Better Care Together Engagement Report

January 2020

If you would like this report translated into another language or alternative format such as large print, Braille or audio, please contact us using the details in section 9.

Contents

1. Executive Summary ...... 3 2. Why did we want to talk to people? ...... 4 3. How did we inform people? ...... 5 4. How did we involve people? ...... 6 5. What did people tell us about their views and experiences of urgent care? ...... 7 5.1 Engagement workshops / deliberative events ...... 7 5.2 Meetings ...... 18 5.3 Survey...... 20 5.4 Emails to the CCG ...... 31 5.5 Postcards ...... 32 5.6 Letters ...... 32 5.7 Petitions ...... 32 6. How many people did we reach and engage with? ...... 34 7. What were the main findings? ...... 35 8. Review of engagement by the Stakeholder Reference Group ...... 36 9. Contact details ...... 37 10. Appendix 1 – Case for Change document distribution with posters and flyers...... 38 11. Appendix 2 - Demographic information for those completing the survey ...... 42

1. Executive Summary At the start of 2019, NHS Guildford and Waverley Clinical Commissioning Group commenced a programme of work focussed on developing robust urgent care provision that meets the needs of the population it serves. This work would need to consider the guidance issued by NHS England in 2017 on Urgent Treatment Centres but this was not the sole focus for the programme.

It is essential for those planning health care to involve patients and the public. That’s why we embarked on a programme of engagement in September 2019 to find out people’s views regarding urgent care in Guildford and Waverley. Just over 12,400 separate encounters occurred as a result of this engagement, although we recognise that individuals will have engaged using multiple channels.

I am pleased to present this report of the views and feedback received. It is good to hear such a wide range of views from a wide variety of stakeholders across Guildford and Waverley. The future provision of urgent care that robustly meets the needs of our population is a priority for Guildford and Waverley Integrated Care Partnership (ICP). We know that there is variation in provision and we now understand more about what is important to those living in our area who took part in this engagement.

We are using this feedback to inform the development of our Urgent Care Strategy. A longer-term strategy is essential for Guildford and Waverley ICP to ensure we work together and consider how best to meet the urgent care needs of our citizens. We plan to publish this strategy at the start of 2020.

A large part of the engagement feedback focussed on Urgent Treatment Centre(s). The CCG will continue to work through options over the coming months that relate to this. As stated throughout the engagement period, the CCG will carry out a formal public consultation should any proposed options indicate that a substantial service change would result if implemented.

Thank you to everyone who took part in our Better Care Together engagement. We welcome all comments and views regarding the services we commission, design, plan and fund. You will find our contact details on page 37.

Dr Sian Jones Clinical Chair

2. Why did we want to talk to people?

In July 2019, NHS Guildford and Waverley Clinical Commissioning Group (CCG) published a document and an accompanying video that described why we wanted to talk to people about urgent care provision across the Guildford and Waverley geography that the CCG covers. The ‘Better Care Together Case for Change’ described the various local and national factors that meant we needed to review how urgent care is provided and, importantly, what people’s experiences are of our current urgent care system.

We wanted to talk to our local population about why our current services need to change and gain their views and feedback on current and potential future urgent care services.

There are many ways to define urgent care, but it is usually understood as medical care that is provided for illnesses and injuries that require prompt attention but are not serious enough to require an emergency service.

The current urgent care system in Guildford and Waverley is made up of a number of largely separate services, including (in alphabetical order):

• An A&E service at Royal Surrey County Hospital • Community Pharmacists • CYP Haven Guildford • GP Out of Hours which is accessed by calling NHS 111 and includes some home visiting services • GP practices providing pre-booked and same day appointments • A Minor Injuries Unit at Haslemere Hospital • NHS 111 • Safe Haven Guildford

We want to be able to provide a consistent offer of urgent care services in Guildford and Waverley for all our population. We want patients to be able to easily understand how to access the service they need. We want them to be able to access these services when they need them, and we want the services they receive to be of high quality.

Engagement on the Case for Change, which describes the various factors affecting the need to review urgent care provision, began on 24 July 2019 and ended on 29 September 2019. This report describes how we sought to engage with a broad range of people living in different parts of the Guildford and Waverley area to ensure we gained a balance of views that would inform our next steps. Importantly, it describes the themes arising from the huge range of feedback received by the CCG through emails, postcards, letters, workshops and face-to-face meetings.

3. How did we inform people?

Local print media 18th June 2019 - media statement 24th July 2019 - press release

Case for Change 2,500 booklets printed and distributed plus posters and flyers Easy Read version published on the CCG website and publicised with key partners Video produced & published on CCG website explaining the Case for Change with British Sign Language and subtitle options included.

CCG website and social media Dedicated webpage created with key documents; video explaining the case for change; dates and venues for engagement events; link to online survey and contact details for sharing of views. Posts created and shared from CCG's Facebook and Twitter accounts

Email Information shared via email with over 200 individual key stakeholders including councillors, voluntary sector leads, charities, health and care leads, schools and colleges and community groups

All information regarding the Better Care Together programme was published on a dedicated webpage on the CCG’s website and updated with information throughout the engagement period.

Summary details of the organisations informed by the CCG can be found in Appendix 1.

4. How did we involve people?

Stakeholder Reference Group 20 members representing different communities and interests reviewed, amended and endorsed all materials and plans relating to the Case for Change engagement Monthly meetings

Engagement workshops Held in Godalming, Cranleigh, Guildford centre, Stoughton, Haslemere and Liphook. Two daytime and four evening events over three weeks (two events per week). Presentation followed by table top disussions and questions and answers session.

Special interest groups Discussed case for change at various forums including Hard of Hearing Forum, Older People's Network, Disability Empowerment Network, Patient Participation Group, Patient & Public Engagement Group, Cranleigh Parish Countil and Waverley Council committee.

Online survey 8 questions regarding urgent care asking about previous and current use of urgent care services and what people felt should be prioritised Closed questions and free text options Link on website and shared through Citizen's Panel (Guildford and Waverley residents only)

Contact Us Dedicated email address FREEPOST address for letters Postcards (FREEPOST) distributed Telephone and SMS text number

5. What did people tell us about their views and experiences of urgent care?

It is important to note that the responses to any engagement or consultation will tend to be higher in areas where people feel they are most likely to be affected. As such, this report is representative of those individuals who wanted their views to be taken into account and not representative of the population as a whole.

5.1 Engagement workshops / deliberative events Six workshops were held across three separate weeks from 5 to 17 September 2019 as follows:

Day Date Start Finish Venue Address time time Thursday 05/09/2019 6pm 8.30pm Godalming Ockford Road, Masonic Hall Godalming, GU7 1RQ

Friday 06/09/2019 10am 12.30pm Cranleigh Village Way, Village Hall Cranleigh, GU6 8AF

Tuesday 10/09/2019 10am 12.30pm Emmanuel Shepherd's Church Lane, Stoughton, GU2 9SJ Thursday 12/09/2019 6pm 8.30pm G Live, London Road, Guildford Guildford, GU1 2AA Monday 16/09/2019 6pm 8.30pm The Haslewey, Haslewey Lion Haslemere Green, Haslemere, GU27 1LD

Tuesday 17/09/2019 6pm 8.30pm Liphook 2-10 Ontario Millennium Way, Liphook, Centre GU30 7LD

The following steps were taken when booking the venue to ensure all workshops were accessible:

• Parking was available on the same level as the venue’s main access. • Where the room used for the workshop was not on the ground floor, a lift was available. • All rooms were accessible via wheelchair. • A public address system was installed ahead of each workshop that included microphones, speakers suitable for large rooms, high quality display equipment and a hearing loop. • British Sign Language interpreters (two) were available at each workshop.

