As the number of patients waiting for surgery continues to grow, nationally and in southwest England, we are asking people about their experiences of being referred for surgery in Somerset and how they have been affected by waiting times. At the end of May 2021, 4,806 patients in Somerset had been waiting 40 or more weeks for non-urgent treatment (source: NHS Somerset Clinical Commissioning Group). The current NHS waiting time target is a maximum of 18 weeks from referral to treatment. Since March 2020, many routine and specialist treatments have had to be cancelled or rearranged due to the COVID-19 pandemic, and this has affected waiting times for surgery. We are gathering patient feedback to highlight how the length of time waiting for treatment impacts on people’s health and well-being, and to identify how hospital providers and commissioners could improve patients’ experience as they wait. We will share their findings and recommendations with Somerset NHS Foundation Trust, Yeovil District Hospital, and Somerset Clinical Commissioning Group, who have asked us to help them understand more about the patients’ point of view. Tanya Camberwell, Healthwatch Somerset Engagement Officer,  explained why they want people to share their experiences: “While we recognise the exceptional efforts of NHS staff who continue to treat patients while also managing the challenges of the pandemic, we also know that waiting for surgery can have an impact on people’s daily life. It can affect independence, work, and personal relationships, as well as mental or physical health. We will use the patient feedback that we gather to raise awareness of people’s wider health and care needs while they are waiting for surgery, and to inform and help influence the management of NHS waiting lists.” Matthew Bryant, Chief Operating Officer (Acute Services) at Somerset NHS Foundation Trust and Yeovil District Hospital NHS Foundation Trust,  said: “We know that many of our patients are currently waiting longer than we would like them to. Although we work with our clinicians to check that these patients are not coming to clinical harm, the emotional and social impacts of being on long waiting lists is less well understood and we welcome Healthwatch’s support in helping us to understand this and support our patients where we can.” If you or someone you know is on a waiting list for surgery in Somerset, or you recently had to wait for surgery, we would like to hear about your experiences. It’s easy to share your feedback and your comments can remain anonymous. [Online survey now closed] You can contact us to arrange a convenient time to feedback over the phone – call Freephone 0800 999 1286 or email:  info@healthwatchsomerset.co.uk In addition to the public survey, we have been working with Somerset NHS Foundation Trust Hospital and Yeovil District Hospital to reach and interview patients who are on the waiting list for surgery in Somerset’s hospitals.

Healthwatch Somerset Annual Report 2020-21: A review of our work over the past year and its impact, plus our work planned for 2021-22. Message from our Chair About us Highlights from our year Then and now Responding to COVID-19 Volunteers Finances Statutory statements Next steps Read our report If you need this report in a different format, please email info@healthwatchsomerset.co.uk or call 0800 999 1286.

