Introduction

Understanding the needs of the population and the performance of the services they use is useful but it is only part of the picture; a vital part of any needs assessment and commissioning process is hearing the voice of the people who live in the area. What people say about their needs and the services they use gives important information on how to improve the services being commissioned in a way that responds to the needs of the population. This is a two-way process – not only do commissioners need to listen to what people are saying but they also need to let people know about local needs and the services they are commissioning on their behalf.

This section looks at the main ways in which local health services and councils hear the voice of local people. It describes the key engagement activities that have taken place in the recent past and where possible we have included what is happening in response. It includes activity carried out by the London Boroughs of Sutton and Merton in relation to social care services for children, young people and adults. It also covers the ways in which local health services have involved patients and the public, the recent insight work by the Merton Public Health Team, and the Joint Strategic Needs Assessment (JSNA) community consultation event held in September 2013.

Why do we need to involve service users and communities?

National evidence suggests that good engagement can:

  • lead to improved clinical and economic outcomes in health care
  • improve experience of and satisfaction with health and social care services
  • make services more responsive to individual needs
  • help develop services that support people’s dignity and independence
  • challenge established methods and ideas and encourage innovation and creativity
  • encourage a better understanding of decision making, prioritisation and use of resources in health and social care services
  • enable individuals to manage their health and social care more effectively, particularly in relation to long-term conditions.

Engagement and involvement strategies

Community engagement is the action taken to consult, involve, listen and respond to communities through on-going relationships and dialogue. Communities participate to develop solutions, and to shape and design policies and services. Engagement enables citizens and organisations to influence decisions as well as make decisions themselves. Engagement activities include the provision of information, consultations, surveys, interviews and focus groups. These activities can be conducted face to face, via telephone, by the provision of hardcopy written information or online.

Duty to Involve in Consultation Report

Health commissioners have a legal duty to consult patients and the public before making commissioning decisions that affect how health services are planned and provided. In 2010, a new legal duty came into force requiring primary care trusts (PCTs) to produce an annual report on consultation. NHS Sutton and Merton’s first Annual Report on the Duty to Involve in Consultation 2009-2010 includes full details on consultations carried out during the year, including commissioning decisions made, what consultation took place prior to the decision being made, what views were expressed, and how they were taken into account. A similar report is planned by Merton Clinical Commissioning Group (CCG).

Annual Residents Survey for Merton

In Merton the 2012 Annual Residents Survey is the last published survey. Although the 2013 survey has been recently completed the results will not be published until early 2014, at which point the JSNA will be updated with these results.

In the 2012 Merton Annual Residents Survey, 65% of adults said they thought local health services were good (8% thought they were poor); 76% of young people thought health services were good (3% thought they were poor).

Regarding social services the proportion of residents who thought adult social services are good was 20% (5% thought they were poor); 23% thought social services for children and families were good (4% thought they were poor); 40% of young people thought that social services were good (5% thought they were poor). The proportion who rated services as good or excellent was higher amongst service users than among all respondents to the survey.

The 2012 Merton Annual Residents Survey also contained some extra questions on health and wellbeing.

  • Respondents’ views of their overall health and wellbeing was generally positive, with few reporting they felt dissatisfied, unhappy, anxious or worthless. Anxiety was the main concern with 9% reporting that they felt very anxious yesterday.
  • Satisfaction with family relationships and social life was seen as most important to respondents, and 31% felt this could be improved. Satisfaction with health and mental health and feeling safe in your local area were also seen as important to respondents.
  • Feeling safe in your local area, satisfaction with health and mental health, and satisfaction with household income and getting by financially were seen by respondents as the main areas that could be improved.

Voice of children and young people

Listening and responding to the views of users is central to Merton Children’s Trust’s design and delivery of services. Merton’s User Voice Strategy represents one of the eight core values of the Children and Young People’s Plan, which highlights the importance we give to listening and responding to our children, young people and service users.  “We listen, respond to and value our children and young people. Children and young people have rights to participate in decisions affecting their lives and participation provides opportunities for them to develop important life skills. Services should not only listen but should help children and young people shape services they receive. We should also canvas and respond to the views of parents and carers”.

Our User Voice Strategy provides a framework by which we capture and monitor feedback to influence service design, delivery and continuous improvement. We have made five commitment to user feedback.

