You can find out what action Healthwatch Cornwall has taken in response to feedback received here, or read about ongoing work on the Our Work page.
A number of people raised questions with us about their Continuing Health Care (CHC) and we asked NHS Kernow for answers.
The information provided by the commissioner can be found by clicking on the link below.
Key points addressed include top up fees charged by care providers, clear guidance for families and patients when going through a CHC assessment at each stage of the process, the constitution of the Multi Disciplinary Team and how different parties are involved in the process, completion of the Decision Support Tool, and issues relating to disagreement with the assessment or the decision.
A new service, The Beacon advice line for Continuing Health Care, which is funded by NHS England is also available. Call 0345 5480 300 or visit www.beaconCHC.co.uk for assistance.
You can also read the NHS CHC leaflet for more information.
St Austell Healthcare
Response update: St Austell Healthcare has responded to our request for details about the measures they have implemented/will implement to improve the service provided at the practice.
This follows patient feedback to us as outlined in the article below.
We received a very quick response from the practice that highlighted technical problems with the phone line from August to November, which we are assured have been rectified. This should prevent patients being cut off unintentionally.
A further 12 receptionists have been employed since October and incoming phone lines increased from 14 to 16. A full complement of reception staff should ensure waits of no longer than five minutes.
The INR (warfarin) monitoring returned to appointments in September and from January the majority of INR and routine blood testing will return to the practices.
St Austell Healthcare is also reviewing its planned care GP appointment availability.
We hope that these improvements will result in more satisfied patients and have offered to review patient satisfaction next year and to continue to monitor patient experience.
Healthwatch Cornwall (HC) has collected 130 feedback comments during October and November from patients that have used St Austell Healthcare (SAH).
This feedback was collected through the HC website, phoneline and targeted service evaluation.
The evaluation was conducted during a flu clinic held at Polkyth Leisure Centre on October 10, 2015, and asked the question, “Have you contacted SAH by phone since September 2015?” September was chosen for this question due to changes made by SAH to improve the phoneline system.
If respondents answered yes they were encouraged to leave feedback about their experience.
69% of the feedback in this report was collected through this particular visit.
In the feedback we have collected to date, patients generally responded negatively (77% negative, 18% positive
and 5% neutral).
You can read more below and our full report with recommendations on the Our Reports page.
We will update on the response to our recommendations in due course.
Healthwatch Cornwall heard from a number of patients experiencing difficulties with the county’s orthotic service. You can read the full report on the Our Reports page.
Our commissioned partner, Disability Cornwall has been providing administration for the orthotics service and, during our research period, provided a statement about how it has been working to bring about improvements.
Healthwatch Cornwall will update on the formal responses from relevant organisations in the near future.
Gender Identity services in Cornwall
Healthwatch Cornwall worked with a number of its network colleagues across the UK to find out more about Gender Identity services and the support individuals receive. It asked for feedback via a Survey Monkey survey.
More than 640 people responded to our survey about pharmacies and the services they deliver in Cornwall, with politeness rated highly but privacy falling short.
Our findings have been forwarded to the relevant commissioners and providers and we will update on progress in the New Year.
Hearing Loss support at Royal Cornwall Hospital Trust sites
Jamie Hanlon is a volunteer with Healthwatch Cornwall. He has 95% hearing loss. Having needed to attend, or visit others at, RCHT’s Treliske hospital he found it was often quite difficult to find the right support at the right time. Instances where intercom systems did not enable those with hearing loss to easily access wards prompted him to raise his concerns with us. From this, we worked with the trust to determine what could be improved and what new ideas could be implemented to offer better support to people with hearing loss. Healthwatch Cornwall has made a film to showcase the outcomes of this work, which you can view on our YouTube channel.
Black & Minority Ethnic – access to services
Healthwatch Cornwall commissioned research into how people who are black or are from minority ethnic groups find accessing health and social care services in Cornwall. A report with recommendations based on the findings is available on the Our Reports page.
Healthwatch Cornwall attended the St Austell Healthcare Health Fair on October 10, held at Polkyth Leisure Centre.
Along with information stands on topics such as the Carer’s Support Service, Abdominal Aortic Aneurysm Screening (for men over 75), and the Stop Smoking service the Fair included an innovative immunisation scheme. This aimed to enable people needing flu vaccinations to access them conveniently and early in the season, in order to protect their health and wellbeing.
6000 people were invited to attend the busy event at set time slots throughout the day and a number of nurse manned stations were set up in the Sports Hall to administer the jabs, with doctors, managers and members of the Patient Participation Group assisting.
Healthwatch Cornwall asked to take part in response to feedback we had received (see September below) that had indicated difficulties in making appointments or ordering repeat prescriptions. We took the opportunity to survey a sample of 100 people and of the 90 responses we received on this topic, 55 were negative reporting long waits in a queue or the need to phone repeatedly.
Several people told us it was quicker to go to the surgery and book an appointment in person. However, 35 people – nearly 40% – said the service was efficient, better or improving.
