You said, we did

Collecting the views of local people and community groups is important, but ensuring that these views are listened to and acted upon is at the heart of what we do.

This involves informing the public about how their views and opinions have influenced change. We call this approach a 'you said, we did' model of engagement.

See below for examples of the difference your feedback has made to health and care services across BSW.

 

This page has been independently reviewed on by Siddarth Patel on behald of BSW CCG, to ensure that our website is user friendly and easy to navigate.

Long-term waiting lists

In May 2020, members of the Swindon locality Patient and Public Engagement Forum were asked by to look at a proposed approach to Great Western Hospitals NHS Foundation Trust validating its long-term waiters 'on hold' file. These are people who have been on a waiting list for more than six months. These patients may not have been seen for several reasons such as – the hospital cancelled their appointment, the patient cancelled the appointment, or the service is oversubscribed with patients and has not been able to meet capacity.

You said:

We did / Responded (Great Western Hospitals NHS Foundation Trust )                                                                                      

It sounds like a reasonable response to waiting lists, but perhaps include a choice to ask patients are they waiting for the pandemic to become manageable before they attend appointments.

 Great suggestion. We could include this as a response.

This seems a fairly straight forward pragmatic approach to the hold file. Are you able to confirm which specialities this covers – I have assumed all specialities e.g. cancer, children’s?

Are you also able to confirm how patients with communication/ language difficulties will be approached?

Can you confirm if this covers all GWH patients or will patients outside of Swindon be dealt with differently?

This would cover all specialities where the clinicians agree that it is appropriate.

Patients that do not respond the text would be prompted for a call.  This would capture any literacy concerns.

This only covers GWH and our follow up waiting list.

The suggested plan of action looks rational to me.  Any idea of numbers?  The pre-triage list (before the clinicians highlight who they would want excluded from this proposal) sits at Circa 12,000 patients.
 

I think they need to look more closely at option 3. Many patients know about their condition and manage it.  However, referring them back to their GP might not be the best option for the patient.  Once they have been referred to the GP if the condition flares up again, they’ll need to restart the process with a referral from their GP.

Another option is for the patient to have a contact at the hospital they could contact for triage rather than going back to the GP.

 Agree – the wording could be better modified.  Any patient that is not under the hospitals care, is under the care of the GP.  It may be an option to consider both discharging the patient to the GPs care for any future conditions while offering a further PIFU period (Patient initiated follow up – the patient is discharged from the list but can directly contact the hospital should they need an appointment for the original condition with a specified time).
 

Will the details of patients removed from the lists be communicated to their GP’s?

When answers are received, I presume they will be checked back against the list used for the contact processes. To ensure none are left hanging.

 

Yes, any patient not under the care of the hospital is discharged back to their GPs care.  This would be confirmed in writing to the GP and patient.

We think this is referring to those that specify options 4 or 5?  If the patients still wish to be seen, we would respond to let them know they will remain on the waiting list and will be contacted when an appointment is available.

At the end of the first line in the section where the five responses are listed, should there be DR and then Doctor as the first word on the second line?

Yes, the telephony text system we use is provided by a company.  That company’s names is “Dr Doctor” 

Fully support this proposal with one reservation namely option 3. Should it be the patient who decides if the condition is stable? And will this action further load Doctors waiting lists?

 Agree – the wording could be better modified.  For clarity, any patient that is not under the hospitals care, is under the care of the GP.  This does not mean the GP needs to take any further action.  It simply means that the patient would visit their GP before being referred to the hospital.  If the condition no longer presents, then this would be the normal route for the patient to receive care. 

Having said that it may be an option to consider both discharging the patient to the GPs care for any future conditions while offering a further PIFU period (Patient initiated follow up – the patient is discharged from the list but can directly contact the hospital should they need an appointment for the original condition with a specified time). 

Thank you for sharing this and asking for comment. We have reviewed the process and feel it is a sensible approach.

