Today we have published four reports about care homes in Somerset – three reporting on the quality of care in Somerset care homes prior to COVID-19 from a residents perspective, and a fourth looking at the challenges faced by care home staff during the pandemic. How to provide quality health and social care for the growing numbers of elderly and vulnerable people in Somerset, and nationally, is a complex challenge and one that has been thrown into sharp focus by the COVID-19 pandemic. As the county’s health and social care champion, we have statutory powers to ‘Enter and View’ publicly funded health and social care premises to speak to residents and patients about their experiences of using the service.  We look at the environment and quality of services, share areas of best practice, identify areas for improvement, and make recommendations based on what people say about the care and support they receive. In January 2020, Somerset County Council’s care home team asked us, in conjunction with the Care Quality Commission, to carry out quality monitoring visits at three care homes: Oak Lodge Care Home, in Chard Oake Meadows Care Home, Taunton Centenary House Care Home, Shepton Mallet (now closed) The monitoring reports from these visits were delayed due to COVID-19, but they have now been shared with the Somerset County Council and Somerset Clinical Commissioning Group. With our face-to-face work on pause due to COVID-19 social distancing requirements, including care home Enter and View visits, they are finding new ways to gain feedback and insight into care home provision in the county. Care homes during COVID-19: care staff perspective It has been widely reported that social care has faced many challenges and been significantly impacted by the COVID-19 pandemic.  People have shared their experiences with us through our ‘Care during COVID-19’ survey which ran from April to September. We wanted to find out more about the challenges faced by care home staff during the COVID-19 pandemic, and to understand how they have managed during this time.  We held a focused feedback interview with a local care home.  The following broad themes have been identified which will be fed back to those who provide and support care homes in Somerset to inform future planning, care and support. Staff anxiety levels were extremely high during the pandemic – they were worried about the safety of care home residents, while also managing concerns about their own health. There was recognition that hospitals were overwhelmed at the start of the pandemic, so needed to discharge patients back to care homes, but the lack of testing had unforeseen consequences. Testing for the virus is considered essential going forward. Regular communication, support and guidance was important – care home staff felt generally well supported by Somerset’s social care services, local NHS, and their own organisations. PPE had been provided when required by Somerset’s Public Health team or through their own organisation if they were part of a larger care home group. GP care for residents was maintained through established links with local surgeries. There was a great support from the local community, which was welcomed. Most care home residents adapted relatively well with support from care staff and relatives, although some were scared, some found the PPE daunting, and some were disconcerted by the lack of normal visiting arrangements. Some staff were concerned that the reputation of their care home would be damaged if residents caught the virus. Healthwatch Somerset Manager, Hannah Gray , said: “Our Enter and View monitoring visits are a useful tool to support the monitoring of quality within the care settings – they are a great way to highlight areas where good practice and best standards are being practised, and to help drive improvements in the quality of care for residents and patients.  We look forward to resuming these important visits in the future.  In the meantime, we will find other ways to engage with patients, the public and care staff to give them a voice in influencing positive changes in health and social care services in Somerset.”

We have joined local and national health and care organisations calling on Somerset residents to give feedback about their care during coronavirus (COVID-19) to help services reflect, recover, and improve. New research from the Care Quality Commission (CQC) and Healthwatch England shows that 62% of people in the South West say they are more likely to take steps to improve health and social care services since the outbreak of COVID-19. In response, we are supporting Because We All Care, a new campaign calling on local people who use services to help shape future health and social care, locally and nationally. The campaign builds on our recent work encouraging local people to share feedback on their experiences of health and social care services during the pandemic, to help services identify and address quality issues to support local patients. What are people in South West England saying? The national research, conducted following the start of the COVID-19 crisis, has revealed a fascinating snapshot of how people in the South West of England view feedback on care: 56% of people said they would be more willing since COVID-19 to support NHS and social care services by actively providing feedback on their care. 44% of people reported to have avoided services due to COVID-19 (27% below national average of 71%). 60% reported noticeable changes to the standard of care resulting from the pandemic. 41% of people are particularly more grateful for GP services. 