Including Communities: Engagement Report March 2022 to October 2023
Between March 2022 and October 2023, Healthwatch Kingston attended health and wellbeing events and community groups (28 in total) across our borough and engaged with attendees from seldom heard from communities and the most vulnerable in our society. Our work solicited 334 responses that have informed this Including Communities report. We wanted to hear people’s views and experiences of NHS and social care services to ensure commissioners, providers and other system leaders responded appropriately to local population health and care needs. Local people we engaged with across this 20-month period included:
- People experiencing homelessness
- Young people (16-18 years)
- Refugees, asylum seekers and other migrants (RASM)
- People with learning disabilities
- Neurodiverse people
- People from areas in Kingston with high deprivation
- People with English as a second language
- People with limited mobility to leave their home, through community libraries
- People with physical and mental disabilities.
There needs to be a easier way of getting time with your GP to go over your health and wellbeing, and come away knowing and understanding what the plan is going forward and who will be involved in my treatment.
Key recommendations to include all communities:
- SWLICP providers to co-develop (with target groups) vulnerable communities awareness training, and ensure this training is then delivered to health and social care staff and boards to support equitable access to and culturally appropriate services that promote inclusion and address stigma and discrimination.
- SWLICP providers to co-develop (with target groups) accessible service satisfaction surveys with a core set of standardised questions for RASM and other seldom heard from communities to complete after they receive primary and secondary care, to monitor timely access, improved communication, triage, follow up care and cooperation between health and social care services.
- SWLICB and Kingston Place leads to ensure core and targeted health and care information, education, promotion and engagement is available in relevant languages for RASM, also in accessible formats for people with disabilities, the digitally excluded (see our ‘Including Digitally Excluded Communities’ report) and other seldom heard from communities.
- SWLICB and Kingston Place leads to improve sector wide promotion about which General Practices in Kingston (and across south west London) are ‘Safer Surgeries’ and what they offer for people experiencing homelessness (including RASM).
- SWLICB and Kingston Place leads to ensure easily accessible translator and interpreter services are available in primary and secondary care for RASM.
- SWLICB and Kingston Place leads to explore use of a centralised telephone number for people with English as a second language (ESL), where a translator would answer to support calls to health and or social care professionals, rather than people with ESL having to call a service provider directly.
- SWLICP providers to explore ways to promote which languages are spoken by their staff and volunteer teams within their services. This could include use of languages spoken charts, ‘I speak…’ badges, or promoting a list of pharmacies where languages other than English are spoken.
- SWLICB and Kingston Place leads to ensure, access to mobile community clinics that support the physical, mental and addiction support needs of people with poor health outcomes and/or accessible signposting to ‘Safer Surgeries’ for people experiencing homelessness who can often have specific barriers when trying to access services.
- SWLICP providers to ensure that additional time is taken to include the person with a learning disability in discussions about their health and social care needs and therefore communications need to be in Plain English and easy to read.
- SWLICP providers to be mindful that a carer is often helping to arrange and attend appointments with patients with a learning disability and remember that if it is necessary to rearrange an appointment, this needs to be suitable for both patient with a learning disability and their carer.
- SWLICP providers to clarify the process to appeal a decision after diagnosis assessment as part of patient post assessment diagnosis letters.
- SWLICB and Kingston Place providers to ensure that advocacy service workers supporting people with ADHD, autism etc., through diagnosis assessments are better informed about the needs of neurodivergent people. NB. Healthwatch Kingston made a recommendation in our ‘Neurodiversity and health and care services’ report (published in March 2022) that sought to help address the obviously ongoing identified need for workforce awareness about the needs of neurodivergent people. Our previous recommendation remains appropriate after listening to neurodivergent people as part of this recent community engagement: ‘Health and social care service leads should commit to increasing awareness and understanding of neurodiversity across the commissioner and provider workforce to deepen understanding of the variety of ways neurodiverse people present. This includes the issues that arise from the ‘invisibility’ of these disabilities due to the fluctuating nature of some symptoms and the disabling impact they have on people’s mental and a physical health and daily life. Impactful neurodiversity workforce training should be co-developed and co-delivered with neurodiverse people and tailored for both specialist and general health and care workforce, including clinicians and commissioners.’
- SWLICP providers to ask neurodivergent patients (autism, ADHD etc.) if they would prefer more time between their therapy sessions (two weeks rather than one) to enable patients to process their thoughts adequately.
- SWLICP providers to text appointment reminders to neurodivergent patients (autism, ADHD etc.) a day before and on the day of their appointment.
- SWLICP providers to improve collaboration with young people to help ensure services are young people friendly (see ‘15 Steps Challenge’ - Youth Out Loud!).
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‘Prosperous Lives for All: The Refugee and Migrant Strategy 2016-2019’ was developed to address the barriers faced by RASM and to facilitate their entitlement to equal access to services. The 2016-2019 strategy (referenced as a supporting strategy to the Royal Borough of Kingston upon Thames (RBK) Joint Strategic Needs Assessment (JSNA) 2023) aimed to:
a. Develop clear guidelines for primary and secondary care staff about eligibility and access to health services
b. Create a widespread understanding within primary care that refugees, asylum seekers and migrants are currently entitled to register for free NHS primary care
c. Promote support services including interpreting services, advocacy and counselling available for non-English speakers to all stakeholders
d. Work in partnership to develop and buy services (joint commissioning) that will focus on reducing barriers, health inequalities and the costs associated with potential inappropriate use of services (i.e. due to not knowing what health services to use when) for all affected groups including refugees, asylum seekers and migrants
e. Promote Kingston Interpreting Services and English language opportunities to all stakeholders
f. Develop targeted health improvement initiatives between organisations and with communities to help prevent vulnerable groups from being further disadvantaged.
Our ‘Including Communities’ engagement has shown that RASM have continuing health and social care concerns about access and service support, that were to be addressed between 2016-2019.
Healthwatch Kingston requests an update from NHS SWL ICB and RBK on how the above strategic aims have been met, and if not, what plans are in place to achieve these, and by when?
