unplanned care report draft v5 (3)

Calderdale and Huddersfield Health and Social Care

Strategic ReviewSummary of findings from the engagement process -

Public, Patients and Carers

UNPLANNED CARE

November 2012 – January 2013

Report prepared by:

Calderdale, Kirklees and Wakefield Communications and Engagement Team

Document control:

Authors: Dáša Farmer/Nick Ward Date: 1 February 2013Version: 5 Status: Draft Circulation:

A partnership programme led by Calderdale Clinical Commissioning Group, Calderdale Council, Calderdale & Huddersfield NHS Foundation Trust, Greater Huddersfield Clinical Commissioning Group, Kirklees Council, Locala Community Partnerships and South West Yorkshire Partnership Foundation Trust.

Contents

1. Purpose of the report Page 4

2. Background Page 4

3. Our responsibilities; including legal requirements Page 5

4. Engagement process and use of existing data Page 6

5. Findings from the engagement process Page 7

5.1 Main themes Page 8

5.2 Unplanned care survey Page 9

5.2.1 General survey results Page 10

5.2.2 Location survey results 0

5.3 Patient feedback/enquiries Page 24

5.3.1 PALS and Complaints information – NHS Kirklees Page 24

5.3.2 Complaints information – Locala Page 26

5.3.3 PALS and Complaints information – CHFT Page 27

5.3.4 Patient Opinion website Page 29

5.4 Other engagement evidence – from Intelligence Library Page 33

5.4.1 Accident and Emergency services Page 34

5.4.2 West Yorkshire Urgent Care service Page 38

5.4.3 Trauma services Page 40

5.4.4 Paediatric Emergency services Page 41

5.4.5 GP practices Page 43

5.4.6 Inpatients (including hospital readmissions) Page 44

6. Equality data Page 47

7. Conclusion Page 50

8. Recommendations Page 51

9. Next Steps Page 51

10. References Page 51Appendices

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Appendix 1 Engagement action plan

Appendix 2 Schedule for engagement activity

Appendix 3 Engagement survey and equality data monitoring form

Appendix 4 Engagement survey – children and young people

Appendix 5 Unplanned Care survey – additional analysis

Appendix 6 Glossary

Appendix 7 National A&E Survey 2012 Results

Appendix 8 National A&E Survey 2012 – Patient Comments

Appendix 9 National A&E Survey 2012 – Long Term Conditions analysis

Appendix 10 Local A&E Discharge survey results 2012

Appendix 11 Patient comments by category – A&E Discharge Survey 2012

Appendix 12 GP Survey results for Calderdale and Greater Huddersfield

Appendix 13 National Inpatient Survey scores/ratings for CHFT 2006-2011

Appendix 14 National Inpatient Survey 2011 – Local peer group scores by section

Appendix 15 Patient comment analysis – National Inpatient Survey 2011

Appendix 16 National Inpatient Surveys 2010-12 – emergency vs planned admissions

Appendix 17 Readmissions Survey results 2012

Appendix 18: National A&E Survey 2012 – Long Term Conditions analysis

1. Purpose of the report

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The purpose of this report is to present the findings from the engagement stage of the Calderdale and Huddersfield Health and Social Care Strategic Review. The report captures intelligence collected from all previous engagement and consultation activities and reports on recent feedback from public, patients and carers. The engagement findings will enable the care stream to:

· Consider the views of patients as part of the strategic review; and· Ensure that public, patient and voluntary community sector feedback is considered in the

development of any future options to change the way a current service is provided or delivered.

· Highlight patient and public priorities and ensure these priorities are in line with current thinking.

2. Background

The health and social care economy in Calderdale and Huddersfield has embarked on a major programme of transformation. Local commissioners and providers of these services are working together to address the significant challenges facing the sectors and ensure that people continue to receive high quality services, now and in the future.

Over recent years, the local health and care system has seen many changes. There have been huge advances in care and treatments, and a shift to providing services as close to peoples’ homes as possible. There have also been changes in the needs of the local populations and the emergence of some significant challenges, not least the impact of the current economic climate. The Strategic Review aims to address these issues and transform services to ensure that patients can continue to receive the highest quality care possible in the most appropriate setting, within the resources available.

The programme’s vision is: We want to make sure you get the best possible care to keep you healthy, safe and well’. To do this, services need to change the way they provide health and social care services to ensure the public;

• Get the best possible results from the care they receive• Have services that meet their needs, personal and easy to access• Receive high quality, safe, specialist services available when they are needed• Are looked after in the local community wherever possible• And receive the right information, guidance and support when it is needed • Work with us to make the best use of the resources we have, including public money.

Four key areas (care streams) have been identified as focal points for the programme and each will be used to develop new models of care. These are:

· Planned care· Unplanned care· Children’s care· Long-term care

3. Our responsibilities

Engaging people is not just about fulfilling a statutory duty or ticking boxes; it is about understanding and valuing the benefits of listening to patients and the public in the commissioning process.

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Patient and public engagement can be defined as the active participation of patients, including children, service users, carers, community representatives and the wider public in the development of health services and as partners in their own health care. Involving people gives local people a say in how services are planned, commissioned, delivered and reviewed. It is important to recognise who to involve through engagement activity. Individuals and groups play different roles and there needs to be engagement opportunities for both.

A Communications, Engagement and Consultation Strategy underpins the principles by which the engagement and consultation operate and highlights the commitment to good practice in delivery. Engaging people who use health and social care services, and other stakeholders in planning services is vital to ensure services meet the needs of local communities. It is also a legal requirement that patients and the public are not only consulted about any proposed changes to services, but have been actively involved in developing the proposals.

3.1 Legal requirements

There are a number of statutory requirements relating to engagement that must be taken into account.

Health and Social Care Act 2012The Health and Social Care Act 2012 sets out responsibilities for NHS commissioners. This includes the statutory requirement for CCGs to involve and consult patients and the public, replacing Section 242 of the NHS Act 2006. Specifically, CCGs must involve and consult patients and the public in:· their planning of commissioning arrangements · the development and consideration of proposals for changes in the commissioning

arrangements where the implementation of the proposals would have an impact on the manner in which the services are delivered to the individuals or the range of health services available to them, and

· decisions affecting the operation of the commissioning arrangements

The Act also updates Section 244 of the NHS Act 2006 which requires NHS organisations to consult relevant Overview and Scrutiny Committees on any proposals for a substantial development of the health service in the area of the local authority, or a substantial variation in the provision of services.

The Equality Act 2010Section 149 of the Equality Act 2010 states that a public authority must have due regard to the need to a) eliminate discrimination, harassment and victimisation, b) advance ‘Equality of Opportunity’, and c) foster good relations. It unifies and extends previous disparate equality legislation. Nine characteristics are protected by the Act: age; disability; gender re-assignment; marriage and civil partnership; Pregnancy and maternity; race; religion or belief; sex; and sexual orientation.

An Equality Impact Assessment (EQIA) will need to be undertaken on any proposals for changes to services that are developed through the programme, in order to understand any impact on the protected groups and ensure equality of opportunity. Engagement must span all protected groups and other disadvantaged groups and care should be taken to ensure that seldom-heard interests are as engaged as much as others and supported to participate.

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The NHS ConstitutionThe NHS Constitution came into force in January 2010, setting out a number of rights for patients which are protected by law. This includes the following right at Section 2a: “You have the right to be involved, directly or through representatives, in the planning of healthcare services, the development and consideration of proposals for changes in the way those services are provided, and in decisions to be made affecting the operation of those services.”

Secretary of State’s key testsAny plans for reconfiguring health services also need to comply with the four tests set down by the Secretary of State, the second of which relates specifically to engagement. These will be assessed through the Strategic Health Authority’s Service Change Assurance Process (SCAP) to assure there is sufficient evidence to progress to consultation if required. The four tests are:

1) Support from GP commissioners2) Strong engagement, including local authorities, public and patients3) A clear clinical evidence base underpinning proposals4) The need to develop and support patient choice.

3.2 Other considerations

There is another major transformation taking place in the adjoining Mid Yorkshire health and social care economy, which will have direct implications for the work taking place in Calderdale and Huddersfield. There is considerable commonality in the drivers for change and issues being addressed so it is important that messages around these are consistent across the region.

4. Engagement process and use of existing data

An action plan for the engagement process was drafted and agreed by the Unplanned Care, Care Stream (Appendix 1). The action plan identified three stages for the engagement process, the three stages are:

· Stage 1: To source existing intelligence which can be used to evidence patient, carer and public views.

· Stage 2: To further engage with patients, public and carers; and· Stage 3: To conclude the engagement process by providing a report of findings.

Stage 1

The engagement team searched local and national files for any existing feedback from public, patients and carers on the theme of ‘Unplanned Care’. It was agreed that a search would go back as far as three years for most intelligence with an exception for relevant information. All the documentation collected was placed in a library folder on the ‘SharePoint’ site for all care stream members to access and consider. Intelligence from the Health Informatics Service, Patient Advise and Liaison Service (PALS), complaints, Patient Opinion and partner organisations was also included.

A key messages report was written to ensure that the care stream had an overview of the key issues, concerns and priorities for patients. In addition the key messages report

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highlighted what we had already been told. This information was used to identify the areas of focus for the care stream as part of ‘Stage 2’.

Stage 2

The method of involvement to engage further with public, patients and carers was to deliver a questionnaire (Appendix 3). The survey aimed to gather the views of the general public in respect of the services they had used the last time they had an unexpected health problem. This work looked at capturing experiences that had occurred in the last 12 months from the date of the engagement activity.

Two surveys were produced; firstly, a “general survey” was developed to be used both in hard copies and on line. Secondly, a “location survey” was developed, which was used by the engagement team to capture the views of people in locations across Calderdale and Huddersfield, including GP practices and Accident and Emergency departments.

Furthermore, an additional version of the general survey was produced specifically for children and young people and this work conducted by an external organisation. The results of this survey can be found in the report entitled Children’s Care produced for the purposes of that care stream. Copy of the survey developed for this engagement initiative can be found in Appendix 4.

Stage 3

The findings from the library of intelligence and the engagement process in stage 2 are captured in the next section of the report.

5. Findings from the engagement process

Engagement evidence was gathered from three main sources:

· Unplanned Care survey conducted over the period November 2012 to January 2013 [see Section 5.2 for detailed findings].

· Patient feedback and enquiries over the last three years, gathered from Complaints and Patient and Advice Liaison Service information, together with a review of local patients’ posts on the Patient Opinion website [details in Section 5.3].

· Evidence from other engagement activities undertaken in the last three years [Section 5.4 provides individual summaries of the key findings from each of these].

This broad, inclusive approach was designed to maximise the use of all feedback and views provided by public, patients, carers and local voluntary and community groups, and ensure good representation from all sections of the community, including a wide range of minority groups.

5.1 Main themes

There are a number underpinning themes which were evident across the whole range of engagement evidence gathered. These are described below, and are evidenced in detail in the sub-sections of the report, as appropriate:

· Patients did not always feel that they knew where best to go to access the care they needed.

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· GPs and community-based health care elements were often closed when the patients needed to access them, forcing them to go elsewhere, despite their preferences to use these services. Other access issues, most commonly related to availability/choice of appointments, were also commonly raised by patients.

· Patients found the system fragmented with poor continuity of care – passed round from pillar to post, sometimes returning to A&E and other services on multiple occasions**. There was a need identified to build a more patient-centred approach and particularly to improve discharge and “hand-on” processes.

· Delayed diagnosis and/or mis-diagnosis.

· Some concerns that staff not sufficiently caring and did not take patients’ concerns about their health seriously enough, or consider their individual circumstances and needs.

· Inconsistencies in standards/quality of care received - patients consistently cited high standard/quality of care as important, but quite often report big inconsistencies in services or along different stages of their pathway.

· A number of examples of poor communication/ information provided to patient on their condition and subsequent management, and sometimes between different areas within the wider healthcare system at various stages of the patient pathway.

· Several cases where patients felt they were inappropriately discharged from A&E and were subsequently readmitted to hospital shortly afterwards.

· Patients placed high value on rehabilitation services/ being supported to self-manage/ manage their condition at home.

· Several groups of patients, most notably those with long term conditions, regularly used and reported poor experiences of a number of aspects of emergency and urgent care services. This further highlighted the importance of effective management of long-term conditions within the urgent care and wider local healthcare system. This review also highlighted the need to put in place better plans to cater for disadvantaged groups such as elderly people and/or those with cognitive impairment, and families with young children, who all featured heavily as users of urgent care systems, across the evidence base.

· Issues were raised about making better use of supporting technology, for instance telecare facilities and problems related to health professionals having limited (and variable) access to patient information available at point of contact.

· Other problems, mentioned predominantly in relation to A&E attendance, were patients’ concerns about long waits and not being told how long they would have to wait/ reasons why, and some patients were concerned that they received no, or inadequate pain relief.

** Note that this theme was also highlighted in the Planned Care engagement event, which is described in detail in the Planned Care Engagement Summary Report.

5.2 Unplanned care survey

The survey was conducted over a two month period from mid-November 2012, with the final surveys completed on 16 January 2013.

The general survey was distributed in paper form to individuals via a wide range of participating organisation across Calderdale and Greater Huddersfield. These included local

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community groups, organisations and their distribution networks, local venues (e.g. a primary school, toddler group, women’s activity centre).

In addition, the survey was also made available to the public in web form, accessible through the external websites of the partnership programme organisations. 93 forms were returned via this channel. In total, 1,339 general surveys were gained during the engagement process.

The location survey (an assisted survey) was used as an assisted survey in settings across Calderdale and Huddersfield, reaching a geographical spread of the venues and consisting of GP practices in Skelmanthorpe, Fartown, Slaithwaite, Hebden Bridge, Rastrick, Boothtown, Southowram and Todmorden. In addition, the two A&E departments were also used as locations and these particular surveys were conducted from mid December 2012 to mid January 2013.It should be noted that the general survey was used in addition to the location survey at various venues across the area.

In terms of the conduct of the assisted surveys, these were carried out following a formal approval from each venue to access their premises. Participants were made aware of the purpose of the survey and the option to freely decide on participation or otherwise. The independence of the work to the services within the setting was noted to ensure that relevant patient experience data were captured.

Completed surveys were submitted for analysis to The Health Informatics Service. Surveys were scanned, and a rigorous data management process applied. Surveys were only considered fit for analysis where question 1a had a valid answer (i.e. one tick only) and a minimum of one other survey question was answered. 63 returned surveys were excluded from analysis as a result of this process (further details are provided in Appendix 4).

Returned Excluded UsableGeneral Paper 1313 71 1242 Web 97 0 97 1339**Location Paper 247 1 246 246

** 1,339 responses in final analysis (8 additional surveys were excluded in error during the analysis).

In total, 1,339 general survey and 246 location survey responses were included in the final analysis.

Results tables and cross-tabulations for the general survey are presented in Section 5.2.1, whilst the main summary tables for the location survey are shown in Section 5.2.2.

Note that, as the numbers of respondents are much smaller for the location survey caution needs to be taken when comparing sub-groups. The main “top-level” findings of the survey, based primarily on the results from the much larger general survey, are summarised below:

• 55% of patients went to a GP, 17% went to A&E, with the remainder attending a mix of community based services (e.g. pharmacy, walk-in centre, dentist), took care of themselves, or contacted a telephone-based service.

• Although “acute” problems were most commonly given for reason of attendance (One off symptom 32%, sudden illness 15%, accident or injury 8%), it was also relatively common for patients to attend for problems related to chronic conditions (an ongoing problem 29%, long term condition 12%).

• A wide mix of reasons for choosing a particular service were given [Question 3], with the most popular being location (24%) and “I have been here before” (17%).

