Healthwatch Bradford and DistrictAnnual Report 2013/14Contents2 Introduction4 Easy Read Summary

What we do7 Listen – gathering views9 Involving Young People11 Invisible at the Desk- work on GP services14 Act – feeding in and holding to account16 A & E at Bradford Royal Infirmary18 Experiences of Visually Impaired People20 Report Back – telling the public22 Help people get the best from services23 Information outreach

How we do it25 Our people29 Involving people with a learning disability30 Our partners32 Patient Networks34 Our powers37 Enter & View at Airedale General Hospital40 Healthwatch England42 Governance44 Finance

IntroductionIn our first year, we have established an effective independent organisation that is giving the public a stronger voice to influence health and social care, and helps people get the best from local services in our area. Healthwatch Bradford and District is now in a strong position to call on health and social care providers to make positive changes for patients, service users and carers across our district. I am pleased to introduce our first Annual Report covering the period April 2013 to March 2014. This report describes some of our work and the resulting changes in local health and social care services. It also describes how we work with other community organisations and how we connect with statutory NHS and social care organisations to ensure they use this information to improve services. Looking back on the work we have done on issues like GP services, Accident and Emergency, hospital care of people with dementia, it shows how we have helped people who are not often heard to have a stronger voice. We’ve actively sought views from, for example, visually impaired people, children and young people, carers, people with a learning disability, those using

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mental health services; hearing about the health or social care services that matter to them, and working towards the goal of equal access, treatment and outcomes for all our diverse communities.I’m very proud of the work that Healthwatch staff, volunteers, and the Board have carried out in the first year, and look forward to building on that for the future. Whilst we have achieved much in our first year there remains a great deal to do.

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Easy Read Summary

Healthwatch Bradford and District helps you say what you think about health and social care services. We pass on your views to the people in charge so they can make services better.

We have been running for one year and this is our first Annual Report. These are some of our Board Members celebrating our first birthday in April.

What is this report about?In this report we tell you what we have done and how we have helped to make health and social care better.

Many people and groups have helped us to do this, so we tell you about them.

We also tell you about the way Healthwatch is run and how much money we have spent this year.

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Some of the things we have done this yearWe worked with children and young people to help them say what they think about health and social care.

Nearly 600 people told us what they thought about their GP practice. We made sure the groups in charge of GP practices listened to what people said. They told us what they would do to make it better for people.

We found out about some problems at the Accident and Emergency department at Bradford Royal Infirmary. We told the Care Quality Commission (who check up on hospitals). They told the hospital about some things they needed to change.

Some blind people told us about problems they had using hospitals and other health services. We have worked with them and with the hospitals to find out what will make it easier for them.

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We gave information to people who asked for help with things like finding dentists and support groups. We also went to hospitals and libraries to talk to people and give them information.

We trained a group of people with learning disabilities to be Healthwatch volunteers. They visit health or social care services to check they are working well.

Clinical Commissioning Groups are the organisations who plan and buy our health services. We helped them set up ways for people to have a say on how GP practices are run.

We visited a ward for older people at Airedale Hospital. We told the hospital how they could look after people with dementia and their families better.

We are proud of what we have done this year, but we still have lots more to do.

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Enter and View

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What we do: LISTENHealthwatch is here to give people a stronger voice to influence the health and social care services that matter to them:

We ask people about their experience of health and social care, going out and talking to people and communities.

We listen to people’s experiences and look for patterns that show where change needs to happen.

We tell organisations in charge of health and social care what the public think works well and what needs to change.

We check that these organisations are listening to people’s views and using this information to improve services.

In our first year Healthwatch has heard from a wide range of people from right across Bradford district, and we’ve actively sought views from some groups whose voices aren’t usually heard:

children and young people minority ethnic communities older people disabled people visually impaired and blind people carers people using mental health services

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Our work is driven by what people tell us about health and social care services in Bradford and District, both good and bad experiences. Gathering views is an important part of how Healthwatch will improve health and social care services. We use a number of engagement methods to gather people’s comments:

We have spoken at dozens of community groups and meetings, gathering people’s views about the local health and care services they rely on.

People share their views with us by phone, email or through our website.

Our leaflet gives people information about us and enables them to share their experiences of local services by returning it to a freepost address.

