A new public survey has been launched to find out more about local people’s experiences of using the NHS 111 service in the region. 111 is the NHS non-emergency number. When you call 111 you speak to a highly trained telephone adviser, supported by healthcare professionals (nurses or paramedics). They ask you a series of questions to assess your symptoms which allows them to direct you to the best medical care for your needs. NHS 111 is available 24 hours a day, 365 days a year, with calls free from landlines and mobile phones. NHS 111 is also available as an online service:  111.nhs.uk . Devon Doctors is the lead provider for urgent care in the region, offering 24/7 access to urgent care services including NHS 111 and Out-of-hours services in the South West. We are the local consumer champion for health and social care services, and will once again be independently collating public feedback from anyone who has recently used the NHS 111 service in the Somerset, Devon, Plymouth and Torbay areas. In Winter 2020/21 local Healthwatch in Somerset, Devon, Plymouth and Torbay conducted a similar public survey and published a  report  which showed that the accuracy and quality of the service people received was not consistent, despite many people rating their experience highly. At the time, Devon Doctors supported recommendations made in the report, and said it would help shape an improvement plan to address public concerns. Local Healthwatch have joined forces again to launch a follow up survey to see if improvements have been made, and to ensure that the people using the NHS 111 service have their say on the way it is delivered to them. All responses will be anonymous, and the information provided will be used to inform a new joint Healthwatch report which will be shared with NHS 111 and the health and social care regulator, the Care Quality Commission (CQC). The Healthwatch online survey runs from 13 September to 24 October 2021. It only takes a few minutes to complete. [Survey closed] Members of the public can also speak to their local Healthwatch directly to share their experience of NHS 111 or receive support completing the survey. For Healthwatch Somerset call Freephone 0800 999 1286, or for Healthwatch Devon, Plymouth and Torbay call Freephone 0800 520 0640. Judith Goodchild, Chair of the Healthwatch Somerset Board, said: “Understanding people’s experiences of using vital health and care services such as NHS 111, allows us to highlight where there are areas for improvement as well as areas of strength. By sharing this insight with those responsible for commissioning and delivering services, we can drive positive change and improve standards of care. Your feedback really will make a difference to the quality of the local NHS 111 service and to people’s lives, so do please share your views with us by completing our survey or contacting your local Healthwatch.” A spokesperson for the Care Quality Commission (CQC) commented: “Local Healthwatch in Somerset, Devon, Plymouth, and Torbay are working in partnership with CQC to invite members of the public to tell us what they think of the services provided by Devon Doctors. Their views and experiences will help CQC inspectors decide what to look at when they inspect the services provided by in the future. People are being encouraged to tell the team about their experiences of services provided by Devon Doctors in the past year and to say where they would like to see improvements made in the future.”

People who use NHS 111 in Devon and Somerset have reported ongoing concerns about the quality of the service, with the most common complaints being about long waiting times and difficulty getting through on the phone. This is a follow up to the original report published January 2021. Recommendations Recommendations that require NHS England action Reducing waiting times for arranged call-backs and inbound calls. Improvements to the call-handling procedures and staff training surrounding these processes. Review the pre-recorded messages and frontline options for patients before they are connected to a call operator. Recommendations that may be actionable locally Ensure that training is consistent for all staff so that delivery of the assessment and conclusions are of the same standard for all patients. Improve procedures surrounding calls relating to patients with mental health problems to ensure they are handled with empathy and diverted to the correct support. Consider the viability/benefits of a call-logging system that provides a point of reference, so that if patients need to call back, a record of their previous call is easy for the call operator to access and review. Read our report If you need this report in a different format, please email  info@healthwatchsomerset.co.uk  or call 0800 999 1286.

Healthwatch Somerset Annual Report 2021-22: A review of our work over the past year and its impact, plus our work planned for 2022-23. Message from our Chair About us Highlights from our year Listening to your experiences Advice and information Volunteers Finances and future priorities Statutory statements Read our report If you need this report in a different format, please email  info@healthwatchsomerset.co.uk  or call 0800 999 1286.