Commitment One - Gathering feedback through a variety of models. Continue to embrace a variety of models of feedback and participation, recognising that one style may not fit all. Key ways in which we approach listening to the views of children and young people, and families:

  • An ongoing ‘practice approach’ expected of all practitioners and managers to put children’s wishes and feelings at the centre of decision making and planning.
  • Continuing to deliver Merton’s youth participation promise.
  • Bespoke targeted user feedback sought from vulnerable groups.
  • Ongoing management oversight to learn from complaints and compliments.

Commitment Two - Providing opportunities for children and young people to influence key decision makers. Continued to develop participation methods for children and young people’s views to be heard in key governance structures, including influencing the work programme of the Merton’s Children’s Trust, Local Safeguarding Children Board and Member Scrutiny Panels. Merton’s Annual Young Resident (2014) demonstrates that we are doing this well as 47% of young people feel involved in decision making, significantly better than the London average of 31%.

Commitment Three - Understand what our feedback is telling us to continuously improve services. We have a long history of reviewing feedback at a local level to influence operational delivery. We review what the feedback is telling us at a strategic level quarterly and share this analysis across the wider Children's Trust to inform service improvement.

Commitment Four - Publish and share our feedback findings across the children’s workforce. Where appropriate, we publish our feedback findings in Young Merton Together the Children's Trust professionals e-magazine, this is published five times a year receiving 52,000 hits by 1000 readers over the year. We share user voice findings with staff and partners at Staff Forums, Merton’s Children's Trust, Merton Safeguarding Children Board and Corporate Parenting meetings.  

Commitment Five - Demonstrate to those who participate in user voice activity the impact of their involvement. We have, where possible, fed back to participants who shared their view. Merton’s Annual Young Residents’ Survey (2014) demonstrates that we are doing this well and that young people feel their input is valued with 57% reporting that they feel listened to ‘a great deal or to some extent’; better than the London average of 47%.

The Children, Schools and Families Department deliver these commitments through an annual programme of activity embedded within our service planning process.

During 2014/15 we are particularly proud of the following:

 

Merton JSNA community consultation event, September 2013

A community consultation was organised jointly by Healthwatch Merton and the Merton Public Health Team in September 2013 at Vestry Hall for residents of Merton. This was a culminating community consultation event where all the insight collected over the past year as well as the present JSNA findings on health areas, services, gaps and recommendations were summarised and final feedback was sought. 38 residents in Merton attended the event.

Key commissioning implications based on what people are telling us

Commissioners have a legal duty to seek the views of service users and patients when commissioning services. This includes looking at users’ experience of existing services, and seeking views about planned changes to services before they are made.

A better understanding of patient or service user experience can help drive improvement by showing where efforts need to be targeted. Commissioners can draw on a wide range of data sources, including national and local, and qualitative and quantitative, to support this process.

Commissioners also need to consider what the appropriate involvement approach for different projects is. For a major service change, a formal public consultation will be required. When seeking to improve health outcomes and access to services for specific groups, engagement may include social marketing insight work to help understand the beliefs and attitudes that influence health behaviours and use of services.

It is important that commissioners are proactive in seeking views from marginalised groups who often experience poorer health outcomes, often referred to as ‘seldom-heard voices’.

How do we hear the views of patients and communities?

Healthwatch Merton

The Health and Social Care Act 2012 replaced the previous public and patient engagement mechanism, Local Involvement Networks (LINks), with a new body called Healthwatch. The Act required local authorities with adult social care responsibilities to commission a local Healthwatch from 1 April 2013. The new Healthwatch Merton is run by Merton Voluntary Service Council (MVSC). Healthwatch Merton joins a network of Healthwatch organisations across England.

The role of Healthwatch Merton

Healthwatch Merton will ensure the views of patients and carers are heard, giving them the opportunity to share their concerns and opinions about their local health and social care services. Healthwatch Merton will be responsible for:

  • providing information and advice to the public about accessing health and social care services and choice in relation to aspects of those services
  • making the views and experiences of people known to Healthwatch England helping it to carry out its role as national champion
  • making recommendations to Healthwatch England to advise the Care Quality Commission to carry out special reviews or investigations into areas of concern
  • promoting and supporting the involvement of people in the monitoring, commissioning and provision of local care services
  • obtaining the views of people about their needs for and experience of local care services and making those views known to those involved in the commissioning, provision and scrutiny of care services
  • producing reports and making recommendations about how those services could or should be improved
  • representing the voice of local communities at the Health and Wellbeing Board.

