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Is NHS 111 First making a difference?

From 1 December 2020, the NHS has introduced a new system called NHS 111 First. This means that NHS 111 can now book you an appointment at your local A&E or get you an urgent appointment at an alternative health service. The NHS 111 First campaign encourages people to call NHS 111 before going to emergency departments.

During COVID-19, people have relied on NHS 111 more than ever to get urgent medical advice. Healthwatch England’s latest research looks at people’s experiences of NHS 111 and awareness of the new A&E time slot booking service.

Find out more about NHS 111 First

To better understand public attitudes towards NHS 111, including awareness of the new services offered by NHS 111 First, and support the best possible roll-out of this new service, Healthwatch England commissioned YouGov to run a UK representative online poll of 2076 adults (18+) between 27 – 28 January 2021.

Through the Healthwatch network, the views of over 400 people who had used NHS 111 in the last six months were also recorded.

  • The majority (84%) of polling respondents said that they were aware that they could call NHS 111 for urgent medical advice. Almost three-quarters (70%) agreed that they were more likely to call NHS 111 than go straight to an emergency department when they had an urgent medical problem.
  • More than three out of four people who had used the service and got through to an advisor (79%) felt they had got the help they needed.
  • Almost three quarters (72%) of those that have used the service agreed that they generally had positive experiences when they called NHS 111​, while 12% disagreed and 13% were neutral.
  • Not feeling confident in the advice given by NHS 111 call handlers was a common issue. Only 55% of all polling respondents said they felt confident that when they phoned the service, the person they spoke to would be qualified to help them.
  • Those who did use NHS 111 First and had a timeslot booked for them at A&E were highly likely to rate their experience as very good, suggesting that that the new system is working when people are given the option.
  • However, awareness of the new service is low. 80% of polling respondents were not aware that NHS 111 could reserve timeslots at GPs and 73% were not aware they could reserve timeslots at A&E.

Read the full report

 

Public concerns about dentistry continue

New data gathered by Healthwatch England shows access to NHS dentistry remains a huge problem for the public amid the COVID-19 pandemic.

Healthwatch continues to hear concerns about dentistry which were highlighted at the end of last year in the Dentistry and the impact of COVID-19 report after a 452% rise in calls and complaints over the summer (July – September).
In a follow-up review, Healthwatch looked at 1,129 people’s experiences of accessing dental care received between October and December 2020 and found:
  • Access to dentistry was difficult for more than seven in 10 people (72%), with some people actively seeking dental treatment being told they would have to wait anywhere between a few months to, in one case, two years for an appointment.
  • Access to urgent NHS treatment was difficult for people with painful teeth, with patients being told that dental pain was not considered an “emergency”, and for those who were prescribed multiple courses of antibiotics by NHS 111 without being provided any further treatment.
  • Examples of the extreme lengths some people went to, to get treatment, include calling over 40 practices to find an NHS dentist, and pulling their own teeth out when they couldn’t bear the pain.
  • When dentists couldn’t offer an appointment, they advised people to buy dental repair kits to treat themselves.

The findings come after some MPs and the British Dental Association called on the Government to scrap its new targets for NHS dentists, which require them to deliver 45% of their pre-pandemic levels of dental activity.

There are concerns this is likely to push practices into prioritising appointments such as check-ups over emergency or more complex longer treatments.

Healthwatch’s findings also suggest that patients are being told that although NHS appointments are not available, they can be treated privately. This creates a real barrier for everyone, and in particular for people on low income, to receive vital treatment.

Tell us about your experience of dental care during the pandemic here or text 07413 385275 and one of our friendly team will call you back.

Covid-19 and NHS dental care

Healthwatch England is calling for action to address widespread issues with access to NHS dental care following an unprecedented surge in concerns. Healthwatch experienced a 452% increase in feedback on the issue in the second quarter of the year, with continuing accounts of people being left in pain, resorting to ‘DIY’ repair methods and in some cases even extracting their own teeth.

The review of 1,300 people’s experiences of accessing dental care found that:

  • More than 7 in 10 people (73%) found it difficult to access help and support when they needed it.
  • Access issues were caused by dentists not taking on NHS patients, as well as conflicting advice from different parts of the NHS about what help is available.
  • Many people were offered treatment if they went private, despite research indicating that 40% of people would struggle to afford private dental care.
  • The impact of not being able to access care led many people to experience pain, discomfort and further complications.

The increase in feedback comes after the British Dental Association reported that treatments delivered by NHS dental services in England are at a quarter of pre-COVID levels, with over 14.5 million fewer procedures taking place.

Laura Floyd, from West Berkshire, was part-way through significant dental treatment when it was cancelled due to the lockdown in March. The new mother explained: “As we went from April to May, I had an abscess develop on the tooth which was still awaiting treatment. I did receive care over the phone and a course of antibiotics which helped ease some of the pain and swelling but this never fully went away, I just lived with it as cautiously as I could. Sadly my eight-month-old wasn’t as cautious when reaching out and grabbing my face!”