74% of people surveyed said that feedback is an important way to improve services, yet despite greater public willingness to contribute, some barriers do remain. While 41% of people are more likely to provide positive feedback on care, 26% also now consider themselves less likely to provide negative feedback on care. 29% of people said they would be reluctant to provide negative feedback in case it increases pressure on services or staff. What are Somerset residents saying about local health and care during COVID-19? So far, almost 200 local people have told us what has worked well and what hasn’t with health and social care services during COVID-19.  (See examples of public feedback below.) The most common areas of feedback have been about GP’s (55% positive), dental care (5% positive), mental health (5% positive) and pharmacies (28% positive).  86% of those who have responded say they have had no symptoms of COVID-19, and 36% of respondents have chosen to self-isolate for 12 weeks, 45% due to other health issues.  Most Somerset residents who have shared their experiences so far are aged 55-69 (81%). Hannah Gray, Healthwatch Somerset Manager , is calling on people from across the county, of all ages and with a variety of health and care needs, to share their experiences to help local services reflect and improve:  “It’s great to see public appreciation for the work our health and social care staff have done during the coronavirus pandemic.  They have had to adapt at great speed to care for people with the virus, while trying to maintain care and support for many of our most sick and vulnerable people.  With services now working to bounce back from the impact of COVID-19, public feedback has never been more important. “We are launching the Because We All Care campaign to help local people understand how, by sharing their experiences, they can help NHS and social care services spot what is working and what could be done better.  We want as many Somerset residents as possible to tell us about their care during COVID-19, the good and the bad, no matter how big or small.  Your views really will help local health and social care services to understand, develop and improve care for you, your loved ones, and the local community.” You can share your experiences and feedback, confidentially, by completing our online survey  or by contacting us on 01278 264405.  [Survey now closed] We can also provide you with advice and information to help you access the care and support you need. Kate Terroni, Chief Inspector Adult Social Care, Care Quality Commission  said: “People working in health and social care have been going to extraordinary lengths to deliver good, safe care during this global crisis.  They have never had a more crucial – or a more challenging – role to play.  This new research clearly shows the public’s appreciation for the care and support they and their loved ones have received and it’s inspiring that people are now looking for ways to channel this into practical action.  Now more than ever, every voice really does matter.  It’s only by hearing what’s working and what’s not, that health and social care providers can improve the quality of care and support that they are delivering.” Public feedback from the Healthwatch Somerset survey about health and care during COVID-19 Care homes outstanding communication with relatives:   “Chelston Park Care home that looks after my mother has been extremely well managed and their level of communication with relatives has been outstanding.  Using Facebook and email to keep us up to date with the care home and changes in government guidelines that affect them has been excellent.  Offering other methods of communicating with our loved once safely has been a very nice touch.” Excellent pharmacy service for repeat prescriptions:  “I routinely use my GP pharmacy for repeat prescriptions.  I already use the Patient Access App to order my medications and this has not changed during the COVID outbreak.  The pharmacy continued to provide me an excellent service without any change to the quality of delivery.  For my most recent collection I received a text message saying the items were ready for collection – this was a new feature I hadn’t seen before but proved to be a great addition and allowed me to collect earlier than anticipated.” Mental health services under pressure:  “I am aware of people who’ve struggled to access mental health services, particularly during the COVID-19 outbreak.  Community mental health teams have had fewer available mental health social workers, and the service has already experienced much more demand than they are able to deliver.  The longer-term effects on the local community’s mental health will need a suitable service and appropriate funding.” Wonderful community support for carers:   “The Carers Service and Village Agents has just been wonderful and so helpful.  Some other charities seem to have closed recently, so it has been great to receive support from my local Village Agent from the start of this situation.” Happy with health check by phone: “My youngest daughter was due to have her two-year check and then COVID19 happened.  I was so impressed that the health worker texted to see if I wanted to rearrange the appointment or was happy to have a call in place of the appointment.  Fantastic and I’m hoping this worked better for everyone – less admin to reorganise another appointment and addressed any concerns at the right developmental stage.” Delays to dental care: “My daughter chipped her tooth and her appointment was cancelled.  I have been told that when I rebook there will be a three month wait and it is not clear what will be done in three months.  I anticipate another appointment will be made as treatment in a community dentist is limited, the dentist said she had referred my daughter, but I have not heard anything yet.”