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• The most common expected outcomes of the visit were diagnosis (29%), treatment (21%), and medication/prescription (15%).

• Satisfaction rates, measured in several ways [see Questions 4b, 5, 6], were similar for GP, A&E and community based services, with an overall average of just under 90% of patients would recommend the service to family or friends.

More detailed comparisons of how the three main types of service (A&E, GP, Community-based services) are accessed and used, together with differences in behaviour of demographic sub-groups, is provided in Section 5.2.

5.2.1 General survey results

Summary resultsNote: totals for individual questions may differ as respondents left some questions blank.

I am completing this survey...

Number Percentage

About me 969 74.1%As a carer 83 6.3%As a parent 154 11.8%On behalf of someone else 102 7.8%Total 1308

Q1a. What did you FIRST DO the last time you had an unexpected health problem (tick ONE choice only)

Number Percentage

Went to A&E 226 16.9%Went to GP 729 54.6%Went to Pharmacy 59 4.4%Went to Walk-in Centre 38 2.8%Went to Optician 32 2.4%Went to Dentist 50 3.7%Contacted Crisis Intervention Centre 3 0.2%Called NHS Direct 68 5.1%Visited the NHS Direct Website 10 0.7%Called West Yorkshire Urgent Care Service 9 0.7%I took care of myself/ patient 60 4.5%Other - (please state) 52 3.9%Total 1336

A full list of the “Other” category breakdown is provided in Appendix 5.

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Q1b. At the time, would you describe your health problem as....? (Tick ONE choice only)

Number Percentage

An ongoing problem 376 28.9%A one off symptom 410 31.5%A long term condition 162 12.5%A sudden illness 190 14.6%An accident or injury 98 7.5%Other - (please state) 40 3.1%Prefer not to say 24 1.8%Total 1300


Q1c. Which of the following did your health problem relate to? (Tick ONE choice only)

Number Percentage

Physical symptom 869 68.2%Your eyes 91 7.1%Dental health 63 4.9%Mental health problem 61 4.8%Substance misuse 29 2.3%Other - (please state) 106 8.3%Prefer not to say 56 4.4%Total 1275


Q2. Why did you choose to use that service? (tick ALL that apply)

Number Percentage

It was my decision 834 53.8%Family/friend suggested I go there 203 13.1%A health professional referred me 70 4.5%Poster/leaflet 28 1.8%NHS Direct sent me there 39 2.5%Advice from NHS Direct website 17 1.1%Advice from another website 9 0.6%I did not know where else I could go 83 5.4%I have used the service before 216 13.9%Other - (please state) 52 3.4%Total 1551

Note: Includes multiple answers from some respondents. A full list of the “Other” category breakdown is provided in Appendix 5.

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Q3. Were there any other reasons why you chose that service? (tick ALL that apply)

Number Percentage

Location 567 24.2%Parking 184 7.8%Public transport 55 2.3%More culturally sensitive 32 1.4%Confidence in the staff 247 10.5%Environment 81 3.5%Opening times 239 10.2%I have been here before 394 16.8%I have a good experience/outcome before 178 7.6%I could fit it in with my daily routine 162 6.9%Other - (please state) 123 5.2%No 85 3.6%Total 2347


Q4a. What did you expect would be the outcome of using that service? (Tick ALL that apply)

Number Percentage

The diagnosis of a problem/illness/symptom 615 28.9%The opportunity to speak to a health care professional 282 13.3%A second opinion 93 4.4%A referral for further consultation/treatment 191 9.0%Medication/prescription 328 15.4%Diagnostics such as X rays and blood tests 115 5.4%Treatment 455 21.4%Other - (please state) 49 2.3%Total 2128


Q4b. Were your expected outcomes of that service met?

Number Percentage

Yes, all expectations were met 865 68.2%Some expectations were met 269 21.2%No 90 7.1%Don't know 45 3.5%Total 1269

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Q5a. How confident were you that the service you used was right for your health problem?

Score Number Percentage

1 17 1.4%2 18 1.5%3 25 2.0%4 41 3.3%5 66 5.4%6 89 7.2%7 140 11.4%8 212 17.2%9 195 15.8%10 430 34.9%Total 1233Average Score 8.0

Q6. Would you recommend this service to a family member or friend as a high-quality place to receive treatment and care?

Number Percentage

Yes 1077 89.6%No 125 10.4%Total 1202

Q8a. How long did it take you to travel to this service?

Number Percentage

Under 15 minutes 279 22.8%15-30 minutes 542 44.3%30-60 minutes 289 23.6%1-2 hours 113 9.2%Total 1223

Q8b. What would be the maximum amount of time you would be prepared to travel for a high quality healthcare service?

Number Percentage

Under 15 minutes 769 63.0%15-30 minutes 320 26.2%30-60 minutes 78 6.4%1-2 hours 12 1.0%Not applicable - travelled by Ambulance 41 3.4%Total 1220

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It is interesting to note, when combining the information provided by individual responders for questions 8a and 8b, that:

· 54.6% of respondents would be prepared to travel further (for a high quality healthcare service) than the journey they actually made

· 41.6% of respondents would be prepared to travel the same distance

· 3.8% of respondents would only be prepared to travel a shorter distance

The majority of respondents travelled “Under 15 minutes” for the surveyed service visit, but would generally be prepared to travel “30-60 minutes”.

Detailed Results – By Service Detailed cross-tabulated results, splitting out findings by the type of service respondents accessed, are shown below. Note that for this analysis “Community” covers all response categories from question 1a other than “Went to A&E” or “Went to GP”.


A&E GP Community

An ongoing problem 9% 75% 16%A one off symptom 13% 50% 37%A long term condition 10% 65% 25%A sudden illness 20% 45% 35%An accident or injury 65% 15% 19%Other - (please state) 10% 30% 60%Prefer not to say 25% 29% 46%Total 17% 55% 29%


A&E GP Community

Physical symptom 17% 61% 22%

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Your eyes 14% 34% 52%Dental health 3% 17% 79%Mental health problem 10% 52% 38%Substance misuse 34% 28% 38%Other - (please state) 24% 48% 28%Prefer not to say 30% 50% 20%Total 17% 54% 29%


A&E GP Community

It was my decision 15% 62% 23%Family/friend suggested I go there 21% 47% 32%A health professional referred me 17% 52% 30%Poster/leaflet 7% 18% 75%NHS Direct sent me there 23% 46% 31%Advice from NHS Direct website 6% 47% 47%Advice from another website 0% 22% 78%I did not know where else I could go 30% 49% 20%I have used the service before 10% 53% 36%Other - (please state) 33% 25% 42%Total 17% 55% 28%

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A&E GP Community

Location 17% 66% 17%Parking 13% 67% 20%Public Transport 9% 55% 36%More culturally sensitive 19% 52% 29%Confidence in the staff 7% 68% 24%Environment 11% 69% 20%Opening times 17% 50% 32%I have been here before 12% 60% 28%I have a good experience/outcome before 6% 59% 35%I could fit it in with my daily routine 10% 51% 40%Other - (please state) 32% 37% 31%No 26% 42% 32%Total 13% 56% 30%

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A&E GP Community

The diagnosis of a problem/illness/symptom 19% 63% 18%The opportunity to speak to a health care professional 15% 56% 29%A second opinion 17% 45% 38%A referral for further consultation/treatment 14% 66% 20%Medication/prescription 8% 69% 22%Diagnostics such as X rays and blood tests 40% 48% 12%Treatment 25% 51% 24%Other - (please state) 10% 20% 69%Total 18% 58% 23%

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A&E GP Community

Yes, all expectations were met 146 474 243Some expectations were met 49 155 65No 16 46 28Don't know 9 25 11Total 220 700 347Average Score ** 80.8 81.7 82.0

** Note: Score calculated as 100 for “Yes, all expectations were met”, 50 for “Some expectations were met”, 0 for “No”. “Don’t know” responses are excluded from the calculation.


Score A&E GP Community

1 2 5 102 2 11 53 8 10 74 7 21 135 15 39 126 14 46 297 22 81 378 31 132 489 32 111 5110 80 225 125Total 213 681 337Average Score 8.0 8.1 7.9


A&E GP Community

Yes 188 614 273No 20 64 41Total 208 678 314Would Recommend 90.4% 90.6% 86.9%

No significant differences between the three groups, although slightly lower percentage “would recommend” for those who attended Community-based services.


A&E GP Community

Under 15 minutes 115 (53%) 500 (72%) 153 (49%)

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15-30 minutes 71 (33%) 154 (22%) 94 (30%)30-60 minutes 14 (7%) 28 (4%) 36 (12%)1-2 hours 2 (1%) 6 (1%) 4 (1%)Not applicable - travelled by Ambulance 13 (6%) 2 (0%) 26 (8%)Total 215 690 313

A larger proportion of those attending GP Practices (72%) travelled for less than 15 minutes, than those attending A&E (53%) or a variety of Community-based services (49%).


A&E GP Community

Under 15 minutes 57 (27%) 161 (24%) 60 (18%)15-30 minutes 89 (42%) 285 (42%) 168 (51%)30-60 minutes 49 (23%) 174 (25%) 66 (20%)1-2 hours 16 (8%) 64 (9%) 33 (10%)Total 211 684 327

No significant differences between the three groups.

Detailed results – by patient characteristics Detailed cross-tabulated results, splitting out findings by patient characteristics, are shown below. Note that results are only displayed for those areas where clear differences exist between patient groups. Full results are available on the analysis files held in the project SharePoint area.

The most striking differences were seen with respect to age groups; in particular, the behaviour of the younger age groups (0-16, 16-25) is noticeably different to others. The main differences were:

• Larger proportion of 0-25 group go to A&E (25% vs 12-14% for other age groups).

• 0-25 group scored lower for “Were your expected outcomes of that service met” and “Would you recommend this service to a family member or friend.”

• Although the profiles of actual distance travelled were similar for all age groups, there was a marked difference in the distance respondents were willing to travel with 76% of 0-25 age group (and/or their parents) only willing to travel 0-15 minutes.

Smaller differences could also be seen for some other patient groups:

• A higher proportion of females tended to go to A&E (21%) than males (14%).

• Females also chose “location” as a reason for choice of service (28% vs 22%) and were generally prepared to travel less far for healthcare services than males (for example 25% of females indicated maximum travel time of “Under 15 minutes” vs 18% males).

• Unsurprisingly, a much larger proportion of respondents who indicated they had a disability, indicated that their reason for attendance was because of “an ongoing

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problem” (44% vs 25% others) or a “long term condition” (23% vs 10%), and this was more likely to be related to a “mental health problem” (9% vs 4%).


Age 0-25 26-55 56-75 76+Went to A&E 25% 14% 12% 13%Went to GP 45% 55% 69% 60%Community - other 30% 31% 19% 27%


0-25 26-55 56-75 76+An ongoing problem 23% 27% 39% 42%A one off symptom 32% 35% 28% 23%A long term condition 8% 12% 16% 18%A sudden illness 18% 16% 10% 8%An accident or injury 12% 7% 5% 6%Other - (please state) 4% 3% 1% 3%Prefer not to say 3% 0% 0% 0%


0-25 26-55 56-75 76+Yes, all expectations were met 59% 71% 71% 74%Some expectations were met 22% 21% 22% 15%No 13% 5% 6% 7%Don't know 6% 2% 1% 4%Average Score ** 74.2 82.0 82.9 84.8

** Note: Score calculated as 100 for “Yes, all expectations were met”, 50 for “Some expectations were met”, 0 for “No”. “Don’t know” responses are excluded from the calculation


0-25 26-55 56-75 76+Yes 82% 92% 92% 94%No 18% 8% 8% 6%

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0-25 26-55 56-75 76+Under 15 minutes 76% 28% 19% 16%15-30 minutes 8% 47% 46% 44%30-60 minutes 10% 19% 26% 27%1-2 hours 6% 7% 8% 14%

Although the profiles of actual distance travelled (Q8a – not shown) were similar for all age groups, there was a marked difference in the distance respondents were willing to travel with 76% of 0-25 age group (and/or their parents only willing to travel 0-15 minutes.

5.2.2 Location survey results

Top level summary results are provided in the section below. Detailed cross-tabulated results, mirroring those from the general survey shown in Section 5.1, are provided in Appendix 5. Note that as survey numbers are relatively small, caution needs to be taken in interpreting these results. Patterns broadly mirror those seen for the general survey results.

Summary ResultsNote: totals for individual questions may differ as respondents left some questions blank.

I am completing this survey...

Number Percentage

About me 169 71.9%As a carer 10 4.3%As a parent 33 14.0%On behalf of someone else 23 9.8%Total 235


Number Percentage

Went to A&E 136 57.6%Went to GP 99 41.9%Went to Walk-in Centre 1 0.4%Total 236


Number Percentage

An ongoing problem 51 22.0%

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A one off symptom 50 21.6%A long term condition 10 4.3%A sudden illness 25 10.8%An accident 61 26.3%For results 3 1.3%Because I don't know what's wrong 19 8.2%Other - (please state) 13 5.6%Total 232

Note: This question has a slightly different response structure to the equivalent question in the General Survey. A full list of the “Other” category breakdown is provided in Appendix 5.


Number Percentage

Physical symptom 190 82.3%Your eyes 7 3.0%Dental health 2 0.9%Mental health problem 7 3.0%Substance misuse 2 0.9%Other - (please state) 14 6.1%Prefer not to say 9 3.9%Total 231



Number Percentage

It was my decision 130 42.5%Family/friend suggested I come here 27 8.8%A health professional referred me 29 9.5%Poster/leaflet 0 0.0%NHS Direct sent me here 12 3.9%Advice from NHS Direct website 5 1.6%Advice from another website 0 0.0%I did not know where else I could go 14 4.6%I have used the service before 60 19.6%Other - (please state) 29 9.5%Total 306


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Number Percentage

Location 117 20.2%Parking 24 4.2%Public transport 6 1.0%More culturally sensitive 2 0.3%Confidence in the staff 62 10.7%Environment 33 5.7%Opening times 49 8.5%I have been here before 124 21.5%I have a good experience/outcome before 65 11.2%I could fit it in with my daily routine 34 5.9%Other - (please state) 21 3.6%No 41 7.1%Total 578



Number Percentage

The diagnosis of a problem/illness/symptom 135 34.4%The opportunity to speak to a health care professional 37 9.4%A second opinion 10 2.5%A referral for further consultation/treatment 21 5.3%Medication/prescription 47 12.0%Diagnostics such as X rays and blood tests 52 13.2%Treatment 86 21.9%Other - (please state) 5 1.3%Total 393



Number Percentage

Yes, all expectations were met 119 64.0%Some expectations were met 21 11.3%No 2 1.1%Don't know 44 23.7%Total 186

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Note: Patients were asked to complete the survey whilst still on-site so not all had completed their episode of care at that point. As a result of this, there were a relatively high number of non-responders or people who answered “Don’t know” for this question.


Score Number Percentage

1 1 0.4%2 2 0.9%3 0 0%4 0 0%5 11 4.8%6 8 3.5%7 19 8.4%8 40 17.6%9 41 18.1%10 105 46.3%Total 227Average Score 8.7

Note: The Average Score (8.7) is higher than in the General Survey (8.0), but the two scores may not be directly comparable. A number of studies have shown that patients typically mark higher scores at “point of care” (as in this Location-based survey) compared to completing surveys retrospectively (as was the case for the General Survey).


Number Percentage

Yes 197 94.7%No 11 5.3%Total 208

Note: The percentage of responders who answered “Yes” for this question (94.7%) is higher than in the General Survey (89.6%), but the two scores may not be directly comparable. A number of studies have shown that patients typically mark higher scores at “point of care” (as in this Location-based survey) compared to completing surveys retrospectively (as was the case for the General Survey).