Community Engagement Networks

INVOLVE is Merton's Community Engagement Network. It is a network of the community and voluntary sector and aims to make sure that the needs and preferences of service users, carers and the wider community are identified and kept central to the planning and delivery of future services in Merton.

Community Forums and Area Committees

Community Forums help people make sure that the borough and other agencies know about their concerns and aspirations for their community. Each Forum meeting is attended by a borough representative whose role is to follow up on issues raised and ensure that they are resolved.

 

As well as the area-based groups described above there are a wide range of other forums, networks, groups and partnerships that enable different sections of the population to express their views on local services and issues. Some examples include youth parliaments, BAME networks, learning and physical disability partnerships, faith-based forums, patient groups, and carer’s forums and partnerships.

 

Patient Advice and Liaison Service (PALS) and complaints

PALS provide a point of contact in the Merton CCG to resolve concerns or any difficulties experienced with health services. PALS will discuss the options available to any member of public if that person has concerns about the services commissioned by Merton CCG. PALS will support that person to resolve those concerns and respect their right to confidentiality at all times.

National surveys

There are several surveys carried out on a national basis. The key results of these surveys and actions arising from them can be found in the national surveys.

Ad hoc consultation events

These are organised by the Council or Merton CCG for various focused areas of work. Public Health Merton has done a number of insight projects, and recently did some qualitative work for an on-going adult mental health review and a school nursing review. A JSNA community consultation event was jointly organised by Healthwatch Merton and Public Health Merton and is reported below.

What our communities are saying

Individual theme areas in the JSNA have a Merton Voice section where relevant, and these sections describe in more depth the engagement work done around those key areas.

Engagement to reduce health inequalities

Vulnerable and marginalised groups are most likely to experience health inequalities, so there is a particular need to identify gaps in patient experience evidence relating to those not using services or whose voices are seldom heard. These groups include:  

  • vulnerable older people
  • BAME groups
  • recently arrived groups (refugees and asylum-seekers or migrants)
  • homeless people
  • drug and alcohol users
  • people with disabilities
  • carers
  • people in routine and manual employment
  • unemployed people.

Annual Residents Survey for Merton

Each year many local authorities across the country carry out a residents’ survey. The methods used to carry out the survey and the individual questions asked may differ between areas but in general the results of the surveys are used for measuring the organisation’s performance across a broad range of service areas and to help decide what can be done to improve services.

In Merton the 2012 Annual Residents Survey is the last published survey. Although the 2013 survey has been recently completed the results will not be published until early 2014, at which point the JSNA will be updated with these results. The survey is conducted by an independent organisation and involved 1,092 face-to-face questionnaire-based interviews with adults, children and young people. It was part of a London consortium which enables comparisons with other participating London boroughs.

In the 2012 Merton Annual Residents Survey 65% of adults said they thought local health services were good (8% thought they were poor); 76% of young people thought health services were good (3% thought they were poor). Regarding social services the proportion of residents who thought adult social services were good was 20% (5% thought they were poor); 23% thought social services for children and families were good (4% thought they were poor); 40% of young people thought that social services were good (5% thought they were poor). The proportion who rated services as good or excellent was higher amongst service users than among all respondents to the survey.

The 2012 Merton Annual Residents Survey also contained some extra questions on health and wellbeing.

  • Respondents’ views of their overall health and wellbeing were generally positive, with few reporting they felt dissatisfied, unhappy, anxious or worthless. Anxiety was the main concern with 9% reporting that they felt very anxious yesterday.
  • Satisfaction with family relationships and social life was seen as most important to respondents, and 31% felt this could be improved. Satisfaction with health and mental health and feeling safe in your local area were also seen as important to respondents.
  • Feeling safe in your local area, satisfaction with health and mental health, and satisfaction with household income and getting by financially were seen by respondents as the main areas that could be improved.

Young Residents Survey

Young Residents Survey 2014-15

The Council commissions an Resident and Young People Survey which contributes to the Children’s Schools and Families departmental User Voice Strategy and as such our understanding of our resident and customer needs.

Last carried out during September and October 2014 Merton residents were interviewed, face to face by independent researchers, about their personal concerns, attitudes to the council and council services. A London-wide survey is carried out at the same time which enables Merton to compare its results with trend and London benchmarking data.

