South West London Listening Event 10 Year Health Plan – Insight Report

Introduction

In October 2024 the government launched a national conversation about the NHS called ‘Change NHS’ – to hear, experiences, and ideas to shape a new 10 Year Health Plan for England.

The 10 Year Health Plan will set out how we create a truly modern health service designed to meet the changing needs of the changing population. This will be focused on the three shifts:

• moving care from hospitals to communities
• making better use of technology
• focussing on preventing sickness, not just treating it

As part of the engagement process, NHS South West London held an event on Wednesday 29 January, bringing together over 80 community leaders and colleagues from the community voluntary sector across south west London.

This report sets out the outputs of the event – including groups discussions on the three shifts and responses to the question “What matters most to your communities?” – we heard personal insights and valuable suggestions from a huge range of people.

Summary of key themes

Common themes from all discussions

Moving care from hospitals to communities

Support for quicker diagnosis, but investment is needed– there was widespread support for the idea that increased care in the community should lead to quicker diagnosis for health conditions, which is better for the health of local people. Groups called for increased investment in community diagnostic capacity through additional funding to support this objective. There was a specific concern for community dentistry services raised in several discussions.

Service navigation and signposting are critical– services in the community can be more complicated to navigate that when they are on a single hospital site. We heard about the importance of good information for local people about where to go and when. Information about services available is also important for those working across the health and care system to be able to access so they can support the patient journey.

Wider community support is key – and under threat – a key theme of all discussions was the potential of the voluntary and community sector to offer additional support for people being cared for at home instead of in hospital. We heard concern that current funding considerations for local community organisations may put the long-term future of this volunteer-supported care at risk.   

Mixed feelings about home-based care– there was widespread support for some of the benefits of home-based care, including people feeling more comfortable in their own space and how visits from health professionals at home can lead to issues being picked up before they get worse, such as UTIs. However, there were significant concerns about people being “sent home from hospital with no support”. It was discussed that “not everyone want to be at home” and that there are concerns about decreased patient safety outside of the hospital setting. It was felt in many discussions that the NHS needs to “help people to understand what services could be better provided at home”.

The impact on unpaid carers must be considered – carers was a common theme in each of the three shift discussions – for the community care focus groups raised the different challenges for carers when people are living at home. There were concerns that, without adequate support, carers “may face burnout” and that this could lead to more hospital admissions.

Integration with social care services– service integration was raised in the majority of discussions with groups advising of a need for “oversight of the whole system” so care isn’t “fragmented”. There were also concerns around NHS care at home becoming means tested as part of this shift, like some social care services already are.

Concerns about staffing levels – current wait times were raised, with concerns that perceived existing workforce shortages in healthcare could “become worst by increased demand for community-based services”.

Focus on the elderly and how it works for them– ensuring home-based care works for the elderly, as a specific group, was raised in many of the discussions. During one discussion about virtual wards there was a concern that “there is a missing tier of care for very elderly and frail people with short term illnesses” to be in  a “low-tech way” that meets all their needs.

Making better use of technology

Protecting human connection – the most common theme in digital conversations stressed that as technology progresses in the NHS, it’s important that human connections within health and care services are not lost. It was felt this was important for everyone – not just the digitally excluded. People felt this would require careful considerations of the patient journey, mapping how patients interact with services.

Single point of access, consolidate services and get the basics right – we heard strongly that there is a range of digital technology that would benefit the health of our communities. Being able to book appointments and access the information from a range of health and care interventions is important – we should make sure the fundamental elements of technology work well, before building on this foundation. It was felt there are lots of positive health-related apps that could make a difference but that they need to be joined up and accessed through a single front door to make them easy to use and maximise uptake.

Digital systems must speak to each other– colleagues in the VCSE sector spoke of the important of data sharing between different professionals working across health and care as well as with members of community and voluntary organisations. It was felt that if those supporting residents in the community could understand health and care referrals and interventions people would be better supported. They also felt it would support health and care professionals to understand the support their patients are receiving in the community.

Concern about digital inequalities and accessibility for all– we heard from the majority of participants that they work with lots of residents who aren’t able to access digital services through smartphones. While some may have smartphones, they don’t have access to data to connect to the internet when free wi-fi isn’t available. It is important not to deepen existing inequalities – there should be a focus on enabling all communities to access the improved services offered through digital enhancements. Participants recommended schemes to enable digital access and education on how to use digital NHS services.

Perception the NHS can’t do technology well – connected to data security concerns– we heard a variety of comments about mistrust amongst communities for the NHS – in some cases connected directly to examples of poor digital services. For example, we heard that while GP services are the most regularly used, they are perceived as some of the least tech-enabled services in the NHS. Some communities are concerned their sensitive data will get into the wrong hands. Many spoke of the important of reassuring communities about data security – more confidence may opt-outs of data sharing agreements across organisations.

Digital can empower people to take control of their own health– there was broad support for the benefits, and potential future benefits of digital technology for people’s health and wellbeing. A range of different solutions were discussed, including apps for physical activity and weight loss – as well as people having more information about their health and health care enabling them to take control.

Think about carers and family members – carers was a common theme in each of the three shift discussions – for the digital shift the focus was on making sure those supporting the care of patients could also access digital health information and are considered in the implementation of technology-enabled care.

Focussing on preventing sickness, not just treating it

Prevention requires a long-term strategic data-led approach – we heard frustration about the length of time the health and care sector had been discussing prevention as part of improvement plans. It was felt by many that many prevention programmes had been ended too soon because they couldn’t report quickly enough on long term positive impacts – “meaningful systemic change is slow”. We heard the NHS must focus on what’s worked previously and use the data available to target specific communities.

The power of trusted community leaders – at a neighbourhood level– we heard about how influential community leaders are with the residents they work with. Comments encouraged the NHS to use the existing VCSE infrastructure to make in roads with communities to discuss prevention initiatives. The long-standing relationships GPs and pharmacists have with their communities was also raised – they are able to work with residents at a neighbourhood level which can be more impactful in this shift.

The NHS can’t do this alone– it was widely discussed that there are a wide range of statutory partners involved in elements of people’s lives which affect their health – housing, schools, employment and social care. All these different agencies must work together to make a difference in prevention.

Early years must be prioritised– raised in the majority of table discussions – we heard “we should be focusing on babies in the womb, not just health checks at 40”. Support for new parents on healthy lifestyles was keen as the key to preventing all future illnesses. We heard particularly frustration in this space about historic schemes which have seen funding reductions over the past decade such as children’s centres.

Promote what’s already available– we heard lots of ideas for how existing NHS prevention programmes like health checks and cancer screening could be better communicated to local people. This included making sure the images we use to advertise services feature diverse people “use images of people that look like me”.

Prevention activities work better when fun and culturally sensitive– there was lots of discussion about the types of activities which encourage local people to be physically and socially active, contributing to staying in good health.

Physical and mental health together – groups discussing how prevention should be tackled in a “holistic way” and that physical and mental health are strongly linked. Any prevention initiatives should consider both in their approach.

Poverty and prevention– groups discussed how cost of living impacts people’s ability to make health choices. It was raised that there was a strong link between poverty and poorer health outcomes.