Over the last year, more than 1,400 people shared their views on the county’s health and social care services with us, helping to make care better for local people. In our latest Annual Report, published today, we highlight how we've worked with communities across the county to make a difference to the way health and care services are run, and to raise awareness of important health and social care issues.  (See below `The year in brief’.) The report also identifies the most common health and social care concerns raised by local people, and outlines work for 2020/21, including a survey exploring how peoples’ access to health and care services has been affected by coronavirus. The year in numbers Over 1,400 people shared their views and experiences of local health and social care. Over 2,000 people sought information, advice, and support on how to get the care they need. We visited over 361 community events, venues and health and care services across the county, to understand people’s experiences. We made 45 recommendations for improvement to health and social care providers. 41 volunteers supported our work last year, giving up 1,285 hours (100 hours a month) of their time to engage with patients and the public, and to assess services. Common issues and concerns The most common areas of comment and concern raised with us last year were about primary care services (eg GPs, dentists and pharmacists), waiting times from GP referral to treatment, and care plans for patients with continuing needs (supported discharge). Announcing the report, Judith Goodchild, Chair of Healthwatch Somerset Board , said: “Looking back over last year provides a great opportunity to highlight the value of listening and learning from people’s experiences. We have connected with local communities across the county and represented their views to NHS decision makers and service providers, to make sure that public feedback is embedded into future planning for health and social care in Somerset. I would like to thank everyone who has shared their story with us, and to our volunteers and the many groups we work with who help make health and social care better for local people.” Hannah Gray, Healthwatch Somerset Manager , added: “We are looking forward to another productive year in 2020/21, focusing on improving services by promoting what matters most to local people. “We are currently investigating how people’s access to health and social care services has been affected by coronavirus. NHS and social care staff have had to adapt to a lot of change over the last few months, and there will be things that can be improved in how they provide care, now and in the future. We want you to share your feedback on GP surgeries, care homes, hospitals, mental health services and dentists etc, to help services spot the issues and understand how to respond.  Tell us what it’s been like for you during COVID-19 by completing our short online survey [now closed] or by getting in touch with us on 01278 264405.” The year in brief: How listening to local people has helped make health and social care better Somerset NHS Long Term Plan:  We asked people #WhatWouldYouDo to improve the NHS locally?  They want local services to focus on improving access to GP care, earlier referral from GP to specialist care, providing care closer to home, and involving people in decisions about their care. Somerset NHS Clinical Commissioning Group will use these findings to develop future plans for local services. Developing the Health Visiting Service:  We gathered people’s experiences of the Health Visiting Service to inform Somerset County Council’s development plans, at a time when cuts were announced to support for young children and families. The service is highly valued by local people, although there are areas for improvement around communication, accessibility, and flexibility. Improving access to community information and support : We investigated how people get information and advice locally to help them manage their health. We also identified common barriers that prevent people from getting the support they need, including difficulties getting to GP appointments and referrals, unreliable information online, and inadequate transport to services. Somerset NHS Clinical Commissioning Group and Somerset County Council will use the findings to develop effective information and support across the whole health and care system. Access to GP care:  We reported on the common challenges people face when accessing GP care, including lack of appointments and not enough continuity of care through the same GP. This work will be extended, and findings will be used to inform and improve GP provision in the county. Our projects for 2020/21 We have identified the following areas for investigation in 2020/21, based on common concerns raised by local people, while reflecting national and local health and social care priorities: Accessing health and care services during coronavirus Access to primary care services Waiting time from GP referral to treatment Supported discharge process for patients with continuing health care needs Children and Adolescent Mental Health Services (CAMHS). These projects will be developed during the year, as heath and care services begin to recover from the coronavirus pandemic, to make sure the work reflects people’s needs.

It’s national Carers Week (8-14 June) and we want to know about your experiences of being an unpaid carer or being cared for during COVID-19, to help local services understand how to provide better social care and support. Read Bob's story: Caring for your family in retirement (In news 8 June 2020) It is clear that the impact of coronavirus, including the lockdown, has been particularly difficult for many of our most vulnerable people. For example, the elderly and those with dementia, those with physical or mental ill health, people with disabilities, and those with addictions. Caring for people who are sick or vulnerable can be hugely challenging and isolating, even in normal circumstances, and COVID-19 has introduced additional pressures. For example, many regular care services have been suspended, such as respite care and specialist health care, and lockdown has imposed even greater social isolation and disruption to normal routines. Hannah Gray, Healthwatch Somerset’s Manager , explained why we are asking people to speak up about caring behind closed doors: “There are millions of people across the country who provide care unpaid every day, often with limited support or hidden behind closed doors. During this national crisis, many carers have had to provide even more care than usual. We want to make sure their voice is heard by those responsible health and social care in the county, so that they understand the challenges faced by family carers and learn from their experiences in order to make care better. “We want to hear from local people who receive care and from those who provide care for a family member or friend who cannot cope without their support. Your story, which can remain anonymous, will help to influence positive change in local services, so please do get in touch.”

