What good health and wellbeing looks like to you What good health and wellbeing looks like to you

This summary aims to offer an idea of what we heard when chatting to our community about what good health and wellbeing looks like to them.

Background

NHS West Clinical Commissioning Group (CCG) works in a three-neighbourhood model. By this we refer to and Aughton; and ; and and the Northern Parishes.

Northern Parishes As commissioners of local healthcare, Ormskirk it’s important we Skelmersdale understand what local residents think of the health services they use, what concerns they have and understand what factors affect their day to day health and Rufford wellbeing.

Burscough Ormskirk Skelmersdale

2 Our conversations We wanted to talk with our community and one of the more effective ways we have found to do this is to simply visit places we know local people come together already, such as a cup of tea at the community centre, a weekly exercise class or a health condition support group. We had conversations with our This document aims to offer a community across the three snapshot of some of what we learned, neighbourhoods of it is broken down by each question we during July and August 2019. asked, and includes quotes alongside the summary to help paint the picture A list of the groups we visited can be of what we heard. found towards the end of this report titled ‘who we spoke to’. In the same way that we recognise everyone has different ways they We used a survey to help capture prefer to communicate, we also need views. We took this with us everywhere to carefully consider how different we went and also shared it through individuals and groups can be reached. various channels, these included: local media, stakeholders such as local For example, some of our community MPs and West Lancashire councillors, will be avid readers of the local paper, local partner organisations e.g. Edge some will be very active on social Hill University and West Lancashire media and others may frequent their Borough Council, Patient Participation community centre for a weekly class Groups of local GP practices, social or read the noticeboards in their local media, schools, the West Lancashire newsagents. Voluntary Community and Faith Sector (VCFS), CCG newsletters and board We therefore need to tailor how papers, My View (CCG’s public and we promote news, developments patient group) and GP practices. and opportunities to get involved in different ways so that we are reaching In total we had conversations with a cross section of our local community more than 730 people and received in West Lancashire. We try to do this survey responses from more than as best as possible with the resources 350 residents across a broad range of we have. We publish all our news interests and demographics. The age announcements on our CCG website range that we spoke ranged from 17 and social media, as well as distributing to 85 and over. them directly to our stakeholders.

3 1. What does good health look like?

• The most popular option, as • Overall though, respondents had chosen by nearly a quarter of all two main perspectives – the first respondents was that good health is was concerned with being in good healthy eating/diet, regular exercise health, free from illness and pain; and good mental health and the second was concerned with wellbeing coping as well as possible with illness and pain. Both perspectives made reference to the need for good health services in order to provide or maintain ‘good health’.

“The ability to lead an active life – to run and walk without pain. A positive mental outlook and a feeling of wellbeing. To have no medical conditions that limit my ability to experience life to the full.”

“To me good health means or looks like avoiding any infections which may worsen my condition.”

“Coping after being diagnosed.”

“Having access to health services in a timely and appropriate manner. Having education about health and ways to either improve my health and/or have good control over long term conditions. Maximising my health to its full potential. Keeping up to date with immunisations, annual checks, smears etc.”

4 2. What are the things that contribute to current health and wellbeing?

• More than half of all respondents felt that support/lack of support from and relationships with family and friends was key

• Direct health matters; ‘having stress/anxiety/depression’

• NHS services – GP/physiotherapy/mental health services

“Good food and a balanced diet. Freedom from anxiety e.g. finance, work, family. Ability to be physically active – run and walk. The money to participate in activities I enjoy. Love of my family and a good circle of friends.”

“Finance, good family links, good job, owning my own house, living in a good area, good schools, low crime. Being able to afford good food. Being able to afford 2 holidays per year.”

“Without my family I would be in dire straits. Anxiety and stress of finances. Mobility issues are causing me to put weight on. Being unable to work through ill health has created issues with social welfare making me feel socially isolated.”

“Finance have a negative impact on my health and wellbeing, also stress/anxiety – negative impact. Housing is a nightmare. Family has a positive impact.”