Specific issues raised on borough table discussions

Croydon

• Community – concerns about caring for people who live in unsuitable housing. They also highlighted that this shift incurs costs to the patients, for instance through heating their homes and public transport to appointments. They wondered if we could make better use of some of our existing empty spaces with good links such as the Whitgift Centre.
• Digital – keen to prioritise different languages and translation, also flagging the impact of community mistrust in the digital space – for example the need for identification (ID) to sign up can be off-putting for some people.
• Prevention – people had concerns about the wider determinants, in particular housing and finances, which plays a huge role in whether people were able to engage in prevention initiatives.

Kingston

• Community – participants valued existing health centres providing a range of services in the community.
• Digital – participants asked for more investment in diagnostic technology and equipment e.g. positron emission tomography (PET) scanners to reduce waiting lists. Highlighted the need for accurate data on NHS App usage to help inform what support is needed to improve take-up in the local population. Build functionality such as voiceover at the start of any technology development for smartphones to ensure accessibility for people with sight loss.  
• Prevention – concerns about the possible impact on mental health of predictive technology and wearables as preventative health measures. This technology can impact on an individual’s mental wellbeing and already poor mental health leading to obsessive behaviours and anxiety around tracking heart rate, blood pressure, glucose levels etc.

Merton

• Community – to meet patients’ needs, health and care services should actively involve them in designing and delivering community-based care.
• Digital – must ensure AI is used as a tool that does not worsen health inequalities and is culturally competent, avoiding biased outcomes. We also need better internal processes to support staff, freeing up their time by streamlining administrative tasks and data access. This allows them to focus on direct patient care. Digital solutions are not one-size-fits-all and must complement other services.
• Prevention – media reports stating that the NHS is overwhelmed can, at times, do more harm than good. It risks deterring patients from accessing the care and support when needed, leading to poorer health outcomes. The NHS needs to support people to proactively look after their own health and wellbeing. There is a lot of misinformation being spread across social media, the NHS needs to ensure that they combat misinformation by providing equitable access to reliable health information.

Richmond

• Community – people highlighted and valued the convenience of community diagnostic centres, such as free parking and avoiding hospital visits. The service is highly appreciated by patients, making these services an attractive alternative.
• Digital – whilst advancements in integration was encouraged, for example providing the ability to help patients track progress on waiting lists, we must ensure there is a balance with privacy. Young people are particularly concerned about how their data is being used and the implications for privacy. Additional thought needs to be given about accessibility, as non-UK ‘phones can’t download certain health apps.
• Prevention – people highlighted the need for building resilience in children and young people and opportunities to address mental health needs before a crisis emerges or progresses.

Sutton

• Community – concerns were raised about whether Sutton had the appropriate estates available to support this shift. People suggested looking at what community buildings were in suitable locations.
• Digital – streamline communications to patients – currently information can be duplicated – on email/app/letter. This is an opportunity to ask people their preferred method and follow that. Need to map bottlenecks in the system to identify what to focus on first.
• Prevention – it was felt that it would be useful to have further insight to understand people’s risky behaviours. We need to understand more about why people can’t make better lifestyle choices. If we know what is preventing them, then we can do more to address these issues.

Wandsworth  

• Community – there is a disconnect between hospitals and community services – transition to home and community services can be difficult because of this.
• Digital – mass systems can be exclusive – they work for the majority but increase health inequalities for example due to language barriers.
• Prevention – people felt work with newly arrived communities should be prioritised in particular families with young children for their vaccinations and preventing poor oral health, as well as registration GPs, and particularly older people, carers.

What other engagement activities took place?

10 Year Plan engagement

Over 90 senior leaders from across South West London joined a virtual engagement event led by the ICB Chair in November, and we held two staff briefings in January for staff to share their views. 

Trusts across South West London held similar sessions with their staff and encouraged them to respond through the Change NHS portal.  A select number of staff from Croydon Hospital Trust were chosen as one of 5 London trusts who joined a London region staff engagement event in February.

We took part in a listening event in January as part of South London Listens, a community partnership between South London communities, the NHS, and local authorities.  The feedback from this event will be published on the South London Listens website.

Winter Engagement Fund

Our voluntary and community sector partners shared information about how local people could share their views through the Change NHS portal at each of the 350 engagement activities and events as part of our Winter Engagement Fund, with a reach of 10,000 conversations. 

Who we reached?

82 people from the below community and voluntary sector organisations attended our Listening Event:

Many of these organisations and groups work with our most vulnerable communities and support tackling health inequalities.  Based on an optional demographics survey, nearly 20% of the organisations who attended support people with disabilities, and 18% of those people with long-term conditions.  Organisations who attended focus their support on those who are digitally excluded, providing mental health support, work with older people and support our communities who live in our most deprived neighbourhoods.  Over 50% of organisations at the event reach our black and global majority communities.

Full insights from borough discussions

Croydon

Focus 1: Making better use of technology in health and care

The Croydon group was made up of 14 contributors from a range of organisations including Croydon Voluntary Action, Croydon BME Forum, Healthwatch Croydon, a local voluntary partnership Chair and community groups working with older people, those experiencing homelessness and a community hub and food bank.

When you think about how we could use technology in the NHS

What are your hopes?

Croydon participants hope that technology in the NHS will:

• Join up patient records so that anyone involved in their care can have a look and see what others are doing so that they learn about the whole person. This would free up time and money for both the patient and clinician.
• Unleash the potential of the VCSE as a true partner in health and care by allowing access to population health data to help better plan our health funded initiatives. It’s frustrating when we can see there is more we could be doing to improve health in communities but we don’t have access to information our health colleagues have.
• Increase face to face contact for people who need it – if technology (including artificial intelligence) makes it possible to deal with more routine issues for patients.
• Give people more information about their own health and advice on how to look after themselves. This would allow people to take charge of their own health and monitor changes for themselves.
• Save delays, repetition and oversights, especially where one part of the system can’t read what is going on in others. One participant told the group about when she recently advocated for her sister who has learning disabilities, explaining that while she was on a medical care ward, she wasn’t receiving eye drops that were prescribed by a clinic at another hospital. She wondered what happens ‘to people who don’t have a belligerent sister’.
• Improve existing services – alleviate pressures on staff and free up more time for them to see other patients who aren’t accessing services digitally.
• Upskilling communities: moving into a more digital world means upskilling people who may be digitally illiterate.

 What are your fears?

• Relying on outdated IT systems – particularly in primary care which is more behind and disjointed – will hold things back and could lead to errors, particularly for older people and those with complex care needs.
• Trust and security – can the NHS be trusted to store personal information on digital systems safely?
• Identification (ID) requirements We have already seen with the NHS app that not everyone has sufficient ID to register with the app, this is not only off-putting for people, but it is also shaming and people do not like to ask for help with this. Need to balance data security with making information accessible, especially when it’s your own data.
• Increase in digital exclusion. Many in the group had experienced older people who may have some digital literacy but may start to have difficulties if they have vision or memory problems. In Croydon, lots of people don’t have secure housing, never mind a smartphone and Wifi, and many can’t afford big data packages even if they have the right equipment. ‘People are already reporting that they feel alienated from technology’.
• Additional barriers for people who do not speak English as a first language. While translations may be available, this is not always accurate and sometimes fails to pick up nuance. This could mean that some people are not able to access important information for their health. The NHS app is only available in English language at the moment which is a barrier to equity.
• Lack of confidence with and access to digital tools could further entrench health inequalities.
• It could negatively impact on health and care staff While the advancements in technology will make teams more efficient, this could lead to fewer people working in health and care and those that do could be working with ‘digital colleagues’ which could be bad for their wellbeing.
• Removing the human element of care health and care staff rely on how a patient presents themselves and there is a risk this will be taken away.