Over the last year (April 2020 to March 2021), during the pandemic, 2,387 Somerset residents shared their feedback on the county’s health and social care services with us or sought information and advice on how to access the care and support they needed. In our latest Annual Report, we explain how we've worked throughout the year to understand people’s health and care needs, and how we've used public feedback to help services respond and improve care for local people.  The report also identifies the most common issues people raised, and outlines work planned for 2021-22. The year in numbers In total, 2,387 people shared feedback or sought information about health and care services. 1,689 people shared their views and experiences of local health and social care. 698 people sought information, advice, and support on how to get the care they need. We published 7 reports and made 25 recommendations for improvement to health and social care providers. The most common areas of comment and enquiry raised with us last year were GP services (63%), dentistry (30%), Covid-19 (4%) and mental health (3%). 39 volunteers supported us last year, giving up 250 hours of their time to engage with patients and the public, and to assess services. Healthwatch Somerset reports published during the year Care home Enter and View reports  x 3 (Sept 2020) Accessing health and social care during COVID-19 : A Somerset perspective  (Nov 2020) Access to primary care through GP surgeries in Somerset : What local people told us  (Dec 2020) NHS 111 service : Public feedback from Somerset, Devon, Plymouth and Torbay  (Jan 2021) The District Nursing Service : People’s Experiences of the Service in Somerset  (June 2021) Announcing the annual report, Judith Goodchild, Chair of the Healthwatch Somerset local Board, said: “This year, despite COVID-19, we delivered a full and impactful work programme.  We adapted our plans so that we could support local people to get the information and care they needed, and we supported local health and care services by using public feedback to help them understand how to deliver effective care in such challenging circumstances.  We were also able to carry out some of the projects that we had anticipated prior to COVID-19, using public feedback to guide improvements in Somerset’s NHS 111 service, to highlight issues with access to GP services, and to support the development of Somerset’s highly valued District Nursing Service. “I would like to thank everyone who shared their views and experiences with us to help improve health care for local people.  I would also like to applaud the dedication of Somerset’s health and care staff who have worked tirelessly to care for the public during COVID-19.  We all need to continue working together as we move out of the pandemic, to ensure that the excellent work achieved this year, in tackling the virus and to provide quality care for local people, is enhanced by what patients and the public tell us they want and need.” Our projects planned for 2021-22 Improving access to primary care – focusing on GP services, NHS dentistry, and the digitalisation of services, including the barriers and inequalities created alongside the benefits. Young Listeners project – seeking children and young people’s views on how health and social care services could work better for them. Hospital discharge process for people with continuing care needs – evaluating the effectiveness of the process for discharging people into care homes or care at home (pathway 3). Waiting times from referral to treatment – exploring the impact of long waiting times on people’s lives. Read the full  Healthwatch Somerset Annual Report 2020-21  to find out more about our work during the past year, including findings and recommendations for changes to services.

Our new report out today, shows that people who receive care and support at home from the District Nursing Service, would like to see the introduction of weekend and evening visits, but many people are more cautious about the introduction of digital consultations. The Somerset District Nursing Service (DNS) can be involved with caring for over 1,000 patients each day in their homes, helping them remain in their communities and out of hospital. As the older population in Somerset grows, so does demand for district nursing and community services; this is a key area of development for Somerset’s NHS and social care providers. Healthwatch Somerset and the DNS want to make sure that patient and carer feedback is used to influence how the service is developed to meet the growing demand for quality care at home. From February 2020 to April 2021, we gathered feedback about the service from 175 patients, carers and family members, through an online survey and phone interviews. We asked people to share their views about how the service is currently delivered, about possible changes to service hours, and about the use of digital technology, for example, video consultations. We now present several key findings and recommendations in our new report. A very good service:  93.6% of respondents rated the DNS as ‘very good’, so maintaining and building on the current level of service should be at the heart of any changes. Extending service hours:  Increasing the hours of service, so that routine visits can take place during weekends and evenings where appropriate, would benefit those using the service – 79.2% of patients said they could manage a routine visit after 5pm on weekdays, and 91.9% said they could manage a visit at the weekend. Extended hours would also provide employment opportunities for people who have caring responsibilities during traditional working weekday working hours but who are available to work in the evenings and weekends. Digital care:  Any move to digital appointments would need to be sympathetic to those who are digitally excluded – 67 people indicated that they would be subject to digital exclusion, for example because they have no internet or device for accessing the internet. Appointment time slots:  The introduction of a time slot system for appointments should be considered; this would be especially useful for patients with memory loss or mental confusion. Continuity of care:  Improvements to continuity of care should be considered for long term service users and those with cognitive impairment, for example by providing a consistent nurse or group of nurses. Healthwatch Somerset Acting Manager, Lucie Woodruff,  said: “As our older population grows, there is greater demand on community services and the ‘out of hospital’ model of care, this includes district nursing which is highly valued by local people. We know that Somerset’s NHS and social care commissioners want to develop more joined up health and care services in the community, and we want to make sure that the services provided, now and in the future, meet the needs and expectations of Somerset residents. So, we asked people about their views and experiences of the DNS and we have shared our findings and recommendations to guide how the service is developed.” Somerset NHS Foundation Trust Neighbourhood Service Lead, Gillian Cook RD , welcomed the report: “Somerset NHS Foundation Trust is about to commence a transformation process for the District Nursing Service in Somerset and our patients’ voice is at the centre of this work. This report containing feedback about our District Nursing Service from patients and carers across the county will be invaluable as we move through this transformation process, and it will positively influence our future service. We want to thank Healthwatch Somerset for carrying out this work; it has been an excellent example of collaborative working that will ultimately inform our future services.”

