You said, we did
Themes emerging from Healthy Conversation 2019 engagement, May 2019
Lincolnshire NHS’s Healthy Conversation 2019 campaign went live on 5 March 2019. Wave 1 of the engagement has included a survey on the acute services review and its enablers such as digital technology, travel and transport; a series of public engagement events across the county; feedback forms for completion at the events and online feedback forms.
The emerging themes from the feedback received so far and our response is highlighted below.
Travel and transport
- Issue isn’t the hospitals but travelling to them – poor road networks and lack of public transport
- Early appointments not achievable when using public transport
- Costly travelling across the county to hospitals further away
- Can’t always rely on family and friends
- Community transport sometimes unreliable
- Unable to get back from hospitals if taken by ambulance
- Provision of shuttle between hospitals or accommodation for family to stay
- Direct trains between Boston, Skegness and Lincoln
- Routes and times clearly displayed at all bus stops
The NHS is responsible for delivering medical and health care services. Local councils are responsible for public transport. However, we fully appreciate how crucial transport is so that patients can access NHS services, therefore we are working closely with Lincolnshire County Council on a joint transport strategy to improve public transport and look at other viable options to supplement patient travel. We have worked to a principle of the most regular care requirements remaining close to home, such as routine screens in cancer care for example. It is when care needs become more complex and specialised that we introduce further travel; we have heard from Lincolnshire’s public that the right care, first time is the priority, even if that means further travel. A large consideration for our clinicians as they review services is how to best spend NHS funding, including whether we divert some of our funds away from care in order to supplement patients’ travel, and we would welcome your continued input into this consideration.
We are also working on digital solutions so where possible, we can prevent the need for travel and for example a face to face consultation could happen by the internet. See technology and information section.
- Golden Hour not achievable from some parts of the county
- Consideration of population need by locality before determining locations of service
- No mention of step down / rehabilitation
- Ambulance response times are poor – assurance needed
- Scope how to link mental health support and stroke community rehab
We are working closely with East Midlands Ambulance Service (EMAS) throughout the process to ensure ambulance response times are meeting targets and patients are transported safely and in appropriate timeframes. For example, being able to reduce the amount of handover time at A&E will reduce pressure on EMAS so they can spend more time on the road caring for patients.
Linking mental health and stroke community rehab is a good suggestion. Alongside the ASR we are also working on Integrated Community Care (ICC) which is aligned to the NHS Long Term Plan. This programme of work focuses upon care in the community, mental health and many other areas. We are taking committed steps towards integrating services and will report back on this progress as ICC develops.
The 'Golden Hour'
The ‘Golden Hour’ refers to the door to needle time, i.e. from the patient arriving in hospital to administering the thrombolysis treatment. It is a target and has no clinical significance to outcome. The sooner the treatment is given, the better the chance of a better outcome for those who are going to benefit from the treatment. Not everybody can have this treatment as it depends on the type of stroke.
The 4.5 hour time limit in the clinical guidance refers to the time within which we can administer the thrombolysis treatment within the current license. It is more relevant to clinical practice, but it starts from the time of onset of stroke symptoms, or from when the last time the patient was seen well.
- Unable to book appointments over the phone in some practices and have to visit in person – difficult for those without transport
- Others can only book online which is inconvenient, especially if they have limited access to a computer
- Communicate all options for appointments and don’t always need to see a GP
- Promote GP Out of Hours services, especially at Grantham Hospital
We are working hard to communicate with the county that there are several options available to access health services which don’t always involve seeing a GP. These include seeing the advanced clinical practitioners (such as nurses) we have recruited across the county.
ASAPLincs is a free app and website resource which was launched to help the public access the most appropriate heath care. It also features an up to date overview of all out of hours services and their availability and has been heavily promoted on bus sides, through local papers, on social media and in GP practices etc. We have also promoted GP Out of Hours services through literature in schools.
Technology and information services
- Welcome e-consultations to avoid concerns regarding transport
- Refreshing to hear; innovative thinking, digital is the future
- E-consultations and telephone consultations are good ideas
- Many people do not have access to the internet and will need alternative options
- Areas of poor broadband and poor mobile phone signal
- Shouldn’t need to keep re-telling your story/medical history
- Patients holding their own records and notes like in France
- Other communications needed such as face to face and local newspapers
In Lincolnshire we have developed the Lincolnshire Care Portal. This is a secure computer system that provides health and care staff with a selected view of a patient’s personal information contained in different health and care systems. The Care Portal enables health and care staff to view an integrated care record for the patient. It brings together selected patient information from multiple organisations and systems in real time. We are in the process of connecting up systems across Lincolnshire organisations, this includes GP practice systems, hospitals along with community and mental health. We are also looking farther afield so when Lincolnshire patients travel to hospitals in other areas, such as Peterborough, Nottingham, Grimsby etc. staff in those organisations have the patient information they need from Lincolnshire organisations. For more information about the Lincolnshire care portal please visit https://lincolnshire.nhs.uk/together/care-portal
There are other digitals plans too. These include plans for remote patient monitoring so for example a blood sugar or blood pressure can be taken by the patient in their own home, using a wearable device, and electronically sent to the patient’s clinician who can review and then agree the treatment directly with the patient.
We use a variety of communication methods, including face to face, local newspapers/magazines and displaying information posters in public areas.
Women’s and children’s services
- Need clearer communications about the situation at Boston
ULHT hold regular events and circulate frequent updates on their website and on social media with regards to the temporary service currently in place at Boston. This engagement exercise is ongoing.
