Agenda item

For the Health and Wellbeing Board to receive an update on the acheivements of Healthwatch in 2023-24 and the Work Programme for 2024-25.

Cleo Chalk (Healthwatch Service Manager) introduced the paper which provided an update on the progress of Healthwatch Brent over 2023-24 and an outline of the planned work programme for 2024-25, which aimed to ensure that all residents in the borough could influence the delivery of health and social care in Brent. In introducing the report, she highlighted the following key points:

·       Healthwatch had a statutory responsibility to engage residents and patients as active planners in Healthwatch projects, which was done partly through the Advisory Board, made up of 11 local experts including representatives from community organisations and patients with lived experience, and partly through The Volunteers Programme. Healthwatch had a pool of 25 active volunteers who undertook activities on behalf of Healthwatch and that pool was made up of many different parts of Brent’s communities, including young volunteers. The majority of volunteers also spoke additional languages, allowing them to reach a wider range of residents, which was fundamental for Healthwatch.

·       Crucial to the work of Healthwatch was its work with grassroots community partners, and Healthwatch had 38 community partners who received updates on their work and had the opportunity to collaborate. A recent survey had recently gone out to community partners to better understand what those partners would like from Healthwatch.

·       During 2023-24, Healthwatch had undertaken a project looking at maternity services, comparing the standards of care across North West London (NWL). Cleo Chalk felt that this was a good example of how Healthwatch could work more collaboratively across NWL. The project had looked at in depth testimonials from women who had recently given birth across NWL. Healthwatch had heard from 207 women, 50 of which were from Brent, and the majority of those women, including the women from Brent, had shared positive feedback both about the experience of giving birth and their postnatal care. Healthwatch identified some key areas of improvement, such as a better listening culture, improving the quality of information shared and better support for breast feeding. Healthwatch had been able to present those findings and areas of learning at an Integrated Care System (ICS) collaborative maternity meeting, and the ICS agreed to respond by outlining the actions they would take to move those recommendations further. Healthwatch was also due to meet with the Northwick Park Hospital Maternity Services team to consider the recommendations with into Brent maternity services specifically.

·       Healthwatch’s Advice and Signposting Hub was highlighted, which provided a set of online resources with information about the topics residents most commonly asked about. Healthwatch recognised that online resources were not suitable for everyone but had found them to be a useful tool for those who could access online resources. This also freed up capacity to be directed into helping those without online access through other channels. Cleo Chalk encouraged partners to come forward with any additional areas that they would like to see explored on the online resource hub. The hub had been accessed by 783 residents the previous year, and Healthwatch had the ability to see which topics were of most interest to website users. In the previous year, the highest topic of interest was around how to access Adult Social Care (ASC), which was why there would be a major focus on ASC going forward into 2024-25.

·       Cleo Chalk thanked Claudia Brown (Director of Adult Social Care, Brent Council) and the Adult Social Care team for their support in shaping and developing the ASC priority and for being responsive and receptive to what Healthwatch could offer. Working with ASC, Healthwatch had developed a Community Engagement Programme which involved connecting with different community groups and conducting mystery shopping exercises through volunteers, which would be complimented by a series of ‘enter and view’ visits into care homes. The focus on ASC was partly because far more residents were coming to Healthwatch with issues relating to ASC than Healthwatch had seen before, and because it had been recognised that there was a gap in Healthwatch’s data. As part of this workstream, Healthwatch intended to engage with different groups including people with dementia, autism, ADHD and young carers.

·       There were a range of other areas Healthwatch were looking to focus on, including the Pharmacy First Scheme, as residents were curious how that scheme would work in practice and whether pharmacies would have the capacity to deliver what had been promised. The Same Day Access Model was another area of focus with many residents in contact with Healthwatch in relation to that.

·       Cleo Chalk concluded her presentation by highlighting Healthwatch’s way of working, which prioritised ensuring as many different resident groups as possible were involved, specifically from those diverse communities. Healthwatch would be continuing its outreach work with Somalian, Romanian and Brazilian communities and would be undertaking targeted work in particular wards such as Harlesden, Stonebridge and Kilburn.

The Chair then invited contributions from those present. The following points were made:

·       The Board was encouraged to see the new ways of working outlined in the report.

·       The Board asked for further information about how Healthwatch had targeted work towards supporting online access of services to make it easier for those without digital access, and how Healthwatch planned to address those challenges in 2024-25, particularly around primary care where patients were being encouraged to use online services. They felt that Healthwatch had a unique position to feed in their learning about groups of people who may be digitally excluded. Members were advised that digital access was an area of work that had been done successfully in other Healthwatch boroughs. For example, Westminster and Kensington and Chelsea had done some productive work on digital exclusion and primary care. Healthwatch Brent was having conversations about how to learn from that work and take it forward in Brent, with good ideas on what that could look like.

