healthwatch enfield · 2017-06-13 · enfield annual report 2015/16. ... whom we welcomed to...

HealthwatchEnfieldAnnual Report 2015/16

Contents

Message from our Chair ......................................................................................................................................................................4

Message from our Chief Executive ...............................................................................................................................................5

The year at a glance ............................................................................................................................................................................. 6

Who we are .................................................................................................................................................................................................7

Listening to people who use health and care services ..................................................................................................... 8

Giving people advice and information ...................................................................................................................................... 12

Our activities ...........................................................................................................................................................................................14

Focus on impact .................................................................................................................................................................................. 20

Our plans for 2016-17..........................................................................................................................................................................24

Our people ...............................................................................................................................................................................................26

Our finances ...........................................................................................................................................................................................28

Contact us ................................................................................................................................................................................................30

Appendix 1 - Outreach and engagement .................................................................................................................................31

Appendix 2 - Formal meetings attended ................................................................................................................................. 32

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Enfield

Message from our Chair

Listening to local people makes sense….

During 2015-16, Healthwatch Enfield listened to local people, identified some key issues that people were experiencing, and secured some important improvements.

The improvements ranged from boosting the numbers of people registered with a GP, to preventing wasted radiology appointments, to improvements on mental health wards that enhance the experiences of people being treated for serious mental health issues.

We achieved these and other improvements through a wide range of work including: Enter & View visits; targeted outreach events; written reports on what we’ve heard; responding to enquiries; pop up engagement

stalls around the borough; and participating in meetings to influence local services.

Some of our work is inevitably long-term, with no short-term impact; it can be about building relationships so that when we do need to raise an issue, people know that we are raising it because it matters to local people.

But we couldn’t achieve these successes for local people without your voices, your views, your volunteering efforts and the important contributions of our Reference Group members and other voluntary and community sector organisations. We also couldn’t have done it without Lorna Reith, our Chief Executive, who retired just after the year end and to whom we are greatly indebted for her work in building up the organisation.

And we also couldn’t have had the impact we have had without the willingness of statutory and other organisations to listen, to work with us, and to respond positively to the issues that we raise on behalf of local people. We look forward to listening to and working with all of you in the year ahead, when we are being led by Patricia Mecinska, our new Chief Executive, whom we welcomed to Healthwatch Enfield in April 2016.

In 2016-17, we will continue to develop our capacity to amplify local voices, to work with organisations to secure change, and to support an increase in the proportion of work in Enfield that is ‘co-produced’ between all those who plan, provide and use services.

Deborah FowlerChair

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Healthwatch Enfield

Message from our Chief Executive

Looking to the future….

Since its inception Healthwatch Enfield’s Board, staff, volunteers and stakeholders have worked with one aim – to put the voices of Enfield’s residents at the heart of service improvement initiatives. Through developing meaningful relationships, establishing a local evidence base and building its brand, Healthwatch Enfield is beginning to be recognised as an instigator of change. The foundations of our operations are solid but we cannot stop there.

With a growing population, including a significant transient element, a wide health inequality gap and increasing pressures on public services, the voices of local people have never been more important. It is only through working together that we are able to identify

solutions and service delivery models that are person-centred, cost effective and which embed integrated working.

I am humbled to have joined Healthwatch Enfield at this point in its lifecycle, at a time when we can take stock, utilise lessons learnt and look ahead. The announcement of commissioning intentions by the Local Authority and the Clinical Commissioning Group has created fora to develop innovative delivery models and to introduce new means of measuring their effectiveness. Acting as the independent health and social care watchdog, Healthwatch Enfield is in a unique position to help shape Enfield’s future. A future where services are co-produced and Enfield’s residents’ voices are amplified to inform commissioning approaches based on the outcomes that local people want to secure.

2016-17 will see us focusing on: access to primary care; mental health; adult social care services; dementia services; and accessibility of communication and information provision for patients.

Like all organisations working in the field of health and social care, we are going to have a busy schedule ahead of us. However, I strongly believe that through working with the team here at Healthwatch Enfield alongside our partners, stakeholders, Reference Group members and the wider voluntary and community sector, we will help to enhance service provision for the people of Enfield.

Patricia MecinskaChief Executive.


Healthwatch Enfield

The year at a glance

Our website received 13,009 visitors

We promoted 72 opportunities for patient engagement

We responded to 21 local and national consultations

We’ve directly engaged with over 1,700 people

We’ve visited 56 local services

We held 32 “pop-up” stalls throughout Enfield

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Who we are

Healthwatch Enfield is the independent consumer champion for health and social care in the borough.

We’re here to amplify the voices of local people and to help them find the health and social care services that they need.

Everything we say and do is informed by our connections to local people. Our sole focus is on understanding the needs, positive experiences and concerns of people of all ages and all backgrounds who use local services or who have loved ones who do.

We use this information to help these people’s voices to be heard. We also work to encourage those who plan and deliver services locally to engage better with local people, and to put their experiences at the heart of service delivery.

Our vision

We believe that asking people more about their experiences can identify issues that, if addressed, will make services better.

We are set up to gather and represent the views of the public. We aim to ensure that all those

who plan and provide services in Enfield listen to the voice of local people and that they work with them to shape good quality provision that meets people’s needs.