Our network of ‘Healthwatchers’ act as our eyes and ears, listening to the experiences of their friends, family, and community and feeding this information in to us.

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Involving Young PeopleHealthwatch has a responsibility to ensure that the voices of children and young people are listened to in health and social care. In April 2013 we worked with Bradford Teaching Hospitals NHS Trust to help them get young people to take part in their involvement activity. We recruited two young people who took part in the PLACE assessments (Patient Led Assessment of the Care Environment). They went in to the hospital to look at the hospital buildings, cleanliness, food, and how the environment supports patient's privacy and dignity. This was the first time the Trust had involved young people in this sort of work.We also adapted our Enter and View training for young people, working in partnership with Barnardo’s and the Children in Care Council. Nine young people took part in the training in 2013 and four of them are now becoming authorised representatives and planning visits to services.We have developed an innovative project to increase the engagement of vulnerable young people with GP practices in Bradford. This joint project with Barnardo’s will carry on throughout 2014.

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Every year, the Children’s Commissioner’s Takeover Day initiative gives children and young people the chance to work with adults for the day and be involved in decision-making. Young people benefit from the opportunity to experience the world of work and make their voices heard, while adults and organisations gain a fresh perspective on what they do.In November 2013, Healthwatch was taken over by a young person as part of Takeover Day.She supported an outreach session with deaf children at Swain House School in Bradford, capturing their views and ideas about what it’s like when they go to the doctor. She also helped us plan some communication activity, and took part in a live radio interview with Bradford Community Broadcasting.

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Invisible at the Desk – People’s Experiences of GP Services in BradfordWhen Healthwatch started in April 2013, we began going out to community groups and public events to talk about our work. Wherever we went we asked, ‘What one thing would you change about health or social care?’ and we found that most people wanted to talk about their GP practice.It made sense for us to respond to this and to find out more, particularly from groups whose voices weren’t usually heard. We used our network of Healthwatchers to take part in group discussions at events about GP services and to gather views from their communities. We worked with voluntary and community organisations to hear from particular groups whose experiences we wanted to know more about, such as those with mental health needs, older people, people with sensory impairment or disabilities, children in care and deaf children. In total we heard almost 600 comments.Healthwatch collated all the experiences and stories we heard into a report, which was mostly in the words of the people who spoke to us. The title is a quote from one woman who said she felt

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‘invisible at the desk’ when she visited her local GP practice. We identified three common themes:

Access and appointments: some people were struggling to see a doctor when they needed to.

Person-centred care: people told us about issues with communication, attitude, or practices not meeting individual’s needs.

Continuity of care: people said they want to be able to see a familiar doctor when they need to, and that information about their care and their individual needs should be passed on to other health or social care services that they might be referred to.

Our report was published in January 2014 and made 15 recommendations for action to improve primary care services for people in Bradford. The report and our recommendations were widely publicised. Each of the three local CCGs and NHS England, as well as the Local Medical Committee (which represents individual GPs) welcomed our report and acknowledged the issues people raised. We asked each organisation to provide a written response and set out what action they are taking to address the issues raised.

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The full report and the responses we received are published on our website.To follow up on our report we held a public event, attended by almost 100 people; many were members of the public who had contributed to the report.Senior figures from the CCGs and NHS England were there to answer questions from the public, and to explain what actions they would take to improve people’s experiences of GP practices.We showed video clips of people talking first-hand about their experiences and illustrating the key themes of our report.Group discussions came up with lots of ideas, questions and comments: particularly on the issue of access and appointments.“Very well attended event and excellent panel. Good facilitation, film clips were very powerful and better than any powerpoint presentation!” “In what is a very complicated structure, we were able to identify more clearly who has overall responsibility for what.”Feedback from our eventHealthwatch Bradford and District are now involved in ongoing work with NHS England and

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the CCGs around improving GP practices and urgent care services.

What we do: ACTThe purpose of gathering views is to make sure they are heard by those in charge of health and social care, and that they are used to continually improve services. Healthwatch is a ‘critical friend’ holding organisations to account and continually challenging them to take action in response to people’s experiences.The first thing we do when we notice a theme or pattern in what we hear is to feedback directly to the provider and ask what action they will take. Examples of issues raised with NHS providers include:

Maternity services Hospital care of people with dementia Access to bariatric surgery Communication with deaf people.

