GROUP

Get involved, share your views

Patient and public’s views and experience of health service provision

January 2009

Produced by the Mill Group

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Contents 2. Introduction / Aims and Objectives 3. Methodology 4. Interview schedule and report / Background of Participants 5. Analysis 6-9. Experiences 10. What you told us - Primary care and hospitals 11. Overall improvements 13. Conclusions 14. Appendix I) Flyer 15. Appendix II) Consent Form – Over 18’s 16. Appendix III) Consent Form – Under 18’s 17. Appendix IV) ‘Get involved, share your views’ leaflet front 18. Appendix V) ‘Get involved, share your views’ leaflet back 19. Appendix VI) Carnival for Life 20. Appendix VII) Pink Picnic

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Introduction NHS Kirklees is the leader of the local NHS. They are responsible for improving the health of their population, reducing health inequalities and making sure that health services are in place to meet the needs of local people. They are responsible for the health of more than 400,000 people across seven areas in Huddersfield North, Huddersfield South, Spen, Dewsbury and Mirfield, Batley, Birstall, and Birkenshaw. The Trust commissioned The Mill Group to explore, through filmed interviews, the public’s perception of its operations whilst gaining an overall opinion of the wider health service provision. Aims and Objectives • To gain an overall insight into public perceptions and experiences of the

services commissioned and provided by NHS Kirklees; in particular local residents who do not usually share their views.

• To identify good areas of practice as well as determining any causes for concern that the public may have about the services provided by NHS Kirklees and to identify any areas that require improvement.

World Class Commissioning NHS Kirklees endeavours to be in line with the following World Class Commissioning: Competency 1: To be recognised as the local leader of the NHS, NHS Kirklees leads and steers the health agenda in Kirklees. The Mill Group’s Comments Campervan will fulfil the organisation’s objective of stimulating discussion on NHS Kirklees and wider community health matters. Competency 3: Proactively seek and build continuous and meaningful engagement with the public and patients, to shape services and improve health. By utilising the Comments Campervan, NHS Kirklees has been proactive in seeking out the views and experiences of the public. Furthermore the Comments Campervan fits in with the NHS Kirklees strategic priority to: ‘Achieve real involvement of patients, staff and our local community in identifying their needs and sharing responsibility for improving health, prioritising service development and allocating resources’.

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Methodology In order to gain people’s views of services within the Trust a qualitative and quantitative approach was taken using semi-structured group and individual film interviews. The interviews were conducted in a mobile campervan ‘diary room’ at four local outdoor events. The benefit of audio-visual recording is that it provides a useful naturalistic record that also captures visual expressions and non-verbal behaviour that can be replayed, analysed and presented later. A campervan mobile film studio offers a private and ‘neutral’ place to conduct interviews and its mobility provides an innovative way to access the public who might not otherwise share their views or concerns (e.g. the seldom-heard). Interviewees were invited to give their views to an independent film producer (The Mill Group) with clear provisos regarding their exclusive later use by NHS professionals planning to improve service provision. Locations To achieve the aim of gaining feedback from Kirklees residents we arranged for the Comments Campervan to be at the following events: 27th June 2009 – ‘Carnival 4 Life’ – Batley, North Kirklees 11th July 2009 – Huddersfield Carnival 26th July 2009 – ‘Pink Picnic’ – Huddersfield 29th August 2009 – ‘Dewsbury-on-Sea’ – Dewsbury Events were chosen to fit in with the locality model approach as well as the organisation’s key objective of engaging with ‘seldom heard’ groups. The events were chosen, as they had previously been very successful and well attended. The key events were coordinated in partnership with Kirklees Council who publicised them throughout the Kirklees district. Leaflets (flyers) were produced by The Mill Group for prior distribution in the key venues and to key organisations. Other channels for publicity included the NHS Kirklees internal communications team, Voluntary Action Kirklees (VAK), the ‘Get involved, share your views’ newsletter and Local Authority publications. During the events, details of The Patient Advice and Liaison Service were made available to interviewees for any follow-up queries and the Self-care Team attended to provide information on services available. Information of how the public’s opinions and how the video tapes would be used was given to anyone interested in sharing their views about NHS Kirklees services and consent was obtained from those willing to be filmed. For the purposes of this report, however, participants remain anonymous and their anonymity has been respected in line with the NHS Kirklees Confidentiality Document.

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Interview Schedule and Report Members of The Mill Group team, using the following interview guide conducted the interviews: Preamble; introduction and aims of the project and consent...

1. Have you heard of NHS Kirklees and its services? (If not understood, interviewers explained it is the main organisation providing and paying for healthcare services in Kirklees such as GPs, dentists and hospital services).