Attendance at the workshops ranged from four people in Stoughton to 134 people in Haslemere:

Location Number of participants

Godalming 14 Cranleigh 30 Guildford centre 9 Stoughton 4 Haslemere 134 Liphook 12

Due to the varying levels of participation, each workshop ran slightly differently although all focussed on the same themes of urgent care experiences and views about current and future provision, as broadly described in the agenda below:

Activity Welcome and agenda Urgent care in Guildford & Waverley Your urgent care experiences – round table discussion Exploring urgent care in different situations Principles for future urgent care provision Close

Each workshop was led by a member of the programme’s Clinical Working Group aside from the workshop in Stoughton. Members of the CCG’s Communications and Engagement Team facilitated the workshop discussions whilst directors within the CCG delivered part of the presentation that began each workshop. All were available to answer questions during and after each workshop.

Theming of feedback No two workshops were the same.

There were noticeable and significant differences in the volume as well as the type of feedback depending upon where the workshops took place.

All of the discussions, including the clinical scenarios, were designed to elicit feedback on existing services and what is needed to improve the quality and experience of care. Feedback from each workshop has been themed as a whole by location of workshop.

5.1.1 Godalming Reflecting on their own experiences of requiring urgent care, participants highlighted the following:

i. Confusion regarding where to go or who to call in an urgent care situation: − ‘Confusion about what Primary Care provides’ − ‘It’s not clear where people need to go’ − ‘It is confusing’ − ‘Need a competent person – someone in the GP practice – better signposting so know how to react’ − ‘Scared to phone for an ambulance’ – discussing anaphylaxis − ‘Frustrating and confusing’

ii. Accessibility − ‘Moving care closer to home is absolutely right’ − If I have an urgent need I go to Woking Walk In Centre and get seen within the hour – brilliant – go there from Normandy’ − Transport is important. Father-in-law lives in Wonersh – no public transport so have to get taxis to GP practice’ − Accessible information is really important’ − ‘Father in law had a fall and was injured; called GP but no appointments’ − ‘Dead spots of mobile coverage [linked to conversation regarding 111 and technology’ − ‘Ask My GP [use email to interact with GP practice] is very good –’

iii. Different ways of accessing care (in some cases these were suggested as a means to reduce traffic congestion) − ‘I have never called 111’ − ‘I have [called 111] and it was very good’ − ‘Pharmacist – ours is very good; offering BP tests. They are important sign-posters’ − ‘I would much rather log on and use a Skype service’ − ‘We should be looking at technology’ − ‘We need more First Aiders’ − ‘Mental Health First Aiders sound useful’ − ‘A Multi GP Practice [example given of one in Suffolk] with an onsite pharmacy, operating room, nurse practitioners, blood testing and other specialists could offer more urgent care’ − ‘Woking Walk-In Centre – very keen to retain it’

iv. Principles of urgent care – themes − Locally accessible, including locally accessibly diagnostics − Find a way to reduce traffic congestion − Explore different locations – supermarkets, pharmacists − Timely − Consistent

5.1.2 Cranleigh The following themes arose from discussions about people’s own urgent care experiences:

i. Use of sites/buildings − ‘Old Cranleigh Hospital needs to be saved as a building’ − ‘Why can’t we have a Minor Injuries Unit in Cranleigh’ − ‘Local minor injuries’ − ‘People want a minor injury unit back’

ii. Accessibility − ‘Can’t get a GP appointment so will go straight to A&E’ − ‘Paramedics service [in Cranleigh Medical Practice] needs to be a drop in’ − ‘Improve GP services’ − ‘Locally, you could improve local GP practices/services – it’s what people know’ − ‘Minor stuff could be dealt with locally’ − ‘Need to publicise services e.g. Safe Haven services’ (mentioned twice) − ‘Signposting – make more known in our surgeries’ − ‘CYP Haven – doesn’t say what it is’ − ‘Be good to extend the hours of the CYP Haven – into the evenings for example’ − ‘In Cranleigh there is currently no option if you have a bad cut other than going to A&E’

iii. Different ways of accessing care − ‘Have a paramedic in a GP practice – great idea’ − ‘Would it be more sustainable to have a nurse on-call rather than a doctor, or a paramedic on call?’ − ‘Improve 111 – people aren’t trained and they could be sending ambulances unnecessarily’ − ‘I would be happy with a same day Hub appointment [if 18-month old with high temperature]. It would be OK to see a nurse but only if they can prescribe’ − ‘Need more nurse prescribers’ − ‘Could the practice have an urgent care line staffed by a qualified nurse as people’s first reaction is to call surgery [poorly toddler]’

Although not a major theme at the workshop, the building of new homes near to Cranleigh did come up in other meetings. In the workshop, one person mentioned that ‘1,700 houses have just been passed which will increase population and affect services’. There is concern about the varying impacts of local housing developments on existing infrastructure.

5.1.3 Stoughton Participants in this workshop in north Guildford were largely focussed on the opportunities for developing GP practices to be better able to manage demand from patients for same-day care and experiences and learning from use of other same-day services.

It was also queried whether London weighting (which means people working within a certain radius of the centre of London receive higher pay for the same NHS band) should be extended into Surrey given that the cost of living is also considerably higher than the national norm; this could help address the workforce shortages.

i. Dissatisfaction with primary care − ‘Four week wait to see my GP’ − ‘Getting access to my GP is my main concern’ − ‘Can’t guarantee which GP you will see’ − ‘Lucky to see GP within two weeks’ − ‘Locum GPs don’t know me and not prepared to make referrals and need to see my GP’ − ‘Locum GPs handle only urgent need’

ii. Good experiences of primary care and learning from elsewhere − ‘Larger centre – GP led, 7 days a week – that’s what’s needed across the board’ − ‘Use of the telephone by GPs – seems like a good idea’ − ‘Who do I trust? My GP practice’ − ‘Ash Vale Surgery – on the day phone call with GP works brilliantly’ − ‘Waiting appointments – works really well for when people DNA [Ash Vale]’ − ‘Being able to talk to your GP who knows you (has details) would be amazing on the day’ − ‘Seen within an hour – triaged by a nurse [other GP practice]’

iii. Support for a dispersed model of urgent care: − ‘Dispersed model accords with the need to reduce car travel and the climate emergency’ − ‘Surely more dispersed that people can get to would be better’ − ‘Equip people in the community to have discussions about mental health e.g. hairdressers, scout leaders’ − ‘Suicide intervention course – more volunteers are needed who are available and known in the local community and can signpost’ − ‘Godalming Naval Club – we leave notices up to seek out Maggie who helps people in crisis’ − ‘Role for the VCF sector – community responder for MH issues – link with social Prescribing’ − ‘Community First Responses (SECamb) are very limited in what they can do and prescribe; it’s a voluntary role. Could use them much more for MH problems – works best in a village/rural areas’

iv. Views of other services − NHS 111 o ‘Good experience of 111: Spoke to a doctor; Referred to HASTE; Referred to A&E; Absolutely fantastic’

o ‘I am not really sure about 111 – I don’t really trust it’ − Pharmacists: o ‘They cannot prescribe anything’ o ‘They will often advise me to just see a GP’ o ‘Not confident they have the right skill set to diagnose and treat’ o ‘So many people have spoken to a pharmacist but not very useful’ o ‘They can’t do anything useful’ o ‘Evening pharmacy – don’t know when they are open’ o ‘Surrey Advertiser – used to publicise opening hours each week’ − Opticians: o ‘Not sure what they do’ o ‘Would prefer to see a GP [with an eye complaint]’ o ‘Look like they are there to sell you glasses’ o ‘Pointless trip’ − LIVI: o ‘Much better along with telephone conversations, especially for students’ v. Principles − Local − Accessible − Prescribing ability − 7 days per week − Open all hours − Physically accessible − Available in evenings for commuters

