Introduction
This report summarises the insight from people and communities in 2023-24. In total, the review examined about 300 reports submitted by Healthwatch organisations, voluntary and community sector organisations, NHS Trusts, local councils, and Place-based public and patient engagement teams. The source reports provide up to date information about public experiences of local health and care services.
Summaries of the key findings under each care setting and priority area are noted below. It provides a review of recent engagement reports rather than a comprehensive review of patient experience by care setting. The key themes, findings and recommendations reflect the engagement undertaken in those reports that have been shared with us for the purpose of this work. Full reports on each care setting will be published separately.
Methodological approach
In January 2024 the SWL engagement team made a call out to partners across the system to share their insight from local people and communities. 90 reports were received in response to this, and were added to a collection of over 200 previously collated.
The reports were filtered to ensure they contained useable, contemporaneous insight and recommendations. The following types of reports were filtered out:
- Qualitative and quantitative raw data reports without analysis
- Detailed engagement events without insight findings or recommendations
- National survey quantitative findings without further analysis to inform local insight
- Strategic plans and annual reports including some without detailed findings from their engagement
- Reports based on data and statistics not derived from engagement insight
- Engagements with single participants
A rapid review based on summaries of key findings and recommendations was conducted to identify key cross-cutting themes and priorities.
Some reports were specific to a particular care setting but the majority covered multiple care settings, health inequalities, workforce and digital issues. Pro formas were developed for each report, with findings and recommendations coded by care setting and priority area. These coded findings were then re-analysed, themed and written up as care setting specific reports.
Key insights and cross-cutting themes
GPs
- Overall, GPs in the South West London footprint are performing in line with or above national average for a range of patient experience indicators[1].
- The national GP Patient Survey 2023 showed ‘overall experience of GP practices’ was rated good by 76% of respondents in the SWL footprint compared to 71% nationally. This has fallen locally from 85% locally in the 2021 survey.
- The availability and accessibility of GP appointments continue to be highlighted as an issue in some reports[2].
- Barriers to accessing GP appointments through booking systems were identified as a specific concern[3]. The need for different methods of booking an appointment was highlighted, including phone, online, or in person. Patients should be supported to use digital access apps and promoting the use of the NHS app for prescription orders.
[1] Ipsos (2023) GP patient survey 2023: SWLICS latest survey results
[2] Ruils Independent Living (2023) Community Conversations – Tackling Health Inequalities in the London Borough of Richmond; Healthwatch Wandsworth (2023) Assembly on GP services
[3] Ruils Independent Living (2023) Community Conversations – Tackling Health Inequalities in the London Borough of Richmond; Healthwatch Wandsworth (2023) Assembly on GP services
Dentists
- Access to dentists was highlighted as an issue in several Healthwatch reports from across the SWL region conducted during the pandemic[1] and continues to be raised as an issue[2]
- Specific problems include: poor and variable access to NHS dentists, including for emergency appointments; implications for physical and mental health due to suffering in pain or being unable to eat; lack of understanding around NHS dentistry pricing.
- A more recent Healthwatch Richmond submission suggested access to NHS dentists is inherently unequal and not based on need. Access to the internet and private transport enables people to identify and access NHS dentistry services better as they can both search and travel over a wider area[3].
[1] Healthwatch Richmond (2022) Dentistry service during coronavirus; Healthwatch Sutton (May 2022) Accessing dental services since the start of the Covid-19 pandemic; [1] Healthwatch Croydon (2022) Croydon residents’ experiences of accessing and using NHS dental services in 2021
[2] Healthwatch Kingston (2023) NHS Dental services: Recent requests for support from Healthwatch Kingston
[3] Healthwatch Richmond (2023) Submission for Health & Social Committee NHS Dentistry Inquiry
Mental health services
- Previous reports had highlighted waiting times for mental health services to be the main issue for people seeking support[1].
- Local adult mental health services are in a transformation process. Healthwatch Richmond’s early evaluation suggests satisfaction with the time taken to access support has increased, although long waiting times to access psychological services continued to be a key issue[2].
- Although a short lead in time for change, the report suggests the majority of ratings showed moderate improvements between the two phases. Positive attitudes towards staff were identified as a key theme.
