be extremely difficult to ensure safe and effective care during this period for all patients that need it. Winter pressures, staff absence and high levels of patient demand, mean the first weeks of January are typically one of the busiest times, particularly for urgent and emergency care services.

Nine months have now elapsed since the BMA Junior Doctor’s Committee first embarked on industrial action in March 2023. The timing, duration and fact that – as yet – no national derogations have been agreed is cause for alarm.

It is now imperative that both Government and the BMA find a resolution and bring an end to their dispute.

It is not too late to restart talks and avert further disruption.

Louise Ansari, Chief Executive of Healthwatch England said “The forthcoming strikes will be concerning for patients already facing long waits for care, especially now we are in winter when demand will be higher. We know that waits affect some worse than others. If you are a woman, on a low income, from an ethnic minority background or have a disability, you are more likely to have a worse experience of waiting for care.”

“It essential that both parties find a way forward to prevent the confidence of patients being undermined when it comes to being able to access care. It also vital that lifesaving care is not affected and that the NHS gets its communications right to ensure that patients know if services will be affected.”

Downloads

Joint letter to the British Medical Association
Download (PDF 777 KB)
Joint letter to the Secretary of State for Health and Social Care
The public’s perspective

The public’s perspective

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Recommendations from Healthwatch England’s report ‘the public’s perspective

As part of Healthwatch England‘s report’ The public’s perspective: The state of health and social care’, recommendations for decision makers across ten key areas have been set.

We want to see teams across the health and care system get the support they need to deliver services that work for everyone.

And we’re calling for more to be done to help services create better listening cultures, and to understand access barriers, health inequalities, and people’s experiences of care.

You can read the full report, or just read the recommendations below.

Healthwatch is calling for improvements in:

1. Getting a GP appointment  

We want to see:

  1. All GP surgeries move to digital phone systems by the end of March 2024, so patients spend less time waiting on hold
  2. Greater public awareness of, and sign-ups to, the NHS app, through the promised national communications campaign
  3. Most patients able to benefit from full NHS app functionalities by the end of March 2024
  4. Evidence that Integrated Care Boards plan to tackle health inequalities around GP access, especially in deprived areas
  5. All GP practices offering free phone numbers
  6. All GP practices sign up for the Register with a GP Surgery Service, which makes registering with a surgery easier for patients, particularly those with no fixed address or ID

2. Getting dental treatment  

The upcoming dental recovery plan must:

  1. Set out a clear vision for improving patient access to a local NHS dentist that provides preventative and emergency care
  2. Incentivise dentists to provide more NHS work, through major changes to the contract introduced in 2006
  3. Conduct a national assessment of the needs and gaps in oral healthcare for diverse populations
  4. Ensure Integrated Care Boards listen to local communities, include dental representatives in their decision-making, and use all opportunities to join up dental care with other local NHS and public health services
  5. Mandate collection of specific data to track the access and experience of people facing the worst barriers to care

3. Getting mental health support  

We’re calling for:

  1. Provision of early or ongoing support through additional staff roles at every available opportunity. This includes through mental health practitioners, peer support workers, and school-based teams
  2. A parity of esteem definition that puts mental and physical health services on equal footing. The government must publish this as soon as possible
  3. The Major Conditions Strategy to include a roadmap that:
    1. Reduces mental health waiting times for assessments, treatment, and crisis support
    2. Improves transitions from child to adult mental health services, based on need, not just age
  4. The Draft Mental Health Bill to be amended and pushed through without delay. The bill aims to ensure patients get more say over their treatment, improve access to advocates, and place a duty on doctors to consider patients’ wishes before deciding on compulsory treatment. It also aims to reduce the disproportionate number of Black people who are sectioned
  5. Bespoke training for NHS staff, to equip them to better understand the needs of young people with learning disabilities and autism

4. Cancer care

People need:

  1. First appointments that meet their preferences and needs, including longer appointments where necessary
  2. Improvements to online referral trackers, so they can understand what is happening with their care
  3. Personalised aftercare support, including post-treatment plans, appropriate home adaptations, and a single point of contact with care teams