Chief Executive of Healthwatch Cornwall Debbie Pritchard said: “We are aware that there have been increases in the number of reception staff employed to answer phone calls during September and processes are under way to improve online prescription ordering.”
All feedback received by Healthwatch Cornwall has been shared with managers, in order to improve services offered.
St Austell Healthcare
Healthwatch Cornwall’s Chief Executive Debbie Pritchard alerted the new St Austell Healthcare practice, which combines the surgeries at Park, Foxhole, Woodland Road and Wheal Northey and incorporates patients from Polkyth Surgery, to a number of negative comments received by Healthwatch Cornwall in August.
This feedback included issues relating to being booked in (Woodland Rd), long response waits from the single telephone point of access, confusion about where to go for what service and concerns with repeat prescriptions.
In response to this, St Austell Healthcare explained that as the surgeries had only been operating for a month it had been anticipated that there would be some teething problems and that patients had been asked to bear with them during the first few weeks.
In response to the delays relating to the phone service, St Austell Healthcare said the single number had a telephone hub with 20 phone lines. They had been amazed to be averaging 3,500 calls each week, not including abandoned calls, which equated to more than 10% of their patients contacting them each week and they said is significantly above average.
The target operating model included having eight receptionists at peak times to deal with call handling but achieving those numbers in August with annual leave commitments proved “impossible”. This led to waiting times of more than 20 minutes at busy times, which the practice recognises as “totally unacceptable for patients”.
The aim is to reduce waiting times to no more than two minutes, even at peak times. Six new receptionists have been recruited and waiting times are now below five minutes. Two more receptionists will also be employed to ensure 10 staff cover the phones every morning.
The practice had tried a walk-in service for INR blood tests (the test used to monitor the effects of warfarin) but waiting times were quite long so an appointment system has been re-introduced. The surgery says this is working well. All other phlebotomy is walk-in and that is working well with waits generally five to 10 minutes.
During August the practice acknowledges that people “voted with their feet” when they were unable to get through on the phone but as the phone issue improves it is lessening pressure on reception.
The Patient Participation Group is helping to ensure patients are aware of new services, local press has highlighted the practice and leaflets have been delivered to every house in St Austell explaining the new services.
The new computer system has all 32000 patients details safely transferred. The Carlyon Road Health Hub is working well with acute patients being seen 8-8 Monday to Friday. There is an acute mental health service starting every day, walk in contraceptive clinics at the Hub and planned care appointments available at the Hub each evening.
Patients at the planned care centres now benefit from longer appointments (12.5mins). One new partner has joined; there are three new salaried Drs, an Emergency Care Practioner, pharmacist, and nurse consultant. This will enable plenty of appointments every day at the sites.
Healthwatch Cornwall Chief Executive said: “The response is very reassuring and we do appreciate that it is very early days for the new services.
“St Austell Healthcare has done a lot to inform people of the change and has provide a full explanation for each issue we raised with them.”
Healthwatch Cornwall will be attending St Austell Healthcare’s open day on October 10. Visit staustellhealthcare.co.uk for more information.
To help Healthwatch Cornwall represent public opinion visit www.healthwatchcornwall.co.uk or call 0800 0381 281 to share your views.
A meeting took place between Cornwall Partnership NHS Foundation Trust (CFT) and Healthwatch Cornwall (HC) in August 2015 to discuss recent patient feedback received by HC about CFT’s services.
The Chief Operating Officer and Associate Director for Functional Community Services were able to give HC answers to some of the queries raised. They are outlined below.
Mismanagement of patient records- two service users stated that their records have been lost or letters around medication and prescriptions had not been submitted by admin staff leaving patients without medication, in one case for more than two weeks.
CFT said it was aware of this feedback – both pieces of which related to complex issues with individuals resulting from communication issues between Royal Cornwall Hospital Trust, CFT and the person’s GP. CFT made recommendations to the appropriate people involved on how to improve this.
Access to a Community Psychiatric Nurse (CPN)- HC had received feedback that service users have had up to four CPNs over a short period of time due to sick leave. There has been positive feedback about communication of changes to CPNs but services users report that the CPNs aren’t around long enough to even meet with them. Waiting time between seeing a CPN in some cases can be months.
CFT does not have particular issues in terms of recruitment of professionals compared to other parts of the country. There was high sickness in North Cornwall earlier in the year – which is reflected in this feedback. There has been some internal movement of staff that could have impacted too. As a trust, CFT write to service users when their community contact person has to be changed. Bank and agency staff is generally not used as care co-ordinators in these services to ensure continuity. However, they are used to undertake assessments and as duty worker this enables the freeing up of regular staff from these activities and to focus on seeing service users. CFT try and be proactive and flagged that there may be staffing issues in Penwith in the near future, which the team manager is already addressing. Internally, CFT has a system for flagging to senior staff potential staffing issues, to allow early or proactive resolution. People seen in the community are monitored at each team meeting to ensure that if not seen by CFT they are being seen by another supportive service such as eating disorders or Addaction.