- An evaluation of the crisis café in Richmond, known as the Journey Recovery Hub,[3] found users of the facility viewed it as a highly positive and supportive service.
- Many participants in Healthwatch Wandsworth’s engagement with diverse communities about perinatal mental health services said they were unsure how to access support and would have liked more information about post-natal mental health earlier during pregnancy[4].
- Demand for children and young people’s mental health continues to be high. Healthwatch Croydon’s engagement on CYP and mental health revealed a quarter to a third of their sample still required help[5]. In 2023, Healthwatch Sutton repeated a wellbeing survey of 9-11 year olds last conducted in 2020 which revealed CYP had declining wellbeing in a range of areas[6].
- More signposting directly targeted to students is needed to highlight the professional mental health support that is available to CYP. Students should be provided with mindfulness tools or online resources to help them manage the stress of school and providing workshop to reduce the stigma around mental health[7].
- Services need to be taken to trusted community groups and locations to reduce stigma and increase uptake[8].
[1] Healthwatch Kingston (2022) Mental Health and Wellbeing Subgroup (Kingston Communities Task Force): End of Year Report 2021-22; SWL CCG (2022) Mental Health Strategy: interim findings
[2] Healthwatch Richmond Upon Thames (2024) Adult Mental Health Services Transformation: Phase 2
[3] Healthwatch Richmond upon Thames (2024) Journey Recovery Hub (crisis café)
[4] Healthwatch Wandsworth (2023) Perinatal mental health experiences of our diverse borough
[5] Healthwatch Croydon (2023) Croydon young people’s mental health insight – Final report
[6] Healthwatch Sutton (2023) The impact of the Covid pandemic on the mental wellbeing of 9-11 year olds in Sutton
[7] Healthwatch Croydon (2023) Croydon young people’s mental health insight – Final report
[8] Healthwatch Wandsworth (2022) Mental Health Wellbeing in our community
Prevention and healthy lifestyles
- Several reports addressed the importance of a focus on prevention and healthy lifestyles[1].
- Most respondents reported already taking action to look after their health[2], with people feeling the easiest lifestyle changes to improve their health would be changing their diet and undertaking gentle exercise. Outreach in the borough to address health inequalities found the top change respondents would like to make to benefit their health and wellbeing was ‘be more physically active’[3]. Nearly half of survey respondents who considered themselves to be overweight said no one had discussed their weight and its impact on their health[4].
- Healthwatch Richmond’s work on healthy living identified some shared influences, motivations, barriers and solutions across four areas of healthy living: healthy eating, exercise, smoking and alcohol consumption reduction.[5] The engagement found social networks and family can influence a person to adopt healthier lifestyle behaviours, as well as the advice of a healthcare professional. Preventing disease, healthy ageing, maintaining or improving health and improving appearance were the most frequently mentioned reasons why respondents would consider making lifestyle changes. Barriers to healthy lifestyles included cost and time, with cost being particularly important to those on lower incomes. Interlinked with cost of living crisis.
- A few engagement exercises touched opportunities for preventative healthcare, including a role for social prescribing, regular health checks and diabetes champions[6]; tackling inequalities and addressing access to healthy food[7]; more mental health support in schools and healthy eating education to empower young people to make better choices[8]. Finally, the importance of exercise to reduce falls in older people and prevent diabetes and respiratory problems[9] and a need for access to affordable community spaces and activities for children and young people were raised.
- Outreach to address health inequalities in the borough found residents were not very aware of their eligibility for NHS health checks and many were not engaging with GPs for health checks[10]. Additionally, although people were aware of the facilities in their local area, they may not have been sure about how to access them[11].
- As part of a major programme of encouraging more active lifestyles, health and care organisations in Merton worked with local voluntary and community organisations to understand the barriers and drivers for some target groups[12]. The programme engaged with older people, women and girls, and a small number of people with a disability. Cross-cutting themes included the importance of offering people social and physical activities which aligned with their cultural backgrounds. All groups mentioned the cost of activities as barriers, as well as transport and access issues.