People have told us they want to feel listened to and involved in decisions about their social care. Here are six things you should expect from care services, according to new guidelines. The National Institute for Health and Care Excellence (NICE) has developed  guidance  to help: you understand what care to expect social care professionals support you to make decisions about your care What should your care look like? NICE has set out six key things you should expect from social care services: You should be able to live your life with dignity and independence. Your care should be planned flexibly around what you want and need. You should understand what types of care are available, and the minimum care you can expect to have. You should have control over how your care is provided and paid for. The staff providing care should develop good relationships with you. Providers of social care should ask you and your family for your views, and use these to train staff and improve services. Having a say in your care It’s important that professionals involve you in any decisions about your care. They should give you clear information about your different options and listen to your worries. They should also: Find out what matters to you and what support you need to live the life you choose. Give you information to make your own decisions, never assuming that you cannot decide for yourself. Involve your family and carers too, if you are happy with this Help you get your views across, for example using communication aids or by providing an advocate. Did your experience of social care meet all six points? If you or a family member has used social care, let us know whether the service met these guidelines. Share your experience with us and tell us your ideas how social care services could improve in the Somerset community. NICE's quality standard NICE's new quality standard (2019), People's experience using adult social care services , covers what high quality care should look like and what people should expect when using social care.

By Max Popham, Healthwatch Somerset Youth Engagement Officer This week we had our first session on Mindfulness – a practice that helps calm our emotions and handle stressful situations in a more controlled way. Learning Mindfulness techniques will help our Young Listeners personally and prepare them to manage any emotional situations they may experience when talking to other young people about their health and care experiences. Through the use of breathing techniques, and practiced thought patterns, Mindfulness allows us to control the ‘fight or flight’ evolutionary response when our brains are telling us we are in danger, and allows us to address the situation more effectively. In this first session we focused on resilience.  As a group we talked about what resilience means and how it can help us in those difficult situations we often find ourselves in.  The Young Listeners opened up about experiences in the past where they have felt difficult emotions, or struggled with stressful moments in their lives, and they were eager to learn some ways of helping this in future. We broke down some of the misconceptions of Mindfulness; of robed monks sitting cross legged for hours on end, incense burning and a blossom tree in the background.  We talked about how Mindfulness can be as simple as taking one deep breathe.  Inhale… and exhale…  Doesn’t that feel better? We then closed our eyes and tried to focus on where we could feel our breathing.  Was it under our nose?  Was it our chest inflating?  Was it the rise and fall of our stomach?  We each felt it in different places, but we all found the benefit of concentrating on our breathing, and feeling that sensation, wherever it was, and allowing ourselves to be present. After discussing how we felt post-breathe exercise, we turned to an activity called ‘The Resilience Punchbag’.  Once again, we all closed our eyes (except me, I had to read my notes!) and listened to a set of emotions – happy, sad, joyful, frightened, and so on.  With each emotion the Young Listeners were instructed to notice where they could feel it.  Were they rounding their shoulders and making themselves small?  Did they feel a smile trying to break through?  When the list was complete, we discussed how they felt, talking of how each emotion brought up memories, both good and bad, and how the negative emotions could feel quite harmful. This is one of my favourite exercises, as it provides such a visceral response, one word can induce such a real response in the body. We discussed how easy it is to dwell on those past experiences and negative memories, and how that can easily ruin a day, a week etc.  We discussed how that is ok and not a weakness.  We talked about how, from those experiences, we learn for next time, and through Mindfulness we are able to take a few calming breathes and rethink our response to slow down that ‘fight or flight’. The hour came around far too fast, but everyone of us could feel the benefits.  The Young Listeners expressed their enjoyment of the activities and couldn’t wait for our next Mindfulness session in two weeks’ time. I highly encourage you to try some of these exercises, especially when you are feeling anxious and stressed, as I am sure lots of us are these strange times.  For more information please don’t hesitate to email or check out Louisa Miles’ website.  She gave us (the Healthwatch Somerset team) a six-week course on all the exercises I will be sharing with our Young Listeners. Thanks for taking the time to read this, each new session is as exciting as the last.