The key findings from 2014/15 are as follows:

  • Merton council continues to be viewed positively by young residents. There are no notable changes between 2013 and 2014 or between the London average except in relation to views about children’s social services for children and families which for Merton is 4 percentage points better than last year and notably 11 percentage points better than the London average.
  • Seventy seven per cent of young people feel they get the services they need (a slight increase from 2013), and 84% feel that the council does enough to protect young people (a significant increase from 2013). In relation to Merton as a place 89% of young people agreed that Merton is a good place for young people to live, 4% more than 2013/14.
  • Young people’s personal concerns are similar to those of adults; litter and cleanliness of the streets remain a primary concern. Concern about crime has fallen but remains the second highest concern for young people in Merton. Bullying and bad behaviour also remain key concerns, however, overall young people are fairly positive about their health and wellbeing, with 92% reporting  that they are ‘fairly’ satisfied with life.

 

2013 Merton Residents Survey

While the results of the 2013 Merton Residents Survey cannot be reported at the moment, three new questions were added for health and wellbeing:

 

1. From April 2013, Merton Council has a new responsibility for improving the health of local residents. Were you aware of this new responsibility?

Answer options: Yes/No/Don’t know

2. a) Which three of the following factors do you think are the most important to your own sense of health and wellbeing?

2. b) and, which three of the following factors do you think could be most improved to increase your own sense of health and wellbeing?

  • Satisfaction with family relationships and your social life
  • Satisfaction with your health and mental health
  • Satisfaction with your school/job
  • Satisfaction with your housing
  • Satisfaction with access to green spaces in your local area
  • Feeling safe in your local area
  • A sense of belonging in your local community
  • Satisfaction with your household income and getting by financially
  • Satisfaction with your qualifications and/or level of training

 

3. How concerned are you about the number of the following in your local area:

  • Fast-food outlets
  • Betting outlets
  • Payday loans outlets
  • Alcohol outlets

 

Answer options: Very concerned/Fairly concerned/Neither concerned nor unconcerned/Not very concerned/Not at all concerned

 

National GP Patient Survey 2012-13

Primary care is the main gateway to other NHS and social care services. Improving the patient experience by enabling access to services, and providing services more conveniently to patients, together with high-quality care, is important in achieving more effective care, greater patient satisfaction, and value for money.  

 

The purpose of this survey is to determine, from the patient’s perspective, the ease of access to primary care services. People can respond to the questionnaire by email, telephone or post. Due to recent changes in the structure of the NHS, the survey is now being produced at CCG level. The latest survey results are from July 2012 to March 2013.

 

National Patient Choice Survey 2010

Around half of respondents in Merton said that they were aware that they had a choice of hospitals to attend for their first appointment and were offered a choice. 62% said that they were able to go to the hospital they wanted. These results were in line with national results.

 

National Inpatient Survey 2012 (Care Quality Commission)

The quality of patient experience is increasingly recognised as a key element of the overall quality of acute healthcare. Each year, people who have been admitted to hospital and had at least one overnight stay are asked what they thought about different aspects of the care and treatment they received. The results from each trust take into account the age and sex of respondents, and whether their admission to hospital was planned or an emergency. The survey gives the scores for the key areas of experience, indicating how the main acute trusts serving the population of Merton compare with other trusts nationwide.

 

National Outpatient Survey 2011 (Care Quality Commission)

Each year, patients are asked about their most recent visit to an outpatient department. The survey includes questions on waiting for the appointment, hospital facilities, seeing a doctor, and any tests and treatment undertaken during the appointment, as well as any medications prescribed.

 

Insight work by Public Health Merton

Insight work was commissioned by the erstwhile Sutton and Merton Primary Care Trust which was completed and reported in 2013 on the following:

  • Sutton and Merton Drink Debate, Over 65s Campaign Evaluation, April 2013
  • Healthy eating in the London Boroughs of Merton and Sutton: Understanding the values and barriers to healthy eating amongst families with children aged one to five years, May 2013
  • Social Marketing Projects Summary Report: Public health insight and recommendations for Sutton and Merton, July 2013
  • Inform, encourage, support – accessing physical health services for those with severe mental illness (SMI) in Sutton and Merton, November 2013.

Additionally there were other recent reports:

  • NHS South West London Childhood Immunisations and Vaccinations, June 2013
  • NHS South West London Physical Activity Project, May 2013
  • NHS South West London Sexual Health and Social Media Project Overview Report May 2013.