From December 2013, we have input all comments we receive from the public into the CCG’s ‘Grassroots’ report which combines comments gathered from a number of sources including Healthwatch and district-wide Patient

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Advice and Liaison Services (PALS) and is presented to the directors of the three Clinical Commissioning Groups in the district.Care Quality Working GroupA Quality Account is a report about the quality of services by an NHS healthcare provider, produced on an annual basis by the provider themselves. These reports have to be scrutinised by various local organisations including Healthwatch, and we have the legal right to comment on their report. Our commentary has to be included in each final Quality Account report which is made available to the public. The Care Quality Working Group is made up of a number of Healthwatch volunteers who study each report and comment on behalf of Healthwatch. This provides an important “reality check” and allows Healthwatch another opportunity to feed in public and patient opinion. The group is supported by the Bradford Resource Centre. In our survey of the general public in March 2014, only 22% of people felt they had an opportunity to have their say on health or social care services. And of people involved with Healthwatch, 40% said their views were rarely or never taken into account by those in charge of health or social care. This shows that

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Healthwatch has much work to do in influencing local organisations to respond to people’s views and experiences.

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Accident & Emergency at Bradford Royal InfirmaryIn June 2013 the local Independent Complaints Advocacy Team alerted us to a pattern of complaints they were involved with where several people had been sent home from Accident & Emergency at Bradford Royal Infirmary without appropriate care and treatment.We raised these concerns with Bradford Teaching Hospitals NHS Foundation Trust, and also the clinical commissioning groups, and began regular meetings with the Trust to develop an open dialogue in order to communicate patient experience and raise issues. With the support of the Trust, we actively sought more evidence about the A&E department. In October, members of the Healthwatch team spent an evening in A&E observing, and talking to patients and carers. This gave us a snapshot of patient opinion and experience – some was positive, but we saw and heard problems around staffing levels, communication, and a lack of privacy.Shortly after our visit, the Care Quality Commission contacted us to say they were carrying out an unannounced inspection of

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Bradford Royal Infirmary and asked for any patient feedback. A&E was not on their list of departments to look at, but when we told them about our concerns the CQC changed its plans and included A&E in the inspection.The CQC inspection resulted in the Trust failing four of the six national standards, and getting a formal warning in relation to staffing. As a result the Trust took urgent action to address some of the issues raised by Healthwatch including increasing staffing levels, improved training, and closer working with Social Services, with other actions set out in detailed plans. One of the specific concerns that Healthwatch found in A&E was the lack of privacy for patients - with initial assessments (triage) being carried out in an open area near the reception desk. The Trust has changed this process and they now assess patients in private rooms, and other changes were made to the reception area to improve privacy.Healthwatch are continuing to work positively with Bradford Teaching Hospitals to make sure that their action plans follow through to mean better experiences and outcomes for patients.

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We have agreed with the Chief Executive of the Trust to revisit A&E in a few months time.

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Experiences of Visually Impaired PeopleIn May 2013 we were approached by members of Bradford Association of Visually Impaired People (BAVIP) which is run by and for visually impaired people and supported by Bradford Alliance on Community Care (BACC). They told Healthwatch about problems visually impaired people experienced at Bradford hospitals and GP practices; they didn't feel anything had been done to address their problems, despite having raised the issues many times in the past.Some of the issues were around communication, such as visually impaired people being sent appointment letters which they can't read. Other issues were about procedures at the hospital which left people feeling humiliated, for example blind people being asked to read sight tests.Healthwatch got in touch with Bradford Teaching Hospitals Trust to raise these issues and see what action they would take. We also gathered views from other groups who work with visually impaired people in the district.We facilitated a meeting between visually impaired people and senior staff at the Opthalmology Department, which took place in October 2013.

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Listening first hand to the experiences and feelings of people with visual impairments helped hospital staff to understand the difficulties they faced. Health professionals involved were also able to explain that what might seem to be an unnecessary procedure does often have a good clinical reason behind it, and that perhaps part of the problem was to do with this not being clearly and sensitively communicated to the patient.

The Trust agreed that some people shouldn't have to go through all the procedures at the hospital, and are looking at how best to flag this up on patient records.