2. What experiences have you had of NHS Kirklees and its services? 3. What did you think? 4. What worked well? 5. What changes would you want to see and why from NHS? (What

didn’t work well and what could have been improved?) Background of Participants Over the course of the four days a total of 109 interviews were carried out, 14 of which were group interviews. The majority of those interviewed were local residents with the possible exception of 7 who chose not to indicate their residency. By ethnicity, the majority (82 – 75.2%) were ‘white British residents’ and 27 - 24.8% came from the ethnic backgrounds listed below. 20 (18%) stated themselves to be of disability, the overall number describing themselves as: White British Resident (82 – 75.2%) Asian (15 –13.7%) Caribbean (7 – 6.4%) Black British (2 – 1.8%) African (1) Irish (1) Other (1) The age range of participants was from 12–89, with the majority (64%) falling between 25-54 years of age. The breakdown by age was: (16 – 24) –17% (25 – 34) – 24% (35 – 44) –19% (45 – 54) – 21% (55 – 64) – 5% (65+) – 4% Following the interview recordings, extensive notes were taken from the first event of video-clips using a modified form of ‘template’ analysis. Main themes were identified from these summaries and grouped together into broader themes. This formed the initial template and it was adjusted and added to following the viewing of the other events.

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Analysis The following main themes were generated from the transcripts; the order of the list does not necessarily reflect the order of importance nor the strength of feeling but comments have been classified as ‘positive’, ‘negative’ or ‘neutral’ which have each been recorded as a percentage of total responses. Descriptions are related to interviewee’s direct or indirect experiences and contact with services. Some have had very little experience with the NHS and with NHS Kirklees in particular, whilst some have an awareness related to the services offered. A full list of interviewees, by name, age, area, disability and ethnicity was recorded but for anonymity does not constitute part of this report. Main Themes Positive and neutral responses – It was found that 95% of respondents failed largely to understand what NHS Kirklees was specifically about (commissioning arm, leader of local NHS, responsible for improving health and reducing inequalities, ensuring health services are in place to meet the needs of local people etc.) and comments included: • ‘It’s there for help in time of need’. • ‘National Health Service helps people with disabilities’. • ‘Looks after well-being and care of people’s health’. • ‘It’s a safety net where everybody pulls together’. • ‘It’s a local neighbourhood service – hospital and medical’. • ‘Everything! – If it wasn’t for the NHS my daughter wouldn’t be here!’. • ‘Somewhere I can go for a free health service in the whole of the UK – we

should be proud of it!’. • ‘Free healthcare for all regardless of who or what you are’. • ‘Somewhere to go if you need some help or you are poorly’. • ‘LIFE...LIFE! I’d have died without the NHS’. • ‘I hear good reports about the NHS – especially here in Dewsbury’. • ‘Someone on hand for any medical care and attention that me and my family

need’. • ‘Ummm...local hospital services provided on your doorstep...particularly for

access without transport’. • ‘It means free treatment if you’re ill’. • ‘It’s the control of medical care in Kirklees’. • ‘Well...doctors, nurses, hospitals...if you need help I mean’. • ‘Yes, it’s where you go to phone, if you need medical advice’. • ‘Well I’ll tell you...Dewsbury District Hospital was marvellous’. • ‘They do a lot in the wider NHS’. • ‘A lifeline in many ways’. • ‘It’s the health people who are looking after us’.

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One interviewee answered: ‘Provides a service to everybody...hospitals, GPs, nurses, medicines, pharmacies – also grass-roots level community work...psychiatry, logistics of supply and stuff – it’s quite a big thing...isn’t?’ Only 5% of respondents reacted negatively to the question: • ‘It means death!’. • ‘Hospitals...no one really thinks about it only when something happens and

then there is queues and queues’. • ‘Absolutely nothing! – It’s an unfair system’ – (shrugs shoulders...long

silence)...’National Health Service...available to everyone...but it’s not!’. Experiences Negative responses included: • ‘Mostly they’re good – only pain management is possible for my wife, but

they’re overworked and getting an appointment is absolute murder. Should be seen more than she is; lucky if she’s seen twice or three times a year. She’s told to go home and ‘try these tablets’...put off always until next time...four months away…! It’s a long time when you’re in constant pain’.

• ‘Can’t say any good things – been in hospital a lot...I had cannulas in and they kept coming out – 24 hours sometimes to get one put back in – delayed my treatment – longer for me to go home. They’re (the nurses) so overworked, I said to my family; “If ever I can’t feed myself, come up and feed me – food comes – bedside table – if you can’t get up, you just don’t get fed!’.