What technologies do you think the NHS should prioritise? and why?

• One system for the whole NHS It can be really frustrating waiting for results to move from one system to another and there seems to be an over reliance on patients knowing what is happening and reporting between clinics, diagnostics and GPs. This is even worse on wards in hospital as they often only have limited records about your prescribed medication and other care needs.
• Updating GP systems GPs are the front door to the NHS yet seem to have the worst IT systems. They should be the point where all the information about a person is collated.
• Artificial Intelligence This would save the NHS lots of time and money, freeing up people to focus on face to face delivery.
• Translation technologies is a huge barrier in many communities. People also worry about inaccurate online translation services such as google translate which is inadequate for translating medical information.

Any other feedback from this discussion

• Consistency Changing systems all the time and expecting the patient to keep up is a real barrier and impacts the most vulnerable the hardest.

Focus 2: Focusing on preventing sickness, not just treating it

What difference good or bad would this make to you?

• Improve quality of life for everyone through healthy communities.
• Reduce the financial burden on taxpayers and the NHS.

What forms of prevention do you think the NHS should prioritise?

Any other feedback from this discussion

• Whole community approach a friendly and fun national programme for all ages for everyone to be involved in. Children ringing their grandparents to compare step counts and checking whether they got their hour’s exercise that day. We saw that this worked during lockdowns where lots of people felt like they had ‘prescribed exercise time’ so an hour a day in fresh air felt like a treat. Encourage a range of initiatives with the focus on the positives, make it exciting and colourful. Involve the NHS, public health, social services and the voluntary and community sector to focus on the same key priorities to give the biggest bang for buck.
• Making it part of everyday life take health advice and preventative measures such as screening and vaccines where people are going about their everyday life – supermarkets, gyms, workplaces. Keep it informal.
• Community outreach make additional efforts for those from marginalised communites who often have to make additional efforts to access the same services and information – take it to them. Will have much higher uptake in screening if you take the tests to where people are and train up clinicians and champions from the same background, people with lived experience and same genetic make up.
• Longer term initiatives with long term funding commitments to build an evidence base allowing people to monitor their own health through things like blood sugar monitoring, blood pressure monitoring and liver function tests would help people to take responsibility for being aware of changes and see for themselves the difference interventions can make.
• Movement as medicine exercise helps people to feel better, socialise more and you can quickly feel yourself getting fitter.
• Speak our language participants felt that many health messages don’t speak to the communities they need to. Translations help and are key for many in Croydon but the messages also need to come from a range of people trusted to have their best interests at heart.
• Tackle health inequalities first through personalised initiatives to our communities otherwise the gaps will continue to widen, especially in communities where distrust is an issue.

Focus 3 – Moving more care from hospitals to communities

What difference – good or bad – would this make to you?

• Community support people would be at home, supported by their loved ones and local communities family carers would not need to travel as well as juggling their lives.
• More convenient for some people to have localised support for everyday health services such as blood tests and screening.

• Save time and money in hospitals so that they can focus on the most sick.
• Some homes are a contributing factor to ill health – poor heating, vermin, stressful households – the NHS would need to carry out thorough assessments of living conditions and family set up to make sure they are safe.
• Cost burden to patients as some in Croydon cannot afford to take on the additional cost of travel to appointments, heating their home and cooking nutritious food.

Thinking about virtual wards, what sounds good?

• Home comforts surrounded by familiarity and community support.
• Family and friends can visit at times that work for them without restricted visiting times.

Thinking about virtual wards, what concerns do you have?

• Safety people are more than a set of statistics and sometimes it needs a person to lay eyes on you to see other vital signs.
• Loneliness and social isolation could be detrimental to recovery, especially if people aren’t able to eat well or heat their home due to the cost.
• Increased risk of falls in homes that aren’t properly adapted for illness or disability.

Thinking about community diagnostic centres, what sounds good?

• Support closer to home would allow people to network with other people in their community to feel less alone. Perhaps group workshops with clinicians about managing their condition.
• Increased uptake for routine screenings as they are at a convenient location, especially if you can book at a time that works for you.

Thinking about community diagnostic centres, what concerns do you have?

• Community resilience will all communities have the right services and support for all conditions?

Kingston

The Kingston group had 11 contributors from a range of organisations including those that support people who are blind or with visual impairment, carers, older people, the North Korean community and ethnic minorities.

Focus 1: Making better use of technology in health and care

When you think about how we could use technology in the NHS

What are your hopes?

Kingston participants hope that technology in the NHS will:

• Make services more connected so that information about the patient e.g. disability and communication needs, unpaid carer etc, follows the patient to each service they access. A possible solution could be that your NHS number includes a tag that identifies communications needs so staff are aware and can respond appropriately for that patient.
• Focus on improving digital inclusion and literacy for those who are not digitally aware or connected. Technology is great for those who can use it to connect with health systems. However, there is an assumption that if you have a mobile phone, you can connect and use digital health systems and apps, and this is not always the case. It is important that we continue to advocate for traditional communication methods whilst finding ways to improve digital inclusion and literacy.  Having health information available in digital form can help community organisations support individuals who may not engage with written information from healthcare professionals.
• Be accessible to all so that any patient-facing digital application such as the NHS app will be easily accessible on a smartphone for everyone including those who do not have English as a first language or people with sight loss. Voiceover functionality should be built into the early stages of any tech development for smartphones as well as laptops.

What are your fears?

• Increases digital exclusion There is concern that digital applications will continue to not be fully accessible to everyone. For example people with sight loss, older people, or people whose first language is not English are being let down by current technology not being accessible.
• Lack of resources to support digital inclusion How do we find the funding and resources to encourage and support people to become digitally literate. There are groups working in the community that can do this, but funding and resources are needed to make this work sustainable.  There is a gap appearing for those who are not digitally literate which is letting people down and leaving them isolated and disconnected as more NHS information and support moves online.
• Innovation comes at the expense of getting the basics right There needs to be a focus on investing in getting the basics in the NHS working well before we jump into the next big technical advancement such as AI which is a concern. There are difficulties connecting across GP practices and hospitals, there are delays in being discharged; waiting lists for treatment; long waits for patients getting letters, prescriptions from hospitals and in some areas, patients are not able to see a GP in person it has to be virtually. Technology will help with this, but it still requires current systems to improve and adequate resources available.  NHS services need to focus on supporting the patient holistically and understand individual needs in order to support them.

What technologies do you think the NHS should prioritise? Explain why these were chosen in your group?

Kingston participants thought the NHS should:

• Invest in more diagnostic technology e.g. positron emission tomography (PET) scanners to reduce waiting times.
• Technologies that will prevent you getting sick
• Improve data sharing, connectivity and communication between GPs, hospitals, and social care so that it works for patients and staff. Data sharing across services needs to be improved.
• Focus on making the technology already available accessible for everyone e.g. NHS App. Get the basics working well for everyone.
• Improve data available about NHS app usage – accurate data is needed on usage – who is using it and how are they using it. This will inform how we can support communities who are not able to use such applications.

