Insights from BAME Communities in Central West London

Healthwatch Central West London in partnership with the BME Health Forum

Research conducted with BAME Community Groups in Central West London in Autumn/Winter 2019 We are Healthwatch Central West London (HWCWL), an independent organisation for people who use health and social care services.

Healthwatch was established under the Health and Social Care Act 2012 to understand the needs, experiences and concerns of people This report provides insights into how primary care who use health and social care services. services are meeting the needs of their Black, Asian and Minority Ethnic (BAME) patients, as well as some We deliver the statutory Healthwatch provision for Kensington & Chelsea of the challenges that still need to be addressed. and Westminster, and we previously delivered this work for Hammersmith & Fulham. Our research and local engagement puts local people’s views at the centre of decision making about health and social care. It highlights some of the principal health concerns for BAME communities, and offers personal and creative ideas for how health outcomes could be improved in the We make this happen by: boroughs of Westminster, Kensington & Chelsea, and Hammersmith & Fulham.

Helping to improve the quality of local Monitoring how health by sharing changes in the what people need healthcare system from their care with affect local people. those who Listening to what commission, run, people like about and make decisions services and what about NHS and could be improved. social care services. HWCWL works within some of the most diverse boroughs in England. It is important to us that we hear from everyone in our communities, especially those who are under- represented in conversations about health and social care.

Residents born abroad 72% of households in H&F Crowded housing contain people aged 16 and Homes over who all speak English as a main language. with Black African (40%)

English as Bangladeshi (36%) Over 20% of K&C residents 53% 54% a second 46% of K&C do not have English as their of Pakistani (32%) of H&F Westminster language first language.

Chinese (25%) 22% of households in Westminster have no people Mixed (28%) Westminster and Kensington & Chelsea who speak are both home to the highest proportion English as a first language. of people born abroad (53% and 54%) in White British (12%) the country. In Hammersmith & Fulham the percentage is 46%. The three boroughs have large North African, Middle Eastern, South American and South Londoners from all BAME backgrounds are Asian populations. French, Arabic and Spanish In Westminster and Kensington & statistically more likely to live in overcrowded are the most widely spoken languages, after Chelsea, 32% and 28% of these residents housing than White British Londoners*** arrived in the last five years. * English.**

*Office of National Statistics (ONS), 2011 ** Office of National Statistics (ONS), 2011 ***Runnymede Trust (2016) Ethnic Inequalities in London Capital For All Who we spoke to for this study

We reached some of the groups interviewed for this project by partnering with the BME Health Forum, a charity made up of a network of voluntary and community organisations that serve BAME communities in Westminster, Kensington & Chelsea and Hammersmith & Fulham. The BME Health Forum connected us with the organisations and facilitated the focus groups. You can learn more about their work, and how to contact them, on page 14 of this report.

We spoke to two groups that worked with particular nationalities: The Iranian Association (in Hammersmith & Fulham) and the Marylebone Bangladesh Society (Westminster).

We spoke to two groups that worked with migrants, from different nationalities: People Arise Now (Hammersmith & Fulham) and Migrants Organise (Kensington & Chelsea).

We spoke to 73 people for this study. The most represented We spoke to two groups that worked nationalities are Eritrean (19), Iranian (10) and Bangladeshi (10). Other participants in this study were Sudanese, Palestinian, Jamaican, with particular demographics within Kurdish, Malaysian, Somali, Ugandan and from the Seychelles. BAME communities: the Eritrean Over- 50s Group, who meet at The Pepper Pot Interpreters attended three of the sessions. Two groups were attended Day Centre (Kensington & Chelsea) and by people of different nationalities, and English was the common the Middle Eastern Women and Society language, so no interpreter was required. Organisation (or MEWSo) (Westminster). Experiences of Primary Care We asked the six groups to tell us about their access to and experiences of primary care. We wanted to know what worked well and what could be improved.

Booking Waiting times Length of appointments appointments All of the groups said that the All six groups waiting times for appointments Half of the groups (three) felt mentioned difficulties were too long. that GP appointments are too with booking their GP short, and that they are limited appointments, Five of the six groups by only being able to raise one particularly those made had negative experiences issue per appointment. online or over the phone. with waiting to see a GP.