“Lack of time due to working hours. Stress brought on by family issues i.e. caring responsibilities. Sometime lack of time means not cooking proper meals or exercising.”

5 3. What are the things that matter to you the most?

• Relationships (friends/family/spouse) • Health and healthcare remain a and keeping active were stated as strong motivator in people’s lives the most important. and raises expectations.

• Access to medication was another • Almost a fifth of those who stated popular choice. that medication mattered most to them either said this exclusively • More than a quarter of respondents or said it first, indicating this was mentioned other health related their main priority. This has a strong matters as being of prime significance for the local health importance, including access to service. good medical services, staying healthy and having good mental health.

“I have always received excellent care from my GP practice. I also make use of local pharmacies which I feel are an untapped resource.”

“My GP is the best I have had for a very long time. Also, physiotherapy at the Ormskirk hospital was excellent.”

“My new GP practice is fantastic. Staff so friendly, easy to get an appointment. Range of services brilliant.”

“Our local GP practice is excellent. We can get appointments within 1-2 days and the GPs are all very good. Also, the hospital services at Ormskirk have been excellent when I have been referred there.”

“NHS 111 has been invaluable to me and my family in terms of advice, out of hours help and appointments. It was NHS 111 operator that got an appointment for my teenager out of hours and in the nick of time.”

6 4. The NHS provides a range of services. What are the most important of these services to you and how has your experience been?

• More than 90% considered GP • More than half of respondents in the practices the most important health Northern Parishes chose pharmacies service as an important health service, again this is higher than both Skelmersdale • This was followed by A&E, Pharmacy and Ormskirk (38 – 41%) and Dentist which were the next most important services, but only • More than 82% of people who considered important by just 40% of completed the survey said that they respondents had received a good experience of health services. • Nearly all respondents from the Northern Parishes (97%) chose GP practices as an important health service. This is slightly higher than in Skelmersdale (85%) and Ormskirk (86%).

“Long term excellent care from the hospital clinic and consultant team I attend. It is what I would term “personalised” medicine and “preventative” medicine. Being able to regularly go to my hospital appointments and see the consultant has kept me relatively well for a long time. I would NOT welcome Apps or Skype or telephone appointments.”

Further comments were made about other services, such as hospices, mental health services, the Falls Clinic, Mind Matters, paramedics and ambulance staff, the diabetes prevention programme, community restart, the Lancashire Wellbeing Service and Specsavers

“The service which I have found most beneficial is ‘Community Restart’. During a time, I was unable to leave the house and felt like ending my life, they showed me patience, understanding, non-judgment and compassion. They supported me to not only leave the safety of my house but to attend appointments, visit gym classes, make friends and socialise in support groups.”

7 5. Are there any NHS services within your neighbourhood or surrounding area (or lack of services) that cause you concern?

• People commented on the difficulty they face when trying to access their GP

• This difficulty in accessing GP services was seen as a key factor in people using other services instead

• Other services that people expressed difficulty in accessing (this includes lack of appointments / long appointments / delays) or were of poor quality, included A&E, mental health services, podiatry, dermatology, physiotherapy, ophthalmology, preventative services, little/no help for carers and NHS dentists.

“Difficulty to get a GP appointment. Lack of communication / ineffective communication from the surgery regarding what services are available. Lack of information/referral to community groups / clubs that might benefit my health (yoga, walking, tai-chi, dance etc.)”

“Having to wait three to four weeks to see a doctor, which is unacceptable. This situation will be further compounded by the huge building development which is still going on in our village.”

“Getting a doctor and not waiting weeks to see someone. Waiting outside the doctor’s surgery so you have a good chance of seeing a doctor as phoning up is a waste of time as all appointments have gone by the time you get through.”

“Length of time to get an appointment at doctors. Being diabetic, the lack of easily accessible support.”

8 “Difficulty getting appointments with GP. The fact that you can only have one problem dealt with. Then have to wait another fortnight to get a small problem dealt with.”

