Notes from these engagement sessions are attached as appendices

Summary of feedback from community engagement sessions in October and November 2016, exploring views on proposals to procure a NHS 111 service for North East London Background Barking and Dagenham, Havering and Redbridge (BHR) Clinical Commissioning Groups, together with other four CCGs in North East London are procuring an enhanced NHS 111 service as part of our work to improve integrated urgent care across the area. Engagement was delivered during October and November to provide feedback from BHR residents that would help design the future service and inform the procurement process. Face-to-face community engagement ran alongside an online survey, which was promoted through CCG channels and networks across Barking and Dagenham, Havering and Redbridge. A presentation was produced to support and guide the community engagement sessions, with notes taken to record the comments and feedback (see appendices). All participants were encouraged to also complete the online survey and a link was shared with them. Community engagement activity who we spoke to The proposals for the NHS 111 service for North East London were discussed with community groups and at events in the community between 17 October and 11 November. These were: Havering Youth Council and Youth Parliament (a combined group of young people) Havering Children in Care Council The Follow Up Expert Patient Programme (EPP) group (Redbridge) Carers group drop-in session in Dagenham Carers group drop-in session in Barking Carers at Sinclair House Jewish Community Centre (Redbridge) Notes from these engagement sessions are attached as appendices Key messages from the feedback Mixed knowledge of NHS 111 o Carers from Redbridge and Dagenham had good knowledge, and used the service regularly o Young people from Havering and carers from the Barking session had less awareness of the service Mixed experiences of using NHS 111 o Carers shared their experience of NHS 111, which predominantly resulted in good advice and help o Young people had little or no experience of calling 111 o Comments ranged from It is an amazing service and they always give good advice to a carer describing how his wife was left on the floor for 7-8 hours waiting for an ambulance after calling NHS 111 Chief Officer: Conor Burke Barking and Dagenham, Havering and Redbridge Clinical Commissioning Groups Chairs: Dr Waseem Mohi, Barking and Dagenham Clinical Commissioning Group Dr Atul Aggarwal, Havering Clinical Commissioning Group Dr Anil Mehta, Redbridge Clinical Commissioning Group

Support for better, direct access to clinicians and other healthcare staff o General consensus that it would be helpful to reduce the time spent with advisors before speaking with a clinician Training and development for NHS 111 staff o Many participants raised issues with the number of questions asked by telephone advisors and questioned their relevance, with the EPP group feedback including comments about the questions not being patient-centred Better promotion of NHS 111 is needed to ensure the service is well recognised, understood and used appropriately: o Young people in Havering compared knowledge of 111 with knowledge of 999, and suggested there could be learning from the 999 branding/ campaign o Promotion via GPs and GP practices, places of worship and libraries were widely supported o Local networks including the voluntary and community sector including the University of the Third Age could help to target promotion o Public advertising (billboards, TV adverts), social media, and printed materials were suggested o Most of the groups suggested informing/ educating young people by involving schools Conclusions Experience of using the current NHS 111 service for BHR is generally positive. Awareness needs to be improved, both of the service and what it offers There is strong support for improving or enhancing callers access to clinicians and healthcare staff Training and development for staff (111 advisors and any clinical staff) would help with communication with callers/ the public. Some participants questioned the number of questions each caller is asked and suggested simpler language could help. Raising awareness and understanding of NHS 111 (which would need to align to a national campaign and messages) was strongly supported Local networks, organisations and services (including GPs) could all provide opportunities for promoting NHS 11 as a reliable and helpful service. Advertising and promotion through existing paid-for channels should also be considered. Appendices Appendix 1 Feedback from Havering Youth Council and Youth Parliament 23 October Appendix 2 Havering Children in Care Council (CiCC) 17 October Appendix 3 Expert Patient Programme group 20 October Appendix 4 Carers drop in sessions in Barking and Dagenham 27 October Appendix 5 Carers at Sinclair House Jewish Community Centre, Redbridge 3 November Page 2 of 10

Appendix 1 NHS111 Procurement Clinical Commissioning Groups Feedback from Havering Youth Council and Youth Parliament How can we engage local people? Group consisted of 12 young people aged between 12-17yrs How can the public be encouraged to call NHS111 for help? Advertising, Posters - on side of buses, prime time TV Slogan (FAST was good example) social media - you tubers Youtubers doing skits and mentioning the phone number is also a great way to reach many people at once Celebrity to advertise going into schools/colleges How can we ensure that people call NHS111 where appropriate rather than call for an ambulance or attend the Emergency Department (A&E)? Clarify/explain what an emergency is emergency means different things to different people. One young person gave the example of reading that someone called 999 because their oven broke on Christmas day and she didn t know how she was going to cook the turkey!!! Educate when to call 111 Penalties for ringing 999?? although this could be negative Have you used NHS111? If Yes, how was your experience? No one had used 111 but had used 999. Both young people felt a lot of information was needed before any help was offered; they were anxious and wanted someone to come and help rather than keep talking to them. How could the NHS111 service be improved? Have lots of knowledge ask what age the caller is and use appropriate language for younger callers especially under 10yrs. What other groups should we be engaging with? Elderly, vulnerable people, people with disabilities, carers/young carers, young men as they don t tend to see their GP, University Students, People with chronic illnesses, Pregnant Women? What do you think is the best way to tell people about 111 and the improvements we are hoping to make? Leaflets, posters multilingual/bilingual as above To reach every demographic, need virtual and physical information. For a younger audience, using social media platforms such as YouTube, Twitter and Snapchat (filters) to inform the audience is effective Page 3 of 10