By Max Popham, Healthwatch Somerset Youth Engagement Officer On Saturday 24 April, we had our first Young Listeners meeting to kick off the series of training sessions for our Young Listeners Project. For those of you who haven’t heard, we are running a project that gives young people a voice to speak about the health and social care services they use.  We want to empower young people to find out what’s good and what could be improved.  The project will be designed and delivered by a group of volunteer Young Listeners, with our support and training. In this first session our volunteers got together for a bit of fun and team building.  Nine young people aged between 12 and 18 joined us online, to meet and get to know the people they will be learning and working with in the coming weeks.  A few musicians, some dancers in training, budding athletes, and artists to name but a few.  They were all a little shy to begin with, but as the session went on it was great to see them relax and enjoy the team building games and activities I’d organised. We started with a general knowledge quiz; How well do you know your Weasley siblings?  Who plays Eleven in  Stranger Things ?  Can you name the Simpson family’s dog?  Our Young Listeners can, and though it was a close score, Grace came out on top with 13/20. But did the fun stop there?  Well, if you ask anyone who doesn’t like Pictionary, yes.  Our Young Listeners (after a brief explanation of how it worked) took to the virtual canvas and brought to life some masterpieces including a box of popcorn, a circus tent, a gingerbread man and many more.  After each of them had had a chance to draw, it was all tied up between the two teams, to be settled with a game of charades. Bay, Speilberg, Abrams – all would have been left a gasp at the theatrical performances our Young Listeners displayed.  Two words.  Film.  First word… you’re rubbing your stomach and can’t stop giggling.  “Hunger Games!” and a point to team two. In the end, one team rose above the other, though both did admirably with only two points in it [*Round of applause*] and all will be sent a little something to start their journey as Young Listeners. It was great to see such a lovely group of young people interacting despite the hard times they have been through in the last year and a bit.  I cannot wait to see what they can do, to hear their ideas about the project, and to work with them to make it happen! Our meetings will now take place every Saturday morning.  As we move on, we will be looking at subjects like interview skills, communication dos and don’ts, maintaining positive mental health and wellbeing, and so much more, all linked in with the AQA Unit Award Scheme.  These bright young minds will have plenty to show for volunteering their time for the betterment of young people all across Somerset. Next Week, we’ll be exploring mindfulness, because we all need to take a break sometimes!

We have announced the areas we will investigate this year, to make sure that local people’s views and experiences are used to drive and support improvements in local services. Following analysis of public feedback to identify common issues and concerns, and consultation with local health and care partners about national and local priorities, four broad areas will be prioritised. 1. Young People’s health and social care services We will be asking local young people about their experiences of health and social care services and gathering their ideas on how services could work better for young people.  The project will be designed and delivered by a group of volunteer ‘Young Listeners’, with support and training from us.  They will engage with other young people during the summer and report their findings to health and care decision makers in the autumn. 2. Access to Primary Care This project will build on our previous work around improving access to Primary Care, such as GP services, pharmacies, and dentistry.  Public feedback will be used to support and influence the effective recovery of services post COVID-19, and the ongoing expansion of the Primary Care Networks in Somerset.  In particular, we will explore the impact of digitalisation of services and the barriers and inequalities this can create for some people, and also access to NHS dentistry which became a major area of concern during the pandemic. 3. ‘Supported discharge’ for patients moving from hospital care into care homes and care at home We will look at the experiences of patients who are discharged from hospital care into care homes and care at home, due to their continuing care needs.  We will evaluate the effectiveness of the supported discharge process (Pathway 3), looking, for example, at access to transport services, rehabilitation and wellbeing services, and community support.  We will highlight areas of good practice and build understanding of patient’s health and social care needs to drive improvements in the quality of care people receive. 4. Waiting times from GP referral to treatment Building on our recent exploratory work, we will look in greater depth at the impact on local people’s lives of long waits for treatment.  The project will compare the experiences of people who are treated within the 18-week time limit and those who wait for over 40 weeks to receive treatment.  It will also investigate how waiting times for treatment in Somerset have been affected by the COVID-19 pandemic.  Findings and recommendations for improvement will be shared with those responsible for providing and improving health and care in the county. Judith Goodchild, Chair of the Healthwatch Somerset local Board,  explained how these projects will make a positive difference to health and social care in Somerset: “Health and social care providers can best improve services if they understand people’s experiences.  We are here to listen to local people, to gather and analyse their feedback and identify themes, and to report what is and isn’t working.  We share our findings and recommendations with those responsible for improving health and care in Somerset, to support and drive positive change.  We want to hear from as many people as possible about their health and care experiences, when these projects are launched throughout the year, or at any time and about any health and care service.  Your feedback really will help to make care better for local people.”