“Privatisation of the NHS and lack of doctors. Wasting money on opening things like a hub for prescriptions.”

“The lack of support for children with additional needs. The stopping of community restart worries me. Social isolation is a massive contributor to poor mental health.”

“Mental health provision. Too few beds locally which means the patient and his or her relatives have to travel too far to visit.”

“Counselling and physio services are two which cause me concern. The waiting lists for both are extremely long.”

9 6. Do you feel, given your needs, that the right range of services are available in your neighbourhood?

We received lots of feedback for this question, so have grouped them into some themes that emerged from these conversations.

Access Support for older people

• Access proved to be an area of • Services for older people were particular concern to residents considered to be of significant importance, such as support from • Public transport which impacts all social care services services, health and leisure. • Closure of day centres and care • Digital technology, and the need centres. to consider that not everyone can access or afford modern technology.

• The level and quality of information Public Transport given to residents both about what is available, where and how this • Many people rely on public transport works to get about, access services and meet people/friends/family

• The perceived poor availability of Leisure Facilities public transport in West Lancashire – both bus and rail, which were not • Concern that some leisure centres only seen as an issue in rural areas, are under threat of closure but also felt in Skelmersdale and • Concern that if leisure centres are Ormskirk and which had a knock- removed or shut, that the activities on effect on other services including within these centres will stop and GPs, health centres and A&E. lead to residents feeling socially • Access to services from rural areas is isolated. This was particularly felt by a big issue older residents

• Leisure facilities and specifically access to these services (public transport to and from) is a big concern.

10 Social connections “Public transport (particularly trains) are not frequent enough to use on a regular basis. • There was concern of the impact The leisure facilities could be improved - Park that social isolation plays on mental Pool looks very tired.” (Northern Parishes) health and wellbeing.

• It was recognised the important role that friends and family play in “No... public transport is awful, services supporting a healthy lifestyle. More are often out of the district, there are than 80% of respondents said that more houses being built in Skelmersdale, their children/spouse/family were the but we do not have the facilities to cope thing that mattered most to them with this such as schools, GP practices etc.” (Skelmersdale) • After family and friends, being able to lead an active life, be it through exercise and/or activities was a close “No bus services without lengthy walk to second. bus stop. Social care is stretched too thin and education services rely on parental fund raising to meet needs.” (Ormskirk) Economic factors

• Work, or particularly the lack of it “We have no buses that come around where contributed significantly towards we live; they stopped them”. poor health, in particular mental health and wellbeing “Transport poor, GP practice oversubscribed, • Cuts to other public or community can’t get appointments, continuing to build services and support groups housing with no infrastructure.” • Cuts to services that impact upon mental health and wellbeing, as well as those for the more vulnerable in “Public transport poor in rural communities. society such as older people, people Lack of youth resources/programmes. who are socially isolated and people Poor social care provision. Lack of social living with long-term conditions prescribing outside Skelmersdale. Poor access to talking therapies/CBT. • Cuts particularly in social care and Poor access to CAMHS.” wellbeing support services.

11 7. Do you feel, given your needs, that the right range of services are available in your neighbourhood?

“Mental health care. Social services. Transport. Secondary schools. Lack of leisure facilities. Poor shopping facilities.”

“Social care. From personal experience I have seen how poor this is. This should be run by the Council not cheapskate profiteering private companies, who exploit their staff and in turn offers a woefully inadequate service. It is not the fault of the staff who are put under great pressure for a pittance wage.”

“Lack of social care for older people and disabled. Lack of council housing. The 2 GP surgeries are not big enough and no longer can supply the numbers of people living in the area. The hospital is split into 2 centres and causes a lot of people long distance issues.”

“Lancashire County Council are stopping wellbeing and although not an NHS direct service, this helps take pressure off the NHS and works hand in hand bridging gap between NHS & community.”

“Many services are not functioning well. Also, so many are left to voluntary bodies and then it becomes a postcode lottery.”

