Children and Young People - Community Health Services Procurement. NHS Bromley Clinical Commissioning Group

Transcription

1 Community Health Services Engagement Children and Young People Engagement Report on: Children and Young People - Community Health Services Procurement Prepared for: NHS Bromley Clinical Commissioning Group Prepared by: September 2016 Healthwatch Bromley Report for Bromley CCG - September 2016

2 Contents 1. Summary Engagement Methodology Findings Case Studies Focus Groups Recommendations About Healthwatch Bromley Acknowledgements Appendices i. Demographic Information ii. Questionnaire Healthwatch Bromley Report for Bromley CCG - August 2016 Page 1 of 16

3 FINAL REPORT: NHS BROMLEY CLINICAL COMMISSIONING GROUP Children and Young People - Community Health Services Engagement 1. Summary In July 2016 NHS Bromley Clinical Commissioning Group commissioned Healthwatch Bromley to deliver comprehensive engagement activity with children and young people and to reach communities that are often seldom heard and harder to reach to help inform Bromley CCG s CYP community health services procurement. This engagement was commissioned to support future models of delivering integrated community based care, which are organised around the needs of patients and local populations. Bromley CCG wanted to seek the direct views and experiences of children and young people, as well as parents and carers, using the children and young people s community health services. These services include: Children community dietetic service Children community physiotherapy Children occupational therapy Children speech and language therapy (SALT) Children paediatric liaison nurse Community paediatrics Paediatric audiology Safeguarding children service Integrated children s nursing team Respite care for children Looked after children Continuing care packages for children Healthwatch Bromley carried out robust and extensive engagement across the London Borough of Bromley using a mixed methodology that included a questionnaire, focus groups, provider site visits and one to one conversations. This engagement was delivered to a wide cross section of the community. This report highlights the key themes and responses from the children and young people and their families about community health services that they use. The final version of this report was submitted to Bromley Clinical Commissioning Group in September Healthwatch Bromley Report for Bromley CCG - August 2016 Page 2 of 16

4 2. Engagement Methodology Using a three staged approach to engagement and mixed methodology, Healthwatch Bromley engaged children, young people and their families from communities across Bromley to capture their experiences of commissioned community health services. Engagement activities actively reached out and enabled meaningful interaction with individuals and groups to gather both positive and negative experiences. A variety of backgrounds and diverse groups were engaged. The first stage was the development of a questionnaire Our engagement was a two-way process, involving detailed conversations and listening. Healthwatch used mixed methodology to capture the views of the children and young people of Bromley: Enter and View, general outreach and targeted sessions and interviews. A total of 263 people were engaged. The full extent of the engagement is detailed below. All Bromley Children and Family centres were visited over a six week period. Healthwatch Bromley s Authorised Representatives visited children s community service clinics over a two week period and spoke to the children and families currently accessing community services. General outreach was carried out at Bromley Library, on Bromley High Street and at the Walnuts Shopping Centre. Five Focus groups were conducted with Newstead Wood School LGBT group, Anerley Town Hall Youth Group, JusB Youth Charity, Bromley Young Advisors and the Petts Wood Play Group. Five in depth case studies were carried out with children with complex conditions and more in depth experiences of local community services. A comprehensive questionnaire using open questions was developed. Online versions of the questionnaire were made available and distributed through the Bromley Children s Hearing Services Group, The Children and Families Forum and the Bromley Children s Project. It was also distributed via social media, through the Healthwatch Bromley website, to our network through our biweekly e-bulletin, the CLB e-bulletin and via Bromley Healthcare. Paper copies of the questionnaire were distributed across the borough with collection boxes left at the Citizens Advice Bureau, Community House, all six Children and Family Centres, the Young Carers offices, and at both Bromley and Biggin Hill Library. The questions asked covered the following: patient experience, service experience, any suggested improvements, as well as access times and criteria for community services. Participant s demographic information was collected and can be found in Appendix i. Healthwatch Bromley Report for Bromley CCG - August 2016 Page 3 of 16

