Getting feedback on our work as commissioners and on local health services is key for us. What is also important is ensuring that the feedback we receive has an impact on our plans and improving local healthcare.
We welcome feedback, comments and suggestions from local people about healthcare services in the borough and would appreciate hearing from you.
On this page, we share examples of what we have done in response to feedback and how it has made a difference to our work. We also show how we are feeding back to our population about the difference their feedback has made.
2019 Support for ME in primary care
As part of our community outreach programme we visited our local ME (myalgic encephalomyelitis) group to follow up with them since our last visit. They were also keen to share their experiences of local health services and there we had an extensive discussion covering a range of services and concerns.
- The CCG should be aware of and share with GPs their view that Graded Exercise Therapy (GET) is not a suitable therapy for ME patients, that it is currently under review by NICE and therefore should not be used GP practices.
- Wanted clarification whether ME is included as an “at risk” group for flu
- Asked that the CCG ensure that all GP practices in Kingston and Richmond can access the “Purple book” published by the ME Association which is a clinical and research guide for those affected by ME/CFS
- Would like to find out how the group can link with the Primary Care Networks (PCNs) in Kingston and Richmond.
- Share their experience of referrals.
- Would like more information about the eligibility criteria for non-emergency patient transport.
- We noted the group’s concerns about GET and that it is currently under review by NICE. Our position is that the current guidance still holds, until it is updated by the review.
- Provided more information about the “at risk groups” for flu as set out by NHS England and encouraged them to talk to their GP or a community pharmacist about getting a flu jab.
- Confirmed that we will be arranging for all GP practices in Kingston and Richmond to get the current edition of the Purple Book published by the ME Association.
- Shared their feedback on referrals with the South West London e-referral team.
- Provided the group with more information about the eligibility criteria for non-emergency patient transport.
- Provided information about the new PCNS in both boroughs.
2019 Developing our local health and care plan
Working with our health and care partners we used the ideas generated at an all-day engagement event with local people in late 2018 to develop draft proposals for our local health and care plan. We published these in a discussion document to continue the conversation with local people with local people most involved in and affected by our draft proposals. We did this through a mix of face to face discussions at local groups and forums, an online survey and written feedback.
We received a wide range of feedback to our health and care plan discussion document and you can read the detailed feedback in the Richmond Health and Care Plan engagement report. Here are some examples of what people told us about our draft proposals:
- Would like to see a greater focus on health and care from conception to age 2 – the first 1000 days, as this is a critical period for laying down foundations of good physical and mental health.
- It is not clear in the proposals how the actions identified will lead to the impacts listed for mental health e.g. will result in reduction of A&E attendance for mental health crisis by 50%.
- It was suggested that dementia should be identified as a long-term condition rather than sitting under a priority for end of life care under Age Well. Others saw dementia sitting under Live Well and were keen to understand how people who fit in both life stages would be supported.
Working with our local health and care partners we considered the feedback to inform the final version of the health and care plan. We made several changes to the plan in response to feedback from local people.
Our responses to the feedback examples above:
- The plan now references the first 1000 days with a commitment to develop a plan to support children, parents and families at this stage of life.
- We agreed that we needed to be more explicit about the actions around mental health crisis and A&E and revised the plan to include an explicit action to redesign the mental health crisis model and pathway
- For dementia, we agreed that it needed greater clarity and it is now a separate priority within the plan.
Find out more about how we have responded to local people’s feedback and how it has informed our final plan in Richmond Health and Care Plan – you said we did.
If you have any questions or would like to know more about our local health and care plan you can contact us on firstname.lastname@example.org.
Children and young people – reducing self-harm
We know that across South West London (SWL) we have a high number of children who are self-harming, and we want both to address and prevent this by developing consistent wellbeing support and early intervention. During summer 2018 we engaged children and young people and parents and carers, as well as teachers and schools to examine root causes of self-harm and poor emotional wellbeing, as well as to test potential solutions. In Richmond we heard from 128 children and young people, 341 parents and carers and 20 teachers.
Parents told us “We are desperate for help and we don’t know where to go.”