Appendix 2 NHS111 Procurement Clinical Commissioning Groups Feedback from Havering Children in Care Council How can we engage local people? Group consisted of 5 young people aged between 12-16yrs The young people worked out the 111 service receive a call every 29.1 seconds How can the public be encouraged to call NHS111 for help? Advertising, Posters in A&E, if you have a cold don t come to A&E tell a friend How can we ensure that people call NHS111 where appropriate rather than call for an ambulance or attend the Emergency Department (A&E)? Clarify/explain when to call an ambulance or go to A&E When to call 111 Have you used NHS111? If Yes, how was your experience? One young person had experience and didn t think 111 were helpful, didn t feel they were listening. However, 111 advised to go to A&E they did follow the advice. How could the NHS111 service be improved? Have lots of knowledge What other groups should we be engaging with? Elderly, vulnerable, people with disabilities, carers What you think is the best way to tell people about 111 and the improvements we are hoping to make? Leaflets, posters - use pictures multilingual/bilingual Page 4 of 10

Appendix 3 Feedback from the Follow Up Expert Patient Programme (EPP) group Newbury Group Health Centre, Diabetes Centre Thursday, 20 October 2016 The session was supported by Julie Atkins, EPP Co-ordinator and facilitated by Boba Rangelov, PPE Advisor, BHR CCGs. Ten members participated in discussion. All participants were patients with complex needs and/or long term conditions. The main points from the session were: Instead of having two numbers: 999 and 111 number, there should be only one number, a single point of access. If there are two numbers, people would still call 999. The promotional campaign of a new 111 service should be as wide as possible to inform everyone about it. This would include: leaflets coming through the letter boxes, TV adverts, billboards, social media (Twitter and FB), to involve schools (primary and secondary schools), nurseries, pharmacists. There should be promotional stands in big shopping centres to raise awareness about 111. We should promote the service through the CVSs and use other community newsletters to reach wider audience. It is very important to educate young people and children. When patients go to their GP, they should inform patients about 111 service and currently they are not doing that. A member called 111 in the middle of the night and she was asked a formulated set of questions which were not all relevant for her call. She felt that she was losing time talking to them. A member said the questions he was asked by 111 staff were too long and not patient centred. The current set of questions asked by 111 staff need to be changed, as currently, they are not patient centred. The majority of members agreed on this, except one member, who thought the current set of questions were focused enough. Another member said when they called 111 service they were told that the ambulance would come within 2-3 hours. The first time they called they had to wait longer time but the second time round the ambulance arrived quickly. That first point of contact is crucial for patient and the questions asked should be straight forward. The time should not be wasted on long and irrelevant questions. It is very important to have direct access to a clinician and other relevant healthcare staff (nurses). The 111 staff should be fully trained to be able to help caller in the first instance. The call should be directed to the right person as soon as possible and spend as little as possible time talking to the first point of contact The 111 staff should have good understanding or some kind of medical background. One member suggested that 111 staff should spend some time in the clinical environment, as part of their training in order to relate better to patients problems. People need to know the consequences when they attend A&E. It is important for 111 service to have direct access to District Nurses, Community Treatment Team (CTT) and other community health and social care services. CTT service is excellent and should be open 24/7. There should be a team that would come out and assess the patient in their home, especially those borderline patients (between urgent and non-urgent care). Page 5 of 10

It is important that 111 staff have direct access to GP records. Whether someone will call 111 or 999 depends very much on the circumstances and the environment. You would call 111 if you are at home, at workplace on in hotel. But if you break your leg on a field you would call 999 instead of 111. So, it very much depends on the circumstances where the incident happens and urgency of it. Which groups we should engage with? They suggested the following groups: MS and stroke patients support groups. The Carers association groups, young people and children, the faith groups, places line churches, mosques and other places where people gather to raise profile of 111 service (bars, gyms, hairdressers, bingo places, buses, libraries, etc.); the Diabetes Centre, libraries, buses, leisure centres. We should use screens at the GP practices to promote 111. There should be a snappy phrase, which everyone would remember (pens, stickers etc.) widely used for people to remember. 20 October 2016 Page 6 of 10