Shepton Mallet resident Bob became a full-time carer when he retired from a long career with the ambulance service. He has spent the past 30 years looking after his late wife and in recent years, their two daughters and son, following a stroke, a cancer diagnosis, and a road accident. Becoming an expert and an advocate A large part of Bob’s time as a carer is spent advocating on his younger daughter’s behalf, which at times can be challenging.  She suffered a stroke six years ago and now lives in specialist neurological residential care.  Bob has had to become somewhat of an expert in her care, particularly in relation to her dysphasia and swallowing difficulties.  This can often be the case for those looking after someone with an acquired brain injury – the side effects can vary greatly, so care needs to be individualised.  One thing which stands out for Bob is that there is often a lack of joint working between the different health and social care settings. Managing multiple care responsibilities Bob’s other daughter underwent a gall bladder operation, which required regular travel to Yeovil Hospital for an operation that was repeatedly cancelled and re-arranged, often at very short notice, and on one occasion as she reached the operating theatre door.  This resulted in a lengthy hospital stay for his daughter, followed by confusion around discharge and incorrectly labelled medication. This was a difficult time for Bob and his family.  He was travelling across a large area, spending money on petrol, phone calls and car parking at the hospital.  He was often tired and felt communication at the hospital during this time was extremely poor.  This was in addition to Bob’s usual day-to-day care for his other daughter, and it also meant that he was away from her for extended periods of time. Caring during COVID-19 Bob is trying not to worry too much about coronavirus, preferring to focus on how he can support his loved ones; he takes pride in “being a comfort to them and speaking on their behalf.” Bob’s daughter was in hospital again at the start of lockdown.  Her discharge was delayed until the COVID-19 test had been set up and administered, and while she waited for the results, which fortunately came back negative.  He is full of praise for the levels of service she has received from her GP during the virus outbreak.  All callbacks have been on the same day and the GP has kept in contact, which they have found very helpful. Carers should be consulted about the care of their loved ones During his career with the ambulance service, a highlight for Bob was the Patient Transfer Service, which allowed him to support people in their recovery.  He found it extremely rewarding to be able to see people making progress and becoming well again. Because of this professional knowledge and his personal experience as a carer, Bob feels it is vital that carers are involved in any care planning and in the hospital discharge process.  He knows that alongside the practical care they deliver, they will also play an important role in maintaining the mental health of the person they are caring for when they return home.  He also recognises that the person being cared for will rely heavily on their carer for support and they will often want their carer to be present at appointments. Carers need support too When caring for his late wife, Bob found the Carer’s Representative at his local GP surgery a great source of support: “You could call them and talk, and they would just listen, and I would feel better.”  He found that having someone to ‘offload’ to at times, was important in maintaining his resilience and coping.

During Mental Health Awareness Week (18-24 May), we are highlighting the care and support needs of people living with dementia and their families, and the particular pressures of life under lockdown due to coronavirus. Bernard’s story We recently heard from the family of 89-year-old Somerset resident Bernard.  Bernard has lived in a care home for several years due to his advancing dementia. But, following a fall in February which required a stay in hospital, his care home had decided they could no longer manage his dementia. By March, Bernard was clinically fit to leave hospital, and the hospital was under pressure to discharge him due to the growing demand to treat coronavirus patients.  Bernard had no home to return to however, and the country was about to go into lockdown.  What would normally be a difficult and stressful situation had just got even harder, for Bernard and his family. Bernard’s family had to make the hurried decision on a new care home. They selected a possible care home and, due to the coronavirus, only one family member was allowed to visit to check if it was suitable. Before making their final decision, the family had to discuss if the home was right for their father via telephone and text, due to the social distancing restrictions. The day before lockdown Bernard moved from hospital to the specialist dementia home. He was taken there by hospital transport and one family member was allowed to meet him at the home and help to settle him in. Both Bernard and his son had their temperature taken at the home as a precaution. Since arriving Bernard has settled in despite not being able to see his family. The home keeps in regular contact by sending the family a weekly update email. They would also facilitate Facetime calls, but the family found this was distressing and confusing for Bernard. The family can send letters via email and they will send video messages to Bernard for his upcoming 90th birthday. Bernard’s daughter-in-law said: "The home has been amazing; they have sent us pictures and Bernard looks very settled.  We had to make a rushed decision about this home, but I believe it was the right one.  We were trusting them with our loved one." Share your story and help make health and social care better for your community We reach out to people across the county to find out about their experiences and views of local health and social care services – what works well and what needs to be improved.  We share this feedback with those in charge of health and social care in Somerset to make sure they understand and respond to the needs of those who use the services. Bernard’s story is a good example of where services have worked well to support the patient and his family.