The Trust distributed advice sheets to staff, written by BAVIP members about supporting and communicating with visually impaired people.

A pilot scheme to arrange appointments by email is being discussed. Using new technology could overcome some of the difficulties people with sensory impairments experience, for example many blind people have software which can read out emails or text messages.

BAVIP and Healthwatch are continuing to work with both the CCG and the Trust to find the best ways of making sure that an

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individual's communication and support needs are met.

What we do: REPORT BACKHealthwatch can only work if local people trust us, work with us and take part. To build this relationship with local communities, we keep the public updated about our work and tell them how the experiences they have shared have helped to shape and improve services.We have attended many events across the district with our banner and promotional materials, for example:

Easier Access disability event Born in Bradford conference Family Fun Day for looked after children and

their families Health Mela in Barkerend Nightstop event for homeless people Hospital open days

People who share their experiences with Healthwatch or who want to know more about our work can sign up to our mailing list. We send monthly e-bulletins, letting them know about our work, sending out copies of our reports, and inviting them to events. Extra emails also go out

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to our Healthwatchers about specific issues, events, or opportunities to get involved. Making our information accessibleWherever possible we try to use simple, and easy to understand language. We have made Easy Read versions of key documents and leaflets, and have had a BSL video made explaining Healthwatch. Digital communicationOur website is an important communication tool, and it has been continually developed and updated. During our first year, traffic to the website has increased by 47%. We also use social media like Twitter and Facebook to raise our profile and engage with people. Our Twitter account was set up in May 2013 and by the end of April 2014 we had 763 followers.Healthwatch in the mediaHealthwatch has been on local radio many times over the year, and in September 2013 one of our volunteers was featured on a BBC Radio 5 Live show about the CQC inspection of Airedale General Hospital.

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We have been regularly featured in local newspapers, with stories about our launch and key pieces of work such as ‘Invisible at the Desk’. We have also established Healthwatch as a credible voice on local health or social care issues and have often been asked to comment on stories.

What we do: Help people get the best from servicesIn May 2013, Healthwatch Bradford and District set up a dedicated phone line to provide information to members of the public about local health and social care services, and community sources of support and advice.0300 56 10 987Our phone line is staffed Monday to Friday, 9.30am to 12.30pm and outside these hours a message can be left. In 2013/14 we received 96 phone calls from people looking for information or advice on health or social care, and we received a further 15 enquiries by email or post.

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At outreach sessions in local libraries and hospitals we gave information to 126 people.Our information line has given people information about a wide range of local health or social care services. We have put people in touch with both statutory and voluntary sector services. Many people who called our information line were looking for help to find an NHS dentist. This has been the single issue on which we have taken most calls. This supports the findings of a report published by Healthwatch Kirklees in February entitled “Why can’t I find an NHS dentist?”. Comments we received via the information service were passed on to help emphasise the need for improved NHS dental services for non-registered patients across West Yorkshire.Healthwatch Bradford and District has given information to 50 people to assist them in making a complaint about health or social care services, this includes sign-posting them to ICAT, our local Independent Complaints Advocacy Team run by Choice Advocacy and Bradford and Airedale Mental Health Advocacy Group (BAMHAG).Information Outreach

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From October 2013 Healthwatch began taking our information service out into the community, to increase the numbers of people we could reach.

We worked in partnership with Bradford Libraries to target four libraries across the district where we carried out regular outreach sessions.

We began monthly outreach sessions in the outpatients departments at Airedale General Hospital, Bradford Royal Infirmary, and St Luke’s Hospital.

30 sessions were held at venues across the district in 2013/14.

Outreach sessions in hospitals proved particularly successful, as we were able to give immediate information. Patients or their friends or relatives often came to speak to Healthwatch about conditions or treatment for which they were attending the hospital. People often had questions or anxieties; in many cases they had been supplied with an information leaflet by the clinician upon diagnosis but felt that they needed to learn more. Healthwatch was able to supply information and refer people to local organisations or support groups that could help them.

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Our outreach sessions have also given us the opportunity to gather feedback about services as well as provide information and advice. The volume of comments we received increased as Healthwatch became a more regular feature in hospitals and libraries.We held monthly sessions at Airedale General Hospital and feedback gathered at these sessions helped hospital staff to identify areas for improvement.