5.1.4 Guildford centre The discussions in Guildford were wide ranging. The proximity of the University led to more focus being on services that meet the urgent care health needs of students, with mental health being the main priority for participants.

a. Initial thoughts on case for change and current urgent care system − Staff in A&E are fantastic − One recent A&E experience shared where patient had to wait 2 hours for initial triage on very busy day where nurse who should have had 6 patients to look after had 16. Patients were on trollies in corridors and people bleeding and vomiting were not seen to for over an hour. During this shift – none of the nurses took their break and this is unacceptable. − Experiences also shared that getting answers and action on the presenting issue also takes too long – people bounced around different departments for hours (in one case 17 hours) before any indication was given about how the issues would be resolved − GP access is an issue in some areas – one patient reported not being able to get an urgent appointment for 7 days − Patients are not aware of the options available to them so don’t know which is the most appropriate service to go to − 111 – when it was first launched people felt it was a team of ‘screen readers’ replacing what had been a very good service (NHS Direct) so the public perception of 111 is not positive − 111 needs to be the fulcrum

b. Appropriate services for students (at University of Surrey) − Surrey University and other higher education organisations are under-resourced to deal with mental health problems facing young people. Security staff from the University have often walked students down the hill to the Safe Haven when they are feeling suicidal because the University doesn’t know how to deal with it. However, Safe Haven is not always the right therapeutic environment for people of this age. − Appropriate support for students is a gap that needs to be addressed – neither preventative nor reactive support in crises are resourced properly − The Wellbeing Centre at the University has counsellors but they’re being cut and in many cases are not equipped to deal with the kinds of issues being brought by students from very different cultures all over the world.

c. Other services − Could there be an option for video consultations to bring more advice into the home? − Information on GP extended access is not shared widely enough as most people don’t know about it − People felt the out of hours GP can be very reassuring [head injury] and that they are critical for people at the most vulnerable time (when other services are closed) − Safe environment for people experiencing mental health concerns must be considered. A&E is not a therapeutic environment − Existing Safe Havens in Surrey are not an appropriate setting for all age groups − We should look to replicate more services like Emerge – already operating in ESCH and St Peter’s – youth workers provide short term support for young people who find

themselves in A&E because they are struggling with self-harm or feeling suicidal. This is run by the faith sector but religion is not part of the service or a pre-requisite for using it. − Listening Post project – is an excellent example of support that is having an impact and we should be looking at developing more of these preventative services − One person shared their story of having attended a falls prevention course and how positive this was for his confidence. People felt this kind of education and support should be publicised more effectively. − ‘Need access to mental health care 24/7’ − ‘Safe Haven – thought it was for “battered women”’ − ‘Where do you find out about Havens?’ d. Principles − Quick response − Tailored/personalised response (not scripted) – contributes to patients feeling anonymous if human interaction is missing − Not having to tell your story repeatedly − Effective communication – being told about action being taken, treatment and any anticipated delays. Understanding what to expect and knowing where you are in the queue - use link/engagement workers in A&E departments to tackle communication issues and update people on their status (like airlines do) − Better inter-department communication to give patients better experience – e.g. between ED and hospital pharmacy

5.1.5 Haslemere The over-riding theme arising from the engagement workshop in Haslemere was huge concern regarding the potential future status of the Minor Injuries Unit based in Haslemere Hospital. There is very clear support for the MIU and fear about how local residents would have their health care needs met should the services there be reduced partially or completely.

Compared with other workshops, it was more difficult to engage participants in considering different urgent care services. Many agreed with the statement of one participant, that the workshop was ‘a cynical exercise in preparing the ground for change which is going to be implemented regardless of local opinion or needs’.

The overriding theme was:

i. Retain/keep/maintain/expand/upgrade Haslemere Minor Injuries Unit − ‘Essential to keep UTC open for longer hours for all reasons’ − ‘The MIU needs to be commissioned for longer hours with supporting diagnostics’ − ‘Expand and upgrade Haslemere MIU. Do not downgrade or close it’ − ‘Increase service provision, profile and opening hours of Minor Injuries Unit at Haslemere Hospital to take pressure off A&E’ − ‘Please leave the MIU in place and do your very best to upgrade it to a UTC’ − ‘Making Haslemere a Urgent Treatment Centre is essential but whatever happens the Minor Injuries Unit MUST stay open’ − ‘Haslemere MIU/health centre and rehab just works well – they all work together and staff are outstanding’

When discussing the MIU, difficulties with the current service were raised:

− ‘Need better facilities – more diagnostic equipment’ − ‘Couldn’t do all diagnostics locally – closing early’ − ‘Need more doctors available to carry out required testing’ − ‘Longer hours required’ − ‘Confusion between GP and receptionist at MIU regarding what provision was available’

Reasons for holding these views were many and varied; these are themed below.

ii. The speed of the service experienced − ‘Seen at Haslemere Hospital – X rayed and put into plaster in 1.5 hours’ − ‘Seen in Haslemere – seen within 1 hour, had injection and problem was solved’ − ‘Wednesday 9.30 spike through hand from broken bush! Haslemere MIU cleaned and X- rayed, stitched and dressed. Seen by GP and nurse home by 10.30 excellent’

Quality of care was also very important to participants - ‘children find MIU in Haslemere less stressful if injured – but good experiences of A&E services were described as well as less good ones, mostly related to having to wait longer than desired.

iii. The local area being rural and far from alternative urgent care services − ‘More rural communities should not have to travel to Guildford, Chichester or Portsmouth for unnecessary interventions’

− ‘More A&E services should be made available in rural and out of city areas. This would be money well spent’ − ‘If the map is structured the Haslemere Department is more central and available than Guildford or Portsmouth’ − ‘Live south side of Haslemere – need clarification on services’ − ‘Haslemere is local and has good access transport time [from where I live]; Guildford is not an option’

iv. Keep pressure off A&E services − ‘It is fantastic and saves our time and takes much pressure of A&E at Guildford’ − ‘Retain the MIU at Haslemere to relieve the pressure on RSCH, preferably updating to a UTC’ − ‘Increase service provision, profile and opening hours of Minor Injuries Unit at Haslemere Hospital to take pressure off A&E’ − ‘Haslemere Minor Injuries takes strain off A&E in Guildford and Chichester’ − ‘We need a UTC in the Guildford and Waverley area, as in all other CCG areas in Surrey. It is especially needed here to relieve pressure on our over-stretched A&E. It must be centrally located’ − ‘Being able to be seen locally, albeit Monday-Friday 9-5 means that we take pressure of the RSCH’