If you are experiencing or feel at risk of domestic abuse, or are worried about someone who might be, find out where you can go for advice and help. The information in this article is taken from  Refuge ,  Women’s Aid  and  Woman’s Trust . Women’s Aid defines domestic abuse as an incident or pattern of controlling, coercive, threatening, degrading and violent behaviour, including sexual violence. In most cases, it is by a partner or ex-partner, but it could also be by a family member or carer. It is more common than you'd think. Domestic abuse can happen to anyone, regardless of age, background, gender, religion, sexuality or ethnicity. However, statistics show most domestic abuse is carried out by men and experienced by women. Domestic abuse is  never  the fault of the person who is experiencing it. Domestic abuse is a  crime. Stay safe online If you need to close this website quickly, click the Quick Exit buttons in this article. This will open up the Google homepage, but it won’t hide the fact that you’ve been on our website. To do that you would need to delete your computer’s browsing history. The Woman’s Trust has more information about  browsing safely online . What is domestic abuse? Domestic abuse is not always physical violence. It can also include, but is not limited to: coercive control and ‘gaslighting’ (a pattern of intimidation, degradation, isolation and control with the use or threat of physical or sexual violence) financial or economic abuse online or digital abuse verbal abuse emotional and/or psychological abuse physical or sexual abuse harassment or stalking Signs of domestic abuse Has someone close to you: threatened or humiliated you, maybe in front of others damaged your belongings or property controlled what you do controlled how you use, or have access to, money followed or visited you without your permission been putting you down constantly, criticising you blamed their culture, religion or personal problems as an excuse for their behaviour towards you pushed, bullied, slapped, kicked, punched or seriously hurt you forced you to have sex when you don't want to forced you to make decisions you don't agree with (personal, physical, financial, legal or maybe about a family member) threatened you or made you fear for your  safety Women’s Aid has more information, which might help you to recognise if you are in an abusive relationship.   What to do if you're in immediate danger If you or someone you know are in danger you should phone 999 and ask for the police. If you are unable to talk on the phone, dial 999, listen to the questions from the operator and respond by coughing or tapping the handset if you can. Then follow the instructions depending on whether you are calling from a mobile or a landline. If you call from a mobile If prompted, press 55 to  Make Yourself Heard  - this will transfer your call to the police. Pressing 55 only works on mobiles and does not allow police to track your location. If you call 999 from a landline If only background noise can be heard and BT operators cannot decide whether an emergency service is needed, then you will be connected to a police call handler. If you replace the handset, the landline may remain connected for 45 seconds in case you pick up again. When 999 calls are made from landlines, information about your location should be automatically available to the call handlers to help respond. If you or someone you know are in danger you should phone 999 and ask for the police. If you are unable to talk on the phone, dial 999, listen to the questions from the operator and respond by coughing or tapping the handset if you can. Then follow the instructions depending on whether you are calling from a mobile or a landline.   Ask for 'ANI' The Government have launched a new code word scheme, where if you are experiencing domestic abuse and need immediate help you can ask for ‘ANI’ in any participating pharmacy. ANI stands for Action Needed Immediately but is pronounced Annie. If a pharmacy has the ‘Ask for ANI’ logo on display, it means they are ready to help you. The pharmacy will offer you a private space, provide you with a phone and ask if you need support from the police or other domestic abuse support services. Organisations and charities that can support you Refuge - National Domestic Abuse Helpline   Refuge runs the National Domestic Abuse Helpline, which you can call for free, and in confidence, 24 hours a day. Its website provides guidance and support for people affected by domestic abuse, as well as those who are worried about friends and loved in ones. It also has a form you can use to book a safe time for a call from them.  0808 2000 247 nationaldahelpline.org.uk Women's Aid Women's Aid works with women and children to end abuse. If you're experiencing domestic abuse you can chat to them using their instant messaging service, email one of their support workers, speak with other women in their forum of survivors or get help and advice from their survivor's handbook. womensaid.org.uk Woman's Trust Woman’s Trust is a specialist mental health charity, providing free counselling and therapy for women who have experienced domestic abuse. womanstrust.org.uk ManKind Initiative Man Kind support men suffering from domestic abuse from their current or former partner (including same-sex partners). Their confidential helpline is available weekdays 10 am - 4 pm.  Freephone: 0808 800 1170 (will not show on your bills) Inclusive minutes: 01823 033 4244 ManKind.org.uk Galop Galop provides Hate Crime, Domestic Abuse and Sexual Violence support services to LGBTQ+ victims and survivors by telephone, text and WhatsApp. Their helpline is available 10 am - 5 pm Monday to Friday and until 8pm on Wednesday and Thursday.  0800 999 5428 galop.org.uk Imkaan Imkaan is a UK based, Black feminist organisation addressing violence against Black and minority women and girls. Their website has a list of specialist organisations by and for BME women. imkaan.org.uk Southall Black Sisters Southall Black Sisters offer specialist support, advocacy and information to Asian and Afro-Caribbean women suffering abuse.  southallblacksisters.org.uk Karma Nirvana Karma Nirvana supports victims of honour-based abuse and forced marriage. Their helpline is open 9 am - 5 pm, Monday to Friday.  0800 5999 247 karmanirvana.org.uk LAWA Latin America Women's Aid runs the only two refuges in Europe by and for Latin American women and children fleeing gender-based violence. They offer advice in Spanish, Portuguese and English.  0753 442 4826 (Spanish and English) - 9.30am-5.30pm 0746 200 3324 (Portuguese and English) - 9.30am -1pm lawadv.org.uk SignHealth SignHealth provides domestic abuse service support for deaf people in British Sign Language (BSL). 020 3947 2601 (call) or 07970 350366 (text, WhatsApp or Facetime) da@signhealth.org.uk signhealth.org.uk/with-deaf-people/domestic-abuse/