Healthwatch Enfield is all about local voices being able to influence the design and delivery of local services.

Our priorities

Our priorities for the coming year are:

• Access to GPs

• Mental Health

• Adult Social Care

• Dementia Care

• Issues affecting people with communication impairments

• Communication and information provision for service users and patients

For more information please see page 24.

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Enfield8Healthwatch Enfield

Listening to people who use health and care services

Gathering experiences and understanding people’s needs

During 2015-16, we estimate that we engaged with approximately 1,700 local people through our programme of community engagement events and pop-up stalls, and in the course of our Enter & View visits to local services.

Through these various activities we have reached out to many people who had not previously heard of Healthwatch Enfield, and invited them to share their experiences and comments about local health and care services. We have used the information as a basis for making enquiries to local commissioners and providers, pointing out where services have not fully met the needs of local people and making suggestions and recommendations for how services could be improved. We also pass on positive feedback which we receive about services.

We try to keep our engagement meetings as interactive as possible, allowing plenty of time for questions, comments and group discussion, and focusing on areas of particular relevance to the group in question. We work closely with many of the voluntary groups that operate in the borough supporting different sections of the community (see Appendix 1 for details).

Some of our meetings have been with service user groups, such as the Diabetes support group, and the Patient Participation Groups at local practices. Other meetings have been targeted at particular BAME (black, Asian and minority ethnic) communities, such as the Turkish community, Caribbean community and others

Disadvantaged, seldom heard or vulnerable

We have noticed that in those meetings or events that are not targeted at a particular ethnic group, such as Parent Engagement Panel meetings, there is almost invariably good representation from many different ethnic groups. However, a review of our community engagement activities at the end of the previous year revealed that there were some communities who we had not engaged with to any significant extent, perhaps because of language barriers or differing social or cultural expectations. As a result, we organised some targeted engagement activities with members of the Chinese, Turkish and African communities, such as our very successful International Women’s Day event in partnership with the African Women’s Welfare Association.

Our diverse team of volunteers play a critical role in our outreach and engagement activities. Between them they speak 10 community

Above: meetings with the Chinese community and the African Women’s Welfare Association


Healthwatch Enfield

languages in addition to English, and they have proved invaluable in helping us to build relationships with some of those communities that can be less heard. For example, a Turkish volunteer has helped to organise several meetings with the Turkish community, as well as a slot on Turkish local radio and coverage in Turkish newspapers.

Young people

We conducted a series of engagement meetings to find out about young people’s experiences of local mental health services and support. We held focus groups with young people who had experience of CAMHS (child and adolescent mental health services), with young carers, youth workers and parents, as well as meetings with mental health professionals. This work culminated in our report: What young people think about mental health support in Enfield, published in November 2015, which contained 11 recommendations for ways in which services and support could be improved. We submitted this report to Enfield CCG and Enfield Council as our contribution to their consultation on the local joint transformation plan for young people’s mental health services. We are currently following up on the response to our recommendations.

Older people

We find that older people are well represented at many of the community group meetings we attend. We continued to engage with the membership of the Over 50s forum, presenting and seeking feedback at one of their larger meetings and running an interactive stall at their well-attended annual Falls Prevention event. We also listened to the views of elderly patients and their carers during our Enter & View visits to ‘care of the elderly’ wards.

We raised over 333 health and social care enquiries in 2015-16

In general, we have found it easier to gather feedback about health services than about social care, despite a number of initiatives in 2015-16 targeted specifically at people who are receiving social care services. We attended a number of day services and visited several sheltered and supported housing projects for frail elderly people, to try and find out about their experiences of care in their own home. We invited comments about social care from the patients and carers we met on our Enter & View visits to ‘care of the elderly’ wards. We also distributed leaflets and questionnaires inviting feedback on social care at our general engagement events, and sent out a targeted mailing 700 disabled people.

People who live outside Enfield, but use services in Enfield

Many of the health services in north London cross borough boundaries, and we often encounter people from Enfield, Haringey, Barnet and Hertfordshire on our visits to local hospitals and at our pop up stalls. With regard to health services, our focus is on the quality of care that patients experience, regardless of where they live. With regard to adult social care, if we meet people from other boroughs who need or are receiving care services at home, we occasionally make recommendations to other local authorities, and also draw issues to the attention of neighbouring Healthwatch as appropriate.

Our Enter & View visits to local services

Healthwatch Enfield has statutory powers to carry out Enter & View visits to health and care premises in order to hear from patients,

residents, service users and their carers, and to observe the nature and quality of services. Enter & View visits are carried out by carefully selected and trained volunteers, supported by staff. Our Enter & View project group, comprising volunteers, staff and Board members, meets monthly to agree on our detailed programme of work, in line with our strategic priorities, to plan and review our visits and discuss training needs.

In 2015-16, we continued our programme of visits to mental health services, with visits to Downhills Ward at St Ann’s Hospital and to Suffolk House, the mental health recovery house based in Palmers Green. (We had previously visited The Oaks Ward and Suffolk Ward at Chase Farm Hospital.) These visits, some of which were undertaken jointly with Healthwatch Barnet and Healthwatch Haringey, formed part of a wider project on mental health which also included a programme of community engagement meetings with local service users, carers and voluntary sector organisations. We embarked on this project, including the visits to mental health wards, because local people and the local voluntary and community sector had raised many concerns about both inpatient and community mental health services.