5 The following table lists the number of responses received through each engagement activity. Responses Anerley Town Hall Youth Group 18 Community Vision Children and Family Centre 25 Castlecombe Children and Family Centre 16 Cotmandene Children and Family Centre 14 Burnt Ash Children and Family Centre 10 Blenheim Children and Family Centre 34 Biggin Hill Children and Family Centre 24 London Borough of Bromley Library 4 Walnuts Shopping Centre 32 Newstead Wood LGBT Group 19 Phoenix Centre 49 Petts Wood Play Group 4 Bromley Young Advisors 2 JusB Youth Charity 6 Other 6 TOTAL 263 Healthwatch Bromley Report for Bromley CCG - August 2016 Page 4 of 16

6 3. Findings A full copy of the questions asked can be found in Appendix ii. Of the participants, 69% were the parents of children and young people, 24% were young people themselves and 7% identified as carers. SERVICE ACCESSED Dietetic 7% Physio 19% Nursing 29% OT 10% Audio 7% CPLN 6% SALT 22% Of the community services currently available, the service cited as the most frequently used was community nursing (29%), followed by speech and language therapy (22%) and then physiotherapy (19%). Healthwatch Bromley Report for Bromley CCG - August 2016 Page 5 of 16

7 The overwhelming majority of people felt that community services for children and young people should be offered until the age of 18. It is worth noting that, more young people thought age 25 was the appropriate age, whereas parents of young children considered 18 years of age to be the most suitable transition point. 83% of respondents thought that community services should be offered in additional settings, with the most popular choices being community centres and Children and Family Centres 200 Additional Services Drop in MH Nuritrion Behav BW ADHD Other When asked what services they would most like to have on offer the overwhelming majority of respondents wanted additional drop in services, with topics such as mental health, and support with behavioural issues being the most frequently chosen. In response to the question about what time of the day they would prefer to access community health services, there was a fairly even split amongst all times on offer, although the majority wanted to access services after school i.e. between 16:00 pm and 18:00 pm. This was closely followed by the option of access during the school day i.e. between 09:00 am and 16:00 pm. The reason given for the in-school time option by families was the ease of taking a child to appointments when their other children were at school. Over 70% of the parents expressed strongly concern around any reduction in health visitors or baby clinics and the difficulties this posed for families, especially Preferred Access Time 13% 23% 21% 26% 17% SD AS Evenings Wkd AM Wkd PM Healthwatch Bromley Report for Bromley CCG - August 2016 Page 6 of 16

8 for those with more than one child. Healthwatch Bromley Report for Bromley CCG - August 2016 Page 7 of 16

9 Analysis of the results indicates the following common themes across the participants engaged: Short waiting times between treatment and referral would put patients at ease and prevent anxiety for both children and their families. Optimising capacity in community settings is of paramount importance, especially in group sessions. People value baby clinics and health visitors, and were concerned about any reduction in clinic times, especially for those families with more than one child. Staff and therapists at community clinics were highly regarded and praised for their work. The majority of those surveyed thought that community health services for children should be provided up to the age of 18. Support for parents between diagnosis and accessing treatment is essential, as well as the provision of support and information for parents to implement and practice at home. There was a keen interest in drop-in services, particularly for mental health advice and information, as well as support for behavioural issues and difficulties. Homework and tasks for children and young people could help develop and aid children s progress. Client access to services in a community setting was preferred, for example within a Children and Family Centres, as they were perceived to be a safe and neutral space for children. Nurseries and playgroups play a pivotal role in identifying any early signs of concern or need for further support for younger children. The need for consistency across the borough and general awareness of community health services within these settings is paramount. The hydrotherapy service is valued by patients. Respondents considered SALT to be a service that users need regular access to in order to progress and develop at a satisfactory rate. Therefore, regular and intensive provision of SALT and high numbers of therapists would be beneficial. A wider understanding of provision within the borough and extra-facilities to support clients would be useful for therapists and community providers. Healthwatch Bromley Report for Bromley CCG - August 2016 Page 8 of 16