“A fully functioning comprehensive range of services, treatments & medications publicly provided in the NHS in West Lancashire; affordable social housing; affordable and regular public transport; good quality consistent education catering for all abilities particularly for children with special needs and learning disabilities; good quality, well paid employment opportunities; affordable leisure facilities; good quality shopping opportunities; lack of affordable, good quality, publicly provided social care; lack of access to justice & affordable legal advice.”

12 8. Are you concerned about accessing any health services now or in the future?

• More than half of respondents • Fear that some people may become expressed concern at the future of digitally excluded or were unable to NHS healthcare services in West access/afford the latest technology. Lancashire. • Some of the causes for this concern around health services included: a growing population and housing developments without supporting infrastructure; staff shortages and access to primary care services, which added pressure on health services, and the perceived privatisation of the NHS.

13 Who we spoke to

Ormskirk Skelmersdale Burscough and the and Aughton and Up Holland Northern Parishes

Twinkle House (supports children/ Prostate Cancer Support Group Little Civvies (Mother and Toddler young people with disabilities/ (support group for men living with Group) additional needs) prostate cancer)

West Lancashire Ark (help for the Tai Chi (for U3A Aughton and Bounce and Rhyme (Mother and unemployed, homeless and ex- Ormskirk) – (+50-year olds) toddler group) offenders)

Community Group Café (students) Scrabble Club (all local community) () – (all local community)

Greenhill Community Hub – (all Creative Writing/Brain Boosters – Mature Movers (+50-year olds) local community) (all local community)

West Lancashire Pensioners Forum Reading café – (all local Seated Exercise Group (+50-year (+50-year olds) community) olds)

Brookside Residential Care Home Skelmersdale Morris Dancers (all Coffee Etc. (Community Café) – (all (staff and elderly residents) local community) local community)

Art Group (Ormskirk) – (all local Active line Dancing – (all local Nifty Fifties – Forever Fitness (+50- community) community) year olds)

Tai Chi Yang Style (all local Veterans Group Football (social Art Group (Banks) – (all local community) group for war veterans) community)

Wildlife Trust Incl. ‘MyPlace’ Toddler & Rhyme, Craft Group & Tai Chi for Health ( ecotherapy mental health group IT Users at Skelmersdale Library Women’s Institute) – (all local (all local community) (mother and toddler group) community)

Skelmersdale PULSE (all local New Beginning (mental health community) group)

West Lancashire Women’s Institute Junk Food Café (all local (women’s skills and social group) community)

Refugee and Asylum Group Morrison’s (Ormskirk) – (workforce) (refugees and asylum seekers)

U3A Aughton and Ormskirk – Tanhouse Pensioners Club (social Horizon Coffee Morning (+50-year group for elderly residents) olds)

Ormskirk Dementia Café (support group for people living with dementia)

14 9. What happens next?

These views will be published by Join My View the CCG and will be considered alongside our partner organisations Views of patients and the public are as we develop essential to what we do and vital Partnership. This partnership is about to the future of healthcare in West working together to better serve our Lancashire. By joining My View, not local population so can help them to only will you receive a regular news be happier and healthier. bulletin from us, you will also: As a CCG, we are always looking • Receive invitations to future events at how we can involve and engage the CCG and its partners host in the with members of the public. From the local area conversations we had, we know that • Receive useful information about we can do more to help our people local health services understand the role of the CCG in West Lancashire and understand which • Be involved in our commissioning health services are available to them. plans and decisions • Find out how and why decisions about your local health services were Sharing your views made If you have any views or experiences • Have the opportunity to take that you would like to share, please part in focus groups and public contact NHS West Lancashire CCG consultations [email protected] 01695 588 000.

To join My View, visit www.westlancashireccg.nhs.uk/myview, email [email protected] with ‘My View’ in the subject header, or call 01695 588 000.

15 Get in touch If you have any feedback or ideas relating to involvement, we would like to hear from you 01695 588 000 [email protected] @WestLancsCCG www.facebook.com/NHSWestLancsCCG

NHS West Lancashire CCG, Hilldale, Road, Ormskirk, L39 2JW