We carried out 7 Enter & View visits in 2015-16

We also took part in two Enter & View projects as part of a consortium of neighbouring Healthwatch organisations, funded by Health Education North Central and East London, (HENCEL). The visits were to find out how well hospital emergency departments are able to meet the needs of patients with additional communication or access needs. Volunteers with a variety of disabilities were recruited and trained to take part. The first group of visits focused specifically on the needs of Deaf

patients who use British Sign Language as their first language. The second group of visits, including a visit to the emergency department at North Middlesex University Hospital, investigated access for a group of patients with a wider variety of communication needs. These visits revealed that emergency departments are generally ill-prepared to meet the needs of hearing-impaired or visually-impaired patients, and helped to raise awareness in local hospitals about the barriers that patients may encounter.

We have also carried out a series of visits to wards in different local hospitals which cater mainly for frail elderly patients. The reason for these visits was because this group of patients are amongst the most vulnerable people in the borough and we wanted to find out about the quality of care they receive locally. We also wanted to ask about any experiences this group of patients had of receiving care in their own homes, as part of our work on adult social care. Our report on Capetown ward at Chase Farm Hospital has already been published and reports on our visits to Magnolia Unit at St Michael’s, and Pymmes Zero ward at North Middlesex University Hospital will be published in the next financial year, following our normal practice of seeking a response from the service provider before making our reports public.

Altogether we carried out 7 Enter & View visits during this period, either working on our own or in partnership with neighbouring Healthwatch. We always highlight good practice where we find it, as well as drawing up recommendations for suggested improvements, and requesting a response from the services we have visited. All completed Enter & View reports are published on our website, and copies are sent to the Care Quality Commission, Healthwatch England and relevant local councils and clinical commissioning groups.

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Giving people advice and information

Helping people get what they need from local health and care services

We know that finding out what is available for people’s health and social care needs or the needs of people that they care for can be difficult. Being able to provide this information and accurately ‘signpost’ people to the services that they need is important for people’s health and wellbeing. Whether people are looking for a specific service, want to make a complaint or ask a general question, our service offers clear and unbiased information, enabling residents to make well informed choices and decisions.

In 2015-16, we received 82 calls, 14 emails and 6 letters plus other forms of communication from people living or working locally seeking help and advice on various issues. These ranged from general information about the booking line telephone number for blood tests, to GP practices requesting contact details of voluntary health and social care organisations in the borough.

While we are able to assist people through the complex health and social care system, in practice many will visit our website, we had 251 visits to the find services page of which 171 were unique visits.

People can find a wealth of information about health and social care services based in the borough. We have information such as finding a GP, dentist or home care services in the area. We also post information summarising key information about local providers, such as waiting times for certain treatments, to inform local people and help them to make informed choices.

From the many calls, emails and letters we received we raised over 333 health and social care enquiries with the various Hospital Trusts, GP practices, Enfield Clinical Commissioning Group and the Council, which helped us signpost over 117 people to the right service or organisation for their needs. 27% of our calls were about access to GP services and the time it takes to get an appointment and also how to make a complaint about a GP practice. Other issues raised varied from access to GP services for those with sensory impairments, to concerns around specialist equipment, to out–of-date information on hospital websites. Healthwatch Enfield is not the provider of advocacy services for people with a complaint about NHS services, so we refer people on to the current provider Voiceability, from whom we also receive summary data.

In each case we supported the caller to make informed choices. For example, we guided a resident who was concerned that the home care assistant providing personal care to their mother was claiming that they had stayed longer than they had and provided care from the care plan when they had not. We provided the caller with information about how to make a formal complaint to Enfield Council about this agency and with a list of other local domiciliary care organisations operating in the borough.

We have found that, as well as giving information to local people, listening to callers can often be a big part of the service that we provide as many people want to be heard, but have found that local health and social care services have not adequately listened to them.

NHS 111

Children and young people's services

A&E / Urgent Care

Dentistry

Hospital inpatient services

Hospital outpatient services

Social care services

Mental health services

Other

GPs

Where we signposted people to

GPsOther (including complaintsadvocacy)Mental health servicesSocial care servicesHospital outpatient servicesHospital inpatient servicesDentistryA&E / Urgent CareChildren and young people’s servicesNHS 111

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Our activities Our reports and recommendations

We have produced a number of reports this year, detailing recommendations for improvements to providers and commissioners based on our intelligence of service user experience.

Enter and view reports

What we did: this year with the help of our trained volunteers, we have carried out 7 Enter & View visits and published 4 Enter & View reports (further reports in preparation). Overall we have made 44 recommendations for improvements to health and care providers and commissioners including Barnet Enfield and Haringey Mental Health Trust, Royal Free London NHS Foundation Trust (Chase Farm) and Enfield Clinical Commissioning Group.