- Older people saw the importance of activities enabling social interaction, including intergenerational connections. Women highlighted the importance of female only spaces for physical activity, with a lack of childcare and toilet facilities being a barrier. A lack of accessible activities, including wheelchair access and parking, was a barrier to participation for people with physical disabilities, as was the cost of paying for a carer or buddy to attend the activity.
[1] SWL CCG (2022) Health and daily life: Understanding priorities to develop metrics to measure health inequality in Core-20 areas of South West London; SWL CCG (2022) Biggest Issue Survey Headlines; Healthwatch Richmond In Partnership with Richmond Public Health (2023) Public Perspectives on Healthy Living in Richmond; Healthwatch Wandsworth (2023) Assembly on GP services
[2] SWL CCG (2022) Health and daily life: Understanding priorities to develop metrics to measure health inequality in Core-20 areas of South West London
[3] Ruils Independent Living (2023) Community Conversations – Tackling Health Inequalities in the London Borough of Richmond
[4] SWL CCG (2022) Biggest Issue Survey Headlines
[5] Healthwatch Richmond In Partnership with Richmond Public Health (2023) Public Perspectives on Healthy Living in Richmond
[6] Healthwatch Wandsworth (2023) Assembly on GP services
[7] Croydon Healthwatch (2023) Feedback from the Healthwatch Croydon Community Engagement Session for the Joint Local Health and Wellbeing Strategy (2024-2029)
[8] Richmond Health and Wellbeing Board (2023) 18 Steps to Health and Wellbeing: Richmond Joint Local Health and Wellbeing Strategy 2024-2029 Report on the Public Consultation
[9] Richmond Health and Wellbeing Board (2023) 18 Steps to Health and Wellbeing: Richmond Joint Local Health and Wellbeing Strategy 2024-2029 Report on the Public Consultation
[10] Ruils Independent Living (2023) Community Conversations – Tackling Health Inequalities in the London Borough of Richmond
[11] Richmond Health and Wellbeing Board (2023) 18 Steps to Health and Wellbeing: Richmond Joint Local Health and Wellbeing Strategy 2024-2029 Report on the Public Consultation
[12] Merton Health and Care Together (2024) Community insight report: Understanding barriers and facilitators to physical and social activity
Referrals and waiting times
- Challenges around getting timely referrals and long waiting times for a range of services continue. The engagement reports highlight long waits for appointments following referrals to a range of services in different borough, e.g. diabetes services, sight tests for people with sight loss, neurodiversity assessments and bereavement services[1].
[1] Healthwatch Kingston (2022) Pulse Check Report – Services for people with diabetes; Healthwatch Wandsworth (2022) Experiences of Health and Social Care Services for People with Sight Loss; Healthwatch Kingston Pulse Check report (2021); Neurodiversity and health and care services report; Healthwatch Kingston (2022); SWLNHS (2023) Experiences of post diagnostic support for Autistic people and people with ADHD; Bereavement Services and Support in Kingston: community engagement report
Support for unpaid carers
- Several reports reveal that caring is a social determinant of health, with a large majority of carers saying caring has impacted their physical or mental health[1].
- Previous reports on hospital discharge suggested carers needed to be identified and supported better to help them to navigate and access support services[2]. Initiatives have been put in place more recently to improve the identification of carers, including the NHS England Carers and Hospital Discharge Toolkit.
- In response to the work on carers, both Epsom and St Helier and St George’s Hospital report ongoing projects to embed improved identification and support of carers[3]. St George’s hospital notes they have assigned significant patient experience resources to improve carer identification, involvement and support for unpaid carers
- Reports indicated that carers need mental health support, respite a life away from caring, community support and information – including financial support. And young carers need a social life[4]
[1] Working for Carers evaluation Carers Trust (2022) Commitment to Carers Programme London Region Merton Council (2021) Carers Strategy Healthwatch Wandsworth (2022) Carer experience of hospital discharge
[2] Healthwatch Wandsworth (2022) Carer experience of hospital discharge Healthwatch Wandsworth (2022) Our work with people with dementia and their carers
[3] Epsom and St Helier Patient Experience and Partnership Annual Report April 2022- March 2023; Epsom and St Helier Patient Experience and Partnership Bi-Annual Report April to September 2023; St George’s Hospital Patient Experience and Partnership Bi-Annual Report April to September 2023
[4] Healthwatch Wandsworth (2022) Our work with people with dementia and their carers London Borough of Merton (2021) Community Dementia Services Public Engagement Report; Royal Borough of Kingston (2022) All Ages Carer Strategy
Diversity and inclusion
- Healthwatch Wandsworth’s report on diverse communities found more than half of the participants felt their ethnicity negatively impacted their experience and care[1]. Previous work found maternity service users had to be assertive and persistent to be believed[2]. A lack of trust was affecting referrals and support[3]. Some residents had a lack of trust in service providers due to previous experiences of racism and unconscious bias[4] and lack of understanding about how personal information is used[5].