By Gillian Keniston-Goble, Healthwatch Somerset Manager Healthwatch Somerset staff and volunteers took to the road during May, visiting community locations to talk to people in 12 of the 13 Primary Care Network areas across the county. The aim of our roadshow was to tell people about Healthwatch Somerset and the service we offer, and we were also carrying out a survey to find out about people’s experiences of using GP websites to access information. We were joined on the roadshow by staff from the Somerset’s NHS Clinical Commissioning Group, who were asking the public about communications around the new Community Pharmacy Service in Somerset. We launched the roadshow in Taunton on Monday 9 May, with a visit from the Mayor of Taunton, Cllr Sue Lees.  She kindly came along to meet staff and talk to the Chair of our Board Judith Goodchild. We wanted to reach out and speak to as many people as possible over the two weeks of the roadshow.  We visited a variety of venues, including community hospitals, medical centres, supermarkets, street markets, garden centres and town centres; in a variety of locations across the county including Minehead, Bridgwater, Burnham-on-Sea, Wellington, Shepton mallet, Cheddar, Chard, Yeovil, Wincanton, Street, Frome and Somerton. We were incredibly lucky with the weather, mainly dry, a couple of days of lovely sunny days, and a nice breeze on the coast. We met some wonderful people who shared their experiences with us, so thank you to you to everyone who took the time to come along and have a chat. We spoke to 363 people across Somerset and 242 people answered our survey about GP websites. We are currently analysing everyone’s feedback and will publish our report later in the summer.

Healthwatch England, is warning that six-week postnatal checks – required of GPs in England – are failing many new mothers. As part of their review of maternal mental health care, the patient champion has analysed experiences of pregnancy and post-natal care since April 2020, shared by 2,693 new mothers and birthing parents from across England. The analysis suggests that not all GP practices comply with the requirement to provide six to eight-week postnatal checks. And where those checks take place, it is not clear that GP practices are aware of NICE guidance which tells them in detail how to spot mental health problems and provide help. Healthwatch is now calling for improved consistency of postnatal six-week checks, monitoring of their delivery, and boosting support for GPs to provide quality mental health care for new mothers. Key findings The experiences of 2,693 new mothers and birthing parents were reviewed in a deep dive analysis of maternal mental health support in England. Over one in 10 women (16%) of new mothers and birthing parents who shared their experiences said they hadn’t received the six to eight-week postnatal check, which NHS England established in 2020 to make sure new mothers feel well and are recovering properly. Of those who received the six-week checks, only one in five (22%) said they were satisfied with the time their GP spent talking to them about mental health. Nearly half (44%) of all respondents felt that the GP did not spend enough time talking to them about their mental health, while a third, 30%, said that their GP didn’t mention this during the check. One in seven (15%) said they had had their six-week check over the phone, with many new parents finding it hard to verbalise their mental health struggles and discuss physical issues. In the worst cases, respondents felt the way their mental health issues were discussed was inappropriate and potentially harmful.   Whilst the survey participants were self-selected, their views are likely to reflect those of a significant group of recently pregnant people. In April 2020, the Government introduced the six to eight-week postnatal check after Healthwatch England shared the experiences of almost 1,800 women on mental health during their journey to parenthood. General practitioners in England have since been contractually obliged and paid to assess new mothers’ mental health and wellbeing, providing an opportunity for referral to specialist services and additional support. Crucially, the checks must take place separately from a postnatal check focused on the health of the baby. Healthwatch England undertook this research between October and December of 2022 to find out to what extent mental health support has improved during and after pregnancy. Their analysis also found the following:   Two-thirds (1,800) of the women and birthing parents who shared their experiences had struggled with their mental health during and after pregnancy. Nearly half of those (41%) received no support to help with their mental health during and post-pregnancy. Delays in accessing mental health support can have a devastating impact on new parents, with some reporting they had struggled to leave the house, bond with their child and maintain relationships. First-time mothers are particularly vulnerable to developing mental health problems and are less likely to access timely care. The findings come after the Care Quality Commission warned  of a “concerning decline” in women’s experiences with maternity services due to a shortage of frontline staff. Also, last year, a report by MBRRACE highlighted that in 2020, women were three times more likely to die by suicide during or up to six weeks after the end of pregnancy, compared to 2017-19.  This is equivalent to 1.5 women per 100,000 giving birth. Louise Ansari, National Director at Healthwatch England, said: "With mental ill health affecting up to a third of new and expectant mums, six-week postnatal checks are key to assessing their wellbeing after the birth. If left untreated, poor mental health can have a devastating impact on new parents and their families. "Unfortunately, our findings show that although most new mothers and birthing parents are likely to be invited to a postnatal consultation, these are frequently carried out as a tick-box exercise, where mental health is not treated as a priority or not assessed at all. "Monitoring the delivery of six-week checks should be the first step to ensuring there’s a consistent approach to offering quality mental health support to all new mothers. NHS England should consider what additional support and guidance it can provide to GPs so that the help new parents get is of the best quality. "We also need to ensure that maternal mental health and peri-natal services continue to remain on the government’s agenda and a priority in workforce planning and funding budgets." Healthwatch England have made five recommendations to help ensure every new mother and birthing parent receive the six-week check, and that it is of the highest quality: Integrated Care Systems should monitor the delivery of six- week postnatal consultations as part of their primary care commissioning responsibilities. NHS England should update the GP contract to make clear that mental health reviews at the six-week postnatal check should be part of an open-ended discussion. NHS England should update the GP contract to include mention of signposting to specialist and community mental health support services at the six-week week check. As part of its Maternity Transformation Programme, NHS England should consider what additional support and guidance it can provide for GPs to have quality conversations about mental health at the six-week postnatal check. Deliver the Long-Term Plan commitments on improving access to perinatal mental health services, including through more perinatal mental health outreach clinics around the country.