We want to know what people think about the care they have received from Somerset’s District Nursing Service, to help the service develop and improve how it cares for local people. Somerset District Nursing Service provides nursing care to people who are housebound living in their own homes and in residential homes.  They are working with us to gather feedback from local people who have used the District Nursing Service in the past six months, including patients, family members and carers. Hannah Gray, Healthwatch Somerset Manager , explained why they are asking people to share their views and experiences: “District Nursing is a long established and vital way to care for people in their homes and in the community, and developing community services is an important part of Somerset’s future plans for transforming the NHS. “As with any service, it is important to listen to those who are being cared for, to understand how best to meet their needs and expectations.  We will use patient feedback to highlight what is working well with the District Nursing Service and where improvements or new ideas could be considered.  For example, we will be asking how easy it is to access the District Nursing Service out-of-hours and whether a weekend and evening service is needed, and we want to know how patients feel about the use of digital technology in their care, such as video consultations.  Please do get involved because your views will make a real difference to how the service is delivered in the future.” It’s easy to share your views and experiences  with us and your feedback can remain anonymous. [Online survey is now closed] You can contact us and arrange a convenient time to feedback over the phone, call Freephone 0800 999 1286 or email:  info@healthwatchsomerset.co.uk If you are currently receiving care from the District Nursing team, you can ask your nurse for a copy of our leaflet for more information about how to get involved. We will share our findings with the District Nursing Service and partner organisations such as local GPs, patient groups, and Somerset NHS commissioners and service providers.  We will publish a report including recommendations for change and improvement.