Number Percentage

Under 15 minutes 152 66.7%15-30 minutes 61 26.8%30-60 minutes 9 3.9%1-2 hours 4 1.8%

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Not applicable - travelled by Ambulance 2 0.9%Total 228


Number Percentage

Under 15 minutes 25 11.4%15-30 minutes 127 58.0%30-60 minutes 46 21.0%1-2 hours 21 9.6%Not applicable - travelled by Ambulance 25 11.4%Total 127

It is interesting to note, when combining the information provided by individual responders for questions 8a and 8b, that:

· 70.0% of respondents would be prepared to travel further (for a high quality healthcare service) than the journey they actually made.

· 27.2% of respondents would be prepared to travel the same distance.

· 2.8% of respondents would only be prepared to travel a shorter distance.

The majority of respondents travelled “Under 15 minutes” for the surveyed service visit, but would generally be prepared “30-60 minutes”.

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5.3 Patient feedback/enquiries

5.3.1 PALS and Complaints information – NHS Kirklees

Note that this information covers the Kirklees population as a whole. We are unable to split out the data to focus purely on our main area of interest for this report, Greater Huddersfield, but would expect key messages to be valid across each component area.

PALS and complaints information most relevant to Unplanned Care was accessed by focusing on information held in the Datix system which related to either A&E or Community Urgent Care. In addition, information on other, mostly condition-related complaints such as stroke and cancer, was also reviewed for any elements which helped inform our understanding of the patients’ experience of urgent/unplanned care.

There were a total of 19 complaints (5 A&E/14 Community Urgent Care) and 44 PALS contacts (12/32), made over the period from 1 September 2009 to 31 August 2012. These, together with relevant condition-related complaints were primarily related to the following themes:


· GPs and community-based health care elements were often closed when the patients needed to access them, forcing them to go elsewhere.

· Patients found the system fragmented with poor continuity of care – passed round from pillar to post.



· Inconsistencies in standard/quality of care received.

Illustrative extracts from the Datix system are shown below:

“Presented himself to his GP on a number of occasions and also visited A&E at HRI complaining of abdominal pain and constipation …. On attending the GP a further time and seeing the locum an urgent ultrasound scan was arranged which confirmed the complainant had advanced pancreatic cancer … He feels the diagnosis could have been made sooner.”

“Although he attended A&E on a number of occasions he was diagnosed with 'whip-lash' and given an exercise sheet and some painkillers. He eventually presented to his GP who immediately rang HRI to book an urgent CT scan which resulted in the complainant being immediately transferred to LGI where he was diagnosed with a broken neck.”

“The patient felt that the A&E dept did not explain what was wrong with him and sent him away still in pain … returned to the A&E dept on three further occasions but was not given any further information .. (later) After undergoing emergency surgery caller was told that he had septic arthritis in his hip bone.”

“She doesn't know why this dentist didn't admit her to A and E due to her worsened condition. She is also complaining predominantly about A&E at HRI due to not treating her at all.”

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“This is the second occasion that I’ve been unable to access a doctor and spoken too by the receptionist in a degrading way offering no help at all except go to A&E.”

“She is angry that she was left for 2 days in severe pain and felt that the Doctor didn't care.”

“After undergoing emergency surgery caller was told that he had septic arthritis in his hip bone … The patients complaint is that the correct investigations were not conducted by the A&E dept at HRI.”

“She was then told to either see her Doctor or to come back to the hospital two days later for her son's hand to be checked. Her Doctors does not redress burns so they directed her to the district nurse. She tried to get through to the district nurse but after a while gave up and contacted A and E. She spoke to the charge nurse … told her to visit the walk in centre at Dewsbury Hospital on Mon to again check it.”

“Her daughter was also admitted with vomiting blood and pain. She felt unreassuringly by the staff and felt they didn't do anything for her.”

“Caller had taken her son to A and E with a swollen hand, they sent him away with just bruised muscles. However she just had a letter yesterday from the consultant that he wants to review the x rays. It turns out he has 2 fractures in his hand.”

“Complainant attended Laura Mitchell Health Centre Out of Hours dental service requiring urgent dental treatment and feels as though has been passed from pillar to post and treated shabbily.”

“Diagnosed with bowel cancer last week she became less mobile and in a lot of pain. The Dr visited but did not examine her and told her to contact the Macmillan Nurses for pain relief. The patient had to ring Macmillan then the District Nurses and the GP and ended up asking the GP for a home visit. She had to explain that she could not get out of bed. The same Dr visited and said that she needed to go urgently to hospital and that he would send an ambulance.”

“The patient woke up with a severely swollen neck and face. When she went to the Walk-In centre to see a Dr the receptionist refused her an appointment as it is dental and the Dr's won't see her. The complainant then had to attend A and E where she was given antibiotics and then further sent to Pinderfields for IV antibiotics and 3 operations.”

“The complainant has been treated at Calderdale Royal Hospital and has felt that she did not receive the correct diagnosis about her mental health. She also felt that people were conspiring against her.”

“She mentioned that she was in a lot of pain and so needs to be seen quickly. She was told that due to a new directive the GP can't refer directly from a GP and instead have to go through a physiotherapist.”

“However, he did not allow the complainant to hold his wife's hand and made him hold the nurses. This made him feel very uncomfortable. The complainant feels that as another Muslim he should have known that this is not allowed.”

“… at logger heads with the new dentist. She has rung the emergency dentist but they say her mouth is not swollen enough to see her. She has also been to A and E as she is in so much pain but they can't deal with dental problems.”

“Caller rang explaining that he had rung up NHS Direct and told to go to A and E they would only give him ibuprofen. He rang NHS Direct up again and they said that A and E should have treated you.”

“The caller had rung the out of hours service at about 6.30 in the morning on Tues (21.06.11), she was told that as she was not next of kin to the grandson (25 years old) the

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mother will need to ring. The mother rang and was told that there were no Dr's available to visit as they were all busy.”

“They had to wait 12 hours before they could get an appointment, which took place at 8:15 that evening, at a time when he is normally fast asleep in bed …. Caller went to the pharmacy recommended by the dentist as open at Greenhead Road, it was closed. They then went to Boots on Leeds Rd, closed. Caller rang Pendoc to see if there was anywhere else they could go, the answer was no. … very disappointed with both services, why did my grandson have to wait 12 hours for an appointment, particularly when it meant that we could not then find a pharmacist open to have the prescription filled?”

“In the end we had to trail over to HRI as his own practice emergency contact numbers were ringing out without answer and the practice, which says is open on Saturday morning, was not open.”

“She has been offered the next available appointment of next Tues. She then tried NHS Direct and were told that they can't help as her GP is open. She could ring this evening after 6pm and get an emergency appointment with a doctor. She then tried the pharmacy and was told that she needs to see a doctor.”

“As a parent if she is unable to get in contact with her child's doctors because they are closed on a particular afternoon or if they are unable to get her a suitable appointment to see him caller feels that she should expect to be able to find an NHS walk-in centre to take him to.”

“Enquirer from WYUCS wanted to make the PCT aware that they were receiving a lot of calls from Practice's patients as their phones are being diverted directly through to WYUCS. Enquirer stated that WYUCS were not aware that the Practice would be closed and needing to use WYUCS.”

5.3.2 Complaints information – Locala

Information below has been summarised from the Locala Community Partnerships Quality Account 2011-12 [Reference 3] and a graphical presentation of the complaints data covering the period 1 April 2011 to 30 June 2012 [4].

Note that this information covers the Kirklees population as a whole. We are unable to split out the data to focus purely on our main area of interest for this report, Greater Huddersfield, but would expect key messages to be valid across each component area.

Of a total of 45 complaints received by Locala over the year 2011-12, the largest numbers were seen for the following services:

· District Nursing – primarily staff attitude (12)· Podiatry – primarily quality of service (10)· Dental services – primarily waiting times (5)

Overall, the most common reasons for the complaints (DH categories used) related to:· Aspects of clinical treatment (17)· Attitude of staff (13)· Delay/cancellation of appointments (8).

The Quality Account highlighted, in particular, the need to learn from complaints around staff attitude as a priority and described how learning from complaints now formed an integral part of recently implemented Service reviews throughout Locala.

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5.3.3 Complaints information – Calderdale and Huddersfield Foundation Trust (CHFT)

Complaints information most relevant to Unplanned Care was accessed by focusing on information held in the Datix system which related to A&E, using a combination of search criteria based on the Specialty field and a series of keyword/phrase searches.

The searches identified a total of 279 complaints made over the period from 1 September 2009 to 31 August 2012. These were primarily related to the following themes:

· Patients found the system fragmented with poor continuity of care – passed round from pillar to post, sometimes returning to A&E on multiple occasions.


· A number of patients complained about long waits and were often not told how long they would have to wait, or reasons why.



· Several cases where patients were concerned that they received no, or inadequate pain relief.

· Poor communication/ information provided to patient on their condition and subsequent management, and sometimes between different areas within the hospital system.

· A few cases highlighting poor hand hygiene, or problems of cleanliness of treatment rooms and surrounding areas.

· Inconsistencies in standard/quality of care received.

It is also interesting to note, from the narratives, the mix of patient characteristics for the reviewed cases; a sizeable proportion appear to relate to children, elderly patients requiring support from family, physically disabled patients, and several patients with some form of cognitive impairment.

Illustrative extracts from the Datix system are shown below:

“Complainant's daughter who has learning difficulties, cerebral palsy and is a quadriplegic and is wheelchair bound, pulled out her feeding tube and needed to go to A & E. They were booked in at 2.55 pm and was still there at 11.35, still in her wheelchair, which is not meant to sit in for more than 4 hours and the staff knew this, there was no bed available to change her pad or make her more comfortable.”

“Concerns re care and treatment following biopsy, unable to contact ward for advise had to come to A&E for post op bleeding and high temperature; doctor in A&E confused re procedure undertaken diagnosed infection and patient admitted; following short stay discharged; confusion re which type of antibiotics and diagnosis; GP had to chase results; patient worsened and developed urine retention; GP arranged admission and conflicting information and lack of pain relief; poor communication.”

“Concerns re lack of care and treatment of son's knee and discharged with no advice.”

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“Daughter concerned re standard of care offered to wheelchair bound elderly father; issues re doctor's handling of hygiene, despite wearing gloves large of amount of blood transferred to stainless steel trolley and whilst with bloodied gloves doctor rummaged through trolley taking out and putting back bandages not to be used. Doctor did not wash her hands; only hand wound looked at daughter had to ask re head wound. Poor communications skills and difficult to understand what was being said, especially when chewing on sweet.”

“Concerns regarding her mother's stay on MAU. The attitude of one of the doctors. The miscommunication regarding her mother's possible discharge and the possible increase in her medication, when A&E had thought this needed to be decreased.”

“Daughters of elderly patient not happy she was kept 7 hours in A&E before being admitted and moved to MAU just after midnight. Raised this with a matron in A&E but have not heard anything further. Also concerns around the communication with the ward regarding discharge.”

“Concerns that elderly patient attended A&E and was discharged the same day despite an x-ray showing lungs to be congested. Patient was admitted a few days later and is quite poorly with pneumonia, heart failure and renal failure. Daughter feels no consideration of her mother's age and condition were thought out before her discharge from A&E.”

“Patient attended A&E department twice after injury to her wrist. Patient received X-ray and advised muscle injury/sprain. Patient has returned to GP who confirmed patient had dislocated her wrist and referred back for orthopaedic OPD.”

“Unclear, confusing and misleading information from nurses, consultant and social workers. No contact was made with family regarding potential homelessness.”

“Patient explained he presented in A&E at approx 2pm with chest pains and was advised that he was to be admitted. Patient advised he was then left by himself on the ward in A&E until 12.20am when he was then discharged home in a taxi as there were no beds … has now contacted his GP and is awaiting a call back.”

“Call from mum who wished to make a complaint regarding the way both herself and her 2 year old daughter were communicated with in A&E following an injury to her eye. Mum was unhappy that her daughter was called Alfie (a boy's name) as staff could not pronounce her daughter's name (Aofie). Mum was also unhappy about the fact that they were left waiting and were not informed how long they would be waiting or what they were waiting for. When a doctor eventually came to see them he/she did not introduce themselves and as they had been waiting so long it was too late to glue her daughter's injury.”

5.3.4 Patient Opinion website

The Patient Opinion website offers patients a chance to submit and search information on their healthcare experiences of NHS services across England and Wales. It describes itself as “An independent site about your experiences of UK health services, good or bad. We pass your stories to the right people to make a difference”. This media also links with information held on NHS Choices.

Information on patient stories related to local services was downloaded and analysed to help us better understand patients’ views and experiences. The website search facility was used to pick out posts related to any of the following:

· Calderdale and Huddersfield Foundation Trust· NHS Calderdale

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· NHS Kirklees· Locala· Calderdale Royal Hospital· Huddersfield Royal Infirmary· and a number of other related searches on smaller individual community-based

services (e.g. Moorfield Primary Care Centre, Holme Valley Hospital)

After reviewing information to remove duplicates and “out of area” cases, the dataset consisted of 256 individual patient posts.

A cautionary note should be applied to interpretation and extrapolation of the findings below. As an external site, we do not have the ability to audit or verify the authenticity of the posts, and it should also be borne in mind that this forum is likely to only attract a certain subset of the service user and wider population. It is also noticeable that certain “clusters” of similar posts occur from time to time, suggesting these may have been prompted by an element of marketing and/or referral to the site.

Common themes prevalent in the patient feedback information, included:

Patients sometimes found the system fragmented with poor continuity of care/discharge – passed round from pillar to post (several positive comments re. Importance of effective triage)“When she returned home from the hospital she was in so much pain we had to call an ambulance. The ambulance arrived after 20 minutes and in my opinion then wasted approximately 45 more minutes in deciding whether or not she needed to be taken into hospital, even though she was clearly in a lot of pain. When we arrived at the hospital I found the staff I saw inconsiderate …My mother was then seen to by a junior surgeon who did not seem to take into account my mothers previous surgery… After a 3 hour wait the staff came to an assumption that my mother needed constipation tablets and could return home …On our arrival at home my mother was violently vomiting and was still in a lot of pain. We managed to ease the pain till the morning. We then had to call the hospital regarding the cannula in my mothers arm. They sent a district nurse out to remove it who told us she was baffled at why my mother had been sent home in such a state as she also suffers from low blood pressure.”

“The doctor saw her on a Friday morning and said she could go home but the nurse pointed out that there were some blood test results that were still awaited … The nurse then told me it was too late to book ambulance transport to let mum come home … with proper planning she could probably have been discharged on the Friday and as a result she was in hospital for 3/4 days longer than I felt was necessary.”

“She prescribed for me something I had already tried, I went back the next day to pick up my prescription and the day staff had no idea what I was talking about because the night staff kept no record.”

“Having been passed from pillar to post, the guys at the diabetic podiatry unit and Dewsbury Hospital have taken responsibility for my care and are doing a great job.”

“On Sunday we sent for an ambulance for my wife and she was taken to Calderdale Royal. The ambulance staff, A&E, the nurses and the doctors were excellent (but) … when the first set of paramedics arrived my wife was in too much pain to move. However, neither of them were allowed to administer entonox … had to wait an hour for another paramedic to come.”

“The doctor wanted a slab plaster putting on my left shoulder for overnight stability but there was no person in A & E that had the capability to fit this plaster.”

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“I trotted off to A and E as it was a deep cut and prepared myself for a long wait. What a pleasant surprise I had instead. I had to wait around 20 mins for triage but as soon as I got in there the male nurse assessed the damage ... I was patched up in two minutes - tetanus background checked and on my way. It was a very pleasant surprise and something I hope happens more and more in triage with minor injuries.”