It's so important that you feel supported as a new parent. Read the article below to find out where you can go to get the help you need. Your mental health is important, both for your wellbeing and your child’s. It’s important that you feel supported throughout your journey of becoming a parent and have a safe space to talk about how you are feeling. Take a look at the information below to find out where you can go to get the support you and your family need.  Are mental health problems common during and after pregnancy? Yes, you are not alone in how you feel.  NICE guidelines  say that depression and anxiety are the most common mental health problems during pregnancy, with around 12% of women experiencing depression and 13% experiencing anxiety at some point; many women will experience both. Depression and anxiety also affect 15‑20% of women in the first year after childbirth. How will my mental health be affected during pregnancy? How your mental health is affected during pregnancy depends on many things. These include: The type of mental illness you have had already. Stopping medication for a mental health problem - you have a high risk of relapse if you do this when you become pregnant. This is more likely if you have had a severe illness, several episodes of illness or a recent episode. Recent stressful events in your life (such as a death in the family or a relationship ending). How you feel about your pregnancy - you may or may not be happy about being pregnant. Upsetting memories about difficulties in your own childhood. Where can I go for support? In our report -  Mental health and the journey to parenthood  - a third of women (33%) who had a diagnosed mental health condition said they were not given any advice about maternity and mental health at any point. If you live in the UK and are looking for extra support or advice urgently, whether it be on behalf of you or a loved one, there are a number of services you can approach.  If you're in a crisis and need urgent help: If you don't feel you can keep yourself safe right now, seek immediate help by visiting your nearest  Accident & Emergency (A&E) department  or call 999. If you need urgent support but don't want to go to A&E: call Samaritans on freephone 116 123 – they're always open and are there to listen contact your GP surgery and ask for an  emergency appointment contact  NHS 111 visit  Mind's website  for more information  Talk to your health professional During pregnancy, you can talk to your midwife, GP or health visitor at any time if you're worried about your mental health. They should ask if you have ever had problems with your mental health in the past, and whether you have been bothered by feeling down, hopeless or unable to enjoy things lately. Don't be afraid to tell your midwife or health visitor how you're feeling. This can help them to identify if you are unwell or might become unwell. Questions to ask about mental health problems in pregnancy and the year after birth Knowing the right questions to ask can be difficult, particularly when you are feeling worried or stressed. Take a look a these questions put together by NICE to help you discuss your condition or the treatments you have been offered. Find support local to you Netmums provide a search for local mental health support by area or postcode. Take a look at the mental health support available in your area using the link below. If you need further help in finding the right support get in touch .  Other services that can provide you with support Action on Postpartum Psychosis (APP) Postpartum psychosis is a rare but serious mental health illness that can affect a woman soon after she has a baby. Find out more about the symptoms  here .  APP offer a peer support service, connecting women and families to recovered volunteers, via: an online peer support forum; one to one email support; meeting a volunteer programme (Skype and in person); social groups and creative workshops. Guidance for women and their partners that have experienced Postpartum Psychosis can be found  here . www.app-network.org app@app-network.org Association of Postnatal Illness Postnatal depression is a type of depression that many parents experience after having a baby. It's a common problem, affecting more than 1 in every 10 women within a year of giving birth. It can also affect fathers and partners. Find out more about the symptoms  here . Get in touch for some friendly advice, or just to talk.  10am – 2pm – 0207 386 0868 info@apni.org apni.org Maternal OCD Maternal OCD  refers to new mums experiencing obsessions and compulsions. Whilst they may vary from patient to patient, a common underlying factor is high levels of responsibility for preventing harm or mistakes. Get in touch with Maternal OCD for more information and to enquire about their peer support.  www.maternalocd.org info@maternalocd.org PANDAS PANDASD help to support and advise any parent experiencing a perinatal mental illness. They can also advise and guide family members, carers, friends and employers as to how they can support someone who is suffering. www.pandasfoundation.org.uk/ 9am-8pm daily – 0843 2898 401 info@pandasfoundation.org.uk Tamba Twinline is Tamba’s listening service for parents of twins, triplets and more. All the calls are answered by volunteers who have multiples themselves. 10am - 1pm and 7pm - 10pm daily - 0800 138 0509 www.tamba.org.uk/support/twinline asktwinline@tamba.org.uk Tommy’s Tommy’s offers support to women who have suffered the loss of a baby as well as support for those who have had a difficult or traumatic pregnancy, birth or postnatal period. Monday to Friday 9am – 5pm - 0800 0147 800 midwife@tommys.org www.tommys.org/about-us Thank you to the Maternal Mental Health Alliance for working with us to put this list together. Take a look at their work  online .