How we do it: OUR PEOPLE154 people signed up as Healthwatchers in 2013/14.Healthwatchers tell us what’s going on in health and social care services in their community, and help us gather views in order to improve services.

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We began developing our network of Healthwatchers in October 2013, with three events across the district.As well as sharing their own experiences of services, we ask Healthwatchers to gather views from their friends, family or community. We regularly ask for their views on particular issues that we are working on, or encourage them to take part in consultations or surveys. We also ask them to help spread the word about Healthwatch. We work with community groups encouraging them to act as Healthwatchers for the people and communities they work with.Healthwatch also help health and social care providers to recruit people for involvement activities, for example Healthwatchers have taken part in the Patient Led Assessments of the Care Environment at both Bradford Teaching Hospitals and Bradford District Care Trust.

Volunteers Healthwatch Bradford and District is a small organisation with a big job to do and our volunteers play a vital role. Volunteers bring

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valuable skills and experience to the Healthwatch team, and support us in key areas of work, like:

Enter and View representatives Care Quality Working Group members Helping at events or outreach sessions Attending meetings on our behalf Board members

We are committed to offering a good quality volunteering experience and have developed a volunteer policy and handbook. Volunteer recruitment is a key area for development in 2014/15. Healthwatch BoardThe Healthwatch Bradford and District Board is made up of volunteers drawn from the diverse communities of our area. Board members were drawn from a number of strategic partnerships, patient networks and service user groups.Current Board members: Javed Khan, Chair Gill Bowskill (AWC CCG Patient Network) Susan Crowe (Bradford District CCG Patient

Network) Mohammad Shabbir (Bradford City CCG Patient

Network) Paul Anderson (Strategic Disability Partnership)

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Pam James (Older People's Partnership) Surekha Thind (Learning Disability Partnership) Trevor Ramsay (Mental Health Service User) Julie Bruce (Carers’ Partnership) Emmerson Walgrove (Supporting People User

Group) Mashud Haque (Health and Wellbeing Forum) Kerr Kennedy (Young Lives Bradford) John Samuel (Equalities Forum) Prof Gerry Armitage (School of Health,

University of Bradford) Isobel Scarborough (KIVCA Trustee) Staff TeamHealthwatch Bradford and District employed 9 members of staff (some part time and some for only part of the year) in 2013/14: Andrew Jones, Manager Afsana Aslam, Development Worker Marcella Celli, Development Worker Becky Mears, Development Worker Frances Spencer, Trainee Development Worker Sally Horner, Administrator Daniel Park, Signposting & Information Officer Andrew Scott, Information Systems Manager Victoria Simmons, Communications Manager

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Our staff team is based at Central Hall in Keighley but travel widely to carry out our work across the district.In a survey of organisations in the district who have worked with Healthwatch, 84% of responses rated the skill and knowledge of our staff as Good or Excellent.

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Involving People with Learning Disabilities Members of Bradford People First and People First Keighley and Craven told us that they were interested in getting more involved with our work, to make sure that their views and needs were taken into account. We worked with the People First groups to adapt our Enter and View training to be accessible for people with a learning disability and delivered this to 12 people. Four people with a learning disability have now gone on to become fully authorised Enter and View representatives. They carried out their first two visits in November and February, to services for disabled people. These visits identified areas of good practice and helped representatives to build up their confidence in carrying out a visit and writing a report. The group were involved in planning the visits, identifying services to visit where they knew of good practice, and deciding on questions to ask.They are now planning visits to a wider range of health or social care services, to see how they meet the needs of people with learning disabilities. This work has strengthened our connection with learning disability groups, and helped us to

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engage people whose voices are not often heard in health or social care. People with learning disabilities are also now active as Healthwatchers, feeding in the views and experiences of their community.How we do it: OUR PARTNERS Healthwatch works in effective partnership with other local organisations, from both the statutory and voluntary sector; working together for the best local health and social care services, shaped by local needs.We have regular meetings with health and social care providers in the district. Our Chair and Manager have met with the Chief Executive and/or Chair of each local NHS Trust to establish channels of communication.Alongside the Health and Wellbeing Board (see page 19) and other forums, Healthwatch has joined and contributed to a number of key joint committees and boards. Here we champion the importance of public and patient involvement. Through participation in these groups we have built positive working relationships with statutory commissioners and providers; creating a route for service user feedback or concerns. Key groups we have contributed to include:

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NHS England Quality Surveillance Group (QSG) for West Yorkshire

NHS England QSG for Primary Care Bradford Safeguarding Adults Board Urgent Care Board Health Improvement Partnership Joint Quality Committee (Bradford Districts and

Bradford City CCGs)Voluntary SectorHealthwatch works effectively by drawing on the considerable skill and expertise of our local voluntary and community sector. We gain better insight into the needs of local people by working with organisations embedded in our communities. We participate in the VCS Health and Wellbeing Forum, and use the structure of the Bradford District Assembly to enable communication and collaborative work.Bradford CouncilHealthwatch has worked with the local authority to ensure public participation in key consultations, such as Fair Access to Care Services, the proposed changes at Whetley Hill Resource Centre,and the overall Council budget.

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We presented twice at the Health and Social Care Overview and Scrutiny Committee during the year, once giving an overview of our work and at a second meeting reporting patient experiences of using Accident and Emergency Services at Bradford Royal Infirmary. At other times we ensure good co-ordination with the work of the Committee through regular attendance by Healthwatch staff, board members or volunteers.

Clinical Commissioning GroupsHealthwatch takes part in the reference groups that each CCG has set up to lead on patient engagement and equality. We have worked closely with them on patient networks and other engagement events. Patient NetworksThroughout the first year of operation, Healthwatch has continued to support the Airedale Wharfedale and Craven Patient Group Network which was originally set up as a Healthwatch Pathfinder project by Bradford LINk.The network was set up to create an effective structure for GP practice patient groups to express their views in the new NHS

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commissioning structures. Patients at GP surgeries across Airedale, Craven and Wharfedale are working together to influence the services that matter to them: 16 of the 17 GP practices in the AWC area have an active patient group who attend the network meetings.This year Healthwatch has focused on developing the network to become self-governing and self-supporting.Healthwatch has worked with the volunteer-led network to set up an executive committee, who are now running the quarterly network meetings themselves. We negotiated with the CCG to secure funding for the administration of the network, and members of the Healthwatch team give training and support to a part-time administrator.The PPGs have shared good practice and ideas for improvement: for example, Addingham practice reported at the January meeting that they have recruited a young person to the network and supported them to put on an information event for young people about drug and alcohol use. The network has also opened up other opportunities for involvement: for example, through the network some GP practices are

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getting involved in patient lead research into social prescribing.Healthwatch Bradford and District has been involved with our other local CCGs, Bradford Districts and Bradford City, to help them develop similar structures for patient groups in their area. Bradford City CCG now has ‘patient engagement’ as one of its top priorities.

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How we do it: OUR POWERSHealthwatch was established through legislation which gives us statutory powers and a strong position to influence decisions on health and social care. Health and Wellbeing BoardHealthwatch Bradford and District have taken our place on the Health and Wellbeing Board since it became fully operational in April 2013, with the seat taken by Javed Khan, the independent Chair of the new Healthwatch Board. He is supported by the Healthwatch Manager and is briefed prior to each meeting, alongside a representative from the Voluntary Sector in the Bradford District, to ensure good co-ordination between the two board members. Our representative has attended all meetings of the Board and a number of development sessions, and has championed patient and public engagement in all discussions about health and social care. Members of the Health and Wellbeing Board congratulated Healthwatch on our work to improve GP services and our report “Invisible at the Desk”. Healthwatch has been at the forefront of calls to join up more effectively the different strands of service user and patient experience from different organisations across the health

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and social care economy, and progress is now being made in this area. Joint Strategic Needs AssessmentJoint Strategic Needs Assessment (JSNA) is a process that identifies 'the big picture', in terms of the health and wellbeing needs and inequalities of a local population. The Bradford district has set up a JSNA Steering Group chaired by Public Health which oversees the work of assessing and analysing current and future health and wellbeing needs. Healthwatch volunteers with support from the Bradford Resource Centre contribute to the work of this group, ensuring that the needs of excluded groups are included and making sure that public and patient experience forms part of the JSNA. The needs assessment is important in that it is used by health and social care commissioners to plan services to improve health and wellbeing, for example in the Health and Wellbeing Strategy for the district. Care Quality CommissionWe have not made formal requests for the CQC to undertake investigations. However we have established a good working relationship with the CQC and share information both ways. In

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2013/14, we have fed in our knowledge of patient experience to inspections at both Airedale NHS Foundation Trust and Bradford Teaching Hospitals NHS Foundation Trust.