Laura, who was entitled to free NHS dental care for 12 months after the birth of her child, did then receive some emergency treatment for a further painful cavity but is still waiting for her main treatment to be completed a year on from her initial diagnosis.

Sir Robert Francis QC, Chair of Healthwatch England, said: “The COVID-19 crisis has impacted on many areas of NHS support but, problems in dental care appear to be particularly acute.

“Even before the pandemic, people were telling us about problems in accessing NHS dental appointments but since the start of the summer these reports have hugely increased.

“If we don’t improve access to NHS dental care, not only do people risk facing far greater dental problems in the future but it also puts pressure on overstretched hospitals and GPs. Untreated dental problems can lead to pain, infection and the risk of long-term harm, which is comparable with other medical conditions.

“Health and care services are working hard to deal with the pandemic, but we believe the Government and the NHS should give more attention to resolving both long-standing and COVID-related issues in dentistry.”

While the report accepts that the overall treatment backlog caused by the pandemic will take time to clear due to limited industry capacity and COVID-related restrictions, it makes several recommendations including:

  • providing more accurate and up-to-date information for patients
  • providing clarity over NHS dentists’ obligations relating to patient registration
  • making more resources available to improve patient access to
    dental care and;
  • reviewing the overall cost to patients of NHS dental care, particularly with a 5% price increase set to take effect before Christmas.

Healthwatch is also calling for people on low incomes who are forced to travel long distances to access dental care to be reimbursed.

Read more on the Healthwatch England website

If you would like to tell us about your experience of accessing dental care during the pandemic you can tell us your story here.

Hospital discharge during COVID-19

A new report from Healthwatch England and the British Red Cross looks at how well the new hospital discharge policy is working for patients, carers and healthcare professionals.

In March 2020, the Government introduced a new hospital discharge policy to help the NHS free up beds by getting people out of hospital quickly. This meant anyone who may need out-of-hospital support to help them recover would now have their needs assessed after being discharged, rather than in hospital.

The report shows significant numbers of people are not receiving follow-up support after being discharged from hospital under new policy, leading to unmet needs. Read a summary of the report below.

What did people tell us?

Overall patients and families were very positive about healthcare staff, praising their efforts during such a difficult time.

However, while the speed at which people were discharged from hospital was important, it often led to a lack of support for some patients leaving hospital.

Key findings

  • 82% of respondents did not receive a follow-up visit and assessment at home and almost one in five of these reported an unmet care need.
  • Some people felt their discharge was rushed, with around one in five (19%) feeling unprepared to leave hospital.
  • Over a third (35%) of people were not given a contact who they could get in touch with for further advice after discharge, despite this being part of the guidance.
  • Overall patients and families were very positive about healthcare staff, praising their efforts during such a difficult time.
  • Around a third (30%) of people faced an issue with delayed COVID-19 test results, potentially putting family and carers at risk, or in a care home, other residents and staff.

What are we calling for?

To improve hospital discharge for patients, their carers and healthcare professionals, ahead of winter and a second wave of COVID-19 admissions, we’re calling on the health and care sector to:

  • Roll out post-discharge check-ins by phone or in person
  • Develop a discharge checklist, including questions about transport and equipment needs
  • Improve communication by assigning a single point of contact for patients and carers
  • Link patients to voluntary sector partners or community pharmacists to deliver medicine and avoid delays.
  • Boost community care capacity and recognise the value of voluntary care sector in hospital discharge.

Read 590 people’s stories of leaving hospital during COVID-19 

 

COVID-19: What people are telling us

Each month, thousands of people share their experiences about NHS and social care services with Healthwatches across the country. During the COVID-19 pandemic, this has ranged from the effect lockdown has had on carers, to the problems getting emergency dental treatment.

In Healthwatch England’s latest briefing they outline the issues over 19,700 people have raised, as well as taking an in-depth look at how technology has been used in response to the pandemic.

You can find a summary of the key points below or click the following link to read the full report:

Read the full report here

The impact of COVID-19

At the start of lockdown, people told us how the measures introduced to help control the spread of coronavirus were affecting their care.

Changes to routine and planned care – In many cases, people were unable to find the information they needed to understand what they should expect from services and were unclear about what the next steps for their treatment or care would be – leaving them feeling stressed and frustrated.

Shielding measures – Those who were shielding told us about problems in getting transport to their hospital care. For some people, the cost of attending one or more hospital appointments was too expensive to arrange private transport, especially if the hospital was far from home.

Access to prescription medicines – Initially people were struggling to get through to their GP or pharmacy by phone, and others experienced delays in getting their medication. This caused anxiety for people running out of supplies, particularly for those with long term conditions.

What can services learn?

  • People need clear, accurate and consistent information about their care and the services they use.
  • People’s experiences of hospital appointments do not start and end at the hospital doors – their journey begins at home, so transport arrangements must be considered.

Lockdown begins to ease

As lockdown restrictions began to reduce, we started to hear new concerns from people.