By Tanya Camberwell, Healthwatch Somerset Engagement Officer Tales from the ‘Spark’ side The effects of COVID-19 are currently impacting all aspects of life in the UK, and Healthwatch Somerset is not alone when it comes to being innovative in the way we contribute and engage with our health and social care services and users. Along with countless other organisations we must follow government restrictions and social distancing guidelines.  This means we are limited in how we carry out our regular public engagement work. The Healthwatch Somerset team are determined to help the people of Somerset through these nationally challenging times and have responded with the same flexible can-do attitude that so many people of the UK are displaying. On top of their regular duties, our Manager and Team Administrator have signed up with local telephone befriending services Re-engage and Somerset Sight as well as responding to befriending referrals directly from  Somerset Village Agents .  Our Volunteer Officer is helping support Burnham and Highbridge Corona Warriors, has signed up to the NHS Responders and continues to keep in regular contact with our amazing volunteers. As Engagement Officer, I am continuing with my regular duties that do not involve meeting people face-to-face.  This now includes supporting  Spark Somerset  for two days each week.  Spark provide information, advice, training, and support to the voluntary and community sector in Somerset and also run the Volunteer Service, inspiring people to get involved and make a difference in their communities. In response to the amazing torrent of offers to help those effected by COVID-19 and imposed restrictions, Spark have put together a website that matches people who want to volunteer with organisations and groups that are helping people. The  Corona helpers  site also matches those who need assistance with their local group of volunteers, and unlike the NHS Responders you do not have to be on the at-risk register to access help. I will be writing a regular short ‘blog’ on the work I am doing with Spark to keep you updated on some of the fantastic things our amazing communities are doing.  For now, I would also like to thank each and every person who helps those in need.

We are looking forward to helping health and social care services develop and improve with the announcement of several new projects for the year ahead. Our new Healthwatch projects will address the impact of coronavirus and look into common issues raised by local people, while also reflecting national and local priorities in health and social care. Projects will focus on the following broad themes (see below for more detail): Accessing local health and care services during the coronavirus pandemic Children and Adolescent Mental Health Services (CAMHS) Access to Primary Care (such GPs, pharmacy and dentistry) Supported discharge process for patients with continuing health care needs (Pathway 3) Accessing transport to health and social care services Waiting times from GP referral to treatment Each project will gather people’s views and experiences linked to a specific aspect of health and care provision.  The aim is to find out what works well for local people and what they think could be improved.  This public feedback will then be shared with those in charge of delivering health and care in Somerset with recommendations to help improve services for local people. Judith Goodchild, Chair of the Healthwatch Somerset Board , explained why we have chosen to investigate these areas of Somerset’s health and social care provision: “Health and care services are more effective when they reflect and respond to the views and needs of local people. Our new projects will investigate the impact of coronavirus along with common themes that we have identified from public feedback received during the previous year. We have consulted widely to ensure that our work also feeds into national and local NHS and social care priorities. This approach will ensure that we are able to influence positive change and make a real difference for local people.” Healthwatch Somerset Manager, Hannah Gray , outlined how we will adapt and deliver their public engagement projects in the face of current social distancing restrictions: “We will launch our projects throughout the year, starting with our new online survey [now closed] to find out how this virus outbreak may be changing the way people access local services, particularly if they rely on them for regular care. “Social distancing means we will need to be creative in how we reach people, but there are plenty of ways people can share their experiences with us including online surveys, via our website, social media and email, and over the phone. When we announce each new project during the year, we will let people know how they can get involved, and we will work hard to reach out and listen.” We are the county’s independent health and care champion. We exist to make sure that local people’s views are heard by those in charge of health and care social care and used to help make services better. We also provide information and advice to help people find out about local services and support. Healthwatch Somerset priorities April 2020-March 2021 Accessing local health and care services during the coronavirus pandemic In April, we launched a new public feedback project to find out how coronavirus is affecting people’s experience of local health and care services. People are sharing their stories about how services are adapting, to highlight what is working well and where things need to be improved. This information will be shared with those providing services in Somerset to help them understand how to adapt and deliver effective care during such challenging times. Children and Adolescent Mental Health Services (CAMHS) This project will build on our ongoing review of children and young people’s mental health services. Feedback will be sought from young people through a new Healthwatch Somerset ‘Young Listeners’ project.  