Our Enter and View Team engaged with members of public at Musgrove Park Hospital. We spoke to people and recorded their comments about health and social care services, and we gave out dozens of leaflets, and ‘How Connected Are You?’ Surveys. Key findings Commentator said that they had suffered with mental ill health, and had recently been treated at Rydon. Despite being a condition that needs hospital input they informed us they had been discharged by West Somerset CMHT this year, and had to go back to the GP for a new referral to Somerset Partnership when they next become unwell with this condition. This takes time to process. The commentator felt they had been discharged as the care co-ordinator had left and had not been re-recruited, and that they had not been discharged based on assessment of clinical need but rather by internal vacancies. The commentator had heard that the service use an orange card system which acts as a fast track back to help with mental health from the Somerset Partnership, however they were not offered this. Commentator told us they had nothing but praise for the Beacon Centre and the staff who work there. Their partner had been efficiently diagnosed referred and treated. Commentator said that they are visiting their husband daily, as he is critically ill and the parking charges are over £80 per week. Commentator thought this was awful. Commentator told us that they had observed poor cleaning and handwashing from staff on Dunkery Ward when moving between patients. Commentator said the floors did not seen to be mopped for days. Commentator said his father had a stroke, but symptoms were not picked up by the GP, only later when he took him to A&E. Commentator said that his relative’s needs were not addressed and that they had not been treated with dignity and respect while currently being treated on Dunkery Ward. Staff had hurried him to eat and not taken advice from relatives about things that distress the patient. The commentator had raised concerns with ward staff and found their response hostile. The commentator was advised to talk to PALS and given information about SWAN Advocacy. This report was produced by the previous Healthwatch Somerset service provider, The Care Forum. Read our report If you need this report in a different format, please email info@healthwatchsomerset.co.uk or call 0800 999 1286.