All of these are reported in the related themes in the JSNA.

Merton JSNA Community Consultation Event, September 2013

A community consultation was organised jointly by Healthwatch Merton and the Merton Public Health Team in September 2013 at Vestry Hall for residents of Merton. This was a culminating community consultation event where all the insight collected over the past year as well as the present JSNA findings on health areas, services, gaps and recommendations were summarised and final feedback was sought. There were 38 Merton residents who attended the event.

Five themed workshops were held on the lines of the themes in this edition of the JSNA:

1. Children, young people and maternal health

  • Health related issues (e.g. causes of morbidity and mortality, immunisation)
  • Social care

2. Adults

  • Conditions affecting the 18-65 year old age group (e.g. long-term conditions, mental health, dementia, end of life care) including cancer, heart disease, respiratory diseases (e.g. COPD)
  • Social care

3. Older adults (65+)

  • Conditions affecting the 65 and over age group (e.g. long-term conditions, mental health, dementia, fractures and EOLC)
  • Social care

4. Sexual health and infectious diseases

  • Lifestyle risk factors
  • Teenage pregnancy

5. Prevention –lifestyle and policy influences (built environment, licensing, planning)

  • Lifestyle risk factors (e.g. smoking, physical activity, diet, alcohol, drugs)
  • Overview of social determinants of health and how they affect the Merton population
  • Overview of correlation between specific health conditions and wider determinants (e.g. deprivation)
  • Education
  • Work/employment
  • Built environment and regeneration
  • Transport
  • Crime

In each workshop the following three questions were explored and three key messages recorded:

  • What did the presentation (on the key findings of the JSNA) bring up for you?
  • What is missing?
  • Where do you think we should focus?

Feedback from workshops

Children and young people and maternal health theme

 

'The arts and creativity amongst younger people should be encouraged, giving them an interest...something to carry on into adulthood.' - Merton resident

Key issues:

Workshop participants identified the following issues:

  • Health issues are complex mental health impacts across a range of issues, but is not always seen as a priority to tackle.
  • No health without mental health there is a lack of priority for improving children and young people’s mental health from an early age.
  • Fears expressed over the future of the Child and Adolescent Mental Health Services (CAMHS).
  • Concerns that there is a slow bureaucratic process for dealing with issues.
  • Accessibility of services need to be improved.
  • There is inequality across the borough in terms of reach of services; some schools, for example, have good access to healthy school related initiatives, others do not.
  • Services need to be encouraged to make better use of the grants available through the East Merton Community Health and Wellbeing Fund from MVSC, for resourcing activities and programmes.
  • Professionals are too quick to label young people with problems.

 

Gaps:

Concerns expressed at the workshop included:

  • Eastern European communities are not accessing local services due to language barriers, and the need for support for young mothers was identified.
  • Poor communication with different BME communities across the borough.
  • There is an over-reliance on volunteers for offering help to services.
  • Sustainability of projects, which are hampered by lack of funding.
  • Need for more outreach with communities.
  • Lack of appropriate support for families especially around domestic violence and alcohol.
  • Parenting classes – gap in primary school years.

 

Priorities:

  • Focus on children’s mental health to prevent difficulties in later life – for children aged 0-3 to build parent/infant relationship and increase prevention and early intervention services.
  • Provide prenatal support for families/family support for first 12 weeks of pregnancy.
  • Focus on the early years and improve access to children’s centres.
  • Sustain targeted services.
  • Ensure the right support for BME communities so that they can make the best use of services (language skills and support).
  • The MMR vaccine has low uptake – it is no longer seen as important, so raise the profile of vaccinations.
  • Raise awareness of the vast array of services through community days and increase involvement in local leisure services.
  • Support schools to deliver better services and promote health.
  • Develop a pastoral care unit in schools.
  • Cyber bullying goes undetected and has an emotional impact this needs to be challenged.
  • Offer workshops to tackle bullying and raise low self-esteem.
  • Train teachers to offer more support in schools, including group support, and to recognise the signs of mental health problems.
  • Offer meditation in schools (follow the Japan model).
  • Foster the school/college transition as this is a main critical period to get information/education/job and activities training to young people.

Adults theme

Key issues:

  • Sharing of quality, reliable information (better network of referrals back and forth, and communication between clinicians and patient).
  • Education of patients with long-term conditions (lack of education and support, and of information in GP surgeries).
  • Increasing and improving our sense of personal responsibility (help to support self- management)
  • Investment in the east of the borough where the need is greater.