GPs and community-based health care elements were often closed when the patients needed to access them, forcing them to go elsewhere.“After having rung NHS direct for advice about my 7 month old granddaughter, I was told to take her to the drop in centre at 1.30pm Sunday. All signs on the door said the centre was closed, but I gave the buzzer a press anyway but did not get any response, so took the baby to A&E to ask where we should take her.”

“This was my first experience of using 'out of hours' services, and I am left feeling a bit alarmed by the lack of professional care available during times deemed inconvenient to GP and dental practices (totalling more than half the year, if you include nights, weekends and holidays).”A number of other different issues with access to services/healthcare facilitiesI called the surgery today for an appointment with the nurse. I was told that they only now “have one nurse and that she would be going on holiday and I would therefore have to wait until the end of September for an appointment.”

“The appointment system is a farce. The GP told me to call or go online for a choice of hospital and appointment times. The reality was that there was no appointments available.”

“There are approx 10,000 patients at the practice at Ravensthorpe health Centre Dewsbury and only 2, yes 2, disabled parking bays. How ridiculous is this? Oh Yes there's lovely green grass going to waste and needs maintaining but how on earth are disabled patients expected to attend the surgery when they cannot park?”

“I only waited around 3 weeks before i received a letter to ask me to ring to make an appointment. The lady on the phone was very helpful, offering various dates for me to attend that fitted around my work schedule (unlike the main hospital where a date is sent out through the post, which is usually not convenient and trying to change it is made to feel like a chore).”

“I've had one appointment cancelled without anyone telling me, another appointment where I turned up and there wasn't even a clinic, and one appointment that over-ran by 1.5 hrs with no apology or reason given.”

“I just rang up to make an appointment with the bookings secretary and she says I can’t have an appointment for 26 weeks! It’s outrageous. I wanted to complain to NHS Kirklees about this, but when I call their PALS line, no one answers.”

Patients did not always feel that they had been provided with sufficient information to know where best to go to access the care they needed. “From my experience, people in their late 70s sometimes do not get enough information about services and help available for dementia patients.”

Delayed diagnosis and/or mis-diagnosis.“I considered then and still consider now that the explanations provided by this doctor should in reality have been provided by A & E when I first went to A&E or by Orthopaedics the following morning.”

“I saw all 3 GP's at the Marsden surgery who prescribed anti-depressants … When I suggested to the GP's that maybe I had Chronic Fatigue Syndrome (CFS) I met a very

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negative response which bordered on hostile from one GP. It was made very clear that I didn't know what I was talking about and that I just had to be patient and take higher doses of anti-depressants. In August I saw an independent consultant who immediately diagnosed me as having CFS and has since put me on several treatments which are slowly making me better.”

Patients consistently cite high standard/quality of care as important, but quite often report big inconsistencies in services or along different stages of their pathway“From the minute I walked onto Ward 4C to the minute I left I was treated with care, compassion, respect and professionalism.”

Staff attitude/Care/ Some concerns that staff not sufficiently caring and did not take patients’ concerns about their health seriously enough, or consider their individual circumstances and needs.“Locala member of staff at the reception desk was abrupt, unhelpful and a little rude in directing me to the correct location for my appointment. The phlebotomist from Calderdale and Huddersfield Trust was very efficient and had a warm, approachable manner, I particularly noticed how gentle and reassuring she was towards the older people who were waiting.”

“The paramedics, the A & E team, medical assessment staff and especially the staff on ward 6D were efficient, concerned, and caring not only towards my mother but also to myself at a very difficult time. The consultant was sensitive to the need of the family to be kept informed and aware of the options open to us as to her continuing care.”

“I was telling my doctor about this problem I have had since I got back from my travels and was showing him the palm of my hand and my foot. He was on his computer, he glanced over and said he couldn't see anything and continued typing. I said the spots are tiny and they are under my skin and if he could actually take a closer look. He got irritated and said there was nothing there and continued typing.”

“I went to the Huddersfield Royal Infirmary last week for a blood test. They asked me to roll up the sleeve of my right arm so I explained that I have Parkinson's and that my right arm shakes especially when extended. "That's all right love, it doesn't matter we can still get it" they said to me. Even though I was thinking that wasn't what I meant … I think some medical personnel ought to listen more to a patient's concerns rather than making some people like me feel patronised.”

Patients put high value on rehabilitation services/ being supported to self-manage/ manage their condition at home.“First I attended joint therapy class where everything was explained, went home happier. I came home on 5th day and on the 6th day met my home therapist, who put me through my exercises.”

“Being introduced to the staff at Eddercliffe Physiotherapy Centre, first "at Home" and the centre itself was the best thing that has happened to me since leaving hospital. Having fractured my spine and broken a shoulder my balance was completely lost and confidence at rock bottom …worked with me at home, having assessed me, they showed me exercises to do. … were both very understanding and I developed an empathy with both. They encouraged me to try hard to do the exercises daily. Later at the centre I met the physio in charge who explained the structure of the session and introduced me to the other people in the group … very professional and encourages everyone making them feel valued and respected.”

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“I have now been having the District Nurses from Cleckheaton Health centre visit me at home for 8 weeks almost every day. They are such a fantastic team of community nurses ....all so friendly ...patient ...empathetic ...sensitive and so many more things.”

“I have received so much support from every nurse that has visited. They really do see the person and not just the "condition /illness /disability " which makes such a difference. They are so incredibly busy and have so much pressure with so many patients to see....but I can honestly say that they never let that affect the care. They will give that time to just sit and listen when you just need that little bit more.”

“Once I had recovered sufficiently to return home I was booked in for regular home visits … Initially he came every 14 days but I have now recovered sufficiently for the visits to cease and I now simply have to call if I feel I need assistance. I would like to say how absolutely wonderful these have been.”

“My introduction to your physio and reduced mobility has been excellent for me. Lovely friendly staff, very helpful, as I have struggled for a while to keep myself mobile when I should have asked for help.”

“After visiting the Podiatrist I was very pleased at the care, treatment and advice that was given. … was a little embarrassed regarding the condition of my feet and the past operations that had left slight deformities. I was soon put at my ease and a problem that I had been experiencing and unable to correct was soon diagnosed and treated … they have kept me out of hospital and sorted out my regular medication.”

Patients generally provide very positive feedback about a number of local community-based services in the area, particularly Moorfield Primary Care Centre (primarily for Dermatology service) and Locala services for Continence, Contraception and Sexual Health, and Podiatry **. Patients rate the ease of location, ease of access, and standards of care and communication provided by staff, highly.[** Note: this conflicts somewhat with Locala complaints information provided in Section 5.3]

“I only required three appointments with the Continence Advisor but found the service provided very impressive and would happily recommend it to anyone in the same situation The advisor who I was seen by was very friendly and approachable which made it easy to talk about problems despite their intimate nature.”

“I contracted chlamydia the other week and rang up my local chlasp clinic to see if I could get an appointment. There and then I told my story of what happened and we arranged to meet that same day. … This was all done within an hour and a half at the longest.”

“Great service right on your doorstep. Lots of interesting leaflets.”

“They felt that everything was kept confidential and that the staff went out of their way to accommodate their needs, such as re-arranging appointments and offering extra support.”

“I recently visited the clinic with a skin complaint and would like to say what a fantastic place this is.”

“I have nothing but praise for the treatment I receive at Moorfield Primary Care Centre which I regularly go to on a 3-monthly basis for skin cancer. I have been seen by one of two doctors. I am always seen on time or before on the treatment given has been excellent.”

5.4 Other engagement evidence – from Intelligence Library

A significant amount of local engagement work has been undertaken in the last three to four years to:

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· gather insight into people’s experiences of using urgent and unplanned care services, · better understand their views on existing service provision,

and to use this information to· drive improvements in existing services, and · redesign and reconfigure services, where required.

Full reports and supporting analyses for all these elements are stored on the Project SharePoint “Intelligence Library” for reference and audit as required, and a full list of references is provided in Section 10 of this report.

Summaries of each engagement area are provided in this section to help draw out key recurring themes and further evidence these with specific data and patient quotes.

Key messages are drawn from reviews of the following services:· Accident and Emergency Services· West Yorkshire Urgent Care Service· Trauma Services· Paediatric Emergency Services· GP Practices · Inpatients

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5.4.1 Accident and Emergency services

Source(s) National A&E Survey 2012Local A&E Discharge Survey 2012Local A&E Real Time Monitoring Results 2010-12Audit of A&E/Minor Injuries Unit 2011

Data collection period March 2012 (National Survey)November 2011 – January 2012 (Discharge Survey)February 2011 (Minor Injuries Unit audit)

Engagement population Patients attending A&E Departments at HRI/CRHLocal GP Practice patients (Minor Injuries Unit audit)

No. of respondents/participants

338 patients (National Survey)218 patients (Discharge Survey)50 patients (Minor Injuries Unit audit)

References (5), (6), (7), (8)

National A&E Survey 2012

338 patients who had visited the A&E Department at either Huddersfield Royal Infirmary or Calderdale Royal Hospital during March 2012, returned the form, a local response rate of 40%, slightly above that achieved nationally (38%).

National results highlighted mixed patient experience:

• Respondents reported longer waiting times than in previous A&E surveys (2004/08).

• Confidence and trust in the doctors and nurses working in A&E Departments continues to be high.

• 17% of patients thought staff did not do ‘everything they could’ to help control their pain, an increase from previous surveys.

• Although many respondents felt their interactions with doctors and nurses in A&E had been positive a substantial proportion reported communications that were unsatisfactory in some areas.

• Feedback on other aspects of communication was mixed: although most people felt they were ’definitely’ listened to by doctors and nurses (75%), there has been a slight increase in those who did not feel listened to.

• 59% of respondents were not told how long they would wait for their examination.

• Just under a fifth of respondents felt their fears about their condition or treatment were not talked about at all (an increase since 2004 and 2008).

• Substantially more people felt they were given enough privacy when talking with a receptionist than in 2008, although percentage still remains low (48%).

• Perceptions of cleanliness have substantially improved from previous surveys.

Transitions between services is a key area where improvement is required:

• Almost a quarter of respondents said they waited more than 15 minutes for their care to be transferred from ambulance to A&E staff.

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• Almost half of respondents who were discharged from A&E did not feel their home or family situations were considered prior to them leaving hospital.

Overall, the 2012 local results showed only marginal improvement to those achieved in 2008, although there was an increase in the number of green-rated questions (top 20% of Trusts nationally) from two in the 2008 survey to seven in 2012. A full table of results for survey questions is provided in Appendix 7, whilst a themed summary of patient comments is shown in Appendix 8.

Positive areas for the Trust included· Ambulance service and A&E staff working together and short waiting time for

handover· Short wait time before speaking to a nurse or doctor · Caring staff – especially nurses· Information given whilst in A&E

whilst key areas requiring improvement include:· Communication - a number of negative patient comments and low scores for

questions on explanation of results/ explanation about the purpose and side effects of medication

· Waiting time and organisation – mixed results, with most patient comments relating to not being told how long/why they had to wait

· Privacy and dignity

“I would say the treatment I received both with the doctors and nurses was very good indeed. The nurses in particular were very caring”

“All grades of staff were polite, respectful and attentive, especially the male triage nurse who gave me immediate pain relief and was very thorough and professional”

“Waiting time and lack of information around this has been a consistent problem”

“The triage nurse was very good and informed me of the possible wait time. She also said she'd speak to a doctor as to whether I'd need an x-ray. If I did she'd arrange for me to be done prior to me seeing the doctor to cut down on my waiting time”

“I have to wait for long time while I was in severe pain”

“It was early in the morning so very quiet and efficient. The receptionist and nurse were very efficient.”

“Issues with giving personal information at reception. People can sometimes overhear what you give out (Dob or Address)”

“The porter took me from my cubicle to x-ray and from x-ray to the ward and did not say a word to me the whole time”

Further local analysis of the survey has recently been performed to better understand how the specific subgroup of patients with long term conditions viewed their experience of visiting A&E. Patients were asked to indicate whether they had any of the following (multiple boxes could be ticked):

· deafness or severe hearing impairment· blindness or partially sighted· a long-standing physical condition

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· a learning disability· a mental health condition· a long-standing illness

46% of patients indicated that they had one or more of these long term conditions.

This work provided strong evidence that this group rate several aspects of their patient experience significantly lower than those without long term conditions, particularly with respect to:

· patient care, and emotional and practical well-being· communication· provision of information around medications and managing day-to-day activities

Detailed results of survey questions responses and an analysis of patient comments is shown in Appendix 18. The survey questions with the biggest differences between the two groups of patients were:

• While you were in the A&E Department, did a doctor or nurse explain your condition and treatment in a way you could understand?

• If you had any anxieties or fears about your condition or treatment, did a doctor or nurse discuss them with you?

• Were you involved as much as you wanted to be in decisions about your care and treatment?

• Did a member of staff explain why you needed these test(s) in a way you could understand?

• Did a member of staff explain the results of the tests in a way you could understand?

• Were you able to get suitable food or drinks when you were in the A&E Department?

• Did a member of staff explain the purpose of the medications you were to take at home in a way you could understand?

• Did a member of staff tell you about medication side effects to watch for?

• Did a member of staff tell you when you could resume your usual activities, such as when to go back to work or drive a car?

Whilst the proportion of positive comments received was markedly lower for the group who considered themselves to have one or more long term condition (51% vs 62% positive), with more negative comments particularly on privacy and dignity issues, care and doctor’s communication. Comments on poor aspects of patient experience included:

“Nurses attitudes toward people with mental health problems.”

“Staff and doctors could have had patience and time due to my severe hearing loss.”

“Being spoken to so you understand medical jargon instead of being spoken down to.”

“Having staff talk about patients, (including self) and after making jokes/ disparaging remarks.”

“Attitude of the doctor due to the nature of my visit. He could have been more understanding and less judgemental.”

“When we arrived in A&E I collapsed on the floor and it took my husband some time to find a member of staff. Then he had to lift me up and take me to a cubicle unaided.”

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Local A&E Discharge Survey 2012

The local A&E Discharge Patient Experience survey received responses and comments from 218 patients (22% response rate) over the period November 2011 to January 2012. Responses were compared to those achieved by the Trust in previous National A&E Survey in 2008.

The main themes largely matched those seen in the later national survey observed may be summarised as follows:

• Patients generally commented positively about their experience of nursing care, but gave mixed feedback on that provided by doctors.

• The biggest improvement since 2008 was related to providing information about who to contact if worried about condition/treatment after leaving the A&E Department.

• Explanations on medications were generally poor – reflected in both question responses and negative patient comments.

• Mixed results were seen for waiting times, with a number of patients reporting there were not told why they had to wait. The waiting areas themselves were also criticised.

• Results for the two hospital sites, HRI and CRH, were broadly similar.