- A few earlier reports found there was under-representation in service uptake by ethnic minority users[6]. Services, such as mental health, need to be taken to trusted community groups and locations to reduce stigma and increase uptake[7]
- Services need to recognise and reflect cultural differences[8]. They should utilise differences in messaging and communication[9], including in community languages. When supporting a patient for whom English is a second language healthcare professionals should be patient and ask more direct questions[10].
- A range of engagement and outreach exercises have addressed health inequalities, particularly for healthy living. Sutton PCNs have continued their programme of outreach, engaging with women on lower incomes[11] and homeless people[12]. Asylum seekers and guests from Ukraine have been engaged to ensure their experiences of health and care services are in line with the general population’s[13].
[1] Healthwatch Wandsworth (2023) Perinatal mental health experiences of our diverse borough
[2] Maternity Voices Partnership (2022) Maternity stories: A deep dive into the maternity journeys of 10 women of Black and Asian ethnicities
[3] Healthwatch Croydon and CQC (2022) Black, Asian, and ethnic minority groups experiences of health and social services and the role of the CQC
[4] Maternity Voices Partnership (2022) Maternity stories: A deep dive into the maternity journeys of 10 women of Black and Asian ethnicities
[5] Healthwatch Wandsworth (2021) Feedback on Wandsworth Healthwatch Assembly: health inequalities
[6] RBK (2022) Day opportunities and meaningful occupations transformation
[7] Healthwatch Wandsworth (2022) Mental Health Wellbeing in our community
[8] Healthwatch Kingston (2022) Bereavement Services and Support in Kingston: community engagement report
[9] BAME Voice (2021) An Assessment of the Impact of the Corona Virus Pandemic on BAME Communities in the London Borough of Merton
[10] Healthwatch Wandsworth (2023) Perinatal mental health experiences of our diverse borough
[11] Sutton PCN – Central Sutton INT (2023) Women’s Health and Wellbeing event
[12] Sutton Primary Care Networks – Wallington (2023) Overview of Place engagements: Homeless clinics
[13] SWLICB (2023) Health and wellbeing insights from Homes for Ukraine guests: 2022 – 2023
Cost of living crisis
- Reports revealed the cost of living crisis was beginning to have an impact on mental and physical wellbeing[1] [2], with people who were already vulnerable being the most affected[3]. Over half of the respondents to surveys said they would need to cut back on spending on food or heating or were anxious about their household bills.
- The cost of living crisis as a barrier to the affordability of healthy eating[4]. Multiple reports from Sutton healthy living events revealed structural problems, both financial and time, to eating well[5]. A healthy behaviours survey for Wandsworth council found 14% of primary school children and 7% of secondary school children worried about not having enough to eat[6]. Pilot initiatives, such as breakfast clubs and ‘grab and go’ breakfasts were introduced by Wandsworth and Richmond councils to address hunger in children[7]. Qualitative and quantitative feedback from the pilots suggests the schemes were highly successful in reaching hungry child, with the Councils looking to extend the schemes.
- A recent report on older people in Croydon found the cost of living rises meant many were concerned about the future and being able to access social or exercise activities[8].
- Concerns about the costs of energy and communication were identified as barriers to some carer’s willingness to use the new ‘virtual wards’ model of community care[9].
- Individual engagements suggest the most vulnerable may struggle to access services for which they need to travel.