Any other feedback from this discussion?

Concerns were raised about how AI could remove the human element and judgement that comes with experience from healthcare.

Focus 2: Focusing on preventing sickness, not just treating it

What difference good or bad would this make to you?

It is good to have a strong focus on prevention as people tend to leave it too late to address health concerns resulting in the need for urgent treatment and complications.

There are concerns around the impact on mental health of predictive technology and wearables as preventative health measures. This technology can impact on an individual’s mental wellbeing and already poor mental health leading to obsessive behaviours and anxiety around tracking heart rate, blood pressure, glucose levels etc.

What forms of prevention do you think the NHS should prioritise?

• Involving more than the NHS by investing in public health services and considering where this investment has the most impact e.g. the role of schools and the voluntary sector in supporting the public health/prevention agenda. Working with local employers to offer health talks, vaccinations, and checks for their staff. There is a sense that Public Health nationally has been downgraded because of reorganisation over the years.
• Unpaid carers the recognition of the role of unpaid carers and their value to the NHS. If we are not supporting unpaid carers this has an impact on their own health which has a knock-on negative impact on the person, they care for and starts a chain of events. There is a need for unpaid carers to be effectively supported to continue their caring responsibilities through respite and breaks.
• Taking a longer-term strategic approach in prevention which needs to be part of a longer-term plan that is not impacted by changes of government. It should be considered alongside treatment and not separate to it. Being support by and involved in community initiatives can have a positive impact of keeping people well and out of hospital, however the outcomes for this community intervention are not immediate. The current approach has inherent cost benefit built into it which needs to change. For example, the GP suggests the flu jab to a patient as they are seeking that outcome, and they are compensated for this. How can we make this work for other preventative measures that do not have an immediate outcome.
• Addressing bias in outcomes measures there is currently bias built into the system around what outcomes you can measure as the easiest and most immediate outcomes are measured. This is inherently biased against public health/prevention measures which are not so easy to measure and have outcomes delivered in medium to long term. There needs to be greater focus and creativity on introducing specific measures in south west London that can demonstrate longer term preventative impact wider than clinical outputs.
• The voluntary and community sector and how they can work with health and social care to release funding and develop systematic long term solutions within the community for mental health, life style support, activities, and social connection.
• The importance of data sharing and improving the connectivity between voluntary and community sector, health and social care systems. This will ensure the good work already happening in the community such as blood pressure checks, and mini health checks are reported back to the GP practice and reduce duplication.
• Continue to work with and invest in community groups and community leaders as a trusted source of health promotion and literacy for their communities. NHS should trust the public and support the training of more people and groups in the community to take blood pressure and other checks to educate and inform people to be more empowered about managing their own health.
• Moving services into primary care and the community to prevent patients going into secondary care particularly for older people. There is real value in having GPs or district nurses supporting people in their homes and stopping illness such as UTIs becoming urgent and needing a hospital admission. Tackling the issue of social care being available to support people at home and on discharge from hospital. Enabling healthcare professionals working in the community such as community pharmacists, GPs and primary care staff to connect with deliver community outreach.
• Lifestyle and accessible education with the need for information for people to manage their own health and understand what support and initiatives are available to them.  Have a greater focus on supporting people to be more active as well as healthy eating. Providing opportunities for activity that are accessible to everyone. Find ways to connect GP practices with local sports and leisure centres to encourages people to be active.
• Health checks investing in MOT style health checks. There needs to be greater promotion of the NHS health check to the target age groups.  Greater awareness of the value of a yearly sight test to pick up early changes and prevent conditions as diabetes or glaucoma.
• Make it easy for people to access health checks, vaccinations, and screenings. Make them available outside of the usual 9-5pm at a time convenient for the target audiences – think about young families, caring commitments, working people. Offer screening, health checks and vaccinations in venues where people are already going to be – community centres, at work.  Find out why people are not taking up these services.
• Mental health services are overwhelmed with current “mental health epidemic” and those who have complex and enduring mental health conditions are not getting the care they need. Having mental health specialists in primary care could prevent hospital admissions and support people to stay well and return to work for example.
• Recognition and value of unpaid carers and family members insight and perspective on an individual’s mental health condition particularly at the start of a diagnosis. They are able to provide insight into behaviour changes and deterioration of mental health which could support early intervention and inform support needed. Need to value the lived experience of both patient and unpaid carer.

Focus 3 – Moving more care from hospitals to communities

What difference – good or bad – would this make to you?

• Existing health centres as an example of what services can be provided in the community.
• The potential of the voluntary sector to provide support in the community with the potential for the compact between local authority and the voluntary sector to support appropriate funding for support in the community.  There is a need for good quality data to understand where those in most need of support are in order for the community and voluntary sector to plan effectively.
• Opportunities to localise services around a hub in specific communities if there is the infrastructure to support and protect the community centre or group that will become the community hub. Experts who know the communities are integral to this approach working. Asking the community and voluntary sector to provide services such as health checks is not sustainable unless there are adequate resources and support that go with the ask.
• Most people would want to stay at home and be cared for there people are worried about getting an infection and becoming more ill if they are in hospital so would feel better to be cared for in a community setting. However, there is an assumption that this is what everyone wants or that everyone has people to care for them at home.  If they see that they community service is rated good, then they are more likely to be comfortable receiving that service.

• Concerns around people being discharged without support in place.
• Short-term low-tech support for older people high tech virtual wards may not work for everyone e.g. elderly and those living alone who may have additional needs. Continue to invest in community beds to for these patient groups to provide short term care and get them back home.
• Community dentistry Not being able to see a dentist can have significant impact on an individual’s health. This is a particular concern for those who are not able to afford or access treatment. Local community organisations have been able to work together to get mobile dental units into particular areas of the borough such as the Cambridge Road Estate.

Thinking about virtual wards, what concerns do you have?

• Concerns about the role and responsibilities for the patient in monitoring health conditions.

Thinking about community diagnostic centres, what sounds good?

• Need for more information about what diagnostic centres offer and where the local centres are.
• Positive if it makes being referred and having the test quicker.

Thinking about community diagnostic centres, what concerns do you have?

• These would seem dependent on having the workforce available to deliver this service in the community.
• Would want to see evidence that these centres save the NHS money.

Merton

The Merton group had 12 contributors from organisations including local community football organisations, employment and citizens advice, theatre and mentoring groups and a local GP. 

Focus 1: Making better use of technology in health and care

When you think about how we could use technology in the NHS

What are your hopes?

Merton participants hope that technology in the NHS will:

• Helps people access care more easily – Technology could really help people who require additional support such as those with disabilities or long-term conditions to access care more easily.  However, education on how to use these apps is really important. 
• Improves communication and information sharing – Systems that could share information between different healthcare providers could enhance patient care and reduce the wait for patients and their families.
• Supports more personalised care – Build on the learning from current initiatives such as the Musculoskeletal (MSK) GetuBetter App. Technology could support more personalised care, allowing patients to manage their health conditions more effectively and access tailored support. We need to understand what has already worked well and ask the patient – is this what you’d want and use and bring in their voice.
• Frees up time of healthcare staff – The need to get the back-office function right, by streamlining the process we could free up valuable healthcare professional time and reduce the pressure on them for example a patient only having to tell their story once and reduce waiting times for patient.