• ‘My mother needed regular kidney dialysis – long ambulance journeys and waiting times – went to bed for two days afterwards to recover, by which time it was time to start all over again. I heard other patients making excuses not to go...really stressful’.

• ‘Not happy about moving childbirth from Huddersfield’. • ‘Admin. Is a complete and utter waste of time, it stops nurses and doctors

caring and doing a proper job’.

Positive responses included: • ‘Being transferred from another area – heard the best neurologists are in

Kirklees’. • ‘A very good service, nurses and doctors are great’. • ‘Really helpful’. • ‘Been to visit people – quite creepy! – But quite friendly too and made to feel

welcome’. • ‘Really helpful, welcomed - in safe hands’. • ‘NHS Direct was very helpful’. Experiences: Primary care services Positive/neutral:

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• ‘GP spot on and nurse practitioners no problem’. • ‘GPs are overrun, can’t always get an appointment, usually find an

emergency appointment’. • ‘GPs good – if given choice prefer a female’. • ‘GP waiting times are good, will see you timely, maybe next day’. • ‘GPs very good – cooperative’. • GP alright’ – ‘The good thing was when I missed my appointment, my GP

rang me – they saved my life when my smear test caught the early stages of cancer’.

• ‘GP been fantastic, real with me, sees me every month, tests cholesterol and blood pressure’.

• ‘My GP is brilliant – go at any time – it’s arranged according to my needs. I get appointments ‘cos I work – it’s arranged around my time’.

• ‘Very fortunate –we have a good doctor – always there – always pleasant – laughs, jokes...always puts me at my ease’.

• ‘Always get good service from my doctor’s surgery’. The greatest praise was reserved for GPs, closely followed by nurses with just over 90% appreciative of services: • ‘Just can’t praise him highly enough’. • ‘Usually get an appointment for the next day and if urgent, on the day’. • ‘Always get good service from my GP surgery’. • ‘He’s fantastic! – We are so lucky, we can go just when we want to go and not

in a few days’. • ‘...ended up in a coma...had to have a tracheotomy in the ambulance...they

did a brilliant job – I’d have died without the NHS’. Negative comments This included some comments about GP’s appointment systems: • ‘Only gripe...unless you book an appointment in advance, is to get someone

to visit you when you need them’. Most interviewees criticised the dental system:

• ‘They’re greedy and avaricious – all gone private. The government says it’s National Health but they say to you; ‘...can’t get in – we’re not taking any more’...what kind of a carry-on is that?

• ‘Dentistry? – It’s like a taboo nowadays. Very hard to find one and they’d rather take private patients.

• Chucked me out! – But what is the point of going to a dentist when you don’t need one? – And paying through the nose for the privilege!’. Some comments were even stronger:

• ‘Something should be done about it – they weald so much power. Their lists are full – they’re laughing aren’t they? Where else do you have so many

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customers on your list? Leave one, for any reason...difficult to get another. So what’s gone wrong?!

• They’re operating in a private capacity – do what they like, when they like and treat you how they like’. Strongest of all came from an elderly lady in Dewsbury;

• ‘Dentistry?! – don’t even want to say the word! ...they’re blackmailers, money-makers, with absolutely no sympathy or care for older people – that’s my experience with three different dentists in three areas. Why isn’t it free?...they call it NHS...it isn’t...the majority over 75 have false teeth...I don’t...and it’s costing me a fortune’.

Experiences: Hospital care services Positive/neutral: • ‘No complaints, had hip replacement’. • ‘Knee op’ in Bradford. No idea why people complain about the NHS –

surgeon fantastic - service absolutely fantastic!’. • ‘Midwife-led care brilliant’ – ‘Been marvellous – transferred to St. James,

Leeds – eternally grateful’. • ‘Hard to get to, but hospital facilities are alright’. • ‘Good service overall’ – ‘Sometimes helpful – sometimes not’. • ‘Doctors and nurses looked after me – I’m so glad – very happy! ...now OK!’. • ‘Gave me the right treatment and dealt with me quickly’. • ‘Seen quickly – given drugs’. • “Physio’ – no complaints at all – great treatment’. • ‘Always give the impression they’re doing their best but mown out with work.

Father was dying, they were very, very good, explained everything, couldn’t have wished for nicer people’.

• ‘Well, I think they’re brilliant! – Absolutely brilliant! – nurses – only I don’t think they’re paid enough’.

• ‘Couldn’t have been under better people, well-mannered, explained everything...what’s happening...’.

• ‘Nursing staff are brilliant but they just don’t have time to do the things they’re supposed to do...’.