[1] Healthwatch Sutton (2022) The cost of living crisis; SWL CCG (2022) Health and daily life: Understanding priorities to develop metrics to measure health inequality in Core-20 areas of South West London; SWL ICS (2022) Wallington Primary Care Network: Health inequalities engagement Sutton PCNs/ICS
[2] Ruils Independent Living (2023) Community Conversations – Tackling Health Inequalities in the London Borough of Richmond
[3] Healthwatch Wandsworth (2023) Cost of Living report
[4] Richmond Health and Wellbeing Board (2023) 18 Steps to Health and Wellbeing: Richmond Joint Local Health and Wellbeing Strategy 2024-2029 Report on the Public Consultation
[5] SWL ICS (2022) Wallington Primary Care Network: Health inequalities engagement
[6] London Borough of Wandsworth (2023) Wandsworth Schools Food Strategy
[7] London Borough of Richmond and Wandsworth (2023) School Breakfast Pilot Programme – feedback and next steps
[8] Croydon Almshouses Charity (2023) Older People Deserve Better
[9] Healthwatch Wandsworth (2023) Carer experiences about hospital arrangements through to discharge
Communication, navigation and signposting
- Several reports highlighted issues with insufficient information and signposting, including Autism, SEND and care services [1] [2] [3]. Services should be well signposted or have one key point of contact to help navigation[4]. Information provision needs to be sufficient to enable self care/provide care for others but not overwhelming, with one point of access[5]. There should be a way to ask follow up questions about support and treatment if necessary.
- Healthwatch Croydon’s work on carers and people living with dementia suggested that despite carers support and information services being available, many carers needed easier ways to access information and support[6].
- Multiple reports highlight the need for information provision to be in a range of appropriate formats: e.g. easy read and information in one place for people with a learning disability[7]; for people with sight loss, information provision and logistics need to be provided in accessible formats or with support provided[8]; young people need to be communicated with in a way that is accessible and relevant to them[9] ; and culturally appropriate information community languages and using images with which communities could identify[10].
[1] SWLNHS (2023) Experiences of post diagnostic support for Autistic people and people with ADHD
[2] Healthwatch Richmond (2023) SEND futures experiences
[3] Royal Borough of Kingston (2022) All Ages Carer Strategy
[4] Healthwatch/One Croydon (2022) Client experience of Croydon’s Personal Independence Coordinator Programme; Healthwatch Croydon (2022) Croydon residents’ Urgent and Emergency Care journey and experience; Healthwatch Croydon (2020) Young People’s experiences of mental health in Croydon; Healthwatch Croydon (2019) Service Users experience of perinatal mental health services in Croydon
[5] Healthwatch Wandsworth (2022) Carer experience of hospital discharge; Maternity Voices Partnership (2022) Maternity stories: A deep dive into the maternity journeys of 10 women of Black and Asian ethnicities
[6] Healthwatch Croydon (2023) Dementia Pathway Experiences in Croydon
[7] The Working Together Group and the London Borough of Richmond-upon-Thames (2021) The Big Plan
[8] Healthwatch Wandsworth (2022) Experiences of Health and Social Care Services for People with Sight Loss
[9] Merton Young Inspectors and Partnership for Young London (2021) Impact of Covid-19 on young people in Merton
[10] BAME Voice (2021) An Assessment of the Impact of the Corona Virus Pandemic on BAME Communities in the London Borough of Merton
Digital inclusion
- Across the engagement reports, it is clear that digital apps, websites, online community meetings and appointments have helped deliver health and care services. Some groups, including older people, people with a learning disability, sight loss or people with English as a second language, can be digitally excluded[1]. Digital exclusion increasingly means social exclusion[2]
- A piece of work was conducted across south west London to increase digital inclusion. To ensure the apps are as inclusive as possible, an engagement exercise was undertaken with patients and GPs to identify any reasons why they are not used or prescribed, respectively[3]. Patients suggested the apps were convenient, trustworthy and easy to use. However, the engagement highlighted concerns about the app not providing the support wanted or diagnosing symptoms, as well as some users lacking digital expertise or understanding the functionality of the app.
- The South London Listens programme of work is identifying community projects to increase digital inclusion is being conducted in SWL[4].
- There are specially designed apps for different groups, for example people with a learning disability, and training courses. Overcoming digital exclusion is not just a case of having spaces and the support to gain skills, many people also need financial support for IT[5].