Children and young people told us “Groups are great because they help you feel more accepted and less likely to take frustrations about loneliness out on yourself”
“You can focus on friendships within activities”
Teachers told us “A lot of teachers are really lacking confidence when it comes to addressing or talking about mental health issues with children and young people. Improving their awareness and confidence (as well as their own wellbeing.”
We are doing
What we heard very clearly was that, whatever improvements are made, children and young people, their parents and carers and teachers need to be further involved.
We are developing an online list of services which shows the support available in our Borough.
We are developing a whole school approach which provides support to children outside of a medical environment
We are working closely with a group of schools to develop a whole school approach and to deliver mental health and wellbeing training to teachers and staff.
Parents of children with special educational needs and disabilities (SEND) living in North Barnes – Summer 2018
Castelnau Community Centre feedback to the CCG about the difficulties local patients were facing: “It’s really difficult for us to access support in this area, and we really need it.”
Working with the community centre and a local SEND charity, we have set up a parents’ co-production and information group. This will help the CCG to understand the difficulties facing parents so we can shape our services to work for people living in this part of the borough
The CCG ran an 8 week consultation between February and April 2017 on the following proposals for IVF and ICSI services Option 1 – No further change to existing service (women aged under 39 who do not have children and are in a long term relationship could continue to have one fresh and one frozen cycle of IVF on the NHS) and Option 2 – Change the access criteria for IVF so that it is funded in limited circumstances only (patients would need to meet the criteria in option 1 AND demonstrate exceptional clinical circumstances such as infertility following cancer treatment, or prevention of the transmission of chronic viral infections, such as HIV)
We listened to the views of patients, and to the Assisted Conception Unit at Kingston Hospital who advised that access should be based on clinical evidence associated with successful outcomes of fertility.
Many respondents suggested that the CCG consider other options, or further restrict the current eligibility criteria to maintain a level of IVF services in the borough. This option was also supported in discussions with the Assisted Conception Unit at Kingston Hospital who suggested that access should be based on clinical evidence associated with successful outcomes of fertility.
We listened to the views of local people and health professionals and agreed a third option, adding the following eligibility criteria to the current policy:
- No previous self-funded cycles of IVF
- Reduce the IVF age to <39 (the evidence shows that successful outcomes reduce with age)
- Reduce access to people with an AMH level of <5.4pmol/l (this is an indicator of fertility and below this level there is less likelihood of success).
The CCG has a substantial financial challenge and we have a duty to spend our funding wisely.
During 2017, we asked local people, for their views on proposals to change the access criteria to IVF (In Vitro Fertilisation) so that cycles are offered ‘on an exception only’ basis; to review prescribing of gluten free foods, vitamin D, baby milk and self-care medications which are now widely available at a reasonably low cost, both online and in local shops; for GPs to help encourage patients who smoke or have excess weight to make some lifestyle changes before they have surgery.
“There is a difference between lactose intolerance and cow’s milk protein allergy (CMPA). Children being misdiagnosed or delayed diagnosis puts a huge strain on the child and on the whole family. Specialists formulas are very expensive and will have a huge impact on low income families or vulnerable mothers.”
“The NHS shouldn’t be prescribing medication which is easily available over the counter for low costs, however there should be some exemptions for some older people, children and those on low income if it makes it difficult for them to manage their condition.”
“GPs should offer support to people who want to lose weight and give up smoking and make sure they are in good health before they have surgery, but surgery shouldn’t be refused to people who find it hard to lose weight or stop smoking. No one should be treated as a second-class citizen by the NHS and some health conditions make it hard to lose weight.”
“These proposals could lead to longer term costs due to the emotional and mental health impact on individuals and the knock-on effect onto primary care. Although this is only a small number of people, it has a significant impact on this group and their mental health can be impacted further by not being able to access NHS treatment. This will also impact more on people in lower income groups.”
We took the decision that gluten free food, vitamin D and self-care medications such as antihistamines and paracetamol will no longer be routinely prescribed. In response to the feedback on CMPA we will continue to support prescribing baby milk where appropriate with improved guidelines and education for GPs and other healthcare professionals.
Rather than making it a condition of having surgery, we agreed that GPs should encourage and support patients to be in the best health possible before surgery so that they will have the best outcomes.
Due to the potential significant impact of the IVF and ICSI proposals we decided to undertake an eight-week consultation on these proposals between February and April 2017.