Young people from across Somerset will be recruited as volunteer young listeners to engage with other children and young people so that their voices are involved in shaping local services. Access to Primary Care Access to primary care is one of the most common themes of public feedback received by us. Primary care refers to the first place people go to when they need health advice or treatment for symptoms that are new or for concerns about physical or mental health. This includes, for example, GP surgeries, pharmacies, opticians, and community care services such as musculoskeletal clinics. People using primary care have a broad and varied range of access and care needs, for example, disabled access, support for carers, access for older people and homeless people. This year-long research and engagement project will build on previous work looking at access to primary care through GP surgeries. The new project will look in more depth at local provision to identity areas of good practice and at primary care access in care settings. The project is also an opportunity to work with Primary Care Networks in Somerset and the Somerset Clinical Commissioning Group to further explore the development of the wider networks. The nature and timing of this project will be reviewed to ensure it reflects the impact of coronavirus on how primary care is delivered. Supported discharge for patients with continuing health care needs (Pathway 3) This project will look at the overall experience for patients who are discharged from hospital care into care homes due to their continuing health care needs. The aim is to evaluate the effectiveness of the supported discharge process to highlight areas of good practice. The impact on patient’s social needs when they return home will also be considered. Project findings will be shared with local providers, Somerset Clinical Commissioning Group, Somerset County Council and GP practices to support the development of community services in the county. Accessing transport to health and social care services This research and engagement project aims to provide an overview of how transport services in Somerset impact on access to health and care in the county. Research will be carried out to identify gaps in provision, and public feedback will be sought through focused engagement work and other projects undertaken during the year. Waiting time from referral to treatment This is one of the most common areas of feedback to us. The aim of the project would be to understand and contrast the experience for patients who wait long periods between referral and treatment, with those who are seen within the NHS standards waiting time of 18 weeks. We are working closely with Somerset Clinical Commissioning Group to capture patient feedback on this theme with a view to developing this project in the future.

We explain why it’s important to have a plan in place, should you or a loved one become critically ill. While this can be a difficult conversation, planning can help you express your wishes, helping your family and professionals make decisions about your care if you are unable to. The NHS should provide care in a way that achieves dignity and compassion for everyone equally. This means that every person is treated as an individual, whose needs and preferences should be considered – and an Advance Care Plan can ensure this happens. We’ve explained what an Advance Care Plan is, how you can create one, and where to find other resources, based on guidance from the NHS, National Institute for Health and Care Excellence (NICE), as well as Marie Curie and Dying Matters. What is an Advance Care Plan? It is your choice whether you make an Advance Care Plan. Its main purpose is to clarify people’s wishes and preferences, so that their end of life care is delivered to meet those needs. This is important for those with the ability to make decisions now, to consider a time when they may not be able to make such decisions in future.  Why plan ahead? The NHS is encouraging patients, particularly those at the highest risk of COVID-19, to discuss their individual treatment preferences in case they develop the virus. An Advance Care Plan ensures that these wishes are recorded and can be acted upon if necessary. For example, this could include talking about the risks and potential benefits of attempting CPR, as well as ‘Do not attempt to resuscitate’ (DNAR) orders. Helping your loved ones Planning ahead can also help make things easier for loved ones too. Having an Advance Care Plan means they will be able to help doctors make difficult decisions because they already know what you would have wanted. The main questions you should think about The Mental Capacity Act provides a number of ways for people to plan their care and support in advance. Advance statements :   What you want to happen.  These are not legally binding but should be considered carefully when future decisions are being made. They can include any information the person considers important to their health and care. Lasting power of attorney :   Who will speak for you.  This involves giving one or more people legal authority to make decisions about health and welfare, and property and finances. Advance decisions :   What you don’t want to happen.  These are for decisions to refuse specific medical treatments and are legally binding. The following questions can help you to start to think about what is important to you If your health deteriorates, where would you like to receive care? Are there any spiritual or religious beliefs you would like considered? Who should your doctors or nurses talk to if you become unable to make decisions? How you would like practical matters dealt with, such as the care of a pet. Do you have any thoughts about what you would like to happen to your body after you die? Do you have any special requests, preferences, or other comments? Your doctors or nurses can help you understand your options and what sort of care you might need. You shouldn’t feel any pressure to include anything you’re not comfortable with. How do I make an Advance Care Plan? You can speak to your doctor or nurse about planning ahead at any time. It may help to read the  Planning for your future care  booklet produced by the National Council for Palliative Care. Before you make your plan, think about talking your wishes through with your healthcare professional, family and friends. Ask your healthcare professional for an Advance Care Planning form. Some NHS trusts or GP surgeries will have these available on their website. For an example of a care plan, see the  Preferred Priorities