- The voluntary, community and social enterprise sectors have been involved in extending digital inclusion across the SWL footprint and mapping exercises have helped identify their work[6]. Projects offer IT support such as training, devices and SIM cards. Some linked with social prescribers to facilitate referrals to digital skills support. Others targeted specific groups, such as older people or carers, or helped people to register and use the NHS app.
- Even with support, not everyone has the cognitive ability to learn or will want to engage digitally[7]. A range of access methods will need to be offered[8].
[1] Healthwatch Wandsworth (2022) Experiences of Health and Social Care Services for People with Sight Loss; Healthwatch Wandsworth (2022) Our work with people living with dementia and their carers; Public Health LBM and Mencap Merton (2021) Impacts of Covid 19 on people with a learning disability or autism and their carer
[2]Impacts of Covid 19 on people with a learning disability or autism and their carer
[3] SWLICS (2023) Digital exclusion in South West London
[4] South London Listens (2024) Priorities and Workplans on a page
[5] Impacts of Covid 19 on people with a learning disability or autism and their carer; Speedway (2020) VCS Digital Exclusion Survey; Healthwatch Wandsworth (2022) Mental Health Wellbeing in our community;
[6] SWL Healthwatch/Superhighways (2023) Digital and the VCSE Roles & opportunities for embedding strategically in digital workstreams; South London Listens (2024) Priority and pledge workplans; SWLICS (2023) Digital exclusion in South West London
[7][7] Healthwatch Wandsworth (2022) Our work with people living with dementia and their carers; Public Health LBM and Mencap Merton (2021) Impacts of Covid 19 on people with a learning disability or autism and their carer
[8][8] Clearview Research (2022) Enhanced Primary Care Hub Evaluation
Community outreach and the VCSE
- The importance of the voluntary and community sector in South West London was revealed across a range of reports. The provision of community services, activities, carer and peer support groups was recognised as highly valuable for health and wellbeing. The importance of peer support groups, both commissioned and self-sustaining, were mentioned in reports on maternity services[1], people with ADHD[2], carers[3], people living with dementia[4] and hospital discharge[5].
- One of the main initiatives being undertaken across the SWL footprint currently is the community connectors programme being delivered by the voluntary, community and social enterprise sector in conjunction with the Integrated Care System[6]. Community connectors have been working on a range of outreach projects to address long term conditions and health inequalities in focus communities.
- Early learning from community connectors about what is effective when engaging with communities at risk of health inequalities included going to trusted places and activities that residents use, where they feel safe and welcome. Building trust through returning to the same events and utilising local networkers and GPs was important. Some approaches included offering a free hot lunch alongside health checks.
Healthwatch Wandsworth reported on the work of a group of diverse community champions in communicating preventative healthcare[7]. The Champions identified the cost and accessibility of gyms as being a potential barrier to better health, finding and initiating alternative activities.
[1] Maternity Voices Partnership (2022) Maternity stories: A deep dive into the maternity journeys of 10 women of Black and Asian ethnicities
[2] Healthwatch Kingston Pulse Check report (2021) Neurodiversity and health and care services report
[3] Merton Council (2021) Carers Strategy
[4] Healthwatch Wandsworth (2022) Our work with people with dementia and their carers
[5] Healthwatch Wandsworth (2022) Carer experience of hospital discharge
[6] SWLICS (2023) Core 20 Plus Connectors
[7] Healthwatch Wandsworth (May 2024) Community champions help people feel healthier:blog
Staff
- Many reports highlighted praise for caring, compassionate, skilled and dedicated staff[1] [2].
- A few reports mentioned the need for greater staff awareness and knowledge of specific conditions: sight loss[3], Multiple Sclerosis[4], Chronic Fatigue Syndrome or fibromyalgia[5], and dementia [6].