“I found the A&E department extremely cold and draughty - especially as I went into shock - but my family were in total agreement that it was a very dismal area to sit in”

“I was fortunate that I had to visit A&E at a quiet time and I was only in for 30 minutes before being discharged, the overall service was excellent Very good and expedient”

“I know there are accidents & emergencies coming into the hospital all the time in ambulances but I was left for nearly 3 hours with no information and when you are urinating blood and in shock and panic that’s not very good”

“The triage system worked well as there was a possibility that I had stomach bleeding I was seen very quickly. My visit to A&E was a wholly positive experience”

“Triage nurse was very empathetic and spoke in terms I could understand”

“Doctors are too proud and have no sensitivity to what the patient is experiencing. There should be recognition between genuine illnesses and instances where patients have minor ailments”

“The nurse was excellent, very pleasant and knew just what she was talking about. Doctors also very helpful”

“The staff nurse who attended my injury could have explained more about my injury & medication and how to take it and be a little more patient friendly”

“I felt the doctors were too busy to see me, one doctor kept saying he would be back with some tablets and after ages came back having forgot them”

Broadly similar results have also been seen in the Trusts ongoing “real time monitoring” programme, which gathers regular feedback from patients whilst they are in the clinic. An ongoing improvement programme is being undertaken to address problems highlighted with:

· General lack of awareness of Patient Experience agenda· Communication at reception

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· Information about waiting times· Pain management· Information on discharge regarding medications and condition

[Action plan taken from “Patient Experience in A&E – The Story So Far”]

Audit of A&E/ Minor Injuries Unit – local GP practice

A local GP Practice (University based) undertook engagement with patients in February 2011, to establish whether behaviour had changed following the introduction of a local Minor Injuries service in the Autumn of 2009.

Responses to a questionnaire were gathered from 50 respondents (41 students, 8 non-students, 1 not declared). The predominant age group was 18-25 years (74%) and non-British students made up a sizeable minority of the sample (24%), representative of the Practice population as a whole (2,598 out of total of 9,756 were “immigrants” to the UK).

The Practice reported disappointing results, with the majority of patients (62%) unaware of the local Minor Injuries service, and only very limited actual usage (4%), with most regarding using A&E as the default option.

In particular, there had been a clear increase in the number of patients who would consider attending A&E for “minor” conditions, compared to a previous survey carried out in 2009 (e.g. glass wound up from 26% to 48%, sprains from 22% to 38% and flu like illness 7% up to 14%).

The Practice highlighted the following planned actions in response to these results:

· Further promote educational programme for the coming months and particularly over the Fresher period in the Autumn of 2011.

· Notice boards will be utilised to communicate this message· A message will be placed on the back of prescriptions· The practice will utilise its website to inform patients of when it is appropriate to utilise

A&E and what alternative services they may consider, i.e. ringing the surgery, contacting NHS direct, using a local pharmacy.

5.4.2 West Yorkshire Urgent Care Service

Source(s) West Yorkshire Urgent Care Services Engagement 2012Data collection period January - March 2011Engagement population Calderdale, Kirklees and Wakefield District Cluster

residentsNo. of respondents/participants

320 (185 in Calderdale and Kirklees)

References (9)

As part of a wider review of West Yorkshire Urgent Care Services, NHS Calderdale, Kirklees and Wakefield District Cluster undertook an engagement exercise to better understand local people’s awareness and usage of the service.

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An engagement document provided background information on existing services and the new telephone-based NHS 111 service. Feedback was obtained using a form – made available in both paper and online form - which included questions on what was important to patients and the public within the service.

A total of 320 responses were received, including 85 from Calderdale and 100 from Kirklees. These 185 responses have been combined in the analysis summary below:

· The bulk of respondents were either members of the public (71%) or voluntary or community organisation members (18%).

· 55% were aware of West Yorkshire Urgent Care Services.

· 42% had previously used West Yorkshire Urgent Care Services; 60 of the 185 people had accessed the Out of Hours service offered, with a further 19 using the unscheduled Dental service (only one patient used the GP surgery-based Minor Injuries unit).

· Those who had used the services reported mixed experiences of access - only 55% said it was “easy” or “very easy” to contact West Yorkshire Urgent Care Services.

The main themes highlighted in the engagement were:

· The West Yorkshire Urgent Care Service is seen as a valued and essential service to those who have used it.

· There is currently a lack of public awareness about West Yorkshire Urgent Care Service with many people calling for more effective awareness-raising of the service.

· There appears to be some confusion between different urgent and emergency care services such as NHS Direct and A&E.

· The majority of people engaged with had a good experience of the service, receiving quick, effective treatment and good advice and information from helpful staff.

· A small number of issues were raised about slow or no call backs.

· A small number of people stated that there had been reluctance to undertake home visits from the service on occasions.

· People were keen to ensure that this service was local and accessible to those who did not have, or were unable to use, their own transport.

5.4.3 Trauma Services

Source(s) Regional Trauma Networks –Stakeholders’ Views 2011Data collection period April - May 2010Engagement population National stakeholders, including patientsNo. of respondents/participants

Not stated

References (10)

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A multi-strand engagement approach was used to gather views of a number of stakeholders who were keen to improve the delivery of major trauma services. The approach adopted a mix of telephone and face-to-face interviews, focus groups, online feedback and social media to achieve the following:

· To engage with the full range of stakeholder groups who had direct and recent experience of major trauma, including hard to reach groups.

· To generate a detailed understanding of the current trauma pathway and perceived strengths and weaknesses of the current service, highlighting key areas requiring change.

· To gain a wide perspective of responses on proposed recommendations put forward by the Clinical Advisory Group.

The key themes from the engagement may be summarised as follows:

Respecting the patient journey should be at the heart of a new major trauma care. i.e. we must build the system around the patients and their needs. This should consider the complexity of patients’ needs and plan for rehabilitating the whole person, paying particular attention to psycho-social needs at earlier stages of the pathway.

Standards of care are not universally high. Patients reported lack of consistency along the trauma care pathway both in terms of variable quality along different stages of the pathway, and regional/ local differences. Standards of initial assessment and care also vary depending on the time of day when the major trauma occurs.

The system continues to be fragmented and uncoordinated, with hospitals not adequately networked together to provide a package of care along the pathway. A key area of focus will be to achieve greater organisational cooperation in the future, and improve a number of aspects of the pathway, including initial handover to acute services, and better pre-hospital assessment to ensure people are transferred to a hospital best equipped to treat their injuries.

Both paramedics and A&E staff need more specialist training and greater exposure to major trauma to increase their experience and skills.

Ongoing management of major trauma in the acute setting can be truncated because of limited bed capacity, staffing shortages and pressures to reduce length of hospital stay.

Acute rehabilitation and community or general rehabilitation facilities were viewed as inadequate and significantly underfunded by many patients. There is currently a lack of coordination and support once people are discharged from acute hospital care. Patients and carers commented frequently about the need to provide non-medical support and psychological support, again taking a holistic approach to trauma care. Currently, they felt, this type of care is generally not seen as being part of the whole, integrated care pathway, and several comments were received about how difficult it is to access dedicated specialist services and wider support groups.

“At the moment rehabilitation is an afterthought – rather than being planned the moment first contact begins with trauma team.”

“The psychological effects of trauma may not be given sufficient priority throughoutthe trauma pathway, and it is perhaps not sufficiently recognised that non psychologist health professionals can play a role in the assessment and support of people’s psychological needs.”

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Patients expressed their desire to be able to plan for their futures, and they were especially concerned about their lack of choices, uncoordinated care and ineffective communication about their care plans.

A team approach to rehabilitation care, with a lead professional, was seen as desirable. Some professionals noted the lack of connection between rehabilitation and primary and community-based services, which often resulted in poor care following discharge and in some cases readmission.

“What I needed was someone to make that cross over – a named district nurse who could be a lead or a team who could support me.”

Patients’ experience of multi-agency working and the quality of social care was also poor.especially where there were ongoing care needs.

Need to make better use of technology, for example timely and accurate assessment can be aided by sending data and pictures to a central hub from the moment a paramedic arrives on the scene.

Commissioners need to consider realignment of incentives to better match the whole system needs and provide sufficient resource where it is most needed.

5.4.4 Paediatric Emergency Services

Source(s) Choose Well For Your Child Campaign Report, 2012Listening to Children’s Views on Heath Provision, 2012

Data collection period April 2012Engagement population Greater Huddersfield publicNo. of respondents/participants

Wide-ranging marketing and engagement campaign, including direct mail to approximately 10,000 parents/ guardians

References (11), (12)

Choose Well For Your Child Campaign Report, (2012)

Background information:

• Hospital attendance figures in Greater Huddersfield show that children under five years of age account for nearly 10% of all A&E visits.

• Those with children in the household are the most likely to have had contact with West Yorkshire Urgent Care: a 24/7 service that directs callers to the appropriate service (mainly called in relation to sick children.

• For Greater Huddersfield A&E attendances are highest from patients attending GP practices in HD1 (Huddersfield town centre) and HD2 (outskirts of Huddersfield town centre) postcodes. Presumably these are closest to the facility, although also some profiling around low income families, vulnerable young parents, and South Asian communities.

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• Confusion between different urgent and emergency services/ lack of awareness about West Yorkshire Urgent Care Services (Choose well for your child campaign report).

The Choose Well for your Child Campaign was conducted in Huddersfield during April 2012, on behalf of Greater Huddersfield Clinical Commissioning Group (CCG), in order to educate parents and carers of children aged 0-4 within the area about which health services to use when their child is ill or injured.

Focus groups were conducted at children’s centres in order to gain an understanding of the target audience; their views were used to help tailor design of communications and marketing methods and materials. Methods included press releases and a social media campaign, a large direct mailing(10,000 parents/guardians), an advertising campaign on 30 local buses, distribution of leaflets and posters to local venues such as children’s centres, libraries and GP Practices.

Pre and post campaign evaluations were undertaken to assess the effectiveness of the campaign, with the following results:

· The campaign recall proved to be very strong: pre-campaign feedback demonstrated that none of the respondents questioned could identify the Choose Well name when shown the logo. Post-campaign, this percentage increased to 40%.

· 63% of those questioned recalled seeing the Choose Well for your Child campaign.

· 55% of people questioned said that they recognised the campaign from receiving the promotional materials through the post.

· 65% of people thought that the information contained on the promotional materials about where to go or who to call if their child is ill or injured was very good. The remaining 35% thought that it was good.

Listening to children’s views on health provision (2012)

Key Messages:

· Working groups should be set up that allow primary care practitioners and emergency department clinical staff to develop services together to meet the requirements of commissioners. (Evidence that absence of dialogue between commissioners and both groups of clinicians appears to be a barrier to improving care).

· The objective should be to break down the barriers between primary care and emergency care clinicians, between the different organisations that employ the staff, and that promotes good joint‐working. However, this must be based on absolute clarity over the strengths that each group has, how they are best deployed in or alongside the emergency department and what each group is expected to do. Only with this clarity will it be obvious to the clinician involved in a consultation when the expertise of another group needs to be drawn on to meet the needs of that patient.

· Enablers include improving and linking IT systems, and align funding into more collaborative approach.

· commissioners must see any initiative of this kind within the broader context of the full urgent and emergency care pathway.

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5.4.5 GP Practices

Source(s) Patient Participation Direct Enhanced Service, 2011-12MORI National GP Surveys, 2009-10 and 2010-11

Data collection period April 2011- March 2012 (DES)April 2009 - March 2011 (Surveys)

Engagement population Calderdale and Kirklees GP patients

No. of respondents/participants

21 Practices (78%) in Calderdale and 43 Practices (60% in Kirklees participated. 264 Calderdale and 881 Kirklees patients are involved in Patient Reference Groups (DES)

References (13), (14)

Patient Participation DESThe results from the surveys showed the following to be of particular concern to patients:

• Patients want a telephone system in place that enables them to get through, first time, to the practice to make an appointment

• Patients want flexibility in being able to make appointments – sometimes with their preferred GP within 24 hours and, at other times, booking several weeks in advance.

• Patients want opening hours to be increased.

• Patients want their waiting rooms to be pleasant environments that provide them with up to date information on services available at the practice.

• Patients expressed concerns with regards to the lack of privacy and confidentiality when talking to the receptionist.

• Patients want to be able to have their blood tests at the practice.

• Patients were concerned about the number of Did Not Attends (DNAs).

The surveys also highlighted a lack of awareness of the different ways of making an appointment, services provided by practices and the opening hours of practices, in particular extended opening hours, and some concerns with the attitude of reception staff and lack of parking.

National GP Survey National Survey results for Calderdale and Greater Huddersfield GPs are displayed in Appendix 12. Whilst overall results broadly match the national average, two particular observations stand out:

• Scores for the section on getting through on the telephone (ease of getting through/ speaking to a doctor/ speaking to a nurse/ getting test results on the phone) are noticeably lower – both nationally and locally – than other aspects of patient experience.

• Patients’ experience varies considerably between Practices, with some Practices scoring markedly lower than others, and rated red (bottom 20% nationally) for all, or virtually all, questions across the survey.

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5.4.6 Inpatients

Source(s) National Inpatient Survey 2011Readmissions Survey 2012

Data collection period June 2011January – March 2012

Engagement population Patients treated as inpatients at CHFT No. of respondents/participants

475 (Inpatients)300 (Readmissions)

References (15)

National Inpatient Survey 2011 The National Inpatient Survey 2011 was sent to a sample of 850 patients who were

discharged from either Huddersfield Royal Infirmary or Calderdale Royal Hospital in June 2011. Four hundred and seventy five patients responded to the survey, representing a response rate of 56%, the highest seen locally in the last five years.

The individual Trust reports were published by the CQC on 24th April 2012, these were a new style of report, with the main differences being: Data presented as a score out of 10 (previously out of 100). Data categorised differently using a statistical technique called the 'expected range',

rather the previous style of top and bottom 20% of trust scores.

Using this approach the Trust scored 'About the same' when compared to other trusts for all but one of the questions and 'Better' for the question 'Did you see any posters or leaflets on the ward asking patients and visitors to wash their hands or to use hand-wash gels?', with a score of 9.8 out of a possible 10.

In order for the Trust to continue with ongoing improvement and performance monitoring, and benchmarking with other Trusts, additional local analysis was performed, accessing a full data set for all questions and for all Trusts, and analysed the data using the previous approach of top 20% (green), middle 60% (amber) and bottom 20% (red).

The 2011 results were the best results the Trust has achieved in 5 years and have moved it from an estimated position of 53rd to an actual ranked position of 37th out of 100.

Detailed results for inpatient survey performance over the last six years 2006-11 are provided in Appendix 13, whilst Appendix 14 shows a comparison with local peers for the 2011 survey. A diagram displaying the key themes related to patient comments is displayed in Appendix 15.

Positive areas for the Trust included: Cleanliness and hand hygiene (6 questions - mostly rated green) Nurses (increase in scores for all five questions) Leaving hospital (increase in score for 8 of the 13 questions, 3 remaining the same,

2 reduced by 0.1). Represented main area of improvement work for Trust in previous year, although some problems remain (highlighted in example patient comments below)

“Huddersfield hospital is always clean & tidy going in to coming out. Doctors, nurses, cleaners are all polite and helpful.”

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“Ward cleanliness is excellent.”

“I found all nurses extremely friendly and caring. All made a real effort to make me feel comfortable.”

“The nurses were very good, kind and caring.”

“I would like to say a big thank you to all staff on the wards, if it wasn’t for the doctors and nurses exceptional care I believe I wouldn’t be here today, they were all fantastic and nothing was too much trouble for them.”

“On discharge the nurse was really good at explaining to me about my condition and meds put my mind at rest.”

Areas requiring further improvement work: Doctors communication - Q31 has remained red for 3 years (do you get answers

you can understand from doctors?) Explanation re operations / procedures – (Q52 – 57, two red out of six questions) Information provided in A&E – red-rated question Issues to watch out for following discharge (questions on medication side effects,

danger signals to watch out for), both of these are amber, however they are 2 of the lowest scoring questions across the survey. Delayed discharge – see example patient comments below

Food – a relatively large number of negative patient comments

“The communication and consulting skills of the clinicians need attention, their approach is not patient centred.”

“Very difficult to speak to the specialist/consultant who did the operation, didn’t like the fact some other doctor coming to explain what was done in op.”

“More information to explain results of tests and what to do following discharge (from a doctor or nurse).”

“More efficient & speedy discharge needed. Doctor wrote prescription out wrong for my support stocking, my poorly husband and daughter had to wheel me around to find the right dept.”