There were a few examples shared where patients attended Haslemere MIU for injuries and illnesses to then be directed to the A&E department at the Royal Surrey County Hospital:

− ‘Son had concussion after a rugby went to Haslemere MIU, they monitored him, called ambulance which took him direct to the Royal Surrey. So had access to treatment immediately. Had brain scan and was kept in over-night it was in the week and MIU was open so he was dealt with speedily’ − ‘X-rayed in MIU – fracture needing treatment – sent to Royal Surrey County Hospital fully prepped for long term care’

v. Other services − ‘Lack of GP appointments causes patients to go to A&E. GP surgery needs to be open 7 days a week’ − ‘GP access – 2-3 week wait problematic for immediate need’ − ‘The problem is possibly limited GP availability’ − Called 111 on Christmas Eve – doctor called back and made an appointment on Christmas Day at the MIU. Antibiotics were available on site at the Pharmacy. Excellent’ − Education is needed to self-care – need much more information on what each healthcare professional does. − ‘I had an allergic reaction to some unknown contaminates. It was dealt with on the phone (111) and I was referred to doctor so useful contact number.’ − ‘Mental health services need improved level of staffing’

5.1.6 Liphook The major themes from discussions in Liphook related to the need to develop a clearer, consistent urgent care service model to reduce confusion and views regarding the range of different services available.

i. Confusion regarding different services − ‘Current confusion between the different points of care – people don’t know where to go’ − Lack of joined up information – no central database of information about patients. Wasted time and resources/inefficiencies, duplications’ − ‘What’s the difference? Who helps whom and when? How do we know? How do we find out?’ − ‘Problems caused by structure of care provision’ − ‘Not joined up service’ − ‘Terminology – means different things to different people’ − ‘Signposting – need to know where to go’ − ‘Access to care – e.g. vulnerable groups – do they understand the different systems?’

ii. Views about different services and their potential benefits − ‘Pharmacy – e.g. can get flu jabs, that’s progress. Brilliant chemist’ − ‘Technology – need to make best use – but not for everyone’ − ‘Importance of signposting’ − ‘A lot of people would not know to call NHS 111. Not an automatic number – should be pushed and explained more’ − NHS 111 don’t always direct people where they need to go. − ‘Need to increase social prescribing - bringing social care/advice/information/medical care to the community’ − ‘Increase people’s confidence in 111’

In addition there was positive feedback about Haslemere Minor Injuries Unit and concerns about housing developments placing strain on the health care system. The ‘artificial silos’ experienced by those living close to the county borders was also a cause for concern as was the need for accommodation for NHS staff with the cost of housing being particularly high in Surrey and into Hampshire.

iii. Principles − Clinically appropriate − Timely − Accessible − Calibre of staff − Human side – compassion − Good IT and networks

5.2 Meetings During the engagement period the CCG attended several meetings with different groups.

5.2.1 Cranleigh Parish Council – evening public meeting The CCG was invited to talk to members of the parish by the committee chair about the review of urgent care described in the case for change. Approximately 50 people attended this meeting. Themes arising from the questions asked and the views expressed are summarised below:

− There is a need for more trained and qualified staff – GPs, pharmacists and nurse – to be able to deliver urgent care at the local level. − The more rural nature of Waverley compared to Guildford meaning that different solutions are needed for urgent care provision. Local provision is more important in more rural areas as travel is more difficult. − Housing developments near to Cranleigh and the impact this additional population will have on health services. − The high quality of care provided in Haslemere MIU.

5.2.2 Waverley Borough Council - Community Wellbeing Overview and Scrutiny Committee The CCG was invited to talk to members of this council committee and the meeting was opened up to all borough councillors. 21 councillors attended and raised the following points:

− Concerns were raised about the future of Haslemere Minor Injuries Unit and the impact of a change to this service. − Overall, there was a lot of interest in the changing demands on NHS services.

The CCG was asked to return to the committee when proposals for the future provision of urgent care across Guildford and Waverley are more developed.

5.2.3 Hard of Hearing Forum (Surrey Coalition of Disabled People) Members of this forum were asked for their views on urgent care. The majority of concerns related to emergency care in hospitals as opposed to other services described as forming part of the urgent care service provision.

However, there was feedback regarding NHS 111 and the lack of responsive SMS options. In addition, a lack of awareness of what NHS 111 can do and difficulties getting a GP appointment that lead patients to attend urgent care services were of concern to this group, reflecting the feedback from other groups and individuals.

Some commended that there is a need for staff in urgent care services to be able to prescribe, again in line with feedback from other engagement carried out.

Managing expectations when an ambulance is called is important as a call does not automatically result in an ambulance arriving quickly. Members felt that more information should be made available regarding this (which relates to the Ambulance Response Programme).

The arrangements in place to arrange British Sign Language interpreters at the point of care were discussed. Members felt that this is often overlooked amongst providers of urgent care. Overall, the non-compliance of providers with the Accessible Information Standard was a significant cause for concern, whatever the service.

5.2.4 South West Surrey Disability Empowerment Network (Surrey Coalition of Disabled People) The main focus for discussion amongst members of this group was in relation to mental health and primary care and associated difficulties in accessing care that then impacts demand for urgent care services. The recommendation being that making it easier to access these services with emerging symptoms would reduce demand for urgent care in the future.

There was also some useful feedback on other services and what the CCG should be doing to raise awareness of these and when and how to access them.

i. Mental health urgent care − Mental health services being appropriately linked with the Police to ensure people experiencing mental health crisis received high quality urgent care. − It was recommended that patients who have experienced mental health crisis and/or have other needs that result in them being vulnerable are linked in to the Pegasus scheme that enables the Police to understand more about people they may come into contact with and help them deal with an urgent care situation. The only option can be to take people in this situation to A&E if they have not been registered on the Pegasus scheme. − There was positive feedback about the Safe Haven and CYP Haven – ‘very effective’ – but it was felt that they needed to open for longer hours than at present. − The group’s members explained that often the lack of a ‘proper care package’ when patients are discharged from inpatient care leaves a patient vulnerable and more likely to contact an urgent care or emergency service. − ‘It takes too long to be seen by the Community Mental Health Recovery Service so things get worse’

ii. GP/Primary care services − The Livi service (face-to-face GP appointments via smartphone or tablet linked with GP record) was felt to work ‘really well’. − ‘Having to call the GP at 8am just to get an appointment is really stressful’ − ‘The triage arrangements at Cranleigh Medical Centre works really well’

iii. Other services − It was felt that NHS 111 staff do not understand mental health as well as they should and that more training is needed for those handling the calls. − ‘Walk-in clinics are great! Better than A&E’. − It was felt that not many people know about all the different services described in the Case for Change; the best way to raise awareness was recommended as being to post a printed leaflet describing these services and when and how to contact them through every door. − Improving the care and support for young carers was recommended as helping overall. − ‘Chemists are under-valued and highly trained’

5.3 Survey An online survey was available for completion between 25 July 2019 and 30 September 2019.

. 8 questions asked about urgent care services o 2 of these questions included Free Text as an option for people to write freely . 7 questions asked about people’s characteristics to enable the CCG to carry out more detailed analysis . 748 people completed all or part of the survey o 539 people answered all of the questions o 209 people answered some of the questions This section will report on the findings from each question and relate them to where respondents live and which GP practice they are registered with.