[1] Healthwatch Wandsworth (2022) Experiences of Health and Social Care Services for People with Sight Loss; NHS SWL (2022) Improving support for people following hospital discharge and bedded rehab: NHS South West London engagement summary; Healthwatch Richmond (2023) London Ambulance Service: Experiences from Richmond; South West London ICS (2022) Insight to inform service redesign or pathway change – stroke rehabilitation services
[2] Healthwatch Richmond (2023) Phlebotomy Survey; Healthwatch Richmond Upon Thames (2024) Adult Mental Health Services Transformation: Phase 2; Healthwatch Richmond (2023) Kew Medical Practice: Enter and View
[3] Healthwatch Wandsworth (2022) Experiences of Health and Social Care Services for People with Sight Loss
[4] Healthwatch Kingston (2022) Pulse Check Report: Multiple Sclerosis
[5] Healthwatch Kingston (2024) Pulse Check report: Chronic Fatigue Syndrome (ME) and Fibromyalgia Services
[6] LBR and SWLICS (2022) Richmond Health and Care Dementia Strategy Consultation
Continuity and coordination of care
- Most people want to have continuity of care through seeing the same GP where possible[1], although some GP practices have high staff turnover and part-time doctors which make it difficult for patients to see their preferred doctor. Early responses to the transformation of adult mental health services suggest issues relating to a lack of continuity of care due to staff turnover appeared to have decreased following the transformation, although they were still being reported[2].
- Children and young people receiving services for Special Education Needs and Disabilities want continuity of care through seeing the same therapist and improved transitions at key stages[3].
- There is a need for better joined up services, with good coordination between GPs/hospitals and other healthcare services[4] [5]. In particular, referrals into community support or care services and for discharge from hospital services to home or virtual wards needed to provide seamless care[6] [7] [8] [9]. Additionally, users of SEND services highlighted the need for efficient communication and collaboration among professionals, service providers, and parent carers[10].
[1] Healthwatch Wandsworth (2023) Assembly on GP services
[2] Healthwatch Richmond Upon Thames (2024) Adult Mental Health Services Transformation: Phase 2
[3] Healthwatch Richmond (2023) SEND futures experiences
[4] Healthwatch Wandsworth (2023) Assembly on GP services
[5] Healthwatch Kingston (2024) Pulse Check report: Chronic Fatigue Syndrome (ME) and Fibromyalgia Services
[6] Healthwatch Wandsworth (2023) Carer experiences about hospital arrangements through to discharge
[7] South West London ICS (2022) Report on the Sutton Frailty Engagement Event
[8] Healthwatch Wandsworth (2022) Carer experience of hospital discharge
[9] Healthwatch Wandsworth (2023) Carer experiences about hospital arrangements through to discharge
[10] Healthwatch Richmond (2023) SEND futures experiences
Travel and parking
- Travel as an issue was raised in several reports, often closely related to the cost of living crisis or social isolation. Rising transport costs, distances travelled to expert services, ULEZ and costs of hospital car parking could impact some respondents’ ability to attend medical appointments[1] [2]. Proximity to bus stops and availability of parking were key issues for patients. Most respondents would prefer to access blood tests within 15 minutes travel[3].
- Transport is an enabler of independence. Where people had mobility issues, support to get out was essential to prevent loneliness and isolation, including attending community groups and accessing appointments[4]. Older people maybe less likely to travel to community activities due to concerns about safety[5].
- Care in or close to home may provide an opportunity to reduce problems experienced by those who find travel is particularly difficult due to pain, fatigue, bowel problems and other physical disabilities[6] [7] [8]. Additionally, virtual wards presented carers with an opportunity to travel less for hospital visits[9].
- Active travel was highlighted as having the potential to tackle obesity, increase exercise levels, reduce local air pollution, and provide mental health benefits. Some people expressed concerns that active travel initiatives might not understand the implications for older people and those with mobility problems who were dependent on cars or public transport[10].