  • Worries about the future – People raised questions with us about how services can reopen safely, reported problems using services that are supposedly already open for business and expressed frustration at some NHS services being slow to reopen compared to other areas of the economy.
  • Testing for COVID-19 – While some people found visiting a testing centre easy, we also heard that the online booking process was difficult to use and there were concerns about the accessibility of testing centres.

What have people been telling us throughout?

  • Lack of accessible information – Throughout the pandemic, we have heard about the difficulties of finding up-to-date information in the languages or formats people need – especially when advice from the Government was frequently changing.
  • Emergency dental care – People did not know how to access emergency dental care – causing them extra stress while experiencing acute dental pain or other symptoms. Many others have felt they have no option but to go private if they want to receive treatment for what their dentist considered to be non-emergency treatment.
  • Access to B12 injections – Although some people received injections, either as normal or at a different GP practice, we also heard that in many areas there was an inconsistent approach to providing this treatment.
  • Care homes – People’s feedback highlighted that while family and friends were unable to visit their loved ones in care homes, timely and regular communication from care home staff really mattered.
  • The hidden effect on families and carers – The lack of respite has left many carers feeling stressed, isolated and forgotten about. We also heard about the difficulties some people faced helping the person that they care for to understand and remember the lockdown measures.
  • Praise for health and social care workers – Throughout the pandemic, we have heard about how much people appreciate the hard work of health and social care professionals during this time of unprecedented challenges.
  • The impact on people’s mental health – Since the start of lockdown, we have heard about the effects of the pandemic on people’s mental health and wellbeing. For some people, the changes to the services they would usually access have left them feeling abandoned – with infrequent telephone appointments not meeting their needs.

What can services learn?

  • Accessible information and meeting people’s communication needs must be considered from the start and should not be an afterthought. The information must also be shared through trusted sources, such as community centres and groups.
  • Families and carers have been providing even more care than usual during the pandemic – but this often goes unnoticed, and many need more support.
  • Good communications between care homes staff residents and their family and friends is key, especially while visiting restrictions are in place. Where appropriate, this should include involving residents’ families or next of kin in decision making about their care.
  • The mental health impacts of the pandemic are affecting both existing service users and non-service users. Mental health services will require investment to support people in both the short and long-term.

Digital healthcare

The pandemic has seen the digitisation of many health and social care services overnight. While digital appointments don’t work for everyone, and services should not be exclusively digital, it’s important healthcare services embrace technology for those who find it an efficient way to communicate. Our recent work in this area demonstrates how services are embracing this shift to digital healthcare:

The doctor will zoom you now

How the new NHS COVID-19 tracing app offers better data privacy

Read the full briefing to find out what we can learn from the rapid roll-out of virtual NHS consultations, and the importance of involving patients from the start when setting up new services.

 

If you would like to share your own experiences of health and social care services during the pandemic you can do so here:

Tell us your coronavirus story

Patient having blood pressure taken

CQC Report: The state of general practice in England 2014 – 2017

The state of care in general practice 2014 to 2017′ published by the Care Quality Commission (CQC), provides a detailed analysis of the quality and safety of general medical practice in England.

Based on inspections by the CQC, the report found that the majority (86%) of general practice services were rated as ‘good’, with 4% rated as ‘outstanding’.

What factors make an ‘outstanding’ general practice?

The report found that practices with the highest ratings showed a clear knowledge of the different needs of their patient groups, and that they also had strong leadership.

These services understood their patients and their needs, and responded by adapting services. Practices that provide high-quality care also demonstrated that they engage their patients proactively by ‘including them in the conversation’ and acting on feedback, complaints and concerns.

General practices with the highest ratings also demonstrate strong leadership, understand everyone’s responsibilities in the practice team and recognise the importance of working as part of their wider local health economies.

Patients willing to share views but need to know how

The CQC report comes after research from Healthwatch England found that the majority of people are interested in sharing their feedback with GPs to improve services but only a minority had done so. The most common reason for this was that patients were unsure how to provide comments and raise concerns.

Read the full report

 

 

 

 

 

Elderly man drinking tea

Home care services: what people told Healthwatch

Over the last year, the number of local Healthwatch citing improvements to home care services as a priority for their community has doubled. Our new report explains what people have told Healthwatch about their experience of home care.

Across England there are more than 5,500 home care providers, collectively helping an estimated 673,000 people to continue living independently within their communities. Home care services help people live at home for longer by offering support, such as regular visits from a carer to help with personal care, getting dressed, using the toilet, shopping and preparing meals.

A new Healthwatch England report Home care services: What people told Healthwatch about their experiences, analyses the experiences of 3,415 people, their families and front line staff across 52 local areas between August 2015 and June 2017.

Most people had positive things to say about their home care. These services are invaluable to many people, both for the quality of care provided and the support and company of care workers.

Older people in particular said that one of the most positive things about home care is that it enables them to remain in their own home and to maintain as much independence as possible.

However,  four areas were discovered where people’s experiences could be improved.

Read more