Long Term Plan
- Many people have numerous medical conditions and need joined up care
- Rapid community teams needed in a large county
- Neurological conditions needs to be included, especially rehabilitation
- Third sector and support groups will need financial input to help with services and activities
- Improve transport to access local support groups
We are committed to the development of rapid community teams in Lincolnshire, for example children with respiratory problems now have access to the Children’s Rapid Response Respiratory Physiotherapy service. This new service, which started in February 2019, aims to reduce unwanted hospital admissions for these children by keeping them comfortable at home where they have all their specialist equipment when they become acutely unwell with chest infections.
Neurological conditions, including rehabilitation will be included in our Integrated Community Care (ICC) work programme which is a priority for Lincolnshire’s health and care system. Updates on this programme of work will be made available as it progresses.
We work closely with the third sector on a daily basis and more formally through our STP Stakeholder Board, of which many representatives are a part,to ensure the NHS is providing appropriate support for voluntary services, whether this is funding, training or other requirements.
The NHS is responsible for delivering medical and health care services and local councils are responsible for public transport. However, we fully appreciate how crucial transport is so that patients can access NHS services, therefore we are working closely with Lincolnshire County Council on a joint transport strategy to improve public transport and look at other viable options to supplement patient travel.
The NHS Long Term Plan was published nationally at the start of this year https://www.england.nhs.uk/long-term-plan/. Towards the end of this calendar year, every STP / NHS economy across England will need to write a plan about how this will be implemented locally. Lincolnshire NHS will be using the information from this public engagement work in the Lincolnshire plan.
- Variation in standard of care between GP Practices
- No infrastructure to support the communities, especially in Mablethorpe
- Focus on education and generational change
- Appointments needed outside of working hours to reduce time needed off work
We are linked with Public Health England and focus heavily on self care and prevention. Our priority Integrated Community Care (ICC) work programme is also a huge part of implementing generational change through education.
The ICC work stream acknowledges the flexibility required to make appointments accessible outside of working hours. For example, Extended Access GP appointments provide evening and weekend appointments and we are developing more digital access in Lincolnshire so patients can benefit from e-consultations where appropriate.
Stamford Urgent and Emergency Care services
- Great service in Stamford Hospital, would like an extended service
- Support for UTC in Stamford to reduce need to travel elsewhere for emergency care
- UTC will reduce the pressure on surrounding hospitals
- Increase in population – need extended access to UC 7 days a week
- Hospital could provide additional out patient and emergency clinics
We have proposed an urgent treatment centre (UTC) which would provide access to urgent care seven days a week. To ensure patients are clearly informed about UTC capabilities and limitations, we are planning a dedicated engagement phase around UTCs. This will occur over the summer and we would encourage people to share their views and suggestions through it.
Mental Health Services
- Really good care and support
- Impossible to get appointment with CAMHS
- Support for community based services, enabling patients to stay at home with family
- Fantastic work with autism
- More information required for parents about what services are available, especially online
- Improve links from children to adult services
- Improve flexibility of CBT appointments for those who work
We are working on a mental health hub in Lincolnshire which will provide more information, including online, for parents about the services available and will also improve links from child to adult services. This hub is a partnership project with charities, voluntary sector and other relevant parties collectively developing it.
We have asked for improved flexibility of CBT appointments and will keep the public updated as this progresses.
Grantham Urgent and Emergency Care services
- Grantham is on major road and rail links and needs an A&E open 24/7
- New housing developments increasing local population
- Travelling time to other hospitals can be above the golden hour, especially for those without their own transport
- Roads to other hospitals terrible and lack of direct public transport – not everyone has a car and not everyone can afford transport
- Lincoln Hospital is stretched and not meeting its own A&E targets
- Ambulance are not available and four hour wait
- Some issues with TASL
- NHS terminology regularly changes and confuses patients
- Those patients transported to other hospitals have to find their own way home at a cost
- Lack of transport to attend another A&E during the night
- Support for new build hospital at MOD site
- Transport or accommodation put in place for patients and their families
- Grantham Hospital needs to be the first option for people calling NHS 111
- Public need to be educated on how not to abuse the NHS
- Patients need to be clearly informed about the UTCs capabilities and limitations
- Free shuttle bus or volunteer transport to hospitals from main train and bus stations and between hospitals
- Travel helpline available 24/7
Grantham Hospital will be the first choice for people calling NHS 111 where appropriate. Please see the UTC FAQs for detailed information on access.
We are aware that people visiting A&E for conditions that do not require emergency care is a big issue for the NHS and there are a number of initiatives in place to correct this, but we also have to accept this is a national problem and not just one that Lincolnshire faces. One of the local initiatives we have introduced to inform people how to use the NHS more appropriately is the ASAPLincs app which helps people to access the most appropriate heath care.
To ensure patients are clearly informed about UTC capabilities and limitations, we are planning a dedicated engagement phase around UTCs. This will occur over the summer and we would encourage people to share their views and suggestions through it.
The NHS is responsible for delivering medical and health care services and local councils are responsible for public transport. However, we fully appreciate how crucial transport is so that patients can access NHS services, therefore we are working closely with Lincolnshire County Council on a joint transport strategy to improve public transport and look at other viable options to supplement patient travel – the options that have been considered include a shuttle bus.
There is a travel helpline already running, details of which can be found here: https://lincsbus.info/