We would however like to ask for more clarity on the excluded mental health and safeguarding patients.   From a patient safety perspective, we would like to know if contacting these patient groups have been considered, as a priority, due to the well documented increase of both Mental Health issues and Safeguarding incidents during Covid-19.

This proposal is formed to ascertain if long waiting patients still require an appointment.  The exclusion cohorts of patients is a stipulation to ensure that we only contact patients identified as safe to contact. 

Regarding the wider impact to mental health and safeguarding in general, the Safeguarding teams continue to operate during Covid.

Does this include CAMHS (Child and Adolescent Mental Health Services) and those on the waiting list for the NDC (neuro development conditions) pathway (although I think those waiting on that list are waiting for a first appointment rather than a follow up so I'm guessing it doesn't include them?)

No, this proposal is only for follow up patients that have been waiting 6 months passed their original follow update.

This new list is a list of patients that clinicians and the operations team are happy to communicate with to ascertain if they still require a follow up appointment.

‘Cross check against ... mental health and safeguarding lists to ensure these patients are not contacted.’

In this instance would the service that the patient is under be following up the needs of the patient? If this is not guaranteed/known then would the service be informed that the patient is/was on this list and will they be following up any needs the patient may have?

Firstly, I don’t think text messages are a suitable way to contact a patient, due to confidentiality issues, especially in sexual health matters, domestic abuse situations as you cannot be sure who will read or even receive the message.

If having ‘text’ a patient what happens if there is no response from the patient, which could be due for example a number change or choosing not to respond to a random text message, will the service then try and contact by other means?

Also, will there be a contact number in the text message, if the patient would prefer to speak to someone rather than text back?

What happens if some patients cannot read or write? Or does not speak English as many cultures do. (As in cases where GP send letters out to patients and he/she could not read the letter, when he/she went to the surgery was informed that she was not on the list anymore as she did not respond to the letter.)

Most services use a withheld number, would the hospital/clinic use the telephone number so as to reassure patients. When they answer the call. (so many people would not answer a withheld number due to scammers).

Yes, if a patient has been waiting more than 6 months past their follow up due date but was excluded from this project – we would be looking to book these patients into the next available appointment for their condition.

The text message requires a date of birth to validate the recipient ahead of any responses being recorded.  In addition, any patients with a safeguarding flag would not be communicated with via this project.

If having ‘text’ a patient what happens if there is no response from the patient, which could be due for example a number change or choosing not to respond to a random text message, will the service then try and contact by other means?

Yes, Any messages not responded to would trigger a telephone call the same as if “Any patient identified on the above list that does not have a mobile phone will be contacted via phone by a member of the administrations team to ascertain the answer to points 1-5.”

No there would not be a phone number included, but this would be available on their original appointment invite as well as on the hospital website/phone book.

If the patient cannot read or write it is assumed, they would not respond to the text.  In this case it would trigger a phone call to establish which of the 5 options apply.

Any nil responses to all communication attempts would default back to the patient being left on the waiting list and they would be booked into the next available follow up appointment for their condition.

The hospitals phone service is from a withheld number.  Any patient that does not want to talk on the phone would not be negatively disadvantaged.  They would not be removed from the waiting list.  If the patient wishes to call the general phone number for the hospital, they could potentially be put through to the relevant clerk to ensure they could complete the survey.

 

Transforming Maternity Services Together

Learn more about our Transforming Maternity Services Together project.

You said

We did

“We are not always getting the right kind of breastfeeding support.”

We have already standardised advice across the Local Maternity System.

We have increased the number of peer supporters available in the community.

We plan to enhance the level of support by:

  • Improving access to support closer to home
  • Holding group support sessions and clinics in the community involving the wider team, e.g. health visitors and breastfeeding supporters
  • Having a 24-hour telephone triage advice line
  • Having community on call staff who will be able to provide breastfeeding support either via the telephone or through home visits/support in community settings

“We want more information to make the right choices about hospital and home births.”