Early Supported Discharge is a service that aims to help patients who have suffered a stroke to be discharged from hospital sooner and to carry out rehabilitation at home rather than in hospital. Four focus groups were held across the county: 21 April - South Petherton Community Hospital 26 April - Williton Community Hospital 3 May - Sydenham Community Centre, Bridgwater 11 May - Shepton Mallet Community Hospital We supported facilitation and gathered feedback to record anonymously. In total we heard from 19 patients and 20 carers. An overview of the information gathered is in the two appendices below. This report was produced by the previous Healthwatch Somerset service provider, The Care Forum. Read our report If you need this report in a different format, please email info@healthwatchsomerset.co.uk or call 0800 999 1286. Early support discharge - independent patient engagement Appendix 1 - all feedback comments Appendix 2 - survey responses

In this Annual Report we share our key challenges and successes, as we continued to engage with the public to understand people’s experiences of health and social care to make a difference. This report was produced by the previous Healthwatch Somerset service provider, The Care Forum. Read our report If you need this report in a different format, please email info@healthwatchsomerset.co.uk or call 0800 999 1286.

We gave a presentation on our patient and public engagement at this advice day hosted by Rethink to raise awareness of Healthwatch and our work. Key findings Concerns about poor discharge management from Western General Hospital. Commentator has early stages of dementia and lives on their own with no family or friends they can call on. They were discharged late at night from General western Hospital and struggled to cope with settling in back home. The Red Cross at Western general Hospital had been involved in a successful discharge experience by supporting the patient to settle in back home ensuring the patient bathroom was clean and that they even picked up some essential shopping. We heard about a poor experience at Musgrove Park Hospital, Gynaecology department; the patient felt ignored by the consultant and was given information about their results while still woozy from the anaesthetic, with no opportunity to discuss them later. We also heard from members of the public who asked questions about the different ways that people can give feedback about services. This report was produced by the previous Healthwatch Somerset service provider, The Care Forum. Read our report If you need this report in a different format, please email info@healthwatchsomerset.co.uk or call 0800 999 1286.

Our report following a visit to Pyrland Ward in Taunton. Wards one and two each have 14 beds, providing assessment and treatment for older people suffering from acute mental problems such as depression, anxiety and bi-polar disorder, along with dementia and other confused states, often with high levels of aggression. This visit forms part of a wider project running from November 2015 to July 2016. Our Enter and View Representatives visited each of the nine wards in Somerset that provide treatment for people with acute mental health issues. Recommendations Ward two be refurbished to make it more welcoming and attractive. Including the refurbishment and re-organisation of the activities room to make it more inviting, accessible and enjoyable. More tactile and memory stimulating objects are provided around the ward to help occupy, stimulate and engage patients. The good practice examples activities list (See appendix 6.3 and 6.3.1) are discussed with staff and at ‘have your say meetings’. That the ward contacts Reminiscence Learning for support and advice for therapeutic activities. This report was produced by the previous Healthwatch Somerset service provider, The Care Forum. Read our report If you need this report in a different format, please email info@healthwatchsomerset.co.uk or call 0800 999 1286. Enter and View report: Pyrland Ward, Taunton Service provider response

We ran a series of focus groups meeting with young people based at Burton’s Orchard in Taunton. The aims of these groups were to explore young people’s experience of leaving care and to involve them in starting to plan their own consultation with other care leavers. Key findings The group feel they would like more support with: Gaining employment or training Budgeting, cooking and other independent skills Moving on from leaving care Support when cases are to be closed with social services Parenting skills Someone else to talk to other the social services. This report was produced by the previous Healthwatch Somerset service provider, The Care Forum. Read our report If you need this report in a different format, please email info@healthwatchsomerset.co.uk or call 0800 999 1286.