Long-term medical conditions – there is a serious lack of education and support groups for people living with a long-term condition. Having more support groups could help with the self-management of care and have better outcomes. GP surgeries do not hold enough information leaflets on long-term conditions. Education and advice on long-term conditions could help with self-management of these conditions.  

 

'...it is important that each of the 26 practices in Merton has a patient participation group. It would be good if good practice could be shared...we should have all 26 practices having an active group with GP involvement. Democratising the NHS is a necessity.' - Merton resident

Lack of patient involvement groups are becoming an issue there are no established groups. Patient participation groups are crucial in order to address the lack of communication between GPs and patients.

Referrals referrals back and forth between services are very stressful and time consuming. Referral rates for long-§term conditions take too long (overlapping into other services, as mentioned above). 

Inequalities and unemployment in the borough and mental health issues – why have we got more services for some issues than others that could affect long-term conditions? More services are needed in the deprived areas. Investment in services is needed.

 

'Investment in the East of the borough!' - Merton resident

Take the service to the community – could NHS Health Checks be carried out in a community setting as well as GP settings?. This is particularly important for patients with dementia who find it difficult accessing GP surgeries. A recent example of taking a service to a community setting was LiveWell attending the Mitcham Festival, which proved very popular. Have services in the community as well as in clinic settings.

 

'Social exclusion has an impact on accessing services for people with a whole range of mental, physical and learning disabilities.' - Merton resident

Older adults theme

Key issues:

  • Community development (one-to-one scheme, getting people together, choir, barrier to access transport, education for carers).
  • Importance of addressing social isolation – lack of human contact (cuts increased due to increased use of technology – technology can increase social isolation).  
  • Signposting/information support (feel like prisoners in their own home, importance of GP engagement about social matters).

Things that could help:

  • Age Concern (now Age UK) had a visiting scheme which worked well to enable people to visit others who are more isolated and less able to get out.
  • Get people to do something together like sharing experiences of putting lunch together to share a meal. There are a lack of development workers and funding to do these things.
  • Intergenerational scheme – like mentors in schools to help with reading schemes etc.
'Loneliness...we need to reach out to the people who never get to talk to anyone.' - Merton resident

 

Other concerns:

  • Worries about crime, social isolation, rising food prices, cuts to services, accessibility to activities due to cost.
  • Lack of keep fit services, access to health information, volunteers, volunteering services and befriending services, continuity of care, advice and information specific to older people.
  • GPs – difficulty in getting an appointment at a suitable time, language not understandable when GP uses jargon, GPs need to take more responsibility for social care related matters and get involved beyond treatment.

More focus on:

  • Volunteer services
  • Communication about core services
  • Identification of socially isolated population
  • Signposting/information
  • Dedicated space in My Merton magazine about health
  • Targeted page/information for older people in My Merton magazine
  • Targeted information through GPs
  • More clubs plus activities.

Sexual health and infectious diseases

Key issues:

  • Need more adult education around sexual health – information, services and how to access.
  • Need to focus on deprived areas and vulnerable groups, but not all resources should be focused on the east of the borough.
  • Female genital mutilation (FGM) and under-age sex – need for prosecutions.
  • Need to increase MMR and TB immunisations.

 

'No JSNA is complete unless it has tackled access issues.' - Merton resident

 

Sexual health related feedback:

  • Age of consent – vulnerable people.
  • HIV prevalence in women is a worrying statistic.
  • Targeting communities and social stigma of HIV.
  • Mother-to-child HIV transmission is a particular issue for Merton.
  • Need to focus on why people are presenting late to antenatal services.
  • Lots of advice for children and young people but not for adults.
  • HIV testing should be offered during registration checks at GP practices.
  • Pubs and social clubs should do more – posters etc. Good slogans in the right places – fast food outlets/pub toilets/libraries/buses/trams. Tell it how it is but with balance.  
  • Many young people think HIV/AIDS is curable.
  • Grassroots organisations need to be used more frequently.
  • Use social media. Peer to peer for young people.
  • Young health champions – give them a remit around sexual health.
  • Many scared of taking an HIV test. Scared of the result and the consequences. Still many myths surrounding what happens and the implications of being positive e.g. insurance, GP confidentiality, ruins your life.
  • Cultural issue – getting the message across especially to BME males.
  • Schools – provision patchy as not statutory. State schools/academies/independent schools have different rules and obligations.
  • Religious and cultural issues in schools and homes.
  • Focus on relationships not just sexual health. Wrong image of sex from media and then parents don’t talk about it so there are lots of myths.
  • Need more detailed statistics to get to where problems are but data protection prevents us getting data in some areas which would give us a better idea of the gaps/issues.
  • East more deprived but need to ensure we don’t forget the west. Two-tier approach needed.
  • FGM should be on the agenda. Cultural issue particularly in the Somali population.
  • Forced marriages – more of an issue now the population is becoming more diverse – like FGM.
  • Engage faith groups to try to get messages across.
  • Impact of mass media on young people’s perception of sex and what is expected of them.
  • Early sexualisation. Being able to recognise inappropriate behaviour.
  • Facilitation for disabled individuals to have sex – more focus and information.
  • Increasing appropriate sex and relationship education (SRE) for people with SEN.
  • Focus on those who speak different languages and with cultural differences.

 

'Sexual health in adults - how to get the message out about HIV etc.' - Merton resident

 

Prevention – lifestyle and policy influences

Key issues:

  • Cheaper food at supermarkets.
  • Junk food too easily available on the high street.
  • Health education to get the message across about prevention.
  • Lack of information dissemination.
  • Build up community spirit.
  • Encourage people to walk.
  • Improve public transport and exercise facilities.

What strikes you about these issues?

  • Obesity – not just seen in those who are poor but in those with better disposable incomes and who have access to knowledge/information.
  • Shift in emotional issues – reasons why not altering behaviour.
  • Psychological wellbeing – key in all areas.
  • Closure of services e.g. Fanon Resource Centre, Merton MIND – people face issues of having nowhere to go and not being signposted where to go.
  • Preventing isolation is key.
  • Prevention of illness is important.
  • Mental health – still has a stigma attached – need to try and remove the stigma to aid prevention.

Access to services – know where to go?

  • More outreach work needed.
  • Concessionary rates at local authority leisure centres – not that different from ‘normal’ membership prices (plus need to be promoted more).
  • Provision of health options in food places is limited.
  • A great deal is down to education, but parental input is just as important.

Promotion

  • Promoting neighbourhood watch scheme.
  • ‘Walking buses’ – encourage people to walk together.

Recommendations

  • Take into consideration the ‘softer’ outcomes – not just numbers but also social inclusions.
  • Opportunities for socialising.
  • Use of technology more innovatively.
  • Provision of groups for peer support.
  • Subsidised rates at gyms, sessions etc.
  • Using council policies, planning etc. to look at where lever change in takeaway, alcohol, food outlets etc.
  • Increase the Council’s objections to licensing applications.
  • Payday loan shops – too many. Look at reducing number.
  • Increase access to advice around debt and money issues.
  • Education – is enough being done?
  • Get more signposting and information out there e.g. information on walking routes, calories burnt, time to next bus stop.
  • Utilise some of the money for prevention of illnesses, diseases, in improving housing provision e.g. insulation.
  • Link in advice and information with housing – illness and housing often go together. Improving housing conditions will have knock-on effect on health.

Transport

  • With so many clinics and services closing, people are having to travel further.
  • Access to healthcare appointments – involve the help of GPs.
  • Alternative means to car transport – different alternatives not promoted enough

Crime and employment

  • Expand age criteria for apprenticeships.
  • Working good for health – keep in work.
  • Increase volunteering.  
  • Encourage mentoring.
  • Work with employers – incentives.
  • Social cohesion – increase this.  

Key commissioning implications based on what people are telling us

Commissioners have a legal duty to seek the views of service users and patients when commissioning services. This includes looking at users’ experience of existing services, and seeking views about planned changes to services before they are made.

A better understanding of patient or service user experience can help drive improvement by showing where efforts need to be targeted. Commissioners can draw on a wide range of data sources, including national and local, and qualitative and quantitative, to support this process.

Commissioners also need to consider what the appropriate involvement approach for different projects is. For a major service change, a formal public consultation will be required. When seeking to improve health outcomes and access to services for specific groups, engagement may include social marketing insight work to help understand the beliefs and attitudes that influence health behaviours and use of services.

It is important that commissioners are proactive in seeking views from marginalised groups who often experience poorer health outcomes, often referred to as ‘seldom-heard voices’.