Enter and ViewTrained Healthwatch volunteers are authorised to carry out visits to health and social care services in our district. Enter and View visits can happen if people tell us there is a problem with a service. They can also happen when services have a good reputation – so we share good practice.Following the transition from LINk we reviewed our Enter and View Authorised Representatives and now have 12 active authorised representatives. In 2013/14 we carried out the following Enter and View visits:

Airedale General Hospital, Ward One – this visit was prompted by a few concerns raised in relation to the care of older people.

Step Forward – this visit was to learn about a new mental health rehabilitation centre at Bradford District Care Trust.

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Catholic Care – an opportunity for newly trained volunteers to carry out a visit to a good service supporting young adults with learning disabilities to live independently.

Waddiloves Heath Centre –to look at facilities and services at a health centre for disabled people.

Reports and recommendations from the visits can be found on our website.Enter and View Representatives: Abbas Ali Hoshiar Singh Irene Cyhanko Jean Hepworth Joan Fenton Katie Matthews Tim Pickles Val Mills Yvonne Jardine Ann-Marie Bentley Damian Marshall Surekha ThindOur Enter and View group is representative of the diversity of our district; including people with a range of different backgrounds, ages, and experiences of health and social care - for

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example carers, disabled people, and people with long term conditions.

Elderly Care at Airedale Hospital - Enter and ViewHealthwatch listened to concerns raised by members of the public and professionals in the community about the way elderly people with dementia were cared for on Ward 1 (now Ward 4) at Airedale General Hospital.Our trained and authorised Enter and View volunteers spent time on Ward 1 (now Ward 4) talking to patients and carers. This gave us a better picture of how people were being cared for and where improvements needed to be made.What has changed?Our Enter and View volunteers wrote a report after the visit which made recommendations for

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improvement. This was presented to the Airedale NHS Foundation Trust Board and influenced the Director of Nursing’s action plan for improvement. Since our visit, the hospital has made changes:

Awareness of the ‘Butterfly Scheme’ has been increased, and the forms changed to include information about a patient’s language needs.

More information is being provided to patients and carers about support in the community.

A new family room has been created to make it easier for families and carers to spend time on the ward and support patients.

Communication with carers and family members has been improved, with daily ‘walkabouts’ by staff to talk to families and discuss any concerns.

By working closely with the Trust and our Enter and View volunteers, Healthwatch found out more about the needs of local patients and carers. Our volunteers also learnt about the challenges the hospital faces caring for people with dementia on a general hospital ward, and the work the Trust is doing to address these challenges.

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Our volunteers for this visit had experience of working with older people living with dementia and connections with local community groups; they helped ward staff to establish links with these groups in order to provide better support for patients and carers.Following up on this visit, Healthwatch began a further piece of work to understand the experience of carers when someone they care for with dementia goes into hospital.

Healthwatch EnglandHealthwatch England is the national organisation responsible for championing the voice of patients, service users and carers at a national level.We feed information about local concerns and issues to Healthwatch England in order to inform national priorities. We upload anonymous

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comments we receive about health and social care locally to the national database. Healthwatch Bradford and District was one of the first local Healthwatch to raise concerns about the roll out of NHS England’s Care.Data programme. We had heard that members of the public did not know enough about the proposals to share their medical records, and had concerns that the information campaign was not accessible for everyone.A quarter of the Healthwatch network raised the issue with Healthwatch England and they took action at a national level. This led to NHS England delaying the roll out and planning more extensive and accessible communication to raise awareness.

Members of the Healthwatch Bradford and District team have taken part in a number of meetings and consultations with Healthwatch England including:

Workshops with Healthwatch England and the Local Government Association on developing a regional outcomes framework;

National steering group on Communications;

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Healthwatch England consultations on their proposed framework of Rights for health and social care.