A joint report released today by a group of local Healthwatch in the South West, shows that although the NHS 111 service in Somerset and Devon is rated highly by the public, there are inconsistencies in the quality of the service. 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. Devon Doctors is commissioned to provide an integrated urgent care service in the Devon and Somerset region, of which the NHS 111 phoneline and urgent out-of-hours care are key components. From 5 October until 20 November 2020 local Healthwatch in Somerset, Devon, Plymouth and Torbay joined forces to promote a regional survey to ensure that people using the NHS 111 service had their say on the way it is delivered to them. 186 people from Somerset, Devon, Plymouth and Torbay completed the online survey, with the responses independently analysed by Healthwatch and detailed in their new survey report, available to read on the Healthwatch Somerset website. Public feedback within the report shows that the accuracy and quality of the service people received was not consistent, despite many people rating their experience highly. Key findings 40.86% (76) of people rated their experience of using the NHS 111 service as ‘very good’. 23.66% (44) of respondents waited longer than three hours for an arranged call-back. A fifth, 20.43% (38), of commentators never received an arranged call-back. Most people, 75.81% (141), said that their call was answered in a timely manner. Improved training for call operators was the most common response to the question: ‘In your opinion how could the NHS 111 service be improved?’ Some people, 7.59% (12), reported that they had to call 999 or visit an emergency department due to inadequate responses from the NHS 111 teams. 7.53% of comments to the question ‘Is there anything else you would like to tell us?’ said that calling NHS 111 was quicker or better than access to their registered GP surgery. It is evident throughout the feedback that the accuracy and quality of the service people received was not consistent. Report recommendations Reducing waiting times for arranged call-backs and inbound calls should be considered of high importance as current long waits may put patient’s safety at risk. Reviews of the assessment questions, staff training, and staffing levels may be required. Improvements to call handling procedures and staff training surrounding these processes could be made, including training and guidance for difficult/emergency situations, flexibility of the diagnostic process for call operators, access to qualified medical support for call operators and staffing levels. Ensure that training is consistent for all staff so that delivery of the assessment and conclusions of this are of the same standard for all patients. Review the pre-recorded messages and frontline options for patients before they are connected to a call operator to reduce message length and increase patient options for faster diagnosis. 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. Healthwatch in Somerset, Devon, Plymouth and Torbay will be inviting the Care Quality Commission (CQC) and Devon Doctors Ltd to work collaboratively with Healthwatch to implement changes highlighted in the report to improve services delivered to the community. Martin Cordy, Interim Director of Contract Assurance at Devon Doctors Ltd, thanked Healthwatch for the report: “Devon Doctors would like to thank Healthwatch for this report and the recommendations made in relation to the delivery of the 111 service. Devon Doctors supports the recommendations made within the report, however, many of these are unable to be implemented locally as it will require national changes in policy, process, and funding. “We are working with Healthwatch to help the patient voice in relation to these issues be raised at a national level so that positive change can be made. The organisation is currently delivering a programme of service transformation to ensure that the quality of the service provided, including patient experience, enables us to deliver the best possible clinical care to patients within Devon and Somerset. The feedback from this report has helped shape elements of this plan to ensure that improvements are made in the areas concerning members of the public as well as those identified internally. “Devon Doctors is pleased to confirm that it will be working in partnership with Healthwatch in the coming months to understand the public’s experience of urgent primary care services within Devon and Somerset and identify areas for future service transformation.” The report findings will be presented to various organisations who have significant interest in the NHS 111 service, and a follow up engagement planned for approximately six months’ time. Hannah Gray, Healthwatch Somerset Manager, commented: “On behalf of Healthwatch Somerset and Healthwatch in Devon, Plymouth and Torbay I would like to thank everyone who took the time to contribute their views and experience by completing our survey. A special thanks also to the dedicated volunteers and all the sector organisations who helped to support the engagement activity despite the limitations of government restrictions. “With essential services facing unprecedented challenges, it is really important that we, as the consumer champion for health and social care services, continue to listen to the community and share feedback with our stakeholders and key decision-makers on what is working well or not so well and what may need addressing. Your feedback from this report will be used to shape and improve the local NHS 111 service and really could make a positive difference.”

Healthwatch in Somerset, Devon, Plymouth and Torbay joined forces to promote a regional survey to ensure that people using the NHS 111 service had their say on the way it is delivered to them. Key messages 40.86% (76) of people rated their experience of using the NHS 111 service as ‘very good’. 23.66% (44) of respondents waited longer than three hours for an arranged call-back. A fifth, 20.43% (38), of commentators never received an arranged call-back. • Most people, 75.81% (141), said that their call was answered in a timely manner. Improved training for call operators was the most common response to the question: In your opinion how could the NHS 111 service be improved? Some people, 7.59% (12), told us that they had to call 999 or visit an emergency department due to inadequate responses from the NHS 111 teams. 7.53% of comments to the question Is there anything else you would like to tell us? said that calling NHS 111 was quicker or better than access to their registered GP surgery. It is evident throughout the feedback that the accuracy and quality of the service people received was not consistent. Read our report If you need this report in a different format, please email info@healthwatchsomerset.co.uk or call 0800 999 1286.

We have been talking to local people about their experiences and views of accessing care at GP surgeries in Somerset. This report tells you what people said when we spoke to them about this. Key messages The survey results showed that 70% of people booked their appointments over the phone with the next most popular booking method being face-to-face. More respondents said the booking process worked well. When asked “What could be done to improve your experience of booking an appointment?” the most popular response was an increase in appointment availability. A significant number of people we spoke to were not satisfied with the length of time it took to answer the phone when they called the surgery. Some people like to see the same GP at each visit because of the personal relationship they have created. This is particularly so for those with mental health issues. Some respondents were prepared to wait longer for an appointment in order to see their preferred GP. Some people told us they were not comfortable being triaged by reception staff. Many people who were satisfied with their continuity of care were seen by the same medical professional. Read our report If you need this report in a different format, please email info@healthwatchsomerset.co.uk or call 0800 999 1286.