Our follow-up: all providers we visit are asked to provide a response to our recommendations. Barnet Enfield and Haringey Mental Health Trust in particular have considered all our recommendations thoroughly and have provided detailed action plans. For example, we recommended that staff on inpatient mental health wards should be given more information about the mental health recovery house, so that they could explain to patients what to expect if they were transferred there. The Trust told us they had now provided this information to ward managers and asked them to discuss it in their team meetings; they had also invited the manager of the recovery house to attend a meeting for ward managers and deputies. Similarly, in our report on our visit to Capetown Ward at Chase Farm, we recommended that more staff should be available to assist patients at about 8am, as we had heard that there was often a delay in responding to the patients’ call bells at that time. In response we were told that the ward manager has now put measures in place so that there are fewer demands on staff

at that time. Our published reports show many more examples of providers responding in a constructive way to our concerns and suggestions. Our Enter & View reports have been discussed at clinical quality and safety committee meetings at the Clinical Commissioning Group and the mental health trust.

In the coming year we are planning to follow-up on previous visits and reports, to see whether recommended improvements have been made and sustained over time.

Children and young people’s mental health report

What we did: our report, What young people think about mental health support in Enfield, published in November 2015 contained 11 recommendations for ways in which mental health services and support for young people could be improved. These recommendations were drawn up based on what young people and parents had told us of their experiences of mental health services and support, including not only CAMHS (child and adolescent mental health services) but also the support available in schools and other settings.

Our follow-up: we submitted this report to Enfield Clinical Commissioning Group and Enfield Council as our contribution to their consultation on the local joint transformation plan for young people’s mental health services. Many of the recommendations we made were closely aligned with the recommendations which appeared in the draft transformation plan. We are waiting to hear to what extent our recommendations will be implemented and will keep a close watch on further developments.

A report looking into individuals not registered with a GP

What we did: In summer 2015 we reported our findings from talking to individuals on the


Healthwatch Enfield

streets of Edmonton to see if they were registered with a GP. Our report highlighted that 17% of the individuals we spoke to were not registered with a local GP. We found that the main reasons for individuals not registering with a local GP were because they did not feel that they needed to, or because they had had difficulties with registering at a GP practice.

Our follow-up: We have since worked with Public Health Enfield and Enfield Clinical Commissioning Group to develop a campaign locally to encourage individuals to register with a GP. Leaflets were distributed door to door in the 5 most deprived wards in the borough, signposting individuals to their nearest GP practice and clarifying the documents needed to register. Campaign materials were advertised in a range of local media and at local urgent care centres, walk in centres and A&E departments. Information has been sent to GPs locally to correct any misconceptions about the documents necessary for a patient to register. We hope to measure the impact of our work in autumn 2016, jointly with Public Health Enfield, when annual data on GP registrations is published. However, early results suggest that there has been an increase of 600 GP registrations across the five wards in recent months .

Our work on Primary Care

What we did: During 2015-16 we conducted three projects on GP services, in addition to the registration work above. These included: an online audit to check the provision of information on GP practice websites and on NHS Choices listings; visits to all GP practices in Enfield to check the physical provision of a range of information; and a report analysing the GP Friends and Family Test results for the first year of implementation.

Our follow-up: We are currently conducting a follow-up GP audit to assess what changes have

been made to GP practice websites and NHS Choices listings since the publication of our audit in March 2015. We hope to publish our follow-up audit in summer 2016 but initial results suggest that a large number of GP practices have updated the information available on their website and/or NHS Choices listings as a result of our previous work. We are specifically pleased to see that 47 out of 49 GP practices in Enfield now have a website, and that 100% of these 47 practices now have vital information on their website such as information about out of hours care and information on how to complain. In December 2015 we published a report on the Experiences of GP waiting rooms in Enfield, following our GP practice visits. Our report highlighted a number of areas for improvement in the provision of information and 43% of Enfield practices responded to our draft report detailing their current priorities and future plans.

Improving services for Deaf patients in Enfield

What we did: In March 2015 we published a joint report with Enfield Disability Action on improving services for Deaf patients in Enfield, detailing 18 recommendations for improvement. Our report received positive responses from our local providers and commissioners who were keen to implement some of our recommendations.

Our follow-up: In January 2016 we wrote to all recipients of our report to request what actions had been taken since publication and to ask for detailed information regarding future improvement plans. The North Middlesex University Hospital NHS Trust, The Royal Free London NHS Foundation Trust, Barnet Enfield and Haringey Mental Health Trust, Enfield Clinical Commissioning Group and Public Health Enfield responded to us with evidence of continuing to improve access to services for Deaf patients. Examples of improvements so far include the provision of Deaf awareness

training for staff, scoping out the use of remote British Sign Language interpreters when face-to-face interpreting is not available and improving patient information systems to include information about individual communication needs on patient notes and referral letters.

Working with other organisations

Healthwatch Enfield works with a wide range of statutory and non-statutory organisations in pursuit of our objectives, such as promoting patient and public voice and prompting improvements to services (see appendices 1 and 2).