Issues contacting and speaking to a relevant person at the trust – service users have stated that they have tried to contact CFT, received poor customer service and haven’t received call backs when requested. This is often at a time when the person needing support is at their lowest.
CFT has put in place a “message handling system” to manage expectations around call backs and will share this with HC. Usually call backs are within 24hours, if they are repeat calls a duty worker follows up, and crisis calls are forwarded to the Home Treatment Team. CFT report 80% compliance with this system. CFT was not aware that this had been an issue at Trevillis House – but it was aware of one of the issues that HC reported and will be looking at a local review of the process at Trevillis House to ensure that the team are managing calls in line with the protocol.
GP contact around referrals. Projects in St Austell and Kerrier, where CFT is looking at care co-ordinators being co-located with GPs to allow easy booking of assessment appointments are being developed. CFT is also signed up to easier sharing of patient records with GPs.
It is developing a dedicated email service for Consultant Psychiatrist support for GPs.
It is also working with the Referral Management Service to provide a basic guide, with scenarios to support GPs to refer to the appropriate service.
Discharge of service users from CFT services – service users have stated that they don’t have a discharge plan and are left abandoned once the service has finished.
Individuals should be aware of the WRAP programme, that designs a wellness and relapse care plan with individuals and an appropriate worker, through the Community Mental Health Teams. More intense work is being developed on this with the Restormel team.
People often do not want to be discharged as there are some natural concerns around this, however CFT is committed to aiding service user recovery by moving the focus away from a reliance on services.
CFT has 40% more referrals than national average .
Access to Treatment – services users have tried to access treatment from BeMe and Outlook Southwest and have been turned away as they were too complex. Inappropriate sign posting from health professionals hasn’t aided this issue.
There are interagency protocols around providing services for individuals. Team managers meet fortnightly to resolve cases and if this is unsuccessful senior clinicians from Outlook South West and Cornwall Foundation Trust meet and are tasked to come to an agreement – but this is bi-monthly. In some cases services are just not available and CFT flag these to NHS Kernow on an individual basis. Some people who receive services from the Trust cannot get access to psychological therapies and CFT is challenging this. CFT have concerns about the current Increasing Access to Psychological Therapies contract, which disincentives multiple sessions. CFT will be training staff to be able to deliver a wider array of psychological therapies services such as mindfulness from September 2015, which is hoped to improve capacity in the system and provide solutions for more people.
Our End-of-life work will culminate in a meeting of relevant providers in January 2016. We will keep you informed of progress.
Healthwatch Cornwall was very worried when a son contacted us to share his concerns that his mother was being incorrectly charged for her care. This related to the care provider allegedly charging a top up fee for services that should have been covered by the NHS, since his mother had been awarded full continuing healthcare funding.
Other people have also shared similar concerns. We queried this with NHS Kernow who confirmed that full continuing healthcare should pay for the totality of a person’s care needs if awarded. There are some exceptions where the patient receives extra services from the care provider or where they only receive an award for nursing care and each case is individually calculated. Trading Standards were aware of the feedback we had received and have now issued a letter to all providers of relevant care services informing them of the legal position around these charges and the consumer rights relating to this. Read the letter in full here.
Earlier this year, Healthwatch Cornwall commissioned its support partner Disability Cornwall to research what people using a personal budget thought of the service. Cornwall Council has now responded to the recommendations (which you can read by clicking on the Our Reports link to the left). Read more about the response here.
The Annual Report was published on June 30. It provides an overview of work undertaken and finances for the 2014 to 2015 period.
Responses from commissioners and providers to our recommendations in relation to the Care at Home and Urgent Care reports are currently being reviewed and an update will be published soon.
Our work looking at the experiences of black and minority ethnic people who have used health and/or social care services is continuing, while our End-of-Life research has led to providers joining a workshop (date TBC) to look at best current practice and gaps in service to determine a clearer means of support for individuals and/or families in need of help.
From our work on GP and mental health support, we have worked with providers to help create an integrated mental health meeting. This ensures providers discuss care for people deemed as too serious for minimal support but not serious enough for long-term support so that they receive the care they need.
We commissioned our partner Disability Cornwall to look into personal social care budgets and from this five recommendations have been made to Cornwall Council. Further research will now take place.
We continue to hold outreach events and attend a number of meetings that enable us to share feedback and ensure public opinions are heard by commissioners and providers.
Healthwatch Cornwall has been instrumental in ensuring Cornwall Council acted on feedback from its Care at Home Framework providers. This included organising a meeting for all interested Framework and non-Framework domiciliary care providers where they could openly share their concerns. From this an open dialogue with Cornwall Council has begun to address all issues raised and find long-term solutions.
As of February 17, Healthwatch Cornwall is finalising an interim report on the process and is attending meetings between the Council and providers every two weeks to ensure that the voice of providers, paid home care workers and the cared-for are heard and are part of the process.