5.3.1 Question 1 The majority of participants indicated that they were completing the survey as a local resident:

This distinction highlights how people identify closely with their local health care facilities and how important such local facilities are to their experience as a local resident.

Those who indicated ‘Other’ explained that they were completing the survey as the following:

• Potential volunteer • Member of a local Civic Society • Former ambulance care assistant • Daughter of a resident in Haslemere • Teacher • Head teacher • Retired nurse

• Spouse of a patient • Helpful neighbour (car driver) to elderly couple • Member of Patient Participation Group (x 2) • Occasional user • Borough and town councillor

5.3.2 Question 2 – GP registration status Almost two thirds of respondents were registered with Haslemere Health Centre, emphasising the huge concern that this review caused in this local area of the CCG. The next largest response came from people registered with Grayshott Surgery followed by Cranleigh Medical Practice.

18 respondents specified other GP practices that they were registered with as follows:

• Bartlett’s Ash Vale - 3 • Liphook Village Surgery as against Station Road - 5 • Riverbank • Petworth Surgery • Crondall New Surgery • Petworth Surgery • Loxwood Medical Centre - 2 • Hollytree Surgery, Wrecclesham • Liphook and Liss Surgery -2 • Riverbank Medical Centre, Midhurst

In total, just under 10% (n=50) of the 539 respondents were registered with GP practices outside the Guildford and Waverley CCG boundary.

5.3.3 Question 3 – use of current services How services have been used (or not used) in the previous year is illustrated below (multiple answers were permitted).

Which of the following services have you used in the past year either for yourself or for someone you care for? 800 700 600 500 400 Yes, for an adult I care for 300 200 Yes, for a child I care for 100 Yes, for myself 0 I have not used this service in the past year

It can be seen that a person’s own GP surgery was the most used service overall, followed closely by Haslemere Minor Injuries Unit and Community Pharmacists, used as follows:

. Own GP surgery – used by 96% respondents . Haslemere Minor Injuries Unit – used by 85% respondents . Community pharmacist – used by 83% respondents

This reflects the very high proportion of respondents registered with Haslemere Health Centre (just under 62%) who would be able to access the Minor Injuries Unit more easily than respondents living elsewhere in Guildford and Waverley. Excluding these respondents from the analysis results in a greater use of community pharmacists and own GP surgeries.

5.3.4 Question 4 – why did you choose a certain urgent care service? The most common reason selected for choosing any of the nine urgent care service options – apart from the CYP Haven or the Safe Haven – was confidence that high quality care would be provided. This was more important than how long a person may need to wait or whether or not it was quicker than seeing a GP.

For the Havens, the most common reason for choosing either of these services was not knowing where else to go or what else to do.

The second most common reason for choosing to attend a service varied across the different services:

. A&E - not knowing where else to go or what else to do . Community pharmacist – the easiest service to get to . Crisis Mental Health Helpline – not knowing where else to go or what else to do . Extended Access GP – the easiest service to get to . Haslemere MIU – the easiest service to get to . NHS 111 - the easiest service to get to . Own GP surgery - the easiest service to get to . 999 - not knowing where else to go

A summary of the overall reasons for attending a given service is shown below:

I was confident I did not that I I thought I It was know would would not quicker It was the where else receive have to than easiest to go or high quality wait too waiting to service to what else SERVICE care long see my GP get to to do A&E 1 5 4 3 2 Community pharmacist 1 4 3 2 5 Crisis Mental Health Helpline 1 5 3 4 2 CYP Haven or Safe Haven 3 3 3 2 1 Extended Access GP 1 4 3 2 5 Haslemere MIU or Woking WIC 1 5 4 2 3 NHS 111 1 5 4 2 3 GP surgery 1 3 5 2 4 999 1 4 5 3 2

KEY Green to Yellow to Orange to Red = main reason to minor reason

Free Text Feedback 97 respondents wrote additional free text feedback under this question. Each response underwent text analysis to identify common themes. The results of this text analysis are presented below:

Just under a fifth of the reasons included a request to support Haslemere MIU. The most common reason after that was that it felt appropriate for the symptoms the person was experiencing.

After that, and taken together as a theme, travel difficulties (from Waverley mainly) and traffic congestion (in Guildford and at the Royal Surrey mainly) accounted for 13.4% of the reasons given. Minor injuries at Haslemere Hospital is a vital service for myself and my two children. I have Lastly, of the major reasons given, being seen been seen quickly there and have received very quickly was important to many respondents that high quality care. It has been convenient to take used the free text option; the majority of these both my children there as the access is good, related to how quickly patients are seen at childcare facilities are great and there is plenty Haslemere MIU compared to other options e.g. of space. GP surgery.

The ‘Referred by GP’ category mostly related to Free text response patients being referred to an A&E department by their GP: “I went to A&E via a referral from the GP - this isn't an option that's included above but important to note”.

Of the eight people who responded that either they or someone they cared for had used either of the safe haven services in Guildford, the main reason given was not knowing where else to go.

5.3.5 Question 5 – how worried were you when you sought the service(s) above As would be expected from experiences of seeking care for an urgent condition, the majority of respondents said they were either extremely worried or somewhat worried.

How worried were you when you sought the service(s) above?

9.3%

22.4%

15.9% Extremely worried Somewhat worried Slightly worried Wanted reassurance or advice

52.4%

Urgent care is for conditions that require prompt attention. Almost a quarter of respondents sought same-day care when they were only somewhat worried or wanting reassurance and advice, which could be due to a number of reasons including difficulty in getting an appointment in primary care.

5.3.6 Question 6 – is there enough information to be able to make an informed decision about how to access urgent health care? This question was asked as one of the outcomes that the Better Care Together programme wants to deliver is that patients and carers have an improved understanding of how to access urgent care services.

Over three quarters of respondents strongly agreed or agreed that they had enough information to make an informed decision. Under 10% strongly disagreed or disagreed with this statement.

6.7% 1.7%

Strongly agree

11.9% 33.4% Agree Neither Disagree 46.4% Strongly disagree

Conversely, inadequate information and confusion about different services was a key theme arising in the engagement workshops.

5.3.7 Question 7 – what should we focus on developing and improving? This question asked respondents to consider a number of different services and move a ‘slider’ along a scale to indicate the level of importance they thought should be attached to each service where 0 = not at all important and 100 = absolutely essential.

It is clear that improving access to same day and other services in primary care (GP practices) is a key priority for respondents followed closely by retaining qualified staff. This all points to workforce being a primary focus of any urgent care strategy moving forward.

Developing an Urgent Treatment Centre was also very important for many respondents.

What should we focus on developing and improving?

Enabling GP practices to provide more same-day pre-booked…

Making it easier to access GP, nurse and other health care…

Working with partners to develop and retain qualified staff

Developing an Urgent Treatment Centre

Making it easier for children and young people to access care…

Making it easier for adults to access same-day care for…

Developing One-Stop Clinics for patients with complex…

Ensuring people understand what NHS 111 is there for

Developing skills to enable people to care for minor ailments…

Increasing the use of different technologies so people can…

Involving community pharmacists more in the urgent care…

0 10 20 30 40 50 60 70 80

Of those respondents who indicated that developing an Urgent Treatment Centre was absolutely essential (score of 100):

. Just over three quarters (161 out of 205 scoring 100) were registered with GP practices in Haslemere, Liphook, Liss, Grayshott and Borden. . 120 of these were registered with Haslemere Health Centre.