• ‘Fortnight in hospital (stroke) – very good’. • ‘Our 2-month old son was admitted with bronchitis – Dewsbury Hospital were

really good with him...nurse with him at all times, taken immediately up into the children’s ward, 24-hour care, everyone was brilliant!...absolutely brilliant!’.

• ‘Broke my foot in Spain – came back – orthopaedic trauma – 2-hour wait in A&E but after that, swung into action – 2 days – pinned and screwed...no complaints there at all’.

• ‘Chemo’ at Dewsbury, short stay in hospital for a blood-count problem...absolutely excellent, no complaints whatsoever’.

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Negative: • ‘Not good (leg)’ – Waiting in reception, you wait a long time for appointments’ • ‘Not happy – injections for my back – have been waiting 18 months in spite of

GP writing’. • ‘Not had good experience – stomach problems – back and forth to GP’s and

hospital – had to go private – NHS stinks!’. • ‘Been to hospital a few times – takes ages to get seen – shouldn’t have to

wait if you’re in an emergency wing – waiting times are out of order’. • ‘Only gripe was being sent to Leeds to have a stent’. • ‘Two broken wrists – one’s alright – other doesn’t seem to be set quite right,

not in my or my husband’s opinion. He had a hip joint done – problems with it ever since – ten years now and still having problems.

• Spend the money on efficiency – it’s there for the patients, not for them to wear their fancy uniforms and wander up and down with clipboards’.

• ‘They need more staff...get looked after properly. You start off poorly enough then get neglected on the wards. Want a bedpan?...might take half-an-hour...you can’t wait half-an-hour. I wet myself...felt awful...never wet myself in my life...just because there’s not enough nurses’.

• ‘Too many cutbacks, it got so it felt grubby – going to the bath or toilet, mould up the walls, shouldn’t be, in a hospital – asthmatic – doesn’t help’. (This last patient was ‘in and out of hospital, nearly every month’ for...‘a week or two at a time’ over the last three years. Her comments include the observation; ‘You notice the deterioration at the hospital, from beginning to end – it totally changed’.

Areas of good practice - satisfaction of service What you told us about: Primary care: GPs • ‘GP – can’t fault’. • ‘GPs have a better understanding with people – more time and don’t mind if

they run over’. • ‘The NHS is a really good organisation, absolutely fantastic – absolutely

brilliant – I don’t know what they could do more! • Doing a good job - keep up the good work!’.

Many complimentary comments made could be classed as ‘good practice’ but have already been included as ‘positive’ views above. What You Told Us: Primary care:

• Effects of centralisation – impersonal/no local contact.

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• Appointment system – speed – cancellations/waiting/availability of GP appointments/difficult making appointments on the day (‘Rang up four times once to get an appointment, it’s a pain and hassle, especially when you’re at work – you forget’.

• Access to services – adaptive to people’s working lifestyles. • Speed of services. • Resources – reduce expense/lighting/money/space/time for individuals • More use of technology. • Greater awareness of local needs. • Administration. • Interpreters. • Attitude towards the elderly. • Communication with the elderly. • Giving more awareness of services. • Promote services, provide, ignorance of campaigns. • Support services for conditions less widely known. • Explore ways of reaching particular communities. • Poor administration. • Large organisations. • Public/patient feedback – what people need. • Stop smoking for teenagers (focus group). • Not enough money – a lot more could be done for mental health, it does not

get the same range of services/provision as others – the poor relations. • Groups of surgeries to work together with specialities e.g. minor surgery. • Lack of information about dentists (struggling to find one). • Open GP surgeries at weekends – relieve A&E. • Appointment system difficult to ring first thing (engaged) and no facility to ring

at work. • Improve attitude of receptions. • Resent paying dental charges, don’t understand ‘virtual’ waiting list of two

years and why excluded from NHS care. • Faster referral from GPs to private care – had to wait the same length of time

as NHS care – should be faster. What You Told Us: Hospitals • Consultants need to come down ‘a peg or two’ and listen to what people say

and are feeling. Treat them like their private patients. • Should try and work out what’s wrong rather than leave you or send you

home. • Earlier discharge. • Food. • Cancelling appointments – not good for mental health patients • Failed to inform patient concerning MIND – found out by accident. • Need of fellow sufferers to give support. • If they can’t fit you in they should let you know and keep in communication. • Long queues, long waiting times for appointments and in the meantime can

get very sick and problems get worse. • Short-staffed and it shows – too much paperwork.

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• Waiting times and length of time with patient – need time to talk to doctor – longer than the 10-minute consultation.

