INSRT IMAGE LOOKING BEYOND THE SYMPTOMS: A Report of the Health and Well-being Needs of BME Patients in 3 Surgeries in Brighton and Hove March 2016 1 The Trust for Developing Communities – LOOKING BEYOND THE SYMPTOMS March 2016 CONTENTS Page Introduction 3 Objectives 3 Roadmap of the report 4 Research Methods 5 Mapping 6 Accessing the sample group 6 Field notes in surgeries 6 Interviews with practice managers 7 Strengths and limitations 7 Key Findings from the Mapping 9 Context for the study 9 Brighton Health & Wellbeing Centre 13 The Avenue Surgery, Moulsecoomb 16 Mile Oak Surgery, Portslade 19 Findings from the Surgeries Interviews 21 Brighton Health & Wellbeing Centre 22 The Avenue Surgery, Moulsecoomb 24 Mile Oak Surgery, Portslade 25 Interviews & Focus Groups Findings 27 ESOL Class, Mile Oak Surgery 27 Japanese Women’s Group, Brunswick. 28 Bangladeshi Women’s Group, Avenue 29 BME Young People Football, Avenue 29 Chinese Elders Group 30 Mosaic Under Fives Group 30 Common themes across BME groups 32 What makes a good doctor 32 The Importance of a good Reception 33 Cultural Understanding 33 Seeing the same GP 33 Communication 34 Health and Wellbeing 34 Case Studies 38 Analysis 43 Recommendations 45 Conclusion 47 Appendices 1 – 6 48 The Research Team Yaa Asare Community Researchers: Sabah Kaiser, Nagwa Bilal, Aleya Khatun, Maliga Banner 2 The Trust for Developing Communities – LOOKING BEYOND THE SYMPTOMS March 2016 LOOKING BEYOND THE SYMPTOMS Introduction Objectives of the project This Black and Minority Ethnic (BME) Mapping and Research report was commissioned by the Engagement Officer of Brighton and Hove Clinical Commissioning Group on behalf of the Brighton & Hove BME Health Needs Assessment Group. It was carried out by The Trust for Developing Communities in collaboration with Yaa Asare. The aims of the research are as follows: to ascertain the health needs of marginalised BME individuals (and communities) around three surgeries to get as close to people’s experience as possible, and with their support to assess what needs to be put in place to better meet people’s needs to gain information about what exists already in these areas as a source of either support or a cause for concern - to investigate available services and to consider, with local people, issues around access and appropriateness to carry out a local mapping exercise in three surgeries to find out the demographics of the local community, focussing on ethnic groups and ascertaining - age groups, employment rates, types of housing, available services/groups that exist locally. Also to get an idea regarding the transience or long term settlement in the area The research was carried out in and around three surgeries in Brighton and Hove: The Avenue surgery in Moulsecoomb, Brighton Health and Wellbeing Centre (BHWC) on Western Road in the city centre and Mile Oak Medical Centre, Portslade. These surgeries were identified because it was felt that they served particular BME communities that were considered to be particularly marginalised. The research was carried out between October 2015 and March 2016. A mapping exercise of the three surgeries and surrounding neighbourhoods was first undertaken. Interviews and focus groups at the surgeries took place in January and February 2016. Participatory, qualitative research methods were used to enable people to express their views and experiences and to get an understanding of the health and wellbeing of BME patients who use the surgeries. 3 The Trust for Developing Communities – LOOKING BEYOND THE SYMPTOMS March 2016 Roadmap of the report This report first describes the research methods used and their limitations. The report then outlines the mapping and its findings about each of the three surgeries and their surrounding neighbourhoods: Brighton Health and Wellbeing Centre in Brunswick; The Avenue Surgery in Moulsecoomb; and Mile Oak Surgery in Portslade. The mapping provides context, and helped us to identify ethnic groups in the area and services and facilities available locally. The report then considers the findings of the interviews at the three surgeries with practice managers and BME patients. It considers the use of the surgery by different ethnic groups, and people’s experience of using the surgery and living in the local area. The report outlines the key findings from the interviews and focus groups with the ESOL Class near Mile Oak Surgery; Japanese Women’s Group near Brunswick Surgery, Moulsecoomb Bangladeshi Women’s group near the Avenue Surgery, Moulsecoomb; BME Young People Football Sessions, near The Avenue Surgery, Moulsecoomb; and also the Chinese Elders Group and Mosaic Under 5s Group. As well as specific findings from these focus groups, the report outlines common themes across BME groups, relating to their experiences of using the surgeries and issues relating to their health and wellbeing. It describes three case studies in detail, as these provide an insight into the reality of the experiences of BME respondents and a more holistic picture of their circumstances and concerns. The report provides an analysis of this