Feedback from the carers at Barking Library Thursday, 27 October 2016 10am-12pm Appendix 4 The feedback I called 111 service couple of times. They have arranged a GP visit for me. People who speak English are more aware about the service then non-english speaking people. I think 111 service is second emergency number people can use. It is useful service. It would be good to go to schools to promote the service and also to use social media (Twitter, FB). You need to have people to go around places like hospitals, A&E, GP practices etc to talk about 111 service; to put posters and notices at visible places to let people know about the service. I haven t heard about 111 service. It would be good to advertise it via different media (TV, FB, newspapers etc) You need to promote it better; to send letters to more vulnerable people; GPs can promote this service; they should display leaflets in the surgeries. This service had bad press recently. The staff must be well trained to help people immediately. It is pretty good service, I have used it several times. They used set of questions and then someone called me back. They made an appointment for me. In general, younger carers were more aware of the service. The main points were that the promotion of the service should be better and that the staff should be well trained and able to provide appropriate advice at the first point of call. Page 7 of 10

Feedback from the carers at Dagenham library Friday, 28 October 16 10am-12pm Appendix 4 I have used the service in the past for my child. Sometimes they give good advice and they were right. But I would still go to A&E if I am not reassured with the advice given over the phone. As a last resort I would take my child to A&E. I usually go to the local pharmacy for minor alignments. Once I was told by 111 service to go the hospital. I am registered with the Urswick Medical Centre and they advised me about 111 service. It is useful service, preventing people going to the hospital. I am not aware of the service. It should be promoted better in the community (posters, pharmacies, GPs) I called them about 2-3 months ago. They called me back and told me to take my child to A&E and gave me advice what to do. I found out about the service listening to the recorded voice message at my GP practice. I have used the service and they arranged an appointment for me. I always use 111 service for my family. It is an amazing service and they always give a good advice. I have serious brain condition, so sometimes I have to call 999 directly but I have been using 111 service as well. It all depends on the situation and how I feel. When I called 111 service they were good and gave me good advice. I have used 111 service for my wife. It is a very good service. It was engaged when I called but I called back again and spoke with somebody. I saw the advert about the service in KGH. They gave a good advice for my wife, so there were no need to go to the hospital. Some people have language barrier, so they need to have interpreter available. I called 111 service twice in the past. I was in pain at that time. They called me back and they asked me the same questions as the first time, which was annoying because I was in pain. But I understand that they have to go through set of questions. I think that this service can give only basic advice but they can t offer proper resolution to my problem. I would rather see someone face to face then talking over the phone. We should have more GPs, so we don t need to call 111 service. We have to be treated the first time round and at the time when we need it. Page 8 of 10

Jewish community centre Sinclair House, Woodford Appendix 5 Thursday, 3 November 2016 11am-12pm The Carers group 111 service-feedback There were five carers present at the meeting. The main points from discussion were: I called 111 service for my wife who had a fall. This was 2-3 years ago. She pressed Life Line button and they put her through to 111 service. They assessed her over the phone and said that the ambulance will attend. 7-8 hours later the ambulance came. All this time she was on the floor and therefore developed UTI. Our experience was not good as my wife had to wait long time for somebody to come and lift her off the floor. After ambulance finally arrived, they took her to the hospital. The staff is not trained enough and this should be better. I thought that 111 service is shut down. I did call once in the past and they were pretty good for me. They gave me good advice. This was pretty quick service when I called them. Between them and Life Line, they put me quickly to the hospital. The ambulance came quickly. The GP came quickly and gave me antibiotics straight away, so I didn t have to go to the pharmacy. However, the GP didn t give me a letter to give it to my GP. The 111 service don t tell you how long you have to wait for GP. You have to advertise new 111 service in the local libraries, GP practices. There is University of third age, an organisation that provides various classes to people over 65. They would be good to spread the word about 111 service to older people. They produce their newsletter for Redbridge and district area four times a year, so they could advertise it there. You should advertise 111 service in places of worship (churches, mosques etc.); you should have flyers to distribute through various community groups and organisations. I.e. Redbridge Institute, Redbridge college, Redbridge Carers Support Service; Age UK, Redbridge Social Club in Beehive Lane, sport centres. Page 9 of 10

The group welcomed the idea to have a clinician available to provide help and advice over the phone and they said that the staff should be more knowledgeable and better trained when they take the call. Their worry was that the current staff are not trained enough to cope with the patients problems. The groups also said that Out of hours GP service should be better promoted as many people are unaware of this service. They were not in favour of on-line booking system (most of them), as they are not confident PC users and would rather book their appointments over the phone or in person. Page 10 of 10