Language Barriers Interactions with staff Gathering patient perspectives

Online and phone booking systems Every group said staff interactions Generally, the groups responded were considered particularly difficult affected their quality of care. positively to being consulted on for people who are not fluent in English, improving NHS services. as were the relatively Patients cited concerns about They felt that they had a short appointments, privacy when discussing great deal to contribute which impact those the purpose of their visit to focus groups. who need longer to with reception staff and explain their problems. with a pharmacist. How do people get an For patients who are not fluent appointment with their GP? English speakers, language is a barrier to using some What could help? 18 people responded to this question. of the booking systems. Video calls Online and phone booking services were suggested as a more were less popular options for booking user-friendly an appointment than walk-in services, alternative or queueing at the practice on the day of to phone the appointment. calls.

Texting patients 55% 4 of the six groups said 55% (10) of the 18 respondents chose to queue up at their that the existing system of texting appointment reminders GP surgery on the day, find a walk-in centre or attend A&E. Booking GP appointments online was considered to patients works well. useful by those who were Improved interpreter 28% (5) of 18 respondents to this question sought help able to use it. over the phone, either calling their GP (17%) or NHS 111 (11%) access However, four different Some participants suggested that an interpreter should 11% book groups mentioned having automatically be booked appointments had difficulties with using at for every GP or hospital online, and 6% use least one aspect of the appointment when the Babylon GP app. online booking system. the patient log shows that person needs one. Being seen, feeling heard. Every group mentioned overcoming obstacles to see a doctor, and additional challenges in being able to discuss all of their health concerns within a limited time slot.

Interactions with staff Privacy concerns

How patients felt about their GP, local pharmacist Two groups said that staff interactions with patients was and frontline staff was considered to be significant: the first area of primary care that needed improvement. all six groups had both positive and negative experiences to share. Some disliked the receptionist’s role in triaging emergency appointments, calling it “inappropriate.” The groups cited Most of the criticisms of frontline NHS staff were privacy as a reason for this discomfort, as they are expected linked to the patient’s ability to see their own GP on a to discuss their condition at the reception desk. They disliked consistent basis. being referred to pharmacists for similar reasons.

Those who were happiest with the staff often saw What could help? the same GP regularly. + Changes to the triage procedure. Those who did not, and who felt they had to explain themselves to reception staff, or + Improved privacy measures, and communication to patients who were referred to pharmacists, about the ways in which their privacy will be protected. had more negative views of primary care staff’s + Improved coordination between the GP and pharmacy: if the behaviour and their pharmacist referred to does not have the medicine in stock, relationships with patients. the patient should be able to go to a different pharmacist. How do short appointments impact BAME patients? Time with your GP

Half of the groups (three) 1. Patients who are not fluent English speakers felt that more time should be need time to explain their issue. allowed for GP appointments, and that patients should be 2. These same patients may not feel allowed to raise more than comfortable discussing their health one issue per appointment. concerns over the phone, and may wait longer for an appointment as a result.

What else could be improved? 3. This might mean they have multiple issues that they wish to address in one appointment.

Some groups said that multiple members of the same 4. If a patient does not speak English confidently, then they are household, with the same symptoms, should be able to entitled to an interpreter. However, some groups described see a doctor on the same day as one another. having had interpreters arrive late, which affected the length of Some patients felt that there was a double time that they were able to spend speaking to their GP. standard: they said that it was unfair that they were expected to wait up The links between language barriers and length of to an hour for their appointment but appointments has come up in previous HWCWL reports. if they were themselves 10 minutes You can read more in our Knowing Which Way to Turn report late, they were sent home and (2019), which spoke to parents of young children attending told to re-book. urgent care centres. Barriers to health and wellbeing for BAME communities We asked the six groups to tell us how they thought the health and wellbeing of children, adults and elders in their communities could be improved. The top response was nutrition: every group said that more opportunities to eat healthily would improve the health of children, adults, and older adults.

School

All six groups considered The groups cited the availability of cheap In the Child Health discussion, five children to be at risk of an fast food options in low income areas, out of six groups (83%) said that it is unhealthy diet, saying that unappetising school dinners and high- important for parents to be educated they need more calorie cooking, traditional to some about how to prepare nutritious opportunities to eat cultures, as challenges to establishing meals, and said that they would like nutritious food. healthy eating habits. to attend a course or class on this. Priced out of participating Meeting mental Tackling isolation wellbeing needs for among older people The cost of activities is a barrier to people of all ages getting physical exercise. young people The concern for older people was isolation and loneliness. Free activities for children, adults and older The group participants who mentioned people were suggested by every group. youth mental health and wellbeing Community-based activities with an were concerned about cultural educational angle, were suggested as stigmatisation of mental health issues. routes to addressing this issue. 4 of the 6 groups mentioned that costs were preventing older Physical Health people from joining physical activity “[In our community] when groups in their communities. children have a mental health issue we don’t want to “Lack of exercise affects not just our talk about it – so problems physical health but our mental “Elders need to go to the gym but health as well” paying for it is difficult: should be free” can stay hidden and unresolved”