What are your fears?

• Increases impact of digital exclusion – There is concern that the increasing reliance on technology could exclude those who are not digitally literate or lack access to technology. Technology should not be one size fits all – we need to make sure we have other options available and it’s communicated. “People are really scared that digital services are being forced upon them.”
• Concerns about data privacy and security – There are many concerns about data privacy and security, particularly among older generations and younger people. People aren’t sure of what their data will be used for and there is a general mistrust amongst Government organisations collecting data on individuals.
• Over-reliance on technology replacing human interaction – There is a fear that technology could replace human interaction and lead to a decline in person-centred care, leaving those who do not use the internet or apps behind.
• Potential for bias and accuracy within Artificial Intelligence – Concerns about the potential for bias in AI algorithms and the accuracy of diagnoses made by AI systems. It was felt that if the AI algorithms if not developed or trained carefully, could possibly accentuate existing biases in healthcare. This could then lead to further inequalities in access to care and quality of treatment. It is crucial that AI systems used in healthcare are culturally sensitive and consider the diverse needs and experiences of all patients.

What technologies do you think the NHS should prioritise? and why?

Merton participants thought the NHS should prioritise:

• Integrating existing NHS IT systems – Systems to communicate with one another to ensure continuous information sharing and reduce administration errors.

• Self-management apps – Continue learning and building on NHS apps for those who want to use them. It is important that apps empower patients to manage their own health conditions and look for the right support.

Any other feedback from this discussion

• People feel “done to”, that they must use these apps – “We use it for everything, our banking, our shopping, if a patient has a long-term condition. Sometimes a person might spend a full day on apps or technology and not speak to a human. Are we causing more harm than good? Where’s the balance?”
• Education is crucial to share the benefits and understand concerns – We need to educate the public about the benefits of technology, and we need to address the concerns about data privacy and security with all communities. We need to understand the barriers and really listen to people to understand fears and concerns. 
• Digital should complement existing services and not be the only option – Technology is not one size fits all and needs to complement other services, and other options always should be available to those who cannot or choose not to use technology.
• Make sure IT systems integrate with each other – We need better internal process within the NHS to successfully implement digital healthcare. Systems across the country do not talk to one another. A patient registered with a London GP will struggle if they are using healthcare anywhere else in the country other than London. If we can get the back office right.
• We need to build trust and address concerns – Build a communications campaign to share key messages. Data is already shared with NHS – it’s to help us look after you!
• Empower patients to self-manage using technology – We should be using our trusted networks to empower patients to self-manage via technology if they can.
• Make sure Artificial Intelligence doesn’t increase health inequalities – A big worry was around using AI and ensuring it’s culturally competent and doesn’t exacerbate health inequalities.

Focus 2: Focusing on preventing sickness, not just treating it

What difference good or bad would this make to you?

• The NHS must start by building trust and combatting misinformation – There is a lot of misinformation around vaccinations, preventative services and public health messages.
• Need for holistic approach to health – physical, mental health and well-being – People need a holistic approach to health, bringing in both physical, mental and social wellbeing to prevent illness and promote overall health.
• Work with the community and voluntary sector as trusted, grass roots organisations – Wealth of information and support within the voluntary and community sector. The NHS needs to think how it could build on these relationships, without overburdening groups. The sector are already doing a lot of prevention – social prescribers, keep fit classes etc. First point of call for many. The NHS needs to fund them better and work with them. Community and voluntary groups are trusted community organisations and are influencers. They are crucial for helping to share key health messages and promoting preventative health measures. NHS need to use them more efficiently.
• ‘NHS is broken’ narrative a barrier to people coming forward for help – Public bodies need to stop saying the NHS is overwhelmed, this stops people going to those services and then they end up sicker, with more conditions and more isolated. An example was shared of a patient who ended up very unwell, then in hospital for six months and sadly passed away at Hospital as they were too sick. This was because they felt they were burdening the NHS at a very busy time (flu season). We need to shift the narrative from being overwhelmed to it’s still open and we can help you.
• Prevention ‘starts in the womb’ not at a health check at 40 – It was felt that prevention starts in the womb via antenatal classes, not at 40 for a health check. The NHS needs to work with parents, carers to give their child(ren) the best starts in life. It was felt prevention was only talked about for “older people”. We are seeing less unhealthy behaviours from children and young people in Merton such as alcohol consumption. It was felt that this wasn’t from key health messages, but from peers and influencers. How can the NHS work with influencers both social media wise and community led in a more proactive way?

What forms of prevention do you think the NHS should prioritise?

• Healthy eating and healthy starts should be a priority but being mindful of the cost-of-living crisis affecting many people. This is because, giving a young person the tools and techniques for a healthy lifestyle will set them up better for future life. “This plan is for 10 years; they will be the next generation and it’s important that they have a good start to make getting older easier. “
• Using intergenerational approaches and connections could really benefit learning from across all age groups.

Any other feedback from this discussion

• Beware of misinformation and need for reliable sources of health information – Participants expressed concerns about the spread of misinformation and the need for reliable sources of health information. They felt surprised to see weight loss jabs as a preventative measure as there is a lot of misinformation about this service.
• Need for cultural sensitivity and tailored approach for diverse communities’ – Preventative health messages and initiatives should be culturally sensitive and tailored to the needs of diverse communities.  Engaging communities and understanding what matters to them is so important. Health and care services need to be culturally aware.

Focus 3 – Moving more care from hospitals to communities

What difference – good or bad – would this make to you?

• “Community” needs to be defined – does it mean nurses, buildings or groups? – What does this mean to an individual? It was unclear whether it meant community nurses, community buildings or community groups.

Thinking about care closer to your home or in your home and these examples:

Virtual wards

• Receiving care in a familiar environment could be more comfortable and less stressful for patients, potentially leading to better outcomes
• While care at home can be beneficial, it could also increase social isolation for some individuals, particularly for those without strong family support networks.
• Concerns around the digital divide – not everyone has access to the technology required which could exclude some patients from benefitting from this model.

Community diagnostic centres

• Shifting care to community settings could help reduce hospital admissions and free up hospital beds for those who need them most.
• Participants felt that providing care closer to home could improve access to healthcare services, particularly for those with mobility issues or those living in areas with poor public transport.
• Community-based care could support earlier intervention and prevent conditions from worsening, potentially reducing the need for more intensive care later.

Ambulance triage

• Existing workforce shortages in healthcare could become worse by increased demand for community-based services.

What sounds good and what concerns might you have?

• Concerns were raised about the capacity of community services and the community and voluntary sector to deliver this level of care, particularly with existing funding constraints.
• It is important that health and care involve patients in the design and delivery of community-based care to ensure it meets their needs.
• The NHS needs to learn from other examples of where things has worked well previously.
• We need to build trust with communities who are used to going to the hospital for care. This means teaching them about new ways to get care at home or in their community and why these new ways are good. We need to work with trusted people in the community to help get the word out. It’s important to show people that the care they get outside the hospital is just as good, and maybe even better because it fits their needs.