We plan to create an Alongside Midwifery Unit at Royal United Hospital and Salisbury District Hospital and enhancing the home birth service.

We plan to increase the choice of midwife-led care across the Local Maternity System (LMS).

We will shortly be launching an electronic app containing information for pregnancy women in the BSW area along with a personalised care planning booklet for women to help support choice conversation and shared decision making.

“What is an Alongside Midwifery Unit?”

An Alongside Midwifery Unit (AMU) is a unit on the hospital site, right next to an Obstetric Unit, and means women can chose midwife-led care but have immediate access to medical care on the same site should they need it.

Great Western Hospital in Swindon already has a successful AMU and we plan to have the same for women across Bath and North East Somerset and Wiltshire. This will provide more birthing choices for women.

“We want joined up services with consistent professional advice throughout pregnancy and the early weeks of our baby’s life.”

Offering births at two rather than four Freestanding Midwifery Unit (FMU) will free up staff to better support continuity of care – so women and families can be cared for by a team of professionals they can know and trust throughout their pregnancy, birth and post-natal journey.

“We value having the Freestanding Midwifery Units.”

We will continue to provide Freestanding Midwifery Units (FMU) in two locations rather than four.

We want the FMUs as an option for antenatal and post-natal care.

“We want home births promoted and you to consider providing a dedicated home birth service.”

We plan to enhance the home birth service with more consistent support and better resourcing.

We will improve the information provided about having a home birth to help inform a mother’s choice.

We plan for midwives to have more capacity to fully promote and support a home birth service.

“We want more time with a midwife and continuity of care is important to us, particularly antenatal and post-natal care.”

We have already improved our appointment systems by standardising them across the service.

We have improved access to booking appointments with the same midwife for both antenatal and post-natal care.

We have increased the length of appointments to between 20 and 30 minutes.

We plan to increase time to care and time to listen, helping to improve mental and physical wellbeing through pregnancy.

We plan to improve the flexibility of staffing to support continuity of care during labour.

We plan to develop continuity of care plans (as set out in the wider Local Maternity System Transformation Plan).

We plan to improve the support for vulnerable groups.

 

 

Our Health, Our Future

Learn more about the Our Health, Our Future project.

You said

We did

“Mental health services should be more accessible to younger people and doctors should provide more information for young vulnerable people affected by mental health issues.”

The Trailblazer scheme underway across BSW offers onsite support for school children for mild to moderate mental health issues, such as exam stress, low mood or friendship difficulties, with the aim of intervening early to avoid these problems getting worse.

TheTrailblazer team will offer support to school staff and a link with local specialist services to help pupils access support if required.

“Being listened to and to have health professionals understand that I should have some influence over the type of treatment I receive. They are the experts, but I am the expert on myself and my symptoms so let’s work together to solve problems.”

There is an increased focus in BSW on shared decision making - a collaborative process through which a clinician supports a patient to reach a decision about treatment. The conversation brings together the clinician’s expertise, such as treatment options, evidence, risks and benefits, and what the patient know best, such as preferences, circumstances, values and beliefs.

“It would be great if there were more services for people affected by autism and their families to offer more help.”

The Sunflower lanyard scheme currently being rolled out across BSW offers children and adults with hidden disabilities such as autism, bipolar disorder and epilepsy a special lanyard so that colleagues working in healthcare settings can be made aware of their disability.

Our Five Year Plan highlights work to improve the quality of life for individuals with learning disabilities and autism by reducing preventable crises and improving access to health and care as a priority. This will involve professionals and volunteers across health, social care and education working even more closely to improve learning disability services and outcomes.

“I think it should be easier to access mental health support, particularly for young people.”

As a priority, BSW wants everyone to be able to access the most appropriate support for mental health within their local communities, and more timely access to specialist help if required. In particular we want to help people avoid crisis and ensure more people with a serious mental illness receive regular physical health checks.