Bradford is one of two local Healthwatch organisations working with Healthwatch England to develop an information management system which will be rolled out nationally in 2014.We have also developed strong relationships with neighbouring Healthwatch organisations, sharing intelligence and ideas. Our manager regularly contributes to the regional network facilitated by Involve Yorkshire and Humber. Healthwatch BrandingHealthwatch Bradford and District are licensed to use the Healthwatch trademark (including the logo and the Healthwatch brand) as per our license agreement with Healthwatch England and the Care Quality Commission.

GovernanceBradford Metropolitan District Council has responsibility for commissioning the local Healthwatch service. It awarded the contract to

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deliver Healthwatch to KIVCA on 11th December 2012.Keighley & Ilkley Voluntary and Community Action, Central Hall, Alice St, Keighley, BD21 3JD. Charity no. 1061641 Company No. 3277881 The separate Independent Complaints and Advocacy Service (ICAT) is being delivered under a separate contract by Bradford & Airedale Mental Health Advocacy Group (BAMHAG) and Choice Advocacy.The Healthwatch constitution sets out the purpose and objectives of Healthwatch Bradford and District, and sets out the provisions for the governance of the organisation. The work is governed by two Boards: The KIVCA Board is accountable for the delivery of the contract with Bradford Council for Healthwatch and the budget, and has responsibility for the staff employed by KIVCA. The Healthwatch Board sets the strategic direction for the organisation, decides on the priorities for work based on what local communities are telling us are the key issues in

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health and social care, and makes sure that Healthwatch is accountable to the public. Together both Boards oversee the performance of the organisation and keep a close view of what we achieve. The roles of each Board and the working relationship between them are set out in a written agreement. A KIVCA Trustee is a member of the Healthwatch Board and all members have signed a Code of Conduct.Annual Report and AGM The annual report will be presented at the Annual General Meeting on 19th June 2014. The report will be available to download on our website, with printed copies available on request.

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FINANCEBelow is a summary of income and expenditure for Healthwatch Bradford and District for 2013/14. Local Healthwatch funding is in two parts. The first part is calculated from the ongoing baseline funding that supported Healthwatch’s predecessor organisations – Local Involvement Networks (LINks). This comes from the Department for Communities and Local Government via the Business Rates Retention Scheme to each Local Authority. The second is additional funding for the new signposting service and other additional duties Healthwatch has to fulfil and comes from the Department of Health. Each Local Authority has to commission a local Healthwatch and ensure it operates effectively and is value for money but the two grants for local Healthwatch organisations are not ring-fenced. Decisions about funding for local Healthwatch are made by each local authority. As a consequence, the level of funding for each local Healthwatch varies considerably between the 152 local Healthwatch in England. Bradford Metropolitan

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District Council provided a grant of £337,000 to fund Healthwatch Bradford and District in 2013/14.

Total 2013-14

Income Bradford Metropolitan District Council

337,000Total Income 337,000 Expenditure Staff costs (salaries, NIC, pension, payroll)

194,311Recruitment & training 2,876Travel (staff travel, mileage expenses) 3,016Mobile phones 2,366Business costs (offices, admin support, printing, postage, landlines)

50,340Management fees (KIVCA management costs, accountancy, insurance)

19,616IT (equipment, software, website, information management system) 4,929Communications (communications equipment, promotional materials)

15,034Launch (set-up, including professional fees) 5,695Events, workgroups & campaigns (public events, engagement activity) 16,056

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Board costs 5,945Volunteers (expenses, training)

10,064Enter & View (training, authorised representative costs) 1,532Total resources 331,780 Underspend for the year 5,220

© Healthwatch Bradford and District 2014 The text of this document may be reproduced free of charge in any format or medium providing that it is reproduced accurately and not in a misleading context. The material must be acknowledged as Healthwatch Bradford and District copyright and the document title specified. Where third party material has been identified, permission from the respective copyright holder must be sought. Any enquiries regarding this publication should be sent to us at info@healthwatchbradford.co.uk You can download this publication from www.healthwatchbradford.co.uk Images on covers and pages 1, 8, 11, 14, 15, 17, 23 by Frances Spencer: francesaspencer@ntlword.comCover images show Damian Marshall, Enter and View Authorised Representative; John Samuel, Board Member; Becky Mears, Development Worker; Andrew Jones, Manager

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Healthwatch Bradford and Districtwww.healthwatchbradford.co.ukinfo@healthwatchbradford.co.uk01535 665 258

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