5. Waiting for elective care 

We’re calling for:

  1. More proactive NHS communications with patients while they wait for treatment
  2. Single points of contact, either in person, over the phone, or via the NHS App, so patients waiting for care can give feedback about issues or changes in their condition
  3. More personalised support for those waiting, such as access to pain management, physiotherapy, and mental health support
  4. Transport and accommodation costs to be covered by the NHS where patients choose to travel for quicker treatment at another NHS setting
  5. Better use of all available data sources, to reduce last-minute cancellations and understand what drives non-clinical, clinical, and patient-led reasons for NHS delays

6. Social care     

We want to see:

  1. A renewed focus on implementing previously announced reforms to cap the amount people can spend on social care costs over their lifetime
  2. Further reform announcements to boost investment in services, address workforce challenges, and support councils to provide proactive social care information and advice services which cover both pre- and post-assessment
  3. People in health and care settings given a legal right to a Care Supporter – a person important to them, like a relative or friend – who can visit to provide emotional support, advocacy, and essential human contact

7. Hospital discharge

We’re calling for:

  1. An urgent focus on workforce and capacity solutions in secondary care and social care
  2. More consistent implementation of latest hospital discharge guidance, including:
    1. Support to help people make informed choices, by providing contact information and advice, and asking about transport home
    2. Better signposting to support services, such as voluntary organisations and services that support unpaid carers
    3. Clear responsibility for who will arrange people’s transport home, with dedicated staff to make travel arrangements
    4. Single points of contact for people to use if their condition gets worse
    5. Greater involvement of family and carers in decisions about discharge

8. Cost of living

We’re calling for:

  1. Over-the-counter medications to be offered on prescription for patients eligible for free prescriptions, and for those struggling financially who pre-pay for prescriptions
  2. Clearer information about annual and pre-pay prescription options
  3. NHS England to restart their review of the health travel costs scheme and introduce a reimbursement scheme that covers travel to primary care appointments
  4. Inclusion of GP phone numbers in the freephone service
  5. Healthcare benefits that keep pace with inflation in real terms
  6. Extended Statutory Sick Pay for those on NHS waiting lists

9. Digital transformation

As services move towards more digital ways of working, we want to see:

  1. Traditional models of access and care to remain alongside digital methods
  2. Patients involved in designing new technological solutions
  3. Built-in patient education (tutorials, how-to guides, digital community champions) with any new digital healthcare rollouts
  4. Funded, accessible community courses or training for those with low digital literacy
  5. A universal right to internet access, with cross-government action to work towards this

10. Accessible information   

Following our Your Care, Your way campaign, we’re calling for:

  1. Action by Integrated Care Boards to ensure providers implement the Accessible Information Standard (AIS)
  2. Routine checks of AIS compliance during Care Quality Commission inspections
  3. All health and adult social care providers to undertake the new voluntary self-assessment of AIS compliance, and work with local Healthwatch and people with extra communication needs on ways to improve accessible information

Visit our feedback page to leave your thoughts on the report, or the health and social care services you have used.

Cost of living

Cost of living

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Cost of living – a barrier to healthcare for the most vulnerable

The cost of living is having a detrimental impact on people’s decisions about their healthcare.

If you are disabled, on means-tested benefits or aged 18-24, research shows you’re more likely to avoid vital health services due to the fear of extra costs. Healthwatch England has set out immediate actions for the government and the NHS.

Over the last year, many charities and campaign groups have warned that millions of people are struggling with the cost-of-living crisis.

To understand the scale of this impact, especially on people’s health and their use of health and care services, Healthwatch England commissioned a poll of people in England.

Findings from waves 1 and 2 were reported on earlier this year.

Key trends

The poll of 2000 adults in England, conducted four times between October 2022 and March 2023, suggests that people are increasingly avoiding vital health and care services due to the fear of extra costs. These include:

  • going to a dentist because of the cost of checks ups or treatment
  • booking an NHS appointment because they couldn’t afford the associated costs, such as accessing the internet or the cost of a phone call
  • buying over the counter medication they normally rely on
  • taking up one or more NHS prescriptions because of the cost.