Any other feedback from this discussion:

• Technology can help speed up diagnosis and reduce waiting times, which can lead to better outcomes for patients. Worried about the digital divide that we are causing. It could also open doors for people – benefits!
• Education is key, people need to understand how these services work and the benefits.
• The NHS need to address people’s concerns about technology.
• The NHS need to be careful not to overburden the voluntary sector, if the NHS are to work with them, they need to be funded properly and for longer term – not just small pots of funding that end after 12 months when the project is up and running and seeing benefits to individuals.
  

Sutton

The Sutton group had 8 contributors from organisations including Healthwatch Sutton and local groups that support people with disabilities, mental health and a local community centre.

Focus 1: Making better use of technology in health and care

When you think about how we could use technology in the NHS

What are your hopes?

Sutton participants hope that technology in the NHS will:

• Provide reassurance around cyber security – giving the opportunity to inform the public around how data is stored safely 
• Reduce pressure on the NHS – for example, by making systems more efficient and reducing waiting times. 
• Streamline communications – currently information can be duplicated – on email/app/letter. This is an opportunity to ask people their preferred method and follow that. 
• Improve accessibility – could improve how people access services giving more people online access and freeing up face to face and traditional methods for those people who really need it.   

What are your fears?

• Removes human element – there were concerns around AI checking results – could things be missed? General concern that apps could take away the human judgement – advice/judgements about who you need to see.
• Deepening health inequalities for digitally excluded – a greater focus on technology could leave people out – create a chasm. Elderly people with sight loss find it difficult to access the apps. To reduce the potential inequity of access it was suggested that apps should be codesigned with people with disabilities so they are accessible and tailored to their needs. 
• Cyber security – concerns were raised that data could be hacked or sold. People were aware that the NHS signposts patients to other apps not run by NHS. It was noted that it being transparent about those companies and if they sell data is really important to build and maintain trust.

What technologies do you think the NHS should prioritise? and why?

Sutton participants thought the NHS should:

• Identify what will have most impact and be most effective – it was agreed that technology has the potential to make services more efficient and faster – but first we need to spend time working out where investment will make the most impact.
• Understand the bottlenecks – there was a discussion around where the problems are – for example is it about getting a GP appointment or being referred for treatment? Once we understand the pinch points it will be easier to prioritise our resources.
• Prioritise technologies to improve access to appointments – it was noted that people have heard many examples of when, if people can’t get an appointment when they need one, they go elsewhere and incur a cost that they can’t afford. Many private companies are promoting fast access to health – the NHS needs to be in a position to compete, otherwise people will go private when they are desperate and possibly can’t afford to – causing more stress and detriment to their wellbeing. 

Focus 2: Focusing on preventing sickness, not just treating it

What difference good or bad would this make to you?

Sutton participants discussed the following themes in terms of preventing sickness. They felt the following issues were important:

• Wider determinants of health – prevention doesn’t all fall under the NHS. So much about our health is determined by wider factors: where we live; lifestyle; access to green space; housing; income. There needs to be a sector wide societal approach. From the NHS perspective, given the full picture, it would be helpful to understand where the NHS can have the biggest impact. 
• Accessibility – services need to be easy for people to access – close to their everyday lives. For example – easy for a working mum to attend. It was noted that people are less likely to attend screenings and other initiatives if they are far from where they live with limited opening times.
• Longer happier lives – early detection and interventions have the potential to not only extend the time you live but more importantly improve the quality of the remaining years. 
• Insight to understand risky behaviours – need to understand more about why people can’t make better lifestyle choices and find out what is preventing them. For example, most people know that it isn’t healthy to smoke or drink a lot – but some still do.
• Education is key – people need to understand more about the benefits of early intervention and lifestyle choices – done in a way that is sensitive to their cultures. It was noted that it is really important to reduce the fear around screening – some people don’t go because they are scared of what might be found. But actually, we need to let people know that screening can pick up on early signs that can be treated more quickly and easily with better health outcomes.  
• Active participation – need to develop a culture where people are active participants in their own health and in decisions about their care. People are more likely to take ownership of their health if they feel in control of it and not passive recipients.

What forms of prevention do you think the NHS should prioritise?

• Target the key life stages where prevention will have impact – lots of research to show that 50% of habits are established in youth and adolescence. Young people might be less resistant to hear messages. Also really important to focus on perinatal care – and pre-conception – mother’s behaviour can influence babies later life. 
• Long term impact – need to prioritise what has the most impact on the NHS. Focus on issues that will have a long-term effect on NHS longer term e.g. vaccinations and obesity. 
• Education – more people will make changes if their families are involved. Peer educators are also really effective at giving health messages that are listened to rather than people who the audience don’t recognise or connect with.
• Culturally appropriate services – important to speak to those experiencing health inequalities to understand their views in order to support them better and improve outcomes. 

Focus 3 – Moving more care from hospitals to communities

What difference – good or bad – would this make to you?

• Cultural shift – work is needed to change people’s behaviours and perceptions to understand that hospital is not always best, and to understand the value of having care in community. Some people assume that they will receive the best care in a hospital setting and that the clinicians there are better trained – these issues need addressing to shift how people think.
• Extra pressure on families – shifting care into the community and out of hospital could put more pressure on family members and carers. There were concerns that people at home will be expected to provide more care than if the individual was being looked after in hospital.
• Cost – it was noted that there might need to be an element of double running in order to set up some of these services – to have hospital services and care in community running in parallel curing the transition phase.
• Improve recovery – it was noted that hospital stays can have a very negative impact on health losing healthy years and mobility the longer you are in a hospital bed. Staying out of hospital has the potential to improve wellbeing.  
• Relationship with social care – there were concerns around the shift between health and care and care being means tested. Will the NHS have to pick up more if social care isn’t able to provide the services that are needed. 
• Risk – due diligence is needed to ensure that it is safe to treat people at home – some concerns were raised around how people are assessed for example – could they be experiencing domestic violence? Is it safe for them to be treated at home?
• Resourcing – important to have appropriate equipment and resource in the community. Need to find ways to reduce wastage – people having equipment at home and not returning them.
• Ownership and responsibility – it has the potential to make people more responsible for their own health as they see the results in their home.

Thinking about care closer to your home or in your home and these examples:

Virtual wards

Good

• Positive feedback – feedback from Healthwatch research about virtual wards was overwhelmingly positive.
• Credibility – Importance of building confidence in the service and the legitimacy of the model of care.
• Case for change – need to help people to understand what services could be better provided at home rather than in hospital. 

Concerns

• Cost of energy to be treated at home – will people incur more gas and electricity costs than if treated in Hospital?
• Risks -reassurance around what would happen if people had a fall and you’re not in a healthcare setting.

Community diagnostic centres

Good  

• Over all people thought that community diagnostic centres sounded like a great idea

Concerns 

• Estate and resources – do we have enough resources to support them? Could we use existing buildings?

Ambulance triage

Good

• Using resource appropriately – it was felt that the triage system would work well – freeing up ambulance services to make sure that emergency services are available to go to where they are needed.

Richmond

The Richmond group had 8 contributors from organisations including local groups that support families, children receiving hospice care and ethnic minority communities.

Focus 1: Making better use of technology in health and care

When you think about how we could use technology in the NHS

What are your hopes?