“Moving from ward to ward due to closure of a ward caused stress and confusion. Problems with discharge drugs from hospital pharmacy (existing drugs not new).”

“Discharge badly managed, had to ask about medication.”

“Discharge was a shambles. No referral for Physiotherapy or Occupational Therapy or to a general specialist.”

“Length of wait on discharge waiting for prescriptions.”

“I was discharged on xxx. On that day I had a blood test, waited for the result and then had to wait for the doctor to come to discharge me. I waited from breakfast time until 7 o'clock at night - I know they are very busy but I feel that it didn't warrant that length of delay.”

“A lot of the food is so lacking in nutrients, it can’t be helping patients recover.”

“The food could have been a lot warmer.”

“I am a retired cook and have been in business over the years. I understand the difficulties of catering - but do feel better results would be achieved by using fresh ingredients, I would sit on a committee to advise on food.”

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“More choice with food, especially halal food. There was an alleged choice on the menu but I was not given what I had chosen.”

Further local analysis of the survey has recently been performed to better understand how the specific subgroup of patients who were admitted to hospital as an “emergency or unplanned” case viewed their experience of the hospital care. This work provided strong evidence that this group rate several aspects of their patient experience significantly lower than those who were admitted from the “waiting list or planned in advance”, particularly with respect to:

· Long time to get a bed

· Doctor’s communication

· Involvement in decisions about care

· Provision of information about condition and treatment

· Information of explanation on a number of aspects of discharge process (medications, what you should or should not do after leaving hospital, and who to contact if worried about condition or treatment after discharge)

Detailed results of survey questions responses are provided in Appendix 16.

Readmissions Survey 2012The Readmissions Patient Experience survey was conducted at HRI and CRH over athree month period starting in January 2012, gathering responses and comments from300 patients using hand held PDA devices. Each site was sent a daily list each morning with the information of all the patients (over 16 years old) who had been re-admitted on the previous day (within 30 days of previous discharge). The study gathered feedback from patients on 12 main questions, primarily related to previous discharge.

A summary of results is provided in Appendix 17. Comparison with related National Inpatient survey data indicated that those being readmitted generally had a poorer patient experience associated with their initial Inpatient stay, particularly with respect to being provided information and advice on:

• “What to watch out for regarding your condition getting worse.” (danger signals)

• “Who to contact if your condition got worse.”

• Provision of written information/understanding of information about “what you should or should not do after leaving hospital.”

• Explanation from staff on “which medication to take when you left and which ones to discontinue”, and “purpose of any newly prescribed medications.”

Patients were also given the opportunity to make additional comments on the survey form. Feedback included:

“When I came in I brought in my own medication, the Dr on A&E lost them so I had a full day without my medication, which is not right, my husband complained because he gave them to the ambulance man who in turn said the last he saw of them a young lady doctor had them.”

“Not being moved from room to room at 2:00 in the morning. My bed has been moved 4 times in the night and I can’t get back to sleep Pharmacy always takes too long to get meds

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for discharge. If the ward knows I am going home in the next day or two, why can’t it be done sooner?”

“The nursing staff are very attentive, I can’t really fault them at all, although very occasionally there is one or two who are crabby. On one occasion I was on the floor and couldn’t get up, the nurse just shouted at me to get up and I couldn’t. 90% of the time they are very good.”

“I was on 2A recently, nursing staff never stopped working, would never pass by without a smile and a word, If ever I have to come into hospital again I hope it will be on this ward, they are so caring in everything they did for me, I won’t forget them.”

“Patient was sent home from A&E without transport in the early hours of the morning, in below freezing temperatures in just her nightgown with no blankets. She had to find her own way home, said staff nurse in A&E was rude and was re-admitted to a ward just hours later, considerably unwell and stayed for several days as an inpatient.”

“I think my dad was sent home too soon first time, he was in two days, came home poorly, back in seven days with pneumonia.”

The hospitals are currently undertaking an assessment of a “virtual ward” process to better manage discharge, and subsequent home re-ablement and hand-on to appropriate Intermediate Care/Primary care services.

6. Equality data

Equality data has been combined for respondents to the General (1,339) and Location-based (246) parts of the Unplanned Care Survey, giving a total of 1,585 respondents.

The information gathered is summarised in the tables below:

Note: totals for individual questions may differ as respondents left some questions blank.

Home Postcode Number Percentage

Halifax postcode area 958 69.6%Huddersfield postcode area 313 22.7%Oldham postcode area 62 4.5%Bradford postcode area 12 0.9%Wakefield postcode area 10 0.7%Leeds postcode area 6 0.4%Other 16 1.2%Total 1377

A full list of respondent postcodes is provided in Appendix 5.

Gender Number Percentage

Female 541 36.9%Male 880 59.9%Prefer not to say 47 3.2%Total 1468

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Transgender Number Percentage

Yes 41 3.1%No 1228 93.8%Prefer not to say 40 3.1%Total 1309

Age Number PercentageUnder 16 75 5.1%16-25 242 16.4%26-35 270 18.3%36-45 245 16.6%46-55 196 13.3%56-65 172 11.7%66-75 154 10.4%76-85 76 5.1%86+ 11 0.7%Prefer not to say 35 2.4%Total 1476

Sexual Orientation Number Percentage

Bisexual 33 2.3%Gay man 15 1.0%Heterosexual 1226 84.8%Lesbian 17 1.2%Other 21 1.5%Prefer not to say 133 9.2%Total 1445


Ethnicity Number Percentage

Bangladeshi 12 0.8%Chinese 4 0.3%Indian 23 1.5%Kashmiri 20 1.3%Pakistani 284 19.1%African 13 0.9%Caribbean 6 0.4%Asian & White 18 1.2%Black African & White 5 0.3%

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Black Caribbean & White 6 0.4%British 949 63.9%European 22 1.5%Gypsy/ Traveller 3 0.2%Irish 48 3.2%Other 14 0.9%Prefer not to stay 57 3.8%Total 1484


Religion Number Percentage

Buddhism 11 0.8%Christianity 571 39.7%Hinduism 6 0.4%Islam 329 22.8%Judaism 5 0.3%Sikhism 11 0.8%Other 59 4.1%No religion 336 23.3%Prefer not to say 112 7.8%Total 1440


Disability Number Percentage


Type of Disability Number Percentage

Learning disability/ difficulty 16 4.1%Long standing illness or health condition 84 21.5%Mental health condition 51 13.0%Physical or mobility 84 21.5%Hearing 22 5.6%Visual 23 5.9%Other 21 5.4%Prefer not to say 90 23.0%Total 391

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Note. Some respondents ticked multiple items.

Carer Number Percentage


Details of equality information for other engagement activities, covered in Section 5.4 of the report, are available in the original full reports held on the Project SharePoint facility.

7. Conclusion

There are a number of key themes which were evident across the whole range of engagement evidence gathered. These need to be carefully considered and prioritised in any redesign of existing services and development of future local healthcare systems:


· GPs and community-based health care elements were often closed when the patients needed to access them, forcing them to go elsewhere, despite their preferences to use these services. Other access issues, most commonly related to availability/choice of appointments, were also commonly raised by patients.

· Patients found the system fragmented with poor continuity of care – passed round from pillar to post, sometimes returning to A&E and other services on multiple occasions. There was a need identified to build a more patient-centred approach and particularly to improve discharge and “hand-on” processes.



· Inconsistencies in standards/quality of care received - patients consistently cited high standard/quality of care as important, but quite often report big inconsistencies in services or along different stages of their pathway.

· A number of examples of poor communication/ information provided to patient on their condition and subsequent management, and sometimes between different areas within the wider healthcare system at various stages of the patient pathway.


· Patients placed high value on rehabilitation services/ being supported to self-manage/ manage their condition at home.

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· Several groups of patients, most notably those with long term conditions, regularly used and reported poor experiences of a number of aspects of emergency and urgent care services.

· Issues were raised about making better use of supporting technology, for instance telecare facilities and problems related to health professionals having limited (and variable) access to patient information available at point of contact.

8. Recommendations

PMO/Care Stream/Engagement

9. Next steps

Any additional engagement activities required as part of EDS or otherwise (PMO/ Care stream/Engagement to add)

10.References

The following are available on the Project SharePoint area in full:

(1) PALS and complaints data, NHS Kirklees (2009-12)

(2) PALS and complaints data, CHFT (2009-12)

(3) Locala Community Partnerships Quality Account 2011-12

(4) Locala Complaints – 1 April 2011 to 30 June 2012

(5) National A&E Survey 2012 – Local and National reports (2012)

(6) Patient Experience in A&E – The Story So Far (local summary) (2011)

(7) A&E Discharge Patient Experience Local Survey (2012)

(8) A&E/Minor Injuries Audit report (2011)

(9) West Yorkshire Urgent Care Service Engagement Report (2012)

(10) Regional Trauma Networks – Executive Summary of Stakeholders’ Views (2010)

(11) Choose Well For Your Child Campaign Report (2012)

(12) Listening to Children’s Views on Heath Provision (NCB, 2012)

(13) Patient Participation DES Report – Year 1 (2012)

(14) National GP Surveys (MORI, 2009/10, 2010/11)

(15) National Inpatients Surveys 2010, 2011, 2012 – Local Reports and Analysis (2010-12)

(16) Readmissions Survey (2012)

53

Appendix 1: Engagement Action Plan

Unplanned Care - Engagement Action Plan KEY: DP (Dawn Pearson), DF (Dasa Farmer), MH (Mohammed Hanif), RK (Richard Kennedy), HIS (Health Informatics Service), PPE (Patient and Public Engagement), WF Leads (work stream members/Leads), (TM) Tabitha Makin Objective: Source existing intelligence which can be used to evidence patient/ public views. (Sept)Objective: Source existing intelligence which can be used to evidence patient/ public views. (Sept)Objective: Source existing intelligence which can be used to evidence patient/ public views. (Sept)Objective: Source existing intelligence which can be used to evidence patient/ public views. (Sept)

Activity (what) Action to be taken (how) Lead (who)

Timescales (by when)

Gather Existing intelligence, including Pals and complaints on the work stream area. Areas defined as:

· Trauma· Orthopaedics· Surgical

Assessment· A&E· Medical

Assessment· Paediatric

Assessment· Stroke

· Contact internal PALS and complaints teams to search for public comments.

· Pull off any existing national surveys completed on the work stream area.

· Identify any findings from Local surveys.

· Gather any information provided at any focus groups, public events or meetings on the work stream area.

DP supported by HIS

MH/DF

DF to contact WF leads.

DF to contact WF leads.

Mid Sept 2012

Analyse the intelligence

· Combine the information received and identify key messages.

· Identify any gaps in client group or questions.

· Ensure the key messages are fed into the process.

MH End Sept 2012

Objective: Engage with Patients, public and Carers. (Oct-Dec)Objective: Engage with Patients, public and Carers. (Oct-Dec)Objective: Engage with Patients, public and Carers. (Oct-Dec)Objective: Engage with Patients, public and Carers. (Oct-Dec)

Activity (what) Action to be taken (how) Lead (who)

Timescales (by when)

Identify the target audience.

· Create a list of key partners.

· Identify or create a diversity forum.· Identify patients and carers.

MH/DF

TMMH/DF

Mid Oct 2012

Mid Oct 2012Mid Oct 2012

Identify the resources required.

· Identify a reader’s panel.· Decide on the mechanisms for

engagement.· Develop the materials for engagement.· Identify a budget.· Test out the materials with the reader’s

panel.· Book meeting venues, catering,

facilitators as required.· Develop an evaluation form.

TMMH/DFMH/DFDPTMMH/DFMH/DF

Beginning Oct 2012Mid Oct 2012End Oct 2012End Oct 2012End Oct 2012End Oct 2012End Oct 2012

54

Deliver the engagement activity.

Activity still to be agreed by each work stream; ideas so far

· Possible Trauma discussion Forum – range of health conditions and pathways.

· Current service views/suggested improvements (ward questionnaires)

· Think tank on ‘A and E’ (confidential forum to look at current A and E views (survey) and testing out concepts for changing the service.

Work stream with PPE team as facilitators /enablers.

Nov – Mid Dec 2012

Objective: Conclude the engagement process, provide feedback and ensure the findings are used as evidence to support future activity.



Objective: Conclude the engagement process, provide feedback and ensure the findings are used as evidence to support future activity. Report the findings of the engagement activity.

· Collate the evaluation forms from each activity

· Collate the Diversity Monitoring Forms

· Collate the findings from the engagement activity

· Develop a report template· Develop a report of findings which

includes the ‘existing intelligence’ as appendices.

DPDPDPDPDF

Nov-Mid December 2012Nov-Mid December 2012Mid December 2012Mid December 2012

Ensure the report forms part of the evidence for options.

· Engagement report findings to be u s e d t o s u p p o r t f u t u r e recommendations as part of the audit trail.

DP January 2012 ?

Provide Feedback · Develop a summary document on the engagement activity.

· Check the summary document with the reader’s panel.

· Circulate the document to key partners, diversity forum, patients, public and carers engaged in the process.

· Upload the findings to the website for public information.

PPE teamPPE teamPPE team

Comms Team.

January 2013January 2013January 2013

January 2013

55

Appendix 2: Schedule for engagement activity

OverviewEngaging patients, the public and other stakeholders in planning services is vital to ensure services meet the needs of local communities. It is also a legal requirement that patients and the public are not only consulted about any proposed changes to services, but have been actively involved in developing the proposals.

Successful engagement cannot be carried out as a stand-alone activity; it needs to be an integral part of the programme. It is vital that senior clinicians and managers invest time in working directly with all stakeholders so that meaningful discussions can take place and to ensure stakeholder views really do drive the planning and delivery of services.

Key Drivers and Considerations There are a number of statutory requirements relating to engagement that must be taken into account.

Health and Social Care Act 2012The Health and Social Care Act 2012 sets out responsibilities for NHS commissioners. This includes the statutory requirement for CCGs to involve and consult patients and the public, replacing Section 242 of the NHS Act 2006, which currently applies to PCTs. Specifically, CCGs must involve and consult patients and the public in:

· their planning of commissioning arrangements · the development and consideration of proposals for changes in the commissioning

arrangements where the implementation of the proposals would have an impact on the manner in which the services are delivered to the individuals or the range of health services available to them, and

· decisions affecting the operation of the commissioning arrangements

The Act also updates Section 244 of the NHS Act 2006 which requires NHS organisations to consult relevant Overview and Scrutiny Committees on any proposals for a substantial development of the health service in the area of the local authority, or a substantial variation in the provision of services.

The Equality Act 2010Section 149 of the Equality Act 2010 states that a public authority must have due regard to the need to a) eliminate discrimination, harassment and victimisation, b) advance ‘Equality of Opportunity’, and c) foster good relations. It unifies and extends previous disparate equality legislation. Nine characteristics are protected by the Act: age; disability; gender re-assignment; marriage and civil partnership; Pregnancy and maternity; race; religion or belief; sex; and sexual orientation.

An Equality Impact Assessment (EQIA) will need to be undertaken on any proposals for changes to services that are developed through the strategy, in order to understand any impact on the protected groups and ensure equality of opportunity. Engagement must span all protected groups and other disadvantaged groups and care should be taken to ensure that seldom-heard interests are as engaged as much as others and supported to participate. The NHS Constitution

56

SECTION 1: CONTEXT

The NHS Constitution came into force in January 2010, setting out a number of rights for patients which are protected by law. This includes the following right at Section 2a: “You have the right to be involved, directly or through representatives, in the planning of healthcare services, the development and consideration of proposals for changes in the way those services are provided, and in decisions to be made affecting the operation of those services.” Commitment to upholding the NHS Constitution has been made within the CCG’ own Constitutions.