10 4. Case Studies The five case studies reported below represent the themes identified from detailed conversations with local services users and their families, who have complex health needs and have had extensive experience of community health services. a) Speech and Language Therapy Communication Difficulties The initial referral and identification occurring early (at playgroup) is very important for the successful development of communication and social skills. Coping strategies for families and children to work on together at home would also be beneficial. Strong links and relationships between playgroups and the community provider are very important to the successful delivery of care. b) Audiology and Speech and Language Therapy Good communication and delivery across health care, social care and education meant that a profoundly deaf child had been able to succeed. c) Occupational Therapy Rapid identification to treatment times for occupational therapy would help ease patient anxiety and encourage a good relationship between the service user and provider. d) Petts Wood Play Group for Children with Special Needs Early support for children with special needs and their families. SALT is integral to the children s development and so regular and consistent interaction between provider, the child and their family is important for building trust. Good access to the physiotherapy service is also a principle need. e) Health Visitors and Baby Clinics Distance, transport and time constraints, especially for those with more than one child need to be taken into consideration when considering the baby clinic and health visitor provision. The clinics were considered important opportunities for establishing any causes for concern or early warning signs, especially with baby weigh-ins. It was felt particular attention needed to be paid to the more isolated parts of the borough. Healthwatch Bromley Report for Bromley CCG - August 2016 Page 9 of 16

11 5. Focus Groups Four focus groups were held and planned around young people s availability and time commitments. The key findings from the individual focus groups are summarised below: Newstead Wood Secondary School GSA Young people here felt that the transition from children s to adult community health services should be aged 25. They identified a need for more sexual health services to be provided, for staff to be from a variety of backgrounds and training on young LGBTQ needs. New services suggested were drop-in mental health services and emotional support in less clinical settings that are available out of standard working hours. Petts Wood Play Group The needs identified by this group were: On-going appointments with the same therapist; Limited waiting times; Access to clinics in community settings and a variety of appointment times including evening and weekend; Provision of services to age 25. Potential additional services suggested included: mental health support, cognitive behavioural therapy, talking therapy and applied behaviour analysis. JusB Youth Charity Mental health and emotional wellbeing support, as was dietetic and nutrition information for young people were ranked high in terms of need. Extension of children s community services to community centres and youth clubs. Bromley Young Advisors Communication between services to enhance/build independence. Transition to adult services at 25 years. Shared partnership between provider and client to support self care e.g. monthly reports on progress with clear recommendations for progress and development. Extension of services to community centres. Healthwatch Bromley Report for Bromley CCG - August 2016 Page 10 of 16

12 6. Recommendations Evidence from the participants Healthwatch Bromley engaged suggests the following would help: Parents should be provided with coping strategies in the waiting period between diagnosis and access to treatment. Training of nursery and play group staff in identifying and referring any child that may present with difficulties or additional needs. Increased number of sessions or increased capacity within sessions to minimise waiting times for children and young people. Community settings to be child appropriate and to be a welcoming and child friendly environments. A safe and neutral space for real time patient feedback without the fear of jeopardising quality and access to treatment for their children. Additional drop-in services, with a specific focus on mental health support and support for behavioural difficulties. Frequent communication between therapists and parents/young person, for example, monthly reports, would be beneficial in supporting the young person s development and self care. Regular and intensive provision of SALT and high numbers of therapists would be beneficial. A good awareness of general community provision and resources to help therapists to signpost service users to relevant and useful local facilities. Limit reliance on agency staff to support building a rapport between staff and service users. Healthwatch Bromley Report for Bromley CCG - August 2016 Page 11 of 16

13 7. About Healthwatch Bromley Healthwatch Bromley is one of 152 local Healthwatch organisations that were established throughout England in 2013, under the provisions of the Health and Social Care Act The dual role of local Healthwatch is to champion the rights of users of health and social care services and to hold the system to account for how well it engages with the public. The remit of Healthwatch Bromley, as an independent health and social care organisation, is to be the voice of local people and ensure that health and social care services are safe, effective and designed to meet the needs of patients, social care users and carers. Healthwatch Bromley gives children, young people, and adults in Bromley a stronger voice to influence and challenge how health and social care services are purchased, provided and reviewed within the borough. Healthwatch Bromley s core functions are: 1. Gathering the views and experiences of service users, carers, and the wider community, 2. Making people s views known, 3. Involving locals in the commissioning process for health and social care services, and process for their continual scrutiny, 4. Referring providers of concern to Healthwatch England, or the CQC, to investigate, 5. Providing information about which services are available to access and signposting, 6. Collecting views and experiences and communicating them to Healthwatch England, 7. Work with the Health and Wellbeing board in Bromley and Lewisham on the Joint Strategic Needs Assessment and 8. Joint Health and Wellbeing strategy (which will influence the commissioning process). Healthwatch Bromley Report for Bromley CCG - August 2016 Page 12 of 16

