Herefordshire LINk Report
Young People’s Access to Health and Social care
Herefordshire LINk Young People’s Working Group
C/O Hereford Council, Plough Lane, HerefordHR4 0LE
T:01432 383 763E:
Executive Summary
This report comprises the findings from the Youth Health Access Project undertaken by Herefordshire LINk Young People’s Working Group. This report is intended forservice providers, commissioners and those who can effect change to enable them to shape future services to offer better access for young people. The Young Carers’ focus group findings havebeen submitted toward the Carers’ Strategy review process in Herefordshire and other findings have been submitted to the PCT and Herefordshire Council for inclusion toward service review within the commissioning cycle.
The report highlights the importance of GP services for young people. It notes the use of dental services which according to the survey findings are slightly higher than the national average. It indicates the importance that young people place on A&E services and the value of staff who communicate well with young people.Verbal feedback and survey findings from Young Carers are highlighted in order that consideration is given to this specific group of young people, particularly in light of an ageing population in Herefordshire, for which the young will bear increasing responsibility. The majority of young people who responded to the survey had not encountered any barrier to accessing health and social care. For those who had, the main problem was inconvenient appointment times.
It is hoped that the information provided will enable commissioners to take the needs of young people into account, and in addition, support service providers to continue to build accessibility for young people into future service provision.
Information was compiled anonymously for this report with identifying features removed. Project participants and partners are listed in the participants chart and the LINk would like to extend thanks toward those involved.
Project Participants
Herefordshire LINk Board Members and Staff / Young People’s Working Group Members / Young Volunteers and PartnersManagement Board Lead
Jacqui Bremner
Project management and reports Esther Grisenthwaite / Richard Betterton
Ruth Storey – youth engagement
Andrew Turner
Tina Harris
Tom Lynch
Allan Lloyd – Ex officio (Herefordshire LINk Chair) / Chelsea Hodges
Ed Roberts
Rhys O’Conner
Students at Hereford 6thFormCollege
Herefordshire Youth