Rising costs further exacerbate health inequalities

The research also highlighted that the financial burden of healthcare is weighing heavily on specific groups:

  • people on disability benefits
  • people on means-tested benefits
  • and younger people, aged 18-24.

People from these groups are more likely to be making tough decisions to avoid essential services. Examples include:

  • People on disability benefits are over twice as likely to have avoided their usual over-the-counter medication than the general public, 15% compared to seven per cent.
  • 20% of people on means-tested benefits have avoided booking an NHS appointment due to the associated costs, including the internet or phone call, compared to six per cent of the general public.
  • People aged 18 to 24 are twice as likely to have avoided an NHS appointment due to travel costs compared to the general public, 14% to six per cent.
  • On average, one in five people from each group avoided the dentist because of the related costs.

The cost of living should never be a barrier to care

As a patient champion, we are worried that vital health and care services are out of reach for many people.

We know that people living with ill health and disability are already much more likely than others to be pulled into poverty because of spiralling costs.  Making decisions between eating, medications and keeping medical devices running, can further impact their physical and mental health, putting them in danger.

The cost of living should never be a barrier to healthcare.

Recommendations

While we welcome the support already in place, social tariffs and schemes must be better communicated to the people who need it.

This includes ensuring that:

  • Communication providers communicate about and signpost to social tariffs
  • Primary care teams make people who need medication aware of pre-payment options
  • Dentistry teams offer check-ups based on individual need, to free up more NHS slots
  • More people are aware of the Healthcare Travel Cost Scheme (HTCS).

The government working with health and care services must also go further to support people in the cost-of-living crisis.

Tangible actions

Healthwatch England has set out immediate tangible actions:

Prescriptions 

Guidance should encourage GPs to offer people over-the-counter medications on prescription based on socioeconomic grounds.

Travel 

NHS England should re-open its review of the HTCS, and introduce reimbursement for journeys to people’s GP, dentist and pharmacy teams.

NHS freephone 

NHS England should work with Ofcom and telecommunications companies to ensure that hospital and GP phone numbers are part of the freephone service, so cost is never a barrier to phoning a health service.

Benefits system 

Government should ensure benefits, including Statutory Sick Pay (SSP), keep pace with inflation in real terms.

Government should also extend the amount of time SSP can be paid to people who can no longer work due to long waits for NHS treatment. One in ten people wait over four months for a GP referral, and 92% of people on waiting lists are currently waiting up to 46 weeks for a hospital appointment. This means that the current 28-week access cannot support those who need it.

Broadband

Health leaders and regulators should look at what more can be done to ensure telecommunications providers introduce and raise awareness of social tariffs to eligible households, as the uptake of this support remains low.

Recent research by Citizens Advice suggests that up to one million people have cancelled their broadband in the last year because they couldn’t afford it.

As we increasingly move to more remote ways of communicating, tracking, managing and attending NHS appointments, we must ensure that everyone can access the support they need.

 

If you would like to tell us about your experience of the cost of living and how it has affected health and social care services you have used please get in touch.

Postnatal checks failing many

Postnatal checks failing many

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Thank you to everyone who told us about their experiences of maternal mental health care. Healthwatch England has analysed the responses shared by 2,693 new mothers and birthing parents since April 2020 and you can read the findings below.

The analysis suggests that not all GP practices comply with the requirement to provide six to eight-week postnatal checks. And where those checks take place, it is not clear that GP practices are aware of NICE guidance which tells them in detail how to spot mental health problems and provide help.

Key findings

  • Over one in 10 (16%) of new mothers and birthing parents who shared their experiences said they hadn’t received the six to eight-week check.
  • Of those who said they had been offered the postanal check, only one in five, 22%, were satisfied with the time their GP spent talking to them about their mental health.
  • Nearly half, 44%, of respondents felt that the GP did not spend enough time talking to them about their mental health, while a third, 30%, said that their GP didn’t mention this during the check.
  • One in seven, 15%, said they had had their six-week check over the phone, with many new parents finding it hard to verbalise their mental health struggles and discuss physical issues. In the worst cases, respondents felt the way their mental health issues were discussed was inappropriate and potentially harmful.