[1] Healthwatch Wandsworth (2023) Cost of living report
[2] One Croydon (2023) Proposed relocation of Diabetes Eye Screening Service
[3] .Healthwatch Richmond (2024) Phlebotomy services
[4] SWL NHS (2023) Joint Forward Plan: Our engagement with people and communities April to May 2023
[5] Croydon Almshouses Charity (2023) Older People Deserve Better
[6] Healthwatch and Health Innovation Network (2023) Qualitative evaluation of non-users’ views on virtual wards in Croydon, Merton, and Wandsworth
[7] Healthwatch Kingston (2022) Pulse Check Report: Multiple Sclerosis
[8] Kingston (2024) Pulse Check report: Chronic Fatigue Syndrome (ME) and Fibromyalgia Services
[9] Healthwatch and Health Innovation Network (2023) Qualitative evaluation of non-users’ views on virtual wards in Croydon, Merton, and Wandsworth
[10] SWLNHS (2023) Joint Forward Plan Our engagement with people and communities April to May 2023
Health inequalities
- Some people are more likely to face more barriers to leading a healthy lifestyle, using NHS services, and accessing prevention services like screening/diagnostic appointments. For example, food and fuel poverty, transport costs, loneliness and isolation, digital exclusion, language and translation barriers, poor experience of services due to prejudice or lack of understanding from NHS staff. People often need some specialised or tailored support that isn’t always provided or available.
- This can mean reliance on family members either to accompany people to appointments to translate and support, or to help with digital interactions. This isn’t always appropriate.
- Some Black, Asian and minority ethnic groups reported:
- Mistrust and being fearful of NHS services, including maternity services, due to previous experiences of racism and this then influences how patients feel about treatment decisions.
- Having to be assertive and persistent to be believed by NHS staff, with some saying they felt frustration about concerns, symptoms or expressions of choice being dismissed, leading to multiple visits and delays before referral.
- Symptoms of ill health especially mental ill health, can often be overlooked in older people. They can also feel they are not always listened to or taken seriously.
- Some NHS staff do not use inclusive language and sometimes don’t use culturally competent language, and can make assumptions about the causes of illness e.g., ‘hard to reach’ or ‘disadvantaged’, or language when trans-women attending prostate appointments, or assumptions about the causes of health problems being attributed to sexuality.
Testing the key themes identified
In January 2025, we collaborated with over 80 of our voluntary sector, community and Healthwatch partners who joined us for our South West London listening event to help us test the themes identified in the report above. Each table was given a summary of the key themes and were asked whether these resonated with the local people that they connect with. They were also asked if there were any themes missing – that were particularly important to their communities now.
Participants felt that the following themes should be added – a summary of the key issues are noted below:
Early years
Common themes that were raised at the event about early years services included:
- Invest in early years health support – Increase funding for early intervention programmes targeting families and young children. Expand initiatives that support parental education on health and wellbeing before birth.
- Early years and education are seen as crucial to improving health outcomes in the long term. Access to quality early education and housing were felt to be particularly important as they significantly influence future health and wellbeing.
- Support for parents and interventions from pregnancy were seen as key to future physical and mental health of children. A focus on perinatal care can have a huge impact on the baby’s later life – important to be able to shape mother’s behaviour early on.
Special Educational Needs and Disabilities (SEND)
Common themes that were raised at the event about SEND services included:
- Delays in assessment and diagnosis – long waiting times for assessment – leading some people to seek private assessments and left people feeling that they had to cope alone. Examples given of people receiving a diagnosis and then feeling abandoned to cope with no follow up support.
- Impact on mental health – difficulties in accessing specialist support was noted as contributing to increased emotional distress and poorer mental health among children with SEND.
- Lack of inclusive support – There were concerns regarding the lack of inclusive activities for children and young people with SEND – often leaving people feeling quite isolated and under pressure to organise activities themselves.
- Challenges in navigating SEND support pathways – many people noted that the system can be hard to navigate without professional help. There were challenges accessing the right services due to a lack of clear guidance following diagnosis.
Housing
Common themes that were raised at the event about housing included:
- Quality of housing can have a huge impact on physical and mental health. Issues such as disrepair, mould, overcrowding, temporary accommodation and emergency accommodation can have a significant impact on the quality of life.
- Housing is a significant determinant of health – the NHS needs to work closely with housing authorities, as inadequate housing puts tremendous strain on healthcare systems, leading to worse health outcomes for individuals.
- Access to affordable and secure housing is crucial for good health. Poor housing conditions can significantly impact physical and mental wellbeing. Addressing housing needs requires an upstream, whole-system approach that considers the social determinants of health and involves collaboration across different sectors.
Taking into account the findings of the initial literature review, together with the issues raised at the January event when we tested these findings back with local communities, we have pulled together a summary diagram that highlights all the issues that matter most to our communities – see below.
Diagram of key issues that matter to local communities
