The Experience of Outpatients
In 2022, Lewisham and Greenwich NHS Trust (LGT) commissioned Healthwatch Bexley, Healthwatch Greenwich and Healthwatch Lewisham to jointly deliver an extensive engagement programme over six weeks to understand the experience of patients when using LGT outpatient services with a particular focus on access and communication.
Project Objectives
- 1. Capture feedback from adults and Children and Young People (CYP) who have used LGT Outpatient services within the last six months to improve patient experience and outcomes.
- 2. Understand the challenges faced by patients in accessing outpatient services.
- 3. Understand any communication issues/barriers that patients experience.
- 4. Encourage patients to have further involvement with LGT Outpatient services through participation on a user group which will support the reshaping of outpatient services to meet patient needs
Project Outcomes
- 1. Provision of timely and accessible findings and recommendations which will support LGT in developing the Outpatient services, based on patient feedback.
- 2. A list of patients who have expressed interest in joining the Outpatient User group for LGT to follow up with, once the mechanism has been established.
- 3. Communication with patients outlining LGT’s response and intended actions to the feedback
During October – November 2022, 946 people completed our survey on their experience of the Outpatients services. We asked questions on contact method preferences, levels of information and communication about - and at - the appointment, getting to the right place onsite, explanation of any diagnosis, treatment and follow-on, and staff empathy.
The majority of questions had a free-text option, enabling participants to describe their views and experiences. In this analysis we examine feedback as a whole, and look closely at age, gender, ethnic background and existing conditions, to establish any findings that may be especially relevant to certain groups.
Key Themes
In addition to the main survey, we conducted focus groups and recorded case studies, engaging with 52 local people in total which included 19 case studies. The Groups included representatives from Carer’s support and Age UK. Case studies were conducted at Greenwich.
Booking and Information
• Notification by written letter is preferred as it serves as a useful reference.
• The majority of attendees feel that the information in the letters is insufficient and, in some cases, inaccurate – such as regarding directions.
• Many are waiting for confirmation of initial or follow-on appointments.
• Those making contact to book, re-arrange or cancel their appointments cite poor telephone access and administrative errors – due to systems or staffing. Some have experienced significant difficulty in resolving booking issues.
• Patients and carers have received bookings for days or times they have stated they cannot make.
Appointments
• Face-to-face appointments are preferred by most attendees.
• Waiting times in excess of 3 hours are experienced for booked appointments, with some not happening at all on the day.
• Patients comment on understaffing and at times a ‘chaotic environment’ with concerns for staff welfare expressed.
• While some feel that clinical and diagnostic information has been good, a majority would like more detail, and greater opportunity to ask questions.
• Older people complain that care is not holistic. One partially deaf patient was inappropriately booked for a telephone consultation.
Staffing
• Staff are generally commented to be kind and helpful.
Our Recommendations
Based on the findings we developed the following recommendations:
1. We recommend that the Trust reviews the findings regarding the preferred method of contact to further develop the way outpatient departments communicate with patients. For example text message was the overall preferred method of contact for patients, however email was the most preferred overall method for middle aged respondents, those from Asian backgrounds and Carers.
2. Although we recognise that 92% of respondents felt they received enough notice for their appointment, it should be noted that 8% felt they received less than 48 hours’ notice and therefore we recommend improvements to ensure consistency.
3. Improved telephone access to outpatient departments is needed, including improving the automated service as well as through providing clear information about how to reach relevant departments.
4. Ensure voice messages left by patients are regularly monitored and responded to in a timely manner.
5. Improve systems to allow patients who call to rearrange or cancel their appointments.
6. Review contact methods to ensure they are suitable for patients with sensory disabilities. This should be done in conjunction with the Trust’s Accessible Information Standard policy and process.
7. Ensure consistency when sharing information about the appointment including who they will see at the appointment, what it will involve how long it will take and clear instructions for where the appointment takes place. This is particularly important for people with a Sensory/Physical Disability or Mental Health condition.
8. Provide additional support and clearer instructions to help people with a sensory disability find their appointment when onsite at the hospital.
9. Ensure treatment explanation is consistent and sufficient across all Outpatient clinics. Patients should be told details of their condition, treatment and follow-up steps. Good practice should encourage patients to become further involved with their treatment by asking questions. More specific leafleting before and after appointments would be valued by patients. This is particularly important for people from a Black background.
10.Improve the quality and consistency of information relating to test results or follow-up contact. This is especially important for people aged 85 and 54 over, those from White other backgrounds and people with a Sensory or Physical Disability.
11.Services should consider patient availability when offering appointments slots. For example, consideration should be given to unpaid carers who have caring responsibilities.
12.Review and learn from instances where appointments run behind schedule.
Download the full report here
If you need this report in an alternative format, please contact: info@healthwatchgreenwich.co.uk