The remaining respondents that scored 100 for this action were registered with the following practices (blue shading – Waverley practices; green shading – Guildford practices; yellow shading – practices in Hampshire and West Sussex):

GP Practice Number Cranleigh Medical Practice 12 Chiddingfold Surgery 5 Witley and Milford Surgery 3 Swan Surgery 3 Wonersh Surgery 3 The Mill Medical Practice 2

Woodbridge Hill 2 Petworth Surgery 2 Merrow Park Surgery 2 Riverbank Medical Centre 2 Guildowns - Wodeland 1 Springfield Surgery 1 Guildford Rivers - St Nicholas' 1 Dapdune House Surgery 1 Crondall New Surgery 1 Hollytree Surgery 1 Loxwood Medical Practice 1 Binscombe Medical Centre 1

It can be seen that only six of the total number of respondents to this question (n=205) who felt that an Urgent Treatment Centre was absolutely essential were registered with GP practices in Guildford compared to 148 respondents registered with practices in Waverley, Sussex and Hampshire.

Free Text Feedback 154 respondents shared their own views regarding what the CCG should focus on developing using the free text option. Each response then underwent text analysis to identify (a) common themes and (b) frequency. The results of this text analysis are presented below:

Common Themes

Frequency The top 10 words most commonly used in the free text responses were as follows:

Word Frequency Haslemere 79 Minor 72 Injuries 59 Extend hours for Haslemere Minor Injuries Unit Care 54 to include weekends and after 5pm weekdays to Local 41 take pressure off an overwhelmed GP surgery. People 38 Urgent 38 Free text response Service 36 Hospital 35 Access 29

The least mentioned words were Surgery, Patient, Parking, Needed, Great, Facilities, Centres (all were mentioned a total of 7 times each); Public, Longer and Locally (mentioned 8 times each).

The mentions for Haslemere, Minor and Injuries all related to the view that Haslemere MIU (and in some cases Haslemere Hospital) should be kept open and enhanced into a UTC (hence why UTC was the most common theme.

Looking at other themes represented in the Compared with family experience in other parts of pie chart above, primary care was the second the country GP access has become significantly most common theme with the most common worse. We really no longer expect to see a doctor for reason for mentioning it being the difficulties any injury or illness as we will be cured or dead by people had accessing an appointment and the time you can get an appointment. Access has having to wait a long time for one. Primary become significantly worse. care was usually mentioned alongside UTC with respondents writing that without the MIU Free text response or a UTC, where would they go when it is so difficult to get an appointment with their GP practice.

Other reasons for mentioning primary care included the need to retain highly qualified staff and diversifying the health care professionals within primary care e.g. paramedics and nurse practitioners.

5.3.8 Question 8 – how important are these outcomes to you? In line with why respondents chose a particular urgent care service, the most important outcome was services being consistently high quality closely followed by having a local urgent care system that staff want to work in. The least important outcome for our respondents was delivering good value-for-money closely followed by having an improved understanding of the different services available. Again this contrasts with feedback from the engagement workshops where the latter was a common theme.

600

2 15 4 3 1 1 46 24 500 52 35 64 61

172 153 400

300

492 489 460 475 460 200 346 350

100

0 Improved Urgent care A&E being better Services being Better health Having a local Having urgent understanding - services able to able to care for consistently high outcomes urgent care care services that how to access meet changing patients with life- quality system that staff deliver good urgent care population needs threatening want to work in value-for-money services conditions

Very important Quite important Not important

5.3.9 Question 9 – where did respondents live The vast majority of respondents lived in the semi-rural villages on the Waverley/South East Hampshire border. Completion of any survey is strongly linked to how much threat people feel from any potential outcome of a programme such as this. Those living in these areas have had access to a Minor Injuries Unit for a number of years and highly value it; as this programme is reviewing the future provision of the type of care that this unit currently provides, it is absolutely understandable that the vast majority of involvement has come from these areas.

The postcode area of respondents is shown below.

West Horsley, East West Horsley, East Horsley, Effingham Horsley,Liss, Greatham, Effingham Selborne, Liss, Greatham, Selborne, Rake Petersfield,Rake Buriton, East Petersfield, Buriton, East Harting, South Harting, Elsted, Rogate Harting, South Harting, Midhurst, Cocking, Midhurst, Cocking, Easebourne Elsted, Rogate Send,Easebourne Ripley, Ockham, Send, Ripley, Ockham, Wisley Wisley Albury, Bramley, Shere Normandy,Albury, Bramley, Puttenham, Shere Normandy, Puttenham, Worplesdon, Christmas Pie, Flexford Worplesdon, Christmas Aldershot, Ash, Ash Green, Aldershot, Ash, Ash Green, Ash Vale Pie, Flexford Petworth,Ash Graffham, Vale Petworth, Graffham, Northchapel, Byworth, Lodsworth Northchapel, Byworth, Burpham, Chilworth, Burpham, Chilworth, Jacobs Well, Shalford Bentley,Lodsworth Frensham, Churt, JacobsCrondall, Well, Tongham,Shalford Bentley, Frensham, Churt, Crondall, Tongham, Ewshot, Seale,… Ewshot, Seale, Tilford, Bordon,Guildford Headley, Town Centre,Headley Guildford Town Centre, Slyfield, Merrow, Burpham Wrecclesham Slyfield,Down, Merrow, Lindford, Burpham Bordon, Headley, Headley Down, Lindford, Oakhanger, Kingsley,… Oakhanger, Kingsley, Farncombe, Godalming Farncombe,GuildfordArford, Park, WhitehillGodalming Onslow Guildford Park, Onslow Village, Park Barn, University of Surrey Chiddingfold,Village, Park Dunsfold, Barn, Chiddingfold, Dunsfold, Elstead, Hascombe, Milford, Thursley,… UniversityElstead, Hascombe, of Surrey Cranleigh, Ewhurst, Alfold Milford,Cranleigh, Thursley, Ewhurst, Witley Alfold Hindhead, Bramshott Hindhead, Bramshott Chase, Grayshott Chase,Liphook, Grayshott Bramshott, Liphook, Bramshott, Conford, Linch, Milland, Passfield Conford, Linch, Milland, Haslemere, Fernhurst, Haslemere, Fernhurst, Shottermill, Grayswood Passfield Shottermill, Grayswood 0 50 100 150 200 250 300 350

5.3.10 Other questions Please see Appendix 2 for demographic information of those completing the survey.

5.4 Emails to the CCG 238 emails were received by the CCG during the period of engagement.

The four major themes of the emails are illustrated in the chart below. 230 (96%) of these were highly supportive of the retention and/upgrading of Haslemere MIU. Difficulty getting a GP appointment and needing to reduce pollution, congestion and traffic were reasons given for retaining and upgrading Haslemere MIU whilst other less frequently mentioned reasons included the need to reduce pressure on A&E departments in Guildford, Portsmouth and Chichester and how long it takes to get to other urgent care services from the villages and towns on the Waverley/Hampshire border.