Secretary of State’s key testsAny plans for reconfiguring health services also need to comply with the four tests set down by the Secretary of State, the second of which relates specifically to engagement. These will be assessed through the Strategic Health Authority’s Service Change Assurance Process (SCAP) to assure there is sufficient evidence to progress to consultation if required. The four tests are:

5) Support from GP commissioners;6) Strong engagement, including local authorities, public and patients;7) A clear clinical evidence base underpinning proposals;8) The need to develop and support patient choice.

2.1 Public survey

Aim of the surveyTo support the work of the ‘Maximising Unplanned care in Primary Care and Community Services’ care stream, it is proposed to develop and carry out a survey with the public in the Calderdale and Huddersfield areas. The proposed areas of feedback to be sought are:· The drivers / reasons for people accessing A&E services.

· The perceived gaps within the community setting which the public would find beneficial.

Other benefits would include:· Identify gaps and improvements in current services and behavioural drivers.

· Begin to engage service users and generate ideas on the support that the public needs in the community setting.

Outcomes· Survey co-produced with THIS. This would be a large scale survey distributed via the

following channels:

o Direct mailout using the Engagement Team’s networks and direct engagement work with client groups/geographical areas where need for the services is highest, e.g. the homeless

o Online survey linked to all partners’ websites

o Community settings, such as Children’s Centres

o Service settings, such as A&E and Pharmacies

57

SECTION 2: ENGAGEMENT PLAN

· The analysis of feedback would be carried out by THIS and a report produced by the Engagement Shared Service. Data on the demographics of participants would be sought to further identify any potential trends.

· Report of findings produced and presented to the Task and Finish Group/unplanned care stream.

· To identify the requirements for any future engagement activity to test out ideas.

.2 Current patient experience data

The Health Informatics Service has been asked to provide any relevant data on patient experience. Additional work has also been collated and analysed to inform a composite report of key messages arising from the data held by partner organisations.

.3 Resources

The cost of delivering this work will be as follows:

Activity Resource CostAdministration Printing surveys, posting surveys,

general distribution to healthcare settings (4 days over a month = 24

hours)

PPE team – no cost

Ward interviewsCommunity setting interviews

PPE staff time 10 scheduled interview dates in various settings(10 x 7 hours staff time = 70 hours)

PPE team- no cost

Media Utilise existing websites of all partners. No Cost

THIS contract Design, development, collection and collation of data and final report of findings

tbc

58

Appendix 3: Engagement Questionnaire and Equality Data Monitoring Form - General

59

Engagement Questionnaire and Equality Data Monitoring Form - location-based

63

Appendix 4: Children’s survey – to be inserted

67

Appendix 5: Unplanned Care survey – additional analysis

General survey


A full list of the “Other” category responses is provided below:

999 Paramedics 1Basement Recovery Project 1CALLED 999 1Called wheelchair services 1

71

CAMHS 1Conacted consultant 1contacted depression support group 1Contacted Nutritionist for repeat bio-acidophilus capsules to reestablish better balance of gut flora 1dialled 999 for ambulance 1Didn't Care 1District Nurse 1Dropped off a labelled urine sample at surgery 1Emergency Services - Ambulance 1EPAU 1GP Home visit 1GP visit 1GP visited home 1GP visited patient 1Haematology 1Healthy Minds 1Issue with daughter's hearing picked up by school 1lynfield mount H+Catal 1Medical Centre on Queen Victoria 1N/A 1No health problems 1No medical problem - just routine check up 1Out patients 1Patient breast cancer found - contacted private medical insurer/hospital. 1Phoned 999 1Practice Nurse 1Prefer not to say 3Psychiatrist 1Rang bringhouse clinic 1Rang for ambulance 1Rang my daughter - A nurse 1Range Eye clinic 1Seen prison doctor 1Self Medicated 1spoke to my health visitor 1This depends - severe pain being sick - self care 1Took Drugs 1Tried to see GP went to walk in centre 1used carephone 1Visited basement Project 1went to hospital 1Went to my cpn nurses building 1



72

Check up 1pregnancy 1Blank 7Eye test appointment 1They could not find the cause 1High blood pressure 1Exma 1Check-up 2Addiction 1Fell off the toilet 1Bleeding while pregnant 1Over dose 1started suddenly and after several weeks still had a cough 1Severe disability complex needs from birth 1Eye infection 1N/A 1Start of dementia 1Went for check up 1don't have one 1New problem from old op 1Prescription 1Enquiry about breast feeding and after care 1Fine 1None 1Insection 1Health Check 1Cosmetic 1Eye test 2Broken hearing aid snapped 1Worsened mental health 1Depression 1dental 1



Blood Pressure 1Ears 1pregnancy 5Moving house too much work 1Thyroid 2Vitemin B12 injections 1chronic neurological disorder 1Asthma 3MSK 1

73

Heart problem 1Constant cough and chest pain 1Diabetic 1Exma on my hands 1Diabetes 1Blood test 12 wt 1Bone injury 1Spine operation 1Diabetis 1C.O.F.D. 1lupus sle 1Temple Artheritus 1Stress @ work 1Back Problems 1Broken Leg 1My back 1N/A 1Skin problem 1Gender disfore 1Hernia 1Diabetes Hypofit 1Pain in chest 1Diabities 1Bowel condition 1Seisure 1Bronical Asthma 1Took tablets 1Cancer 2Flu symptoms 1Bladder 1Stomache 1Flu 1Tonsilitis/virus 1Tonsilitis 1Sickness 1finger 1Chest pains 1kidney 1Epilepsy and stroke 1Frozen Shoulder 1None 1Asmath 1Epilepsy 1Broken Ankle 1Cosmetic 12nd left hand finger 1Skin rash 1

74

HCAD 1Ribs and back 1Headpain - Temple artheritis 1Viral 1Pains 1Throat-chest 1Breathing 1Blood presure 1Hand/Back/Side/Other 1Blood pressure pulse 1Facial 1Car acident 1head injury 1Asthma/chest infection 1previously broken hip 1Combination of issues 1Ear infection 1FALL IN A FIELD 1gynea 1



Emergency 3Carred for's descision 1Obvious place to go 1Couldn't get appointment with my doctor too late in the day 1Contact Lense broke in my eye-it was an emergency on a sunday morning 1No Choice 1District Nurse 1Taken by Ambulance 1Self Managed 1Never use any 1Unconsious 1Door ways 1Breakfast and advice 1Doctor 1Went with partner 1didn't know there was any other service 1It was the most appropriate in emergency 1Was advice from GP 1The GP/Doctors surgery was closed for 4 days over Easter 1I asked to be refered 1N/A 1Needed expert help 1Check-up 1

75

My own dentist couldn't fit me in 1Been Before 1Only service available 1Prefer not to say 1Doctor wanted to see me 1Ambulance took me 1Teenage son was taken to A&E by ambulance from the cinema 1Physiotherapist 1Work at hospital 1I am a pharmacist 1Didn't need to go 1Because doctor's surgery always too busy and no appointment available 1Because of medication I have to ask Dr before taking anything 1As a parent I was concerned 1Cheapest eye test 1No where was open 1Did not have to wait for appointment 1My Local GP 1Emergency - Ambulance 1No option at Sea 1Emergency Need 1unable to get through to nhs direct 1Closer to where I work 1



Emergency 6Local GP 5My GP 4Only practice in Tod 3Convenience 2Only A&E in the area 2my own doctor 2Ambulance took me 2Intense pain very worried 1Nearest Practice 1A&E 1Because of the pain I experienced 1Didn't need to go out 1It was the appropriate service for the condition 1Thought that was what I had to do 1For speed. I knew I would see a Dr same day. 1refered by specialist 1Registered GP 1My Local GP 1

76

It is the appropriate service for my condition 1It was an emergency 1My Doctor's surgery 1she wanted urgent advice 1Severe pain 1Needed Immediate Action 1I was very ill. Seriously ill 1Registered here 1GP's Sugestion 1Only GP in Tod 1Only appropriate place 1not my decision - staff at cinema took decision to call ambulance 1Self Managed 1My Doctors 1I needed help 1It was the obvious one 1Was an emergency 1Middle of night could not breath 1My Local G.P. 1Recommended 1Emergency Referal 1Knowledge of eye condition 1medication 1Speed and Confidence 1No other choice 1knew I had flu and no pint bothering any professionals 1Was part of care package 1Surgery was closed 1It was a medical problem so GP seemed obvious choice 1Only GP in town 1Necescary 1Always come here 1staff at surgery advision 1For good advice 1Immediate information 1Local Practice 1N/A 1Speed of service 1Only A&E 1late at night - phone easily accessable 1Panicking 1It is my GP 1Extreamly polite professional 1No where else would x-ray my leg 1Local (my) GP. 1Taken by an ambulance 1It's the doctors - where else would I go? 1My Dentist 1

77

My Daughter Rang 1No other option avaliable 1Because he's my doctor 1Cost 1It's my doctor 1My Local Hospital 1thought I was having a heart attack 1Because of senows condition 1Its my Doctors 1Felt right thing to do. 1Unable to visit GP 1My CPN Nurse is based here 1No choice # lousr 1Necessary to go to A&E 1Ongoing health problem 1MOst appropriate service to access 1My Surgery I use 1emergency! 1Because its my surgery which I use 1It was the appropriate service 1GP knows my medical history 1I knew I had a time-limited problem 1Urgency 1only option available 1No appointments available at Quln Drs 1to chase up hospital app 1Advice, what to do next 1Near Home 1



Recovery 1To get out of depression - talk to people 1Birth of child 1Advice 2Reassurance 1A thourough check up of my eyes explaining their health 1Self Managed 1To get well 1Sobriety 1Check up 1NA 1Feel better in time 1N/A 1She advised me to see G.P. 1it didn't explain anything 1

78

Glass in my eye 1Prefer not to say 1Care and safe environment 1sick note for work 1Medical chick and told to get to hospital 1it would have beenfine if I needed it 1Get well after a good rest 1Expected to get paramedic dispatch 1eye test new glasses 1A new mould for hearing aid 1New Glasses 1If my G.P. Couldn't help then he could arrange x-ray and blood tests 1Check for any serious injury 1support 2OTC medicine to alleviate symptoms 1ambulance 1help in alleviating pain 1eventually get better 1My wife and I suspected a broken ankle 1Put my mind at rest as this was making me extremely anxious. 1

Location survey



Check up 1Complications post op 1Flujab 1NHS Direct Referal 1Pregnancy 3Refered from optician 1Several issues with 18 month old 1Test 3



Contraception 1Faulty blood test result 1

79

Flu jab 1Pregnancy 2Smeer test 1Test 3



Ambulance 3appointment available 1Care home advice 1Doctors were full and wouldn't see me 1First time at practice 1Football injury 1It was nearest 1Live Locally 1Meant to be quicker than Dewsbury 1My GP 4Nearest A&E 3Out of Doctor's hours 1Police Advice 1Regular check up 1School 4



A&E 1Ambulance 2Asked by hospital staff 1Been advised 1Best option 1Closer than halifax 1Dr sent me 1due to serevity 1Huddersfield are very busy 1I work here 1Local 1NHS Direct 1No appointments at Hebden 2Registered 1Registered practice 1Weekend 2My GP 2

80



Blood test 1Check out 1Given flu jab 1rehydration admission 1

Detailed results – by service (location survey)Detailed cross-tabulated results, splitting out findings by the type of service respondents accessed, are shown below. Note that this mirrors the detailed analysis presented for the general survey in Section 5.1 of the report.


A&E GP

An ongoing problem 24% 76%A one off symptom 49% 51%A long term condition 30% 70%A sudden illness 57% 43%An accident 98% 2%For results 0% 100%I don't know what's wrong 67% 33%Other - (please state) 54% 46%Total 57% 43%


A&E GP

Physical symptom 61% 39%Your eyes 57% 43%Dental health 100% 0%Mental health problem 33% 67%Substance misuse 100% 0%Other - (please state) 14% 86%Prefer not to say 56% 44%Total 58% 42%


81

A&E GP

It was my decision 45% 55%Family/friend suggested I go there 83% 17%A health professional referred me 86% 14%Poster/leaflet - -NHS Direct sent me there 92% 8%Advice from NHS Direct website 50% 50%Advice from another website - -I did not know where else I could go 64% 36%I have used the service before 29% 71%Other - (please state) 62% 38%Total 53% 47%


A&E GP

Location 49% 51%Parking 30% 70%Public Transport 17% 83%More culturally sensitive 50% 50%Confidence in the staff 45% 55%Environment 48% 52%Opening times 45% 55%I have been here before 48% 52%I have a good experience/outcome before 45% 55%I could fit it in with my daily routine 29% 71%Other - (please state) 58% 42%No 85% 15%Total 49% 51%


A&E GP

The diagnosis of a problem/illness/symptom 55% 45%The opportunity to speak to a health care professional 36% 64%A second opinion 80% 20%A referral for further consultation/treatment 67% 33%Medication/prescription 24% 76%Diagnostics such as X rays and blood tests 83% 17%Treatment 82% 18%Other - (please state) 40% 60%Total 60% 40%

82


A&E GP

Yes, all expectations were met 61 53Some expectations were met 9 12No 1Don't know 31 10Total 102 75Average Score ** 92.3 90.8

** Note: Score calculated as 100 for “Yes, all expectations were met”, 50 for “Some expectations were met”, 0 for “No”. “Don’t know” responses are excluded from the calculation


Score A&E GP

1 12 2345 6 46 5 37 11 68 23 149 22 1710 54 50Total 124 94Average Score 8.6 9.0


A&E GP

Yes 103 85No 7 3Total 110 88Would Recommend 93.6% 96.6%


A&E GP

Under 15 minutes 39% 61%15-30 minutes 91% 9%

83

30-60 minutes 86% 14%1-2 hours 100% 0%Not applicable - travelled by Ambulance 100% 0%Total 56% 44%


A&E GP

Under 15 minutes 48% 52%15-30 minutes 54% 46%30-60 minutes 64% 36%1-2 hours 68% 32%Total 57% 43%

Equality data

Home postcodeA full list of respondent postcodes is provided below:

Postcode FrequencyHD06 1HD1 43HD13 1HD14 1HD2 35HD3 18HD4 28HD46 1HD47 1HD5 15HD6 71HD61 1HD63 3HD7 31HD8 45HD88 2HD9 15HDG 1HX 2 1HX 6 1HX0 1HX1 330HX11 1HX13 6

84

HX14 4HX15 1HX2 243HX26 2HX27 3HX28 1HX29 1HX3 127HX31 1HX35 1HX39 1HX4 20HX43 1HX48 1HX5 52HX50 1HX51 1HX53 3HX54 2HX55 1HX56 1HX57 1HX59 2HX6 83HX61 1HX64 1HX7 57HX76 3HX8 1HX9 1BD 1BD10 1BD12 2BD13 6BD6 2LS13 1ls14 1LS15 1LS20 1LS27 1LS28 1OL14 600L14 2WF 1WF12 2WF13 2wf14 3WF4 2AD6 1

85

BO13 1BP13 1H02 1H05 1H3 1H59 1HK7 1HL8 1HV6 1RD7 1S36 2S75 1UX2 1UX3 1Grand Total 1377**

** Note: not all respondents completed this question. Some typographical errors existed within the above list of returned responses.