• Moving child birth services – bad thing if having a baby. • A&E to improve. • Separate waiting areas for drunks in A&E. • More communication between departments – lack of joined-up thinking. • Back to old system when nurses in charge of all aspects of wards and in

charge of cleaners. • More staff. • Attitude of A&E staff – get treated like idiots because of the few. Overall improvements: • Need private benefit scheme like other countries to alleviate pressure on the

businessman. • Good with physical problems but falls down with mental health – got to work

on that. • Places that are grotty don’t make you feel good – listen to the patient – to

what they need. • Make prescriptions cheaper – have to buy annual cards to help. • Stop renovating and redirect monies to staff – treat people with respect – get

priorities right – spend money on the right things – preference to the NHS in the north compared with the south.

• Some services should be kept local – services kept within Huddersfield. • Stop moving services to Halifax – gradually sending everything to Halifax. • Cut dental charges and equalise services not to depend on where you live. • Awareness and attitudes to diversity – assume that you are married and

heterosexual. • Make health targets more publicly known. • So many foreign doctors – can’t understand them. • Attitude – feels like a production line. • Eliminate prescription charges. • Get services back in local areas. • Train staff better – no one knows what they’re doing. • Make care more accessible – more personable, not a number – more time for

patients’ needs. • More information – person-to-person, not just an answer machine e.g. swine

flu. • Perception of immigration relating to lack of capacity and extended NHS

waiting times.

� � �

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These primary and secondary care cross-service pie charts are intended to show ‘at-a-glance’ significant areas for consideration. They are largely subjective and are based on a weighted overall impression of 109 lengthy interviews carried out over four days, covering a wide sector of NHS Kirklees services.

Positive

GPs

Nursing Staff

Patient Care

Maternity

Pharmacists

Consultants

Negative

Communication

Dentists

Waiting Times

Centralisation

GP Appointments

Local Needs

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Conclusions The over-riding impression from four days of interviews is one of gratitude for the services provided. This piece of work has identified the importance of the various interactions that patients have with the NHS services they access and how many aspects impact on patient journeys and their experience of it. The feedback received can and does indicate areas for improvement, such as communication, which are often inexpensive and addressed not through high investment, but changes to current practices. Disillusionment with NHS dental service provision was the key concern amongst participants throughout the exercise, as was the general fear of losing local hospital services; Dewsbury residents were especially fearful of losing services to Wakefield and Pontefract and there was a clear pride in the excellence of provision at Dewsbury Hospital over many years. Nearer to Huddersfield the loss of services there (maternity) was already regretted and further losses are feared. The GP appointments’ system was greatly praised, as was their overall service provision generally and this was especially noted by The Mill Group, making comparison with other NHS PCT areas, where patients have strongly criticised the fact that they do not have access to a weekend and evenings’ out-of-hours service. Nursing staff is greatly praised throughout and receive strong sympathy for being overworked and underpaid. Any shortfalls here are invariably blamed on ‘the system’ and never on the nursing staff. The Mill Group note that Kirklees NHS hospital consultants, unlike in other areas, are praised and only rarely criticised.

Get involved

, share your view

s...

in a camp

ervan !To N

HS Kirklees, it’s really im

portant what local residents think about the services w

e plan and pay for. So w

e’re heading out on the road over the summ

er to a number of local events to do just that. W

e’d like the people of Kirklees to visit the Com

ments Cam

pervan at the events below and enjoy a great day out too!

The campervan, w

hich acts as a mobile ‘diary room

’, will give everyone the chance to share their view

s on NH

S Kirklees.

the

comments TM

©ÊTHEÊM

ILLÊGROUPCAMPERVAN

For more inform

ation, please contact: NH

S Kirklees, Patient &

Public Involvement (PPI) Team

: 01484 466151/466129 or em

ail ppi@kirklees.nhs.uk

When

? Saturday 27th

June 10.00am - 5.00p

mW

here? Carnival 4 Life, Batley M

arket Place and Batley M

emorial G

ardens

When

? Saturday 11th

July 12.00pm

- 8.00pm

Where? H

udd

ersfield Carnival, G

reenhead

Park, Hud

dersfield

When

? Sunday 26th

July 12.00pm

- 7.00pm

Where? Pink Picnic , Castle H

ill Fields, Lum

b H

ead Farm

, Hud

dersfield

When

? Saturday 29th

August 10.00am

- 5.00pm

Where? D

ewsb

ury on Sea, Dew

sbury tow

n centre

Appendix IFlyer

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Appendix IIConsent Form - Over 18’s

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Appendix IIIConsent Form - Under 18’s

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Appendix IVGet involved, share your views leaflet(front)

17

Appendix VGet involved, share your views lea�et (back)

18

19

Appendix VICarnival for Life

Appendix VICarnival for Life

Appendix VIIPink Picnic

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