·       Continuing to discuss access, the Board felt it was positive to see references to projects in relation to access, such as work with people with learning disabilities and work with Romanian communities. They queried how much of the experience of residents with learning disabilities rested on them being able to access health information in an easy read format. In addition, for those residents who had a language barrier and also poor literacy skills, the Board queried how health services were ensuring resources were produced in easy read in different languages. Cleo Chalk agreed that Healthwatch recognised there were members of the community who did not speak English and did not have high literacy levels in their native language, and this had come up in a number of different areas of work. Healthwatch were seeing a good push across health services to have more information available in multiple languages and easy read resources could be requested if they were not immediately available, but she highlighted there was a gap for those needing other ways to access information, such as easy read material in a language other than English. There was some best practice that Healthwatch could highlight where services had produced particularly accessible resources which could be shared with health services.

·       The Board endorsed an approach whereby statutory partners explored a tech partnership to support the development of resources in accessible formats, such as through AI.

·       The Board asked for further information on the maternity project Healthwatch had undertaken. They raised concerns around the maternity risks for Black and Asian women and asked whether Healthwatch was speaking with those women to understand their experience of maternity services in Brent. Cleo Chalk agreed to share the demographic breakdown of the people who Healthwatch had spoken to, as they had targeted people from a range of ethnicities and also patients who did not speak English. It had been hypothesised that people who did not speak English might be receiving a worse standard of care, but that was not evidenced in the findings and Healthwatch found a lot of work had been done to ensure information was being presented in a range of different languages. Only one of the women Healthwatch had spoken to who did not speak English had a negative experience of care relating to her interpretation needs. Healthwatch had not found that inequalities in standards of care were not driven by a person’s borough, the hospital they used or their demographic information, and instead were driven by the busy-ness of the ward, understaffing and complexity of need. Healthwatch were keen to do further research with people who did not speak English to drill down on the findings.

·       In relation to antenatal work, Healthwatch had done some work in 2022-23 on antenatal care specifically with Northwick Park Hospital, which had then resulted in the maternity project that had recently concluded. That report had been less focused on language barriers and had found more recommendations for improvement than the more recent maternity project. It was agreed that the antenatal report would be shared with the Board.

·       The Board asked whether North Central London ICS had consulted Healthwatch on Start Well and when Healthwatch thought there would be some early feedback of the significant learning about women and families’ experiences. Cleo Chalk confirmed that North Central London ICS did engage with Healthwatch and Healthwatch had done some joint consultations with the Start Well teams who had come to the groups at Church End Unity Centre. Healthwatch had not seen the timeline for when those findings would be published.

·       The Board asked whether any commissioned or statutory services that Healthwatch had visited had required recommendations for improvement. They were advised that Healthwatch was starting to see some of the changes in response to recommendations made from previous years now come into effect. For example, Healthwatch had visited Park Royal Mental Health Inpatient Wards in 2022-23 and as a result of those visits had now seen some positive changes around how patients received information about advocacy, complaints, and their access to faith leaders through the Multi-Faith Forum. Similarly, Healthwatch had done some work with the London Ambulance Service and made recommendations about how patients were triaged if they had mental health needs and had now seen changes to how triaging worked, particularly with NHS 111 services. Healthwatch had done a series of ‘enter and view’ visits to GP practices the previous year and made some individual recommendations that were due to be published, the implementation of those would be monitored.

·       In terms of priority setting, Cleo Chalk advised the Board that Healthwatch needed to be quite lean with setting priorities as it was a small team and limited in what it could do. As GP access and mental health had been the priority areas for the past 2 years, Healthwatch had wanted to move to a stronger focus on ASC this year. However, Healthwatch did not want to step away entirely from GP access and mental health as these remained important issues within the borough, so there were some plans in place working with the Integrated Care Board (ICB) on a GP access survey looking at resident preferences for accessing primary care. Similarly, in relation to mental health, Healthwatch was looking at doing follow up visits to mental health wards in Park Royal and working with the community teams to see how Healthwatch’s recommendations were being made. If anything came up that was felt to be an urgent priority, Healthwatch could be agile and pick that up as an additional priority in the work plan.

·       In response to how the GP access survey would work, Cleo Chalk advised the Board that the new Same Day Access model would affect all residents, so Healthwatch were trying to reach out to residents to gather as much feedback as possible, including going out through Patient Participation Groups (PPGs). The survey would also go through Healthwatch’s regular engagement activity, taking residents through the survey at different community locations. The survey was also available online and Healthwatch would be promoting that through social media and asking for the information to be shared on patient group social media accounts.

In concluding the discussion, the Chair felt there were areas of information that Healthwatch was working on that could be reported back to the Board before the next annual update, including learning around maternity care and primary care as well as the new work looking at ASC. Cleo Chalk agreed to share Healthwatch’s timeline and full work programme for the year, which described what Healthwatch would be focused on month by month and could return to Board in 3-6 months’ time to update on these different areas. The Chair invited resident advocates to support the next presentation.

RESOLVED: To formally thank Healthwatch and recognise the progress and outcomes for 2023-24, as well as the work programme for 2024-25.