14 8. Acknowledgements Healthwatch Bromley would like to thank all the participants that took part and shared their experiences and stories with us. We would also like to thank the following organisations and networks that supported us in engaging children, young people, and their families: Anerley Town Hall Youth Group Biggin Hill Children and Family Centre Blenheim Children and Family Centre Bromley Young Advisors Burnt Ash Children and Family Centre Castlecombe Children and Family Centre Community Vision Children and Family Centre Cotmandene Children and Family Centre JusB Youth Charity London Borough of Bromley Library Newstead Wood LGBT Group Petts Wood Playgroup Phoenix Centre Walnuts Shopping Centre Healthwatch Bromley Report for Bromley CCG - August 2016 Page 13 of 16

15 9. Appendices i. Demographic Information Of respondents, 85 % were female, 8% male and 7% did not say. One respondent identified as transgender. 75 % of respondents were aged over 25. AGE Over 25 Did not say 8% 10% 4% 3% 75% The following pie chart demonstrates the ethnic breakdown of those engaged. (Please note, DNS stands for Did Not Say ). ETHNICITY White British White Other Black Mixed Asian Other Traveller DNS 9% 2% 0% 5% 4% 11% 6% 63% Healthwatch Bromley Report for Bromley CCG - August 2016 Page 14 of 16

16 ii. Questionnaire Community Health Services for Children and Young People in Bromley Healthwatch Bromley is working in partnership with Bromley Clinical Commissioning Group to capture your views on local community health services for children and young people. We would be very grateful if you could take the time to complete the following survey. 1. Are you the? Service User Parent Carer 2. Which of the following community children s services have you used? Please tick all that apply. Physiotherapy Occupational Therapy Speech and Language Therapy Community Paediatric Liaison Nurse Paediatric Community Audiology Community Nursing Children s Dietetic Service 3. What was your experience of using the service/s? Service name: Experience: 4. Can you recommend any ways of improving the service that you used? Service name: Improvement: 5. What age should community health services for children and young people be available until? Other Healthwatch Bromley Report for Bromley CCG - August 2016 Page 15 of 16

17 6. At which of the following times would you prefer to access community health services? During the school day (9:00 16:00) After school (16:00-18:00) Evenings (18:00-21:00) Weekends AM (9:00-12:00) Weekends PM (13:00-17:00) 7. Should community health services be available in other settings? For example, places such as local community centres or children's centres. Yes No If yes, please state where: 8. Which of the following services would you most like to have on offer? Drop-in clinics for advice, information and guidance Emotional wellbeing and mental health support Dietetic and nutritional support Support for children with behavioural issues Bed wetting support ADHD support Other, please state: 9. Are there any gaps in services that you have identified? Are there any additional services that you would like to be able to access in a community setting? Please state: 10. Please state your age: 11. How would you describe your ethnic origin? Please select one box: White British (English, Scottish, Welsh, Northern Irish) White Other (Irish, European, other White background) Asian / Asian British (Indian, Pakistani, Bangladeshi, Chinese, other Asian background) Black / Black British (Black African, Black Caribbean, other Black background) Mixed background / Dual Heritage Gypsy / Roma / Traveller Other ethnic group (please state) Prefer not to say 12. Are you? Female Male Other (please state) Healthwatch Bromley Report for Bromley CCG - August 2016 Page 16 of 16

18 Healthwatch Bromley 2016 Community House South Street Bromley BR! 1RH Tel: Website: Healthwatch Bromley Report for Bromley CCG - August 2016 Page 17 of 16