Richmond participants hope that technology in the NHS will:

• Improved access across the system – to enabling the community and voluntary sector and social care providers to access the same patient health data with consent to support better coordinated care.
• Improved technological integration – across apps – including consolidating health tracking apps into the NHS system for ease of access and to encourage healthy behaviours and provide patients with all the information in one place.
• Improve accessibility and efficiency of technology – for example introducing tracking systems to help patients monitor their progress in waiting lists, reducing uncertainty and helping to provide helpful reminders for individuals who are unaware of available health services.

What are your fears?

• Worries about privacy and confidentiality – for example who has access to patient data and how it is used. Young people are particularly concerned about how their data is being used and the implications for privacy.
• Digital exclusion and accessibility – Some individuals lack digital literacy or access to smartphones, making it difficult to engage with healthcare apps. Additionally, digital poverty remains a barrier, even if they have smartphones, some families struggle to afford data and internet access.
• Fear and discomfort around using digital tools – preventing some individuals from engaging with online healthcare resources.
• Loss of personal contact – need to ensure a balance of digital solutions with personal contact. While digital tools enhance efficiency, they should not fully replace one-to-one personal contact, which remains essential for many patients. Some people find digital navigation confusing and prefer speaking directly with healthcare professionals.
• Limited access for carers – Carers, including parents, often act as the primary contacts for service users – their access to health data needs careful consideration. Without proper carer involvement, patients risk missing essential care appointments.

What technologies do you think the NHS should prioritise? and why?

Richmond participants thought the NHS should prioritise:

• The integration of healthcare and voluntary sector systems – so that all partners have access to the information they need to support a patient. with patients having to tell their story only once.

Focus 2: Focusing on preventing sickness, not just treating it

What difference good or bad would this make to you?

Richmond participants discussed the following themes in terms of preventing sickness. They felt the following issues were important:

• A multi-agency approach is needed – The NHS alone cannot tackle health inequalities; education, social services, and local government must work together. There needs to be equal effort and responsibility. 
• Intervention should begin in early childhood – Intervening in the early years, even before birth, can prevent the need for significant healthcare interventions later in life. This includes identifying and supporting families during pregnancy and early childhood can lead to better long-term health outcomes.
• A focus on mental health prevention – including early mental health support, giving individuals the tools to care for themselves while ensuring services are accessible before crises arise and an emphasis on removing barriers to mental health services.
• Acknowledgment of the challenges in implementing a prevention focus – for example a lack of political and public focus, government and media attention often only shift towards prevention after high-profile issue or tragedy. It was shared that a fundamental shift in policy and funding is needed. Despite recognition of the link between poverty and health, meaningful systemic change is slow. Many preventative healthcare measures are difficult for marginalised communities to access.

What forms of prevention do you think the NHS should prioritise?

• Investment in early years health support – Increased funding for early intervention programmes targeting families and young children. Including an expansion of the initiatives that support parental education on health and wellbeing before birth.
• Strengthened multi-agency collaboration – Focusing on improved communication between the NHS, social care, education, and community organisations.
• Enhanced mental health support and resilience building – Providing more accessible mental health resources, including early intervention services.
• Addressing socioeconomic barriers to health – Recognising that poverty is a major determinant of health, consideration needs to be given to implementing policies that reduce financial barriers to healthcare access. With an emphasis on increased community-based health education to raise awareness of preventative measures.
• Increased outreach initiatives – Expanding health outreach services, such as mobile health buses, to reach underserved communities.
• Carer health – Recognising the critical role that carers play in supporting vulnerable populations and ensuring they have access to the healthcare that they need.

Focus 3 – Moving more care from hospitals to communities

What difference – good or bad – would this make to you?

• Improved patient experience – Hospitals can be stressful environments, particularly for children and vulnerable individuals. Providing care in familiar settings can enhance comfort and compliance with treatment and follow ups.
• Improved and better health outcomes – Patients with chronic conditions or neurological conditions often experience deterioration in hospital settings. Care at home or in the community can promote better recovery and long-term wellbeing.
• Reduced pressure on hospitals – Reducing unnecessary hospital admissions allows resources to be focused on acute cases. Ensuring quicker discharges with appropriate community support can free up hospital beds.
• Financial efficiency – Community care can often be more cost-effective than hospital stays. Redirecting funding towards preventative and home-based care may reduce long-term healthcare costs.

Some of the challenges in shifting to community care could include;

• Funding barriers – There is often reluctance to fund community care models, even when they are more cost-effective. A lack of clear financial arrangements can prevent smooth transitions from hospital to community settings.
• Lack of coordination and integration – Effective community care requires integration between NHS services, social care, and voluntary sectors. Currently, a lack of oversight and coordination results in fragmented care and inefficiencies.
• Reduced access and equity – Not all patients have equal access to community-based services. Those who self-fund care often struggle with costs, and there is limited support for individuals who fall outside traditional NHS and social care funding or are not referred into a system.
• Increased need for carer support and crisis prevention – Many patients rely on informal carers who may struggle with the demands of care. Without adequate support, carers may face burnout, leading to more hospital admissions.

Thinking about care closer to your home or in your home and these examples:

Virtual wards

Good

• Viewed as an effective model for delivering healthcare outside traditional hospital settings, offering the support of community-based professionals.
• praised for their ability to manage patients with severe conditions, with skilled ward sisters and specialists facilitating care.
• The main advantage is the reduced need for patients to visit the GP or hospital, with the virtual care model instilling confidence in both patients and professionals.
• Effective for remote monitoring of patients, preventing unnecessary hospital referrals and allowing for more efficient care management.
• Viewed as a promising approach, enhancing accessibility and reducing the pressure on hospitals, though there is a need for continued focus on technology and accessibility improvements.

Bad

• Dependent on the integration of technology, ensuring accessibility and seamless communication between healthcare providers and patients.

Community diagnostic centres

Good

• Recognised for providing diagnostic services in more accessible locations, reducing the need for hospital visits.
• The convenience of community diagnostic centres, such as free parking and avoiding hospital visits, is highly appreciated by patients, making these services an attractive alternative.
• This model is seen as a return to more localised healthcare settings, where services are more personal and easily accessible. Thing back to cottage hospitals.
• There is an emphasis on bringing diagnostic services to local communities, allowing people to receive care in familiar, less overwhelming environments, rather than having to visit large hospitals.
  

Wandsworth

The Wandsworth group had 11 contributors from groups including local community organisations supporting Asian families, people with digital access issues, older people and GP patient forums. 

Focus 1: Making better use of technology in health and care

When you think about how we could use technology in the NHS what are your hopes?

Wandsworth participants hope that technology in the NHS will:

• Simplify access to healthcare and appointments for patients – Being able to use one app/system for booking GP appointments, prescriptions, hospital and community care.  At the moment too many different ones – NHS app but GP practices using a different booking system. Frees up primary care for more face-to-face capacity. Use good technology for the administrative side of GPs role thus freeing up time for more face-to-face appointments
• Build confidence and trust in the NHS use of technology and data sharing is increased – Patients have confidence and trust in the NHS using technology, that they have the confidence in the systems and apps to understand that sharing data between hospitals and GPs is an advantage, rather than opting out because of distrust and worries about data compromise
• Lead to advances in treatment and care – That technology improves responses to conditions, advances care for medical conditions
• Identify low uptake and targets services to help reduce health inequalities – Use technology and data to identify low take up and target services where most needed rather than a mass system for all that can be exclusive – technology has huge potential to reduce health inequalities
• Help overcome access and language barriers including physical and learning disabilities for example translation, talking apps for blind people
• Be well thought through and integrated – The evolution of systems is not rushed, take time, make sure systems sync with each other and put the right systems in that work, so well thought through procurement systems are needed

When you think about how we could use technology in the NHS, what are your fears?