small scale research carried out in the three surgeries. Given that outreach was carried out in the waiting rooms, this research represented a unique opportunity to speak to people who may not be members of BME support groups, and thus may represent some experiences of more marginalised BME individuals. Finally, the research points to important recommendations and concludes with the key issues that have been raised in the research through outreach to people at surgeries about their experiences. Whilst diverse communities may have needs that differ in some respects, the commonality of experience of BME communities around isolation and marginalisation; racial harassment and a lack of knowledge about services, are critical, common issues that this research report has revealed. 4 The Trust for Developing Communities – LOOKING BEYOND THE SYMPTOMS March 2016 Research Methods Most of the mapping work was carried out through internet research and visiting the neighbourhoods. The remit of the surgeries research was to get an understanding of the health and wellbeing of Black and Minority Ethnic patients who use the surgeries. In particular this research set out to express their views and experiences as accurately as possible and to base the analysis and recommendations on this information. We were able to identify community groups through the mapping and the surgery research. Between October 2015 and January 2016 the following tasks were carried out; Recruiting the team of four community researchers Preparing questionnaires to find out the experiences and views of BME patients; piloting questionnaires and redrafting Preparing focus group questions Establishing links with practice managers of the surgeries and arranging schedule to meet with patients Devising an information introductory leaflet and arranging for translation into the four most common languages, Cantonese, Arabic, Bengali and Farsi Meeting with various interest groups and community groups as background preparation and to set up focus groups Meetings with relevant stakeholders, to inform them of this work and to ensure mutual support and ensure no duplication Attending Black History Event in Moulsecoomb to begin the process of meeting with potential patients at The Avenue surgery The rest of the project, from January to March 2016 involved Meeting BME patients to find out their needs in the waiting rooms of surgeries and where possible arranging and carrying out interviews Conducting focus groups in the surgeries and with key BME groups and conducting individual interviews in those groups Writing up the research The mapping exercise was carried out by one of the members of the research team. The three researchers carrying out the interviews and the focus groups were Community Champions (who were among those who had attended an accredited course at the Black and Minority Ethnic Community Partnership to learn basic and practical qualitative research methods). Pilot questionnaires were carried out by the research group and then the questions were refined within the team. 5 The Trust for Developing Communities – LOOKING BEYOND THE SYMPTOMS March 2016 Mapping Mapping of the three surgeries and their surrounding areas was carried out, focusing on the following: community facilities surrounding the surgeries - sports club, community colleges, preschools etc. and whether these carry out ethnic monitoring? statistical information about populations of all three areas, e.g. the proportion of older people, under 16s, crime figures (including hate crime), types of housing local amenities - play parks, NHS dentists, shops, ESOL support, advice services, sports facilities, youth clubs any environmental issues, local social issues photographing the key surgeries Accessing the sample group Initial contact was made with the surgery practice managers; the CCG Community Engagement manager facilitated this. The research remit was to focus on the experiences of those BME patients who used the particular surgeries. For reasons of patient confidentiality, it was not possible to have access to patients’ addresses or phone numbers so the patients needed to be approached in the surgeries. Researchers spent a few hours a week in each of the surgeries’ waiting rooms, identifying people who were BME and arranging to interview them. The practice managers had facilitated interview space in each of the surgeries. We were introduced to the reception staff who were made aware of our presence in the waiting rooms and supported the process by making our translated leaflets (Appendix 1) available to patients. ‘Field notes’ in surgeries Observation notes were taken in the waiting rooms. On several occasions, particularly at Mile Oak surgery, we recorded that we sat in the waiting room for two hours without seeing a single BME patient. One of the limitations of the research was that it required the researchers approaching people in waiting rooms. As the researchers were all active in BME communities, a few of the patients were already known to us, so it did not seem appropriate for us to interview them (for reasons of confidentiality).