Six-week postnatal checks

In April 2020, the Government introduced the six to eight-week postnatal check after Healthwatch England shared the experiences of almost 1,800 women on mental health during their journey to parenthood.

General practitioners in England have since been contractually obliged and paid to assess new mothers’ mental health and wellbeing, providing an opportunity for referral to specialist services and additional support. Crucially, the checks must take place separately from a postnatal check focused on the health of the baby.

The latest research took place between October and December of 2022 to find out to what extent mental health support has improved during and after pregnancy.

Experiences of mental health support during and post-pregnancy

  • Two-thirds, 1800, of the women and birthing parents who shared their experiences had struggled with their mental health during and after pregnancy.
  • Nearly half of those, 41%, received no support to help with their mental health during and post-pregnancy.
  • Delays in accessing mental health support can have a devastating impact on new parents, with some reporting they had struggled to leave the house, bond with their child and maintain relationships.
  • First-time mothers are particularly vulnerable to developing mental health problems and are less likely to access timely care.

Louise Ansari, National Director at Healthwatch England said: “With mental ill health affecting up to a third of new and expectant mums, six-week postnatal checks are key to assessing their wellbeing after the birth. If left untreated, poor mental health can have a devastating impact on new parents and their families.

“Unfortunately, our findings show that although most new mothers and birthing parents are likely to be invited to a postnatal consultation, these are frequently carried out as a tick-box exercise, where mental health is not treated as a priority or not assessed at all.

“Monitoring the delivery of six-week checks should be the first step to ensuring there’s a consistent approach to offering quality mental health support to all new mothers. NHS England should consider what additional support and guidance it can provide to GPs so that the help new parents get is of the best quality.

“We also need to ensure that maternal mental health and peri-natal services continue to remain on the government’s agenda and a priority in workforce planning and funding budgets.”

Recommendations

Healthwatch England has made five recommendations to help ensure every new mother and birthing parent receives the six-week check, and that it is of the highest quality:

  1. Integrated Care Systems (ICSs) should monitor the delivery of six to eight-week postnatal consultations as part of their primary care commissioning responsibilities.
  2. The Medical Licensing Assessment being introduced from 2024 should check understanding of the importance of postnatal mental health and the mental health element of postnatal checks.
  3. The section of the GP contract on delivery of postnatal consultations should be updated to include mention of signposting to specialist and community mental health services and point to best practice guidance around carrying out open-ended discussions.
  4. As part of its Maternity Transformation Programme, NHS England should consider what additional support and guidance it can provide for GPs to have quality conversations about mental health at the six to eight-week postnatal consultation.
  5. Deliver the Long-Term Plan commitments on improving access to specialist community perinatal mental health services.

 

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Are you struggling to access health services this winter?

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With the NHS under extra pressure this winter, we need to hear your experiences of care to help services understand what is working and spot issues affecting support for you and your loved ones.

The NHS is facing added pressures this winter. This means that it can be more challenging for people to receive the care they need.

Feedback from the public can play a vital role in helping health and social care services understand what is working and spot issues affecting the care of local people.

This is why we have launched a campaign to get more people to share their experiences of care this winter.

If you or a loved one have used GPs, hospitals, pharmacies, care homes or other support services this winter, we want to hear about your experience.

Every experience matters

Have you faced challenges or delays accessing health and care services this winter? If you have, we want to know how this has affected your health and wellbeing.

Have you found accessing NHS services easy? Are there any aspects of the care you got that you really valued?

Your positive or negative feedback can help services hear what is working and spot issues affecting care for you and your loved ones.

Have your say

Please share your experience and help us make NHS decision-makers aware of what needs to change to improve access to care.

We’re completely independent and impartial, and anything you say is confidential.

Share your story

You can also provide feedback on care by giving us a call on: 03332 408 468

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