Wandsworth participants fear that technology in the NHS will:

• Lack of trust leads people to ‘opt out’ That people won’t trust the NHS with technology and choose to opt out either via option, or by not using systems.  There is a history of distrust especially in some communities with the NHS in general and particularly about personal data.
• Rushed in systems won’t be suitable or integrated – They may not be the most suitable for patients to use, may result in lots of different apps and system.  Also ensure systems can sync with community and voluntary sector and other organisations who have contracts to deliver for the NHS.
• Too many apps and systems will add to confusion and complexity – Too many apps and systems which make it more complex for people, issues with syncing and authentication will put people off using them and resort to telephoning or not engaging with the NHS. People have devices but need to know how to use them.  Will the NHS also provide support and guidance so people know how to, so people don’t struggle, give up and a medical condition could get worse
• Increases barriers to access and digital exclusion – Patients, mainly older people who generally have the greater health needs will be left out and already feel abandoned by the NHS and don’t want to be forced to use technology.  That they will resist and may miss out on medical care as a result.  Mass systems can be exclusive – work for the majority but increase health inequalities for example due to language barrier. For people from other countries where technology is less advanced than the UK this will be very difficult for them to adjust to, they will need support and teaching how to use apps.  Members of her community are very worried about this. Could it create a postcode lottery for access?  Rural areas still have issues with wi-fi and this could create a barrier to use
• Losing the human connection, technology can make mistakes – An example given where someone else’s appointments were being sent to the participant, who had the same name.  Also with GP triage, asked to send a photo of a lump but not visible on a picture.  Still need face to face for some diagnoses.

What technologies do you think the NHS should prioritise? Explain why these were chosen in your group?

• Systems that create capacity within the NHS and deal with a lot of the current administrative burden.
• Technology that provides data and capacity to address health inequalities through identifying low take up and targeting services where there is most need.
• The need for help support those who don’t use smartphones – e.g. issue a basic phone to patients so they can access NHS services by calling.  Some local authorities are funding similar schemes.

What technologies are you worried about? Why is this a concern?

• Not concerned about specific technologies but concern about trust of the public in the NHS ability to use technology.  For example safety of patient data, also of mistakes being made having an impact on a person’s health.

Focus 2: Focusing on preventing sickness, not just treating it

What difference good or bad would this make to you?

• Importance of the role of local authority public health teams and the community and voluntary sector in prevention – For the NHS to further contribute to preventing ill health it needs to be more integrated with other services and work together with local authorities, and the voluntary and community sector who can address wider determinants of health for example poor housing and low income.  Should the NHS focus more on prevention or not?  If they NHS focused more on prevention for example managing conditions early on like high cholesterol, this can prevent people developing heart conditions.  But is this the role of the NHS or the local authority (public health)? 
• Improving health through exercise and social connection in the community ‘health by stealth’ – Holistic care and community involvement key to prevention for example through peer support activities, social prescribing and neighbourhood-based projects.  An example given where a GP practice gave a talk on menopause, the people who took part decided to form a walking group which now meets regularly.  They are getting healthier through exercise but also through social connections – ‘health by stealth.’
• Empower people to have the knowledge and confidence to self-manage – Long term conditions – example of the Expert Patient Programme, will prevent declining health. 
• Clear, targeted and accessible health campaigns – Ensure campaigns and communication messages are clear and simple, at the moment there is confusion with multiple communications from different parts of the health care system, leads to confusion especially in health inequalities groups.  Importance of awareness campaigns and screening information being accessible, translated into different languages – example of cervical screening leaflets in Urdu made a big difference for Roehampton wellbeing for women and children project in supporting their members to book for tests.
• Longer term funding would maximise long term benefits of prevention – If focusing on prevention less short-term funding for relevant health programmes.  Especially with prevention work, change happens over the longer term and funding should reflect this to enable them to have a positive impact
• Measuring the impact and effectiveness – Most measuring in NHS is clinical data, this doesn’t capture the broader benefits for example a walking group’s impact on mental and physical health, how do we know if this reduces visits to GP? 
• Use NHS data to target resources to the most vulnerable groups – for example under 5s, to really tackle prevention – Sure Start was a great holistic programme that focused on prevention (oral health, healthy eating and cooking for families) but funding was ended. Addressing these issues through targeted outreach focused on communities facing health inequalities.

What forms of prevention do you think the NHS should prioritise? Why have you chosen these?

• A focus on children will have the biggest impact on preventing ill health later in life Community based work with early years families focusing on childhood immunisation, oral health, healthy eating, exercise. 
• Work with newly arrived communities, older people and carers all who may have more involvement with health services and if prevention work can engage with them, could have a big impact on interactions with health services.
• Reducing health inequalities through prevention.
• Working with the community and voluntary sector to connect with communities alongside other social networks as a vehicle to do other things for example childhood immunisations awareness talk at coffee morning.  Working in this way makes the best use of limited resources. 
• Digital information and support through the NHS App – so people can make best use of tech such as NHS app.

Focus 3 – Moving more care from hospitals to communities

What difference – good or bad – would this make to you?

Thinking about care closer to your home or in your home and these examples:

Virtual wards, Community diagnostic centres and Ambulance triage

• Reliance and pressures on families and carers – Families and carers will take on the responsibility when shifting more care into the community.  Caring at home can have better outcomes for patients but it places significant burden on families that impacts work, personal life and wellbeing.  Need for carers respite, support for families and carers to prevent burnout as caring for people in the community requires resources, much of which isn’t currently provided by the NHS.
• Need for funding to support and follow up patients outside of hospitals – Challenge of properly funding the support patients need for care outside of hospitals.  If not funded adequately there can be unintended consequences such as strain on families and carers and strain on community services if provision isn’t available.  Example given of 12-week wait for rehab community physiotherapy after a patient was discharged from hospital due to demand for the service.  Understand that moving more care out of hospital could save money, there is concern about whether there is enough funding to ensure community services can meet increased needs and be sustainable.
• Better communication and coordination between hospital, community and patients and their families – Needs to be improvement in communication between families, carers and healthcare services and for healthcare services to signpost to services like social prescribers.  Involving families and carers more in discharge planning is critical, as is making sure local community services for example district nurses and essential adaptations for homes, are available and accessible in a reasonable timeframe.  Disconnect between hospitals and community services – transition to home and community services can be difficult because of this.  If more care is transferred to the community, there needs to be greater integration of services in hospitals and community services.
• Patient experience centred and personalised care – Importance of a consistent relationship with staff in primary care and community services so a patients social and other needs can be considered not just the medical, which would be the approach if in hospital. The experiences of patients is the most important consideration not just making things easier for hospitals.
• Technology to improve coordination from hospital to community – Potential for tech to improve healthcare coordination and make processes more efficient in the transition from hospital to community services care. 
• People trust hospitals more than GP and community services – Feeling that people trust hospitals more than GP and community services – broader theme of patient confidence in the overall healthcare system, which may need addressing if more care is shifted out of hospital.