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.