Number of emails

16 26

229

Retain Haslemere MIU Difficulty getting GP appointment Upgrade MIU to UTC Pollution, congestion, traffic

There was recognition of the difficulties relating to retaining or upgrading services at the MIU in Haslemere e.g. needing more nurses and doctors to staff a facility. There is clear support for longer opening hours to further reduce pressure on A&E services elsewhere.

A handful of emails that were not focussed on Haslemere MIU or a separate site elsewhere for an MIU or UTC e.g. in Cranleigh, provided a few ideas for how to improve urgent care provision overall.

Education of the public to More qualified staff for become more self-reliant and community services i.e. communities to be more aware district nurses of the needs within them and ready to help is needed

Greater publicity for walk-in 'I feel it is important to services - we need to know change mental health care locations (and not just have it for the better, in crisis available on the internet) situations'

5.5 Postcards Postcards that could be posted FREEPOST to the CCG were made available at the engagement events and in several health care settings.

− 35 postcards were returned to the CCG − 31 of these conveyed strong views that Haslemere MIU should be retained and in some cases enhanced into a 12 hour per day service − 1 described a positive experience elsewhere when on calling 111 for a deep cut to a finger, a nurse called back and assessed the situation; she then made an appointment the same day at a local MIU

Major reasons for wishing to retain the MIU in Haslemere were:

− having to wait two to three weeks for a GP appointment − the distance to other services that provide urgent care − a lack of suitable transport to other services − the proximity of a number of schools (11 independent schools, 2 colleges and numerous state schools) − the speed that patients are seen − the high quality of care provided by all staff − to relieve the pressure on A&E

5.6 Letters Two letters were received during and shortly after the engagement period, both of them asking for local facilities to be retained, referring to Haslemere Hospital and Haslemere MIU. Reasons for having these views were related to:

− the cost of travelling to other locations where urgent care services are provided − the environmental impact of additional car journeys to these services through increased pollution − parking problems at other sites − the high quality of the care in Haslemere MIU and Haslemere Hospital (caring and sympathetic) − the fact that the Haslemere facility is in a central position for Haslemere and surrounding villages such as Fernhurst, Brook and Camelsdale − the diagnostic and therapeutic services provided at the MIU (x-ray and physiotherapy)

5.7 Petitions Three petitions were received during the engagement period or shortly afterwards, all of them supporting the development of either a MIU or a UTC in Cranleigh. The petition purpose and the number of signatures are detailed below:

i. We the undersigned would like our minor injury clinic re-opened in Cranleigh Village Hospital and to say no to a private care home • 223 signatories ii. Open Cranleigh Hospital Minor Injury Clinic and Day Hospital • 819 signatories iii. Do we need an ‘Urgent Treatment Centre’ in Cranleigh?

• 2,489 signatories

It’s not possible to say whether or not each signature is unique or whether one or more people signed one or more petitions. However, the petitions as a whole demonstrate the desire of people living in and around Cranleigh to have access to a minor injuries unit or an urgent treatment centre.

6. How many people did we reach and engage with?

Engagement workshops 203 members of the public attended the engagement workshops

Special interest groups 110 people attended organised meetings with the CCG

Online survey 748 people commenced the survey 539 completed surveys 209 partially completed surveys

Website & social media 1,217 website page views 115 views of video on YouTube 1,229 Facebook views 4,180 Twitter views

Emails, postcards, letters and petitions 289 emails (some from two people) 35 postcards 2 letters (from four people) 3,531 people signed petitions

Some people may have engaged with more than one channels whilst others may have only engaged with one channel.

Hence it is not possible to say overall how many people shared their views.

7. What were the main findings? The engagement carried out by the CCG aimed to find out views regarding different urgent care services. The themes arising from the wide range of feedback covered these different services and are presented below to inform the future development of urgent care services across Guildford and Waverley.

Service Themes NHS 111 and 111 was recognised as being essential to the functioning of a comprehensive urgent Primary Care care service but there is a high level of distrust in the service: Out of Hours • Differing experiences of 111 service affect future trust in the service Service • Low awareness of increased range clinical advisers since the new service began in April 2019 • A belief that 111 simply sends for an ambulance therefore ‘why bother’ Positive experiences of the 111 service were shared with specific examples whilst generic mistrust did not relate to specific examples. Public understanding of the new 111 service needs to be addressed alongside positive patient stories such as those described during the engagement period. Community The value of being able to see a local health care professional on a high street was pharmacists recognised but there were varying levels of trust regarding the clinical and medical expertise amongst community pharmacists. People were not sure what community pharmacists could and could not advise them on. Some explained that they had reached out first to a community pharmacist only to be told to see their GP hence they did not see much point in consulting them again. GP practices Not being able to see a GP within a reasonable time-frame (same-day for urgent providing pre- cases and within a few days to a week or so for less urgent needs) caused the most booked and concern amongst participants and to a greater or lesser extent, affected behaviours same-day in terms of seeking alternative care. appointments This was the area that those answering the survey wanted the CCG to focus upon the most. CYP Haven Integrating mental health needs into urgent care services was recognised as being and Safe important. Haven There was low awareness of the two Havens. Those who had used these services greatly valued them. Minor Injuries There was very broad and robust support in both Cranleigh and Haslemere and Unit/Urgent immediately surrounding areas for an Urgent Treatment Centre for a range of Treatment different reasons but mainly related to distance that would need to be travelled to Centre secure the right health care somewhere else. Principles for Local Consistent urgent care Clinically appropriate Ability to prescribe services Timely/quick response 7 days a week, daytime and evening Accessible Joined-up IT communications tell you Caring/personalised/compassionate only need to tell your story once

8. Review of engagement by the Stakeholder Reference Group The Better Care Together Stakeholder Reference Group (SRG) was asked to review the effectiveness of the engagement programme. They were asked whether, in their view, further engagement was needed e.g. with particular groups.

Their feedback is detailed here:

Engagement Events • Informing the public about the engagement programme and venues could have been better via key community agencies e.g. Chamber of Commerce, League of Friends, posters outside the event venues on the day. • The SRG noted that more advertising would increase the costs significantly. • Content of the engagement events provided too many options for consideration by the public to be manageable. • Venues where the public were invited to “share your views” were misleading as respondents were led to consider only four options. At the Liphook event people were genuinely able to share their views with less structure. It was noted that there were significantly differing levels of attendance which influenced the style of workshop that could be delivered

Web survey • “Unconvinced that the survey was good value.” • Answers from the web survey contradict the answers from respondents at venues. • Questions were too focused on the respondent rather than their opinions. • Some questions were too broad so less effective. • Web survey questions should have been tested on a sample group to check that their answers would be useful. There is the option to conduct another survey which is more robust, using paid for market research expertise, if required and the SRG can appoint a sub group to inform its design.

Additional feedback • “The [engagement] report struck me as comprehensive, well-structured and honest.” • The SRG noted that many GPs in the G&W geography already provide same day appointments for patients whose symptoms are described by patients as urgent.

Agreements reached by the SRG 1. An additional web-based engagement survey is NOT required at this point and no further engagement events are required at this point

2. A Task and Finish Group would be established to support future surveys and engagement events

3. The SRG endorsed the draft conclusions in the Engagement Report as comprehensive and fairly reflecting the evidence from the engagement

The CCG appreciates this feedback and takes on board the various suggestions provided by members of the Stakeholder Reference Group.