We work with Enfield Clinical Commissioning Group (CCG), Enfield Council and our main local providers through regular meetings and other contact. During 2015-16, we encouraged Enfield CCG to develop a more planned, strategic approach to their engagement work across all areas of their work and were pleased to find that they recognised this need. With the main provider organisations, we passed on positive feedback received, and raised issues and concerns that had been raised with us, as well as some arising from publicly available data on their performance. For example, we pressed North Middlesex University Hospital on the need to improve their arrangements for booking blood tests, ensured that we received from the Royal Free London Foundation Trust (RFL) performance data about the Chase Farm and Barnet Hospital sites that are particularly used by Enfield residents, and pressed RFL on its handling of excessive waiting times for certain treatments. We also sought assurances, where appropriate, from the relevant CCG that they were pressing their providers to improve the quality of service that those providers give to the people of Enfield.

As highlighted above, we worked with Enfield Council’s Public Health team, and Enfield CCG to increase the number of people in the borough’s most deprived wards registering with a GP.

We encouraged local residents to provide feedback to the Care Quality Commission (CQC) about their experiences when the CQC inspected our local hospitals during 2015-16. We also shared with the inspectors all the feedback that we had gathered about the hospitals during the previous year. We participated in the post-inspection Summit meetings for each hospital, as well as a Risk Summit held for one of the hospitals. We passed on intelligence about specific concerns to the CQC and where the intelligence concerned a care home, we informed Enfield Council as well as the CQC. We supported local safeguarding work, and used our allocated place on the local Safeguarding Adults Board.

We routinely work with nearby local Healthwatch, sharing attendance at key cross-borough meetings and sharing feedback on key issues that affect more than one borough, such as those affecting a local hospital. Increasingly in 2015-16, with the proposed transformation of NHS services to be planned and provided across a wider area, we shared representation at meetings where commissioning decisions affecting the five boroughs of North Central London (NCL) were discussed. Such cooperation is essential given the limited resources of each local Healthwatch.

Working with local Healthwatch and local CCGs across NCL on the re-commissioning of NHS 111 and Out of Hours provision, we had a significant impact on the service specification of the new, combined service – particularly in ensuring that the needs of people with communication impairments, and those with limited English, were covered. Together with Healthwatch


Healthwatch Enfield

Brent, we represented London Healthwatch in giving evidence to the Greater London Assembly Health Committee on Accident and Emergency care.

We also worked with 12 other Healthwatch in the North Central and East London area on a project focusing on access for patients with communication barriers. Through the project, volunteers who were Deaf or visually impaired were trained to undertake Enter and View visits to 3 local Emergency Departments – including North Middlesex University Hospital. The outcome of this work was presented to a Conference on Accessible Information Standards in May 2016. This work was in addition to some joint Enter & View visits undertaken with neighbouring Healthwatch to shared mental health services.

We escalated to Healthwatch England concerns raised with us by Enfield Citizens Advice Bureau about some GP practices making high charges to patients for signing documents and providing letters. Healthwatch England put our evidence with that gathered from other areas of the country and together we met with the British Medical Association and NHS England, to help them to understand the issue so that they might prepare guidance on the subject. We also provided reports and feedback to Healthwatch England on a range of other subjects, as well as completing their information surveys about our work.

At a local level we worked closely with the Voluntary and Community Sector (see Appendix 1). We exchanged views and information with members of our Reference Group and sought the views of the wider sector on a range of issues, including our priorities for 2016-17. We alerted colleagues in other VCS organisations to public consultations in which we thought they or their stakeholders would be interested. We undertook engagement work in

partnership with a number of local groups and organisations, such as the African Women’s Welfare Association, and also received feedback via VCS staff.

Involving local people in our work and decision making

Local people are involved in the work of Healthwatch Enfield in a range of ways, including running pop-up stalls, planning and conducting Enter & View visits, participating in our engagement events, feeding back to us their views on local services, giving us their views on what our priorities should be, and making decisions at Board level.

Throughout the year, our diverse team of 17 volunteers helped with a wide range of outreach and engagement activities. Our volunteer ‘Authorised Representatives’ undertook Enter & View visits. Those volunteers who are members of our Enter & View Project Group also helped to plan, arrange and implement our programme of Enter & View visits.

On 32 occasions in 2015-16, we held pop-up stalls in public places and in health and social care venues. Our teams of volunteers, sometimes supported by staff, captured local people’s views, feedback and concerns. Similarly, throughout the year our volunteers and staff collected the experiences and issues raised by local people through our targeted engagement events, our Enter & View visits, our ‘Tell us your story’ feedback cards, and via email, Twitter and letters.

In October 2015 we held our annual conference, which was well-attended by a good mixture of more than 100 local residents and people who work in Enfield. As part of our conference, we

invited all those present to give us their input and views on our current and prospective priority areas of work, as well as their suggestions for possible new areas of work that they thought should be a priority for us. We had undertaken a similar exercise in October 2014 to collect additional local input into our priorities for 2015-16.

Based on feedback from local people throughout the year and at our annual conference, as well as feedback from local voluntary and community sector organisations, and also our working knowledge of local statutory sector initiatives, we developed a draft programme of work for 2016-17. The draft priorities were designed to balance work that would benefit a wide range of people - such as our work on access to primary care - with more targeted work for more specific groups of people, such as work supporting Deaf people’s efforts to make services more accessible (see page 16). We sought the views of members of our Reference Group of key people in the local

voluntary and community sector on our draft priority areas of work.