for Care booklet . Once you’ve decided what to have in your plan, give a copy of it to the people involved in your care and your family members or friends. This helps to make sure that people around you can follow your wishes. How do I record and share my Advance Care Plan? The Somerset End of Life Care and Bereavement Support website provides information and resources for Advance Care Planning including some information in Easy Read format. If you write the plan yourself You have the final say in who sees your plan. Keep it somewhere safe, and tell people where it is, in case they need to find it in the future. You can keep a copy in your medical notes. You do not have to sign an advance statement, but your signature makes it clear that it is your wishes that have been written down. If you write the plan with a professional If you make your plan with a health or social care professional, it can help if the discussion or any decisions made are recorded. Check that you agree with the notes that have been made, and make sure you receive a written record of your advance care plan, which you can take to show different services. You should be asked if you consent for your plan to be shared with relevant people who provide your health and care. If you consent, your plan should be shared and when relevant, transferred – for example, if your care provider changes. While you have capacity, your advance care plan should be reviewed whenever treatment or support you receive changes. All changes requested should be updated, including to any copies. If you are nearing the end of your life, you may be asked if you would like to review your plan, or develop one if you haven’t already. What is a living will? When thinking about end of life care, some people may choose to have a living will. This is called an advance decision. An advance decision is a decision you can make now to refuse a specific type of treatment at some time in the future. It lets your family, carers and health professionals know your wishes about refusing treatment if you're unable to make or communicate those decisions yourself. For example, you can refuse a treatment that could potentially keep you alive, known as life-sustaining treatment. Other things to think about Organ donation Organ donation in England has moved to an 'opt out' system. You may also hear it referred to as  'Max and Keira's Law' . This means that all adults in England will be considered to have agreed to be an organ donor when they die unless they have recorded a decision not to donate or are in one of the  excluded groups . Your family will still be approached and your faith, beliefs and culture will continue to be respected. You still have a choice whether or not you wish to become a donor.  Get the facts  about organ donation to help you decide.  What do I have to do? The NHS Organ Donor Register is asking everyone to: Record your organ donation decision on the NHS Organ Donor Register Tell your family and friends what you have decided If you would like to speak to somebody about your choices, please call their dedicated line:  0300 303 2094 Coping financially Ask your GP, hospital doctor or nurse to refer you to a hospital social worker or community social worker to help with your finances. As well as that, you can check if you are eligible for any benefits, or perhaps there are certain charities that can help.  Helpful links The information in this article has been drawn from the following guides. These sites provide further information about the planning of care at the end of life, which may be helpful when planning your Advance Care Plan: NHS -  End of life care Marie Curie –  Planning your care in advance Compassion in dying –  Making an advance care plan National Institute for Health and Care Excellence –  Advance care planning Gold standards framework –  Advance care planning

We have launched a new survey asking local people to share their stories to help identify how health and care services are adapting and working well during the coronavirus outbreak, and to highlight common challenges that need to be addressed. The survey [now closed] gives local people an opportunity to anonymously share their views and experiences of how coronavirus has changed the way they access services.  We will review this public feedback and report back to those in charge of health and care services to help them learn and adapt, now and in the future when the virus outbreak has passed. Healthwatch Somerset Manager, Hannah Gray , explained the aim of the survey: “We recognise that public feedback is essential to influence positive change in local health and social care services, this includes how to effectively manage services and deliver support during exceptionally challenging times. “The enormous pressure placed on services due to the coronavirus is likely to impact on how people get the care and support they need, particularly if they have regular care needs. Also, people are likely to have different experiences depending on their needs and the severity of their symptoms. We are asking people to share their stories so that we can help our amazing, dedicated health and care professionals to understand how best to adapt and manage services in these difficult crcumstances.”

We can help health and social care organisations to communicate clearly and effectively with local people about the coronavirus and the impact on services and support. Our volunteer Readers Panel reviews reports, leaflets and other documents, to ensure information is accurate, clear and user-friendly. We support a range of organisations including NHS trusts, Clinical Commissioning Groups, Somerset County Council, charities and service providers. Healthwatch Somerset Manager, Hannah Gray , explains more about the service: “Our Readers Panel helps organisations communicate using clear and appropriate language, so that they reach the people who use their services. Our readers are all volunteers, who are experienced in this work and committed to helping organisations improve the way they deliver their services, including through the information they provide. “At times of crisis, effective communication is crucial. There’s so much information being put out about coronavirus as organisations seek to communicate with local people to convey advice and messages of support. Our Readers Panel can help make messages effective.” Organisations who need support from our Readers Panel, can call us on 0800 999 1286 or email  info@healthwatchsomerset.co.uk .