9. Contact details

NHS Guildford and Waverley Clinical Commissioning Group Dominion House Woodbridge Road Guildford GU1 4PU

Tel: 01483 405450

Text: 07917 087560

Email: [email protected]

10. Appendix 1 – Case for Change document distribution with posters and flyers

5th Guildford Scouts, Guildford Abinger Tennis Club Abraham Cowley Unit (inpatients and outpatients) Academy of Contemporary Music Academy of Contemporary Music Global House Academy of Contemporary Music Student Union Airhop House All Saints Church Hall, Vicarage Gate, Onslow Village, Guildford Alton Library Austen Road Surgery Autism Hampshire, Fareham Badgerswood & Forest Surgeries - Badgerswood Surgery Badgerswood & Forest Surgeries - Forest Surgery Bellfield Chidren's Centre, York Road, Guildford Bellfields Youth & Community Centre, Jacobs Well, Guildford Beverley Hall Community Centre, Guildford Binscombe Medical Centre Blackhawaks Wheelchair Basketball Club Bordon Library Bramley Golf Club Burpham Tennis Club Burymead Table Tennis Club Catalyst Catholic Parish Guildford Chase Community Hospital, Bordon Chiddingdold Surgery (Temporary) Clinic locations for all age groups and needs Community Youth Centre, Ludgerhall, Hampshire Craggy Island Cranleigh Library Cranleigh Medical Practice Cranleigh Primary Care Centre, Cranleigh Village Hospital Cranleigh Village Hall, Village Way, Cranleigh Cranleigh Village Hospital Cranleigh Village Sports & Social Club Crann Dara Crossroads Care Surrey CYP Haven

Dapdune House Surgery Dene Croft, SeeAbility, Guildford Denecroft (SeeAbility) Diocese of Guildford Dunsfold Surgery East Horsley Bowling Club East Horsley Medical Practice Elstead Village Tennis Club Fairlands Medical Centre Farnham Memorial Hall Farnham Road Hospital (inpatients and outpatients) Farnham Sixth Form College Fernhurst Surgery Forest Community Centre, Bordon Friday Sport Group Gateway Club Glaziers Lane Surgery Godalming College Godalming Library Godalming Tennis Club Grayshott Surgery Guildford Careline Guildford Club for Disabled Guildford College Guildford Family Centre, Guildford Guildford Library, 77 North Street, Guildford Guildford Parent Carer and Learning Disability Carers Group Guildford Physiotherapy & Sports Clinic Guildford Primary Care Centre, Royal Surrey County Hospital Guildford Rivers Practi ce - St Nicholas Guildford Rivers Practice - Hurst Farm Guildford Saints Football Club Guildford TALK Guildowns Group - Stoughton Road Surgery Guildowns Group - The Oaks Surgery Guildowns Group - The Student Health Centre Guildowns Group - Wodeland Surgery Hampshire Supported Living, Petersfield Haslemere Health Centre Haslemere Hockey Club

Haslemere Hospital Haslemere Hospital Haslemere Library Haslemere Minor Injuries Unit Haslemere Primary Care Centre, Haslemere Hospital Haslemere Village Hall, Bridge Road, Haslemere High Street, Bramley, Guildford, Surrey, GU5 0HG Homeless Outreach and Support Team Horsley Library Horsley Village Hall, Kingston Avenue, East Horsley, Leatherhead Kathryn's House Liphook Surgery Liphook Village Hall Liss Surgery Liss Youth Centre, St Marys Church Hall, Liss Mallow Crescent Residential Home, Guildford Meath Epilepsy Charity Merrist Wood College Merrist Wood Golf Club Merrow Park Surgery Merrow Village Bowls Club Milford Golf Club Milford Hospital National Autistic Society New Inn Surgery Normandy Tennis Club Oakleaf Entrerprise (for Safe Haven and other) Outpatient locations in RSCH Park Barn Community Centre, Cabell Road, Guildford Petersfield Community Centre, Petersfield Petersfield Community Hospital Petersfield Library, Petersfield Pinehill Surgery Riverside Partnership Royal Surrey A&E department Shalford Tennis Club Shere Surgery Shere Village Hall, Gomshall Lane, Shere SMART Cranleigh, Oliver House, Cranleigh High Street Springfield Surgery

St Luke’s Centre, RSCH St Luke's Surgery Stonham - Guildford Stroke Club - Guildford Stroke Club - Haslemere Student's Union, Union House, University of Surrey Surrey Community Action Surrey Minority Ethnic Forum Surrey Sports Park Surrey Wildlife Trust The Borough Hall, The Burys, Godalming The Bungalow The Crescent Project, Woking The Jarvis Centre The Mill Medical Practice The Plantation, Guildford The Spinney Family Centre, Guildford The Swan Surgery The University of Law The Villages Medical Centre The Witley & Mlford Medical Partnership - Milford The Witley & Mlford Medical Partnership - Witley Surgery Transform Housing and Support, Burpham, Guildford Unit 12, Winchester University Library, George Edwards Building, Univeristy of Surrey University of Surrey Centre for Wellbeing University of Surrey Student’s Union Universtiy of Creative Arts Wanborough Youth House, Wanborough, Guildford Whitehall Village Hall, Bordon Whole Notes Choir Wonersh Surgery Woodbridge Hill Surgery Woodlands Hall, Headley Down

11. Appendix 2 - Demographic information for those completing the survey

11.1.1 Age range

What age range are you in?

1.3%1.5% 0.0%

5.6% 6.9% under 18 18-24 15.5% 25-34

24.4% 35-44 45-54 55-64 22.7% 65-74 75-84 22.2% 85+

11.1.2 Carer status The proportion of respondents who identified as a Carer, at 36%, is significantly higher than the background Carer status for Surrey (10%).

Are you a Carer? 70.0%

60.0%

50.0%

40.0%

30.0%

20.0%

10.0%

0.0% Yes No

11.1.3 Disability status Just over four fifths of respondents stated that they did not have a disability. Of those that did, the most common was a long-standing illness or health condition followed by a mental health condition.

Disability

Learning disability/difficulty 2

Blind / having a serious visual impairment 3

Deaf / having a serious hearing impairment 5

Prefer not to say 13

Other 17

Physical impairment 22

Mental health condition 27

Long-standing illness or health condition 47

0 5 10 15 20 25 30 35 40 45 50

Other disabilities included bladder cancer, pace maker, recovering from trauma, arthritis, chronic fatigue syndrome, pulmonary fibrosis, recovering from cancer, asthma, recovering from a stroke and COPD. Some of these could be described clinically as a long-standing illness or health condition.

11.1.4 Gender The majority of respondents were female, not truly reflecting the gender balance of the Guildford and Waverley population. Nine preferred not to say what their gender was and none identified as transgender. The chart below shows the proportion identifying as male or female.

Gender 80.0%

70.0%

60.0%

50.0%

40.0%

30.0%

20.0%

10.0%

0.0% Male Female

11.1.5 Sexual orientation Most respondents (89%) identified as heterosexual in line with what would be expected from national level data regarding sexual orientation.

A noticeable proportion of respondents preferred not to say what they sexual orientation was (9%). There was equal representation of people identifying as gay (0.4%) and lesbian (0.4%)

11.1.6 Ethnic group The majority of respondents (91%) indicated that they were White British, in line with ONS data for our population.

Ethnic group - %

British Irish Other Indian White and Black Caribbean White and Black African Nepalese I do not wish to disclose my ethnic origin