The Board of Healthwatch Enfield, most of whom are local residents, then reviewed all this local input and came to a final decision at a Board meeting. Our Board meetings are held in public, advertised in advance, and members of the public can get involved by asking questions in advance or on the day. The Board decides on strategy, priorities, policies, etc, informed by input from local people, as set out above.

The agenda of board meetings and papers for discussion are published on our website in advance of meetings. Minutes from board meetings are published on our website subsequently.

Day-to-day decisions are made by the Chief Executive, supported by the Chair as necessary.

Above: stall at the Enfield Over 50’s Forum Fall’ Awareness Day, June 2015.

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Focus on impact Improving individuals’ access to and accuracy of information

Throughout 2015-16 Healthwatch Enfield was involved in more than 20 initiatives around information provision within Enfield. We worked with:

• North Middlesex University Hospital NHS Trust

• Barnet Enfield and Haringey Mental Health NHS Trust

• Royal Free London NHS Foundation Trust

• Enfield Clinical Commissioning Group

• GP practices across Enfield

to ensure all information available within the public domain is accurate and complete This advances Enfield residents’ basic human rights, as defined by Article 19 of the Universal declaration of Human Rights, which states “Everyone has the right to freedom of opinion and expression; this right includes freedom to hold opinions without interference and to seek, receive and impart information and ideas through any media and regardless of frontiers”

Increasing registrations with GPs to promote access and prevention

Over 600 residents from the five most deprived areas in Enfield registered with a GP following a joint initiative by Healthwatch Enfield, Enfield’s Clinical Commissioning Group and Public Health Enfield, where our evidence base caused statutory bodies to distribute a customised leaflet to individuals affected. These residents now have improved access to healthcare.

As a result of our work with GP practices:

• 92% of GP practices now have visible information about how to register at their practice (over 40% increase within a 6 month period)

• 70% of GP practices now have information available online on how to book interpreters for appointments (increase of ca.15% on the previous year)

With around 23% of Enfield’s residents describing themselves as non-native speakers of English, Healthwatch Enfield created a leaflet which advises patients and practices on how to book interpreters for GP appointments enabling those patients to meaningfully communicate with their physician.

Making a community phlebotomy (blood test) service more accessible to improve health and wellbeing

Our work with the North Middlesex University Hospital NHS Trust enabled Healthwatch Enfield to clarify blood test pathways for housebound residents within private and residential settings. This will limit the negative effects caused by delays in medication changes, that require blood tests.

Improving service provision within a local Radiology Department to eliminate wasted appointments

Feedback from Enfield residents indicated that letters inviting patients to attend the Radiology department did not advise them to stop taking blood thinning medication beforehand. This resulted in wasted and re-booked appointments. Our intervention instigated changes to the wording to ensure the relevant test can be undertaken first time.

What our stakeholders say about our impact


Healthwatch Enfield

BMA guidance on fees revised, following our action with Enfield CAB

After the local CAB contacted Healthwatch Enfield, we jointly raised concerns with Healthwatch England about the amounts some GP practices charged patients for letters and forms. Following this work, the British Medical Association issued nation-wide guidance on fees, so our intervention had national impact.

Improving mental health services to make them more accessible

Healthwatch Enfield undertook peer-informed research into the provision of mental health services in Enfield. This resulted in the publication of“What young people think about mental health support in Enfield” - a report with recommendations to inform the development of Enfield’s Children and Adolescent Mental Health Services’ (CAMHS) Future in Mind Transformation Plan.

Removing barriers faced by Enfield’s Deaf residents to bridge the health inequality gap

Healthwatch Enfield worked with North Middlesex University Hospital NHS Trust to raise awareness of challenges faced by the Deaf community , which resulted in the Trust reviewing its Policy on Interpreters and setting up a ‘Working Group on Deaf Patients’. Our involvement around procurement of NHS 111 and Out-of-hours services for North Central London enabled Healthwatch Enfield to ensure that the specification included meeting the needs of deaf people. Healthwatch Enfield’s report on barriers faced by deaf people influenced the North London Hospice, which now provides an individual hearing device on its sites.

Beneficial individual outcomes that are also cost-effective

Healthwatch Enfield’s interventions do not only have a positive impact on Enfield’s residents such as improving their health and wellbeing, furthering the prevention agenda or making it easier for people to access services.

Healthwatch Enfield’s work is also affecting the wider health and social care system:

• a saving of approximately £160 is generated for each appointment at North Middlesex University Hospital NHS Trust’s Radiology department that does not need to be rescheduled;

• Enfield’s Clinical Commissioning Group saves £88 for each Enfield resident, who registered with and attended a GP appointment as opposed to presenting at an Accident and Emergency Department;

• by promoting the prevention agenda and enabling more Enfield residents to access primary care services, Healthwatch Enfield improves health outcomes and save costs (Ref: The King’s Fund “Transforming our health care system. Ten priorities for commissioners”). For example, five minutes of advice in a general practice setting to middle-aged smokers to quit smoking can increase quit rates and save £30 per person for a cost of £11 per person.