Sexual orientationA full list of the “Other” category responses is provided below:

Female 5Illegiable 1I'm normal 1Noemal 1None 1Normal 2Straight 3Strat 1Unknown yet, only a baby 1Why?? 1

EthnicityA full list of the “Other” category responses is provided below:

Arabic 2Asian - English 1Asian - Philippines 1English 2Filipino 1Iranian 1Srilankan 2Syria 1White-English 1

One response written in error as “went to hospital a few days later”

86

ReligionA full list of the “Other” category responses is provided below:

Agnostic 1Anglican 1Athiest 1Believe in Jesus 1Catholic 10Church of England 6GB 1Heretic 1Jedi 1Jehovahs Witness 1Methodist 1N/A 2No 1Non 1Non m8 1None 5Pagan 2R.C. 2RC 1Roman Catholic 2Roman Catholics 1Wicca 1

87

Appendix 6: Glossary

A&E – Accident and EmergencyAQP – Any Qualified ProviderCHFT – Calderdale & Huddersfield Foundation TrustCOPD – Chronic Obstructive Pulmonary DiseaseCRH – Calderdale Royal HospitalDES – Direct Enhanced ServiceDH - Department of HealthENT – Ear, Nose and ThroatEPP – Expert Patient ProgrammeHRI – Huddersfield Royal InfirmaryJSNA – Joint Strategic Needs AssessmentME - Myalgic EncephalomyelitisMSK – Musculo-skeletalPALS - Patient and Advice Liaison ServiceTCS - Transforming Community Services

88

Appendix 7: National A&E Survey 2012 results

Appendix 8: National A&E Survey 2012 – Patient Comments

89

Appendix 9: National A&E Survey 2012 – Long Term Conditions analysis

Note: Groups 0 = No Long Term Conditions (LTC), 1+ = One or more LTC, RAG rating relates to bottom 20%/middle 60%/ top 20% of Trusts nationally.

91

Appendix 10: Local A&E Discharge Survey Results 2012

94

Appendix 11: Patient comments by category – A&E Discharge Survey 2012

95

Appendix 12: GP Survey Results for Calderdale and Greater Huddersfield

96

Red/Amber/Green Rating - scores for applicable questions have been separated into those in the top 20%, middle 60%, and bottom 20% of all the practices which took part in the Mori National Survey in either 2009/10 and 2011/12

97

Appendix 13: National Inpatient Survey Scores/Ratings for CHFT 2006-2011

National Inpatient Survey YearNational Inpatient Survey YearNational Inpatient Survey YearNational Inpatient Survey YearNational Inpatient Survey YearNational Inpatient Survey Year

2006 2007 2008 2009 2010 2011

The A&E

Department

Q3. While you were at the A&E Department, how much information about your condition or treatment was given to you? 7.9 7.9 5.7 8.2 8.3 7.8

The A&E

Department

Q4 Were you given enough privacy when being examined or treated in the A&E Department? 8.9 9.0 8.7 8.8 8.7 8.8

The A&E

Department Q5 Following arrival at the hospital, how long did you wait before

being admitted to a bed on a ward? 6.6 6.2 5.8 6.3 6.1 6.3

Waiting List

or Plann

ed Admission / Wait

for Bed

Q8 Overall, from the time you first talked to this health professional about being referred to hospital, how long did you wait to be admitted to hospital?

6.9 5.0 6.1 6.2 6.1 5.6Waiting List

or Plann

ed Admission / Wait

for Bed

Q9 How do you feel about the length of time you were on the waiting list before your admission to hospital? 8.5 8.1 8.2 8.5 8.0 8.0

Waiting List

or Plann

ed Admission / Wait

for Bed

Q10 Were you given a choice of admission dates? 2.9 3.3 2.9 3.0 3.4 2.8

Waiting List

or Plann

ed Admission / Wait

for Bed

Q11 Was your admission date changed by the hospital? 9.1 9.4 9.6 9.3 9.3 9.3

Waiting List

or Plann

ed Admission / Wait

for Bed

Waiting List

or Plann

ed Admission / Wait

for Bed

Q12 From the time you arrived at the hospital, did you feel that you had to wait a long time to get to a bed on a ward? 8.4 7.7 7.0 7.9 7.4 7.9

The Hospi

tal And Ward

Q14&Q17 Did you ever share a sleeping area, for example a room or bay, with patients of the opposite sex? 8.0 7.5 7.3 8.5 7.9 8.9

The Hospi

tal And Ward

Q19 While staying in hospital, did you ever use the same bathroom or shower area as patients of the opposite sex? 7.0 6.6 7.1 8.3 8.0 8.5

The Hospi

tal And Ward

Q20 Were you ever bothered by noise at night from other patients? 6.6 6.1 6.1 6.2 6.5 6.5

The Hospi

tal And Ward

Q21 Were you ever bothered by noise at night from hospital staff? 8.7 8.9 7.8 8.2 7.6 8.1

The Hospi

tal And Ward

Q22 In your opinion, how clean was the hospital room or ward that you were in? 8.4 8.2 8.3 8.7 8.9 9.0

The Hospi

tal And Ward

Q23 How clean were the toilets and bathrooms that you used in hospital? 8.1 7.8 8.0 8.4 8.6 8.8The

Hospital

And Ward

Q24 Did you feel threatened during your stay in hospital by other patients or visitors? N/a 9.7 9.7 9.5 9.7 9.8

The Hospi

tal And Ward Q25 Did you have somewhere to keep your personal belongings

whilst on the ward? N/a 6.0 6.2 6.2 6.4 6.3

The Hospi

tal And Ward

Q26 Did you see any posters or leaflets on the ward asking patients and visitors to wash their hands or to use hand-wash gels?

N/a N/a N/a 9.8 9.6 9.8

The Hospi

tal And Ward

Q27 Were hand-wash gels available for patients and visitors to use? N/a N/a N/a 9.9 9.7 9.8

The Hospi

tal And Ward

Q28 How would you rate the hospital food? 5.1 5.0 4.8 5.4 4.8 5.1

The Hospi

tal And Ward

Q29 Were you offered a choice of food? 8.6 8.6 8.4 8.5 8.3 8.6

The Hospi

tal And Ward

Q30 Did you get enough help from staff to eat your meals? 6.8 7.5 7.4 7.5 7.3 7.1

Doctors

Q31 When you had important questions to ask a doctor, did you get answers that you could understand? 8.0 7.9 7.9 7.6 7.8 7.7

Doctors

Q32 Did you have confidence and trust in the doctors treating you? 9.0 8.9 9.0 8.9 8.8 8.7Docto

rsQ33 Did doctors talk in front of you as if you weren’t there? 8.4 8.2 8.4 8.4 8.2 8.4

Doctors

Q34 As far as you know, did doctors wash or clean their hands between touching patients? 7.9 7.5 8.4 8.7 8.3 8.5

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Nurses

Q35 When you had important questions to ask a nurse, did you get answers that you could understand? 8.5 8.2 8.1 8.2 8.0 8.3

Nurses

Q36 Did you have confidence and trust in the nurses treating you? 8.9 8.8 8.6 8.8 8.5 8.7

Nurses Q37 Did nurses talk in front of you as if you weren’t there? 9.0 8.9 8.7 8.7 8.8 9.1Nurses

Q38 In your opinion, were there enough nurses on duty to care for you in hospital? 7.4 6.9 7.1 7.5 7.3 7.4

Nurses

Q39 As far as you know, did nurses wash or clean their hands between touching patients? 8.4 8.0 8.6 8.9 8.8 9.2

Your Care and

Treatment

Q40 Sometimes in a hospital, a member of staff will say one thing and another will say something quite different. Did this happen to you?

8.2 7.9 7.8 8.1 8.0 8.2

Your Care and

Treatment

Q41 Were you involved as much as you wanted to be in decisions about your care and treatment? 7.3 6.9 7.2 6.9 7.0 7.0

Your Care and

Treatment

Q42 How much information about your condition or treatment was given to you? 7.9 7.9 7.6 7.9 7.9 7.7

Your Care and

Treatment

Q43 If your family or someone else close to you wanted to talk to a doctor, did they have enough opportunity to do so? 6.4 6.3 6.1 6.1 6.3 6.3

Your Care and

Treatment

Q44 Did you find someone on the hospital staff to talk to about your worries and fears? 6.3 6.2 5.8 5.8 5.7 5.9

Your Care and

Treatment

Q45 Do you feel you got enough emotional support from hospital staff during your stay? N/a N/a N/a N/a N/a 7.2

Your Care and

Treatment

Q46 Were you given enough privacy when discussing your condition or treatment? 8.3 8.0 7.8 8.2 8.1 8.0

Your Care and

Treatment

Q47 Were you given enough privacy when being examined or treated? 9.5 9.3 9.2 9.3 9.4 9.3

Your Care and

Treatment

Q49 Do you think the hospital staff did everything they could to help control your pain? 8.5 8.6 8.3 8.3 8.4 8.4

Your Care and

Treatment

Q50 How many minutes after you used the call button did it usually take before you got the help you needed? 7.2 6.9 6.5 6.7 6.9 6.6

Operations

& procedures

Q52 Beforehand, did a member of staff explain the risks and benefits of the operation or procedure in a way you could understand?

8.9 8.7 8.9 8.8 9.1 8.9

Operations

& procedures

Q53 Beforehand, did a member of staff explain what would be done during the operation or procedure? 8.4 8.2 8.4 8.2 8.5 8.4

Operations

& procedures

Q54 Beforehand, did a member of staff answer your questions about the operation or procedure in a way you could understand?

8.5 8.6 8.7 8.6 8.6 8.4Operations

& procedures

Q55 Beforehand, were you told how you could expect to feel after you had the operation or procedure? 6.8 6.9 6.9 7.0 6.9 7.0

Operations

& procedures

Q56 Before the operation or procedure, did the anaesthetist or another member of staff explain how he or she would put you to sleep or control your pain in a way you could understand?

8.7 8.9 8.9 8.9 9.3 8.9

Operations

& procedures

Q57 After the operation or procedure, did a member of staff explain how the operation or procedure had gone in a way you could understand?

7.3 7.4 7.5 7.4 7.7 7.7

Leaving

Hospi

Q58 Did you feel you were involved in decisions about your discharge from hospital? N/a 6.9 6.9 7.2 6.8 6.9

Leaving

Hospi

Q59 On the day you left hospital, was your discharge delayed for any reason? N/a N/a N/a N/a N/a N/a

Leaving

Hospi

Q60 What was the MAIN reason for the delay? 7.1 7.3 6.6 6.9 6.7 6.8

Leaving

Hospi

Q61 How long was the delay? 8.4 8.4 7.9 8.2 8.1 8.1

Leaving

Hospi

Q62 Before you left hospital, were you given any written or printed information about what you should or should not do after leaving hospital?

N/a 6.2 6.3 6.4 6.5 7.2

Leaving

Hospi

Q63 Did a member of staff explain the purpose of the medicines you were to take at home in a way you could understand? 8.6 8.3 8.3 8.4 8.1 8.3

100

Leaving

Hospital

Q64 Did a member of staff tell you about medication side effects to watch for when you went home? 4.5 4.5 4.7 4.7 4.6 4.6Leavi

ng Hospi

talQ65 Were you told how to take your medication in a way you could understand? N/a 8.1 8.4 8.1 8.2 8.2

Leaving

Hospital

Q66 Were you given clear written or printed information about your medicines? 7.7 7.4 7.1 7.2 7.5 7.4

Leaving

Hospital

Q67 Did a member of staff tell you about any danger signals you should watch for after you went home? 4.7 4.8 4.7 5.0 5.3 5.2

Leaving

Hospital

Q68 Did the doctors or nurses give your family or someone close to you all the information they needed to help care for you? 5.2 5.2 5.2 5.3 5.5 5.7

Leaving

Hospital

Q69 Did hospital staff tell you who to contact if you were worried about your condition or treatment after you left hospital? 7.7 7.4 7.5 7.4 7.5 7.9

Leaving

Hospital

Q70 Did you receive copies of letters sent between hospital doctors and your family doctor (GP)? 4.8 4.3 3.4 4.0 4.6 6.9

Leaving

Hospital

Q71 Were the letters written in a way that you could understand? N/a N/a N/a 7.8 8.2 8.8

Overall

Q72 Overall, did you feel you were treated with respect and dignity while you were in the hospital? 8.9 8.7 8.6 8.9 8.7 9.0

Overall

Q73 How would you rate how well the doctors and nurses worked together? 7.8 7.6 7.6 7.7 7.5 7.7

Overall

Q74 Overall, how would you rate the care you received? 7.9 7.8 7.6 7.9 7.7 7.8Overall Q75 During your hospital stay, were you ever asked to give your

views on the quality of your care? 0.5 0.6 0.6 0.9 0.8 1.0

Overall

Q76 While in hospital, did you ever see any posters or leaflets explaining how to complain about the care you received? 1.5 3.3 3.0 3.5 3.6 4.7

Overall

Q77 Did you want to complain about the care you received in hospital? N/a N/a 8.8 9.1 9.4 N/a

CHFT Extra Optio

nal Questions

Are you confident that the hospital is keeping your personal information / health records secure and confidential? N/a N/a N/a N/a 9.3 9.4

CHFT Extra Optio

nal Questions

Would you recommend this hospital to your family and friends? N/a N/a N/a N/a 7.8 7.8

CHFT Mean Total – All Questions 7.4 7.3 7.2 7.5 7.5 7.6

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Appendix 14: National Inpatient Survey 2011 – Local Peer Group Scores by Section

Mean Section Scores CHFT East Lanc Aire-dale Brad-ford Harro-gate LTH Mid Yorks Shef-field YorkPEER Avg.

The A&E Department 7.6 7.8 8.0 7.4 8.2 7.3 7.6 8.0 8.0 7.8

Waiting Lists/Planned Admission 6.4 6.9 6.7 6.6 6.7 6.6 6.2 6.6 6.9 6.6

Waiting to get a bed on a Ward 7.9 7.8 8.6 7.1 8.6 7.8 7.0 8.4 8.1 7.9

The Hospital and Ward 8.2 8.3 8.4 8.0 8.4 8.1 8.3 8.1 8.2 8.2

Doctors 8.3 8.6 8.5 8.4 8.7 8.5 8.6 8.7 8.8 8.6

Nurses 8.5 8.6 8.6 8.2 8.7 8.2 8.3 8.6 8.5 8.4

Your Care and Treatment 7.5 7.7 7.5 7.3 7.8 7.4 7.5 7.8 7.6 7.5

Operations and Procedures 8.2 8.4 8.2 8.3 8.6 8.3 8.3 8.5 8.5 8.4

Leaving Hospital 7.1 6.9 6.7 6.6 7.1 6.3 6.5 7.0 7.0 6.8

Overall 6.0 6.2 6.1 5.9 6.1 5.9 5.6 6.1 5.9 5.9

TOTAL 7.6 7.7 7.6 7.4 7.8 7.4 7.4 7.7 7.7 7.6

National Ranking Percentile(Percentile out of 161 Trusts) 37th 21st 33rd 68th 12th 73rd 57th 20th 22nd

National Inpatient Survey 2011- Quadrant Chart

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Appendix 15: Patient Comment Analysis – National Inpatient Survey 2011

Note: Patient comments were analysed (above) to further enhance our understanding of the issues raised by patients, with 254 positive comments being received and a similar number of negative comments – 249. There were significantly more positive comments made regarding ‘care’ than there were negative. Some of the areas where we received a high proportion of negative comments related to food, communication and the discharge process

103

Appendix 16: National Inpatient Surveys 2010-12 – Emergency vs Planned Admissions Emerg Plan

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Appendix 17: Readmissions Survey Results

105

Appendix 18: National A&E Survey 2012 – Long Term Conditions Analysis

Note: Groups 0 = No Long Term Conditions (LTC), 1+ = One or more LTC, RAG rating relates to bottom 20%/middle 60%/ top 20% of Trusts nationally.

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unplanned care report draft v5 (3)

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