Mental health issues for adults were 6 groups were concerned finance-based: participants said that about the amount of time lack of work opportunities and young people spent on 2 groups linked physical and mental health. access to universal credit or video games instead of on disability benefits are serious exercise, and suggested One group said they worried taking up contributors to poor offering low cost exercise would result in their being mental health. activity options. considered too well to qualify for their disability benefits . Cultural considerations Adapting activities to be inclusive spaces for women and for non-English speakers were suggested as improvements to adult and older adult health.

Three groups Two groups said that One group made mentioned the need for offering activities in unfavourable comparisons more women-friendly different languages would between the opportunities activities enable more older adults to for children to be physically get involved in local active in the UK and their activities. own childhoods abroad.

“Here in England you can’t just leave them They suggested offering to play outside.” women’s only swimming classes or including a More low cost activities childcare element to and open space were adult activities. suggested improvements. Filling in the gaps At the end of each session, HWCWL provided additional information and guidance for the group’s participants. There were some ways of participating and improving care that the group attendees were not aware of.

Finding the right GP for you The power of the PPG: Making requests helping your local practice One of the participants was not meet patient needs We also heard some important aware that a patient could change cultural concerns that we advised Participants suggested they liked to a different GP practice if theirs ought to be raised with the Participants suggested they having a ‘focus group like this did not feel right for them. participants’ general practice. liked having a ‘focus group one’, as they learnt a great deal likeThe this HWCWL one teamas they pointed learnt out and received useful information One such concern was that women about GP services. allotthat thisand was got an more option for her, and were often not comfortable with provided additional information using a male interpreter. We advised HWCWL raised Patient informationon how to raise about a complaint. GP these participants on how to raise services, and GP practices Participation Groups (PPGs) as a this issue with their GPs, and agreed should start giving out route that some participants to raise this in our ongoing work at might be interested in. They could the North West London level. information like this.’ continue to use their voices to influence the delivery of their Issues with access to online booking primary care by joining a PPG. were also raised, to which we Only one participant had responded with the same advice. attended a PPG meeting before. Our outreach has helped to shape our priorities for 2020-21. We carried out these discussions in September 2019. The insights we gained from speaking to the diverse groups have informed our research, reporting and local engagement objectives for the coming months.

Small Grants for COVID-19 Engagement with under-represented in our BAME health groups communities concerns

In March 2020, much of our We are committed to maintaining In January 2020, Healthwatch project work shifted to meet the our relationships with the groups Central West London launched its growing demand for research and who worked on this outreach. We first ever Small Grants Project. engagement in response to the are also continuing to respond to COVID-19 pandemic. the disproportionate impact of £500 was awarded to five groups in COVID-19 on BAME communities. April this year, with the funds We provided additional funding to contributing to local engagement We will share our findings from the Small Grant recipients to carry (focus groups and surveys) with Central West London to inform and out COVID-19-focused research. people who are under-represented influence the decision making of in health and social care discussions. North West London healthcare We also created our survey, Your providers and local authorities. Experience Matters, and shared it Two of the grant recipients are throughout our communities, to groups which provide services for As part of the national network of learn about how local residents are Healthwatch providers, our work is BAME communities. being affected by the virus. shared with Healthwatch England. Contact us

If you would like to contact HWCWL about this report, or about BME Health Forum our other research and local engagement in Westminster and Kensington & Chelsea, you can get in touch with us here: The BME Health Forum improves the quality of health and social care services for patients from deprived backgrounds living primarily in Westminster, Kensington & Chelsea and Write : Hammersmith & Fulham. It does this by empowering its 5.22 Grand Union Studios, communities to influence local health care provision. 332 Ladbroke Grove, If you would like to contact the BME Health Forum, you can: W10 5AD Write: Phone: Church Street Neighbourhood Centre, Cherwell House, 020 89687049 Penfold Street, NW8 8PT Email: Email: [email protected] [email protected]

Phone: Tweet : 07958 479 217 @HealthwatchCWL Tweet: @BMEHealthForum Message: Facebook.com/HWCWL