The Council continues to recognise and value the operational independence of Healthwatch Enfield as being at the heart of

the local community, embracing Enfield’s diversity, and playing a key part in enabling people to become active residents. As

the independent local consumer champion for health and social care in the borough, it effectively engages and involves individuals, organisations, professionals and the wider public to facilitate genuine improvements in health and social care

services in Enfield. Healthwatch Enfield helps to ensure people are aware of the health and social care services available to

them and how they can get the best out of these services. It has a seat on the Enfield Health and Wellbeing Board,

ensuring that the views and experiences of patients, carers and others are taken into account when preparing local needs

assessments and commissioning strategies, including the Joint Strategic Needs Assessment.

Michael Sprosson, Service Manager Procurement Enfield Council

It has been a pleasure working in partnership with Healthwatch to support disabled people to have improved access to health services.Producing the joint report between Enfield Disability Action and Healthwatch ‘Improving services for Deaf Patients in Enfield’ produced positive results for this isolated community. I very much look forward to working with Healthwatch again in the near future.Liane Burn, CEO, Enfield Disability Action

NHS Enfield Clinical Commissioning (CCG) values the work of Healthwatch Enfield and their contributions to the CCG through

their attendance at the Governing Body, as well as local and London wide quality meetings where their reports, findings and

responses from providers are shared. Healthwatch Enfield are also a valued contributor to the CCG’s Equality and Diversity and

Patient and Public Engagement areas of work

Dr Mo Abedi. Chair, Enfield Clinical Commissioning Group

25Healthwatch


Our plans for 2016-17 Future priorities

Following engagement and consultation with local people and stakeholders our Board agreed the following areas of work as our priorities for 2016-17.

• Access to GPs

• Mental Health

• Adult Social Care

• Dementia Care

• Issues affecting people with communication impairments

• Communication and information provision for service users and patients

Over the year we plan for our volunteers to re-visit GP surgeries and websites to see if information provision and access have improved since the publication of our previous audits. We will continue to build links with Patient Participation Groups.

We plan to publish a report on our Mental Health work to date, focusing on the potential benefits of closer working between commissioners, service users, carers and providers. Later in the year we aim to look at provision for people with Dual Diagnoses.

We will continue to seek information from residents about their experiences of social care services. In 2017 we plan to focus on services for people with dementia and their families and carers and this will inform our programme of Enter & View visits.

We are aware of the importance of good access to information for all patients and service users, but our work with the local Deaf community has highlighted how difficult this access is for some groups. We aim to undertake some work focusing on how well local providers are meeting their obligations under the new NHS England Accessible Information Standards which come into force in summer 2016.

In addition, we will continue to promote our recently launched local web-based Data Hub which provides Enfield residents with easy access to key official statistics on health and social care performance locally, such as: A&E performance, referral to treatment waiting times (including cancer), and CQC reports on care homes.

Finally, it is clear that we will need to work ever more closely with our neighbouring Healthwatch organisations as an increasing number of services are commissioned and provided over a wider, three or five borough, footprint. Our role will be to encourage and facilitate the involvement of local people in the work of commissioners.

Above: volunteers and the public discuss the year’s priorities at the annual conference in October 2015

27Healthwatch


Our people Our Board

Deborah Fowler - Chair

Parin Bahl

John James - Treasurer

Audrey Lucas

Noelle Skivington

Our Staff

Patricia Mecinska - Chief Executive

Emma Friddin - Policy, Insight and Research Manager

Joe Lee - Communications and Events Officer (until July 2016)

Michelle Malwah - Information and Signposting Officer

Lucy Whitman - Programme Manager: Community Engagement, Volunteers and Enter & View

We would like to sincerely thank Lorna Reith, who served as Chief Executive from the formation of Healthwatch Enfield until April 2016, for her tireless work in establishing the organisation and

bringing it to where it is today. We wish her a happy and fulfilling retirement.

Our Volunteers

We are very grateful to our volunteers who contribute their time, energy and skills to helping us in our work, including outreach to local communities and Enter & View visits.

Linda Doyle, Gillian Edwards, Debra Edwards, Esen Etkin, Laurence Green, Elisabeth Herschan, Saada Ibrahim, Laxmi Jamdagni, Faiyaz Karim, Renu

Khetarpal, Jana Knowles, Clare Malyon, Katherine Murray, Janice Nunn, George Oyekwe, Christiana Ozoemelam, Stafford Pottinger, Shadeen Rose, Rajinder

Sunner, Maryanne Tully and Nora Walsh.

Above: staff and volunteers at our volunteer appreciation lunch in June 2015

29Healthwatch


Our financesINCOME 2015/16 (£) 2014/15 (£)

Funding received from local authority to deliver local Healthwatch statutory activities

264,109 268,640

Other income 1,666 438

Interest receivable 116 156

Total income 265,891 269,234

EXPENDITURE

Office costs 13,081 11,218

Operational costs 23,557 28,962

Staffing costs 195,721 179,224

Total expenditure 232,359 219,404

Net Income for the year 33,532 49,830

Income and Expenditure Statement of Activities for the period ending 31 March 2016

ASSETS AND CREDITORS 31 MARCH 2016 (£) 31 MARCH 2015 (£)

Assets 132,611 98,959

Creditors (1,975) (1,855)

Net Assets 130,636 97,104

RESERVES - INCOME AND EXPENDITURE ACCOUNT

Balance brought forward 97,104 47,274

Net Income in the year/period 33,532 49,830

Balance carried forward 130,636 97,104

Balance Sheet as at 31 March 2016

Auditor: Stanley Francis-Joseph FCCA, Senior Statutory Auditor, Anthony Joseph & Co. Limited, Chartered Certified Accountants and Registered Auditors, Business and Technology Centre, Bessemer Drive, Stevenage, Herts SG1 2DX

Bank: Co-operative Bank Ltd, PO Box 250, Delf House, Skelmersdale WN8 6WT

@@##

31Healthwatch


Contact us Get in touch

Address: Healthwatch Enfield

Room 11, Community House

311 Fore Street

London N9 0PZ

Phone number: 020 8373 6283

Email: [email protected]

Website: www.healthwatchenfield.co.uk

Facebook www.facebook.com/healthwatchenfield

Twitter @ HealthwatchEnf

Healthwatch Enfield is registered as a Community Interest Company no. 8484607 (under the name of Enfield Consumers of Care and Health Organisation).

We will be making this annual report publicly available by 30th June 2016 by publishing it on our website and circulating it to Healthwatch England, the CQC, NHS England, Enfield Council, Enfield Clinical Commissioning Group, Enfield Health Scrutiny Panel, and Health and Wellbeing Board members.

We confirm that we are using the Healthwatch Trademark (which covers the logo and Healthwatch brand) when undertaking work on our statutory activities as covered by the licence agreement.

If you require this report in an alternative format please contact us at the address above.

© Copyright Healthwatch Enfield 2016

Appendix 1 - Outreach and engagement

Community engagement events attended

African Women’s Welfare Association

CAMHS (Child and adolescent mental health

service) service user group

Care home carers network

Carers Centre Community House group

Carers Centre dementia carers group

Chinese community meeting

Christchurch Lodge supported housing

(Riverside)

Community Aid

Diabetes support group

East Enfield Surgery Patient Participation Group

Enfield Disability Action Hard of hearing group

Emerald House supported housing (One

Housing)

Enfield Caribbean Association

Enfield Homes Access to services forum

Forest Road Practice Patient Participation Group

Jubilee Ward neighbourhood forum

Mendip House (Metropolitan Housing)

Over 50s Forum

Parent Engagement Panel all area meeting

Park Road supported housing (One Housing)

Positive Enfield (Umoja)

Enfield Patient Participation Group Network

Ruth Winston Centre

Skinners Court supported housing drop in

(Greek and Greek Cypriot Community of Enfield)

St Edmund’s Church Ghanaian community

group

Turkish community event (Community House)

Turkish community event (Kirkisrak Centre)

Pop up stalls held at

Beyond HIV event (African Health Policy

Network) Green Towers Community Centre

Chase Farm Hospital

Chase Ward wellbeing events

Edmonton Green Children’s Centre

Edmonton Show, Pymmes Park

Eldon Road Primary School

Enfield Carers Fun Day

Enfield Highway Library

Enfield Town Library

Kirkisrak Community Centre (Stop smoking

event for Turkish community)

Moving on event for young people with special

needs, Dugdale Centre

North Middlesex University Hospital

Over 50s Forum Falls Awareness Day Edmonton

Green

Palmers Green Festival Broomfield Park

Sainsbury’s Winchmore Hill

Southgate Circus Library

Southgate Festival

Trinity at Bowes Community Centre

Wilbury Primary School

Appendix 2 - Formal meetings attended

Formal Meetings with Healthwatch Enfield Representation

BEH MHT Trust Board Meeting

BEH MHT Patient Experience Committee

BEH MHT Strategic Partnership Board

Health and Wellbeing Board (HWB)

HWB Better Care Fund Working Group

HWB Health Improvement Partnership Board

HWB Enfield Integration Board (EIB)

HWB Primary Care Strategy Implementation

Board

HWB JSNA Steering Group

HWB Integrated care older people’s working

group

Enfield Clinical Commissioning Group

Governing Body (CCG)

CCG Patient and Public Engagement Committee

CCG Equalities sub-group

CCG Quality & Risk sub –group

CCG Voluntary Sector Stakeholders Group

HW England Board

HENCEL HW Network

HW North Central London Local Network

LBE – Carers Partnership Board

LBE - Mental Health Partnership Board

LBE - Physical, Sensory, HIV/Aids Disabilities

Partnership Board

LBE- Safeguarding Adults Board

London Ambulance Service - Patient Experience

Forum Meetings

North Central London Urgent Care Programme

Board

Enfield Health Scrutiny Work stream

North Central London Joint Health Scrutiny

Barnet, Enfield and Haringey Joint Health

Scrutiny

Royal Free Hospital Trust Board

NMUH - Trust Board Meeting

NMUH Patient Experience group

LBE Hospital Discharge Working Group

Integrated Care Board

Learning Disabilities Partnership Board (LDPB)

LDPB Health sub-committee

Quality in Adult Social Care group

LBE - Quality Improvement Board

NHS England North Central East London Quality

Surveillance group

32 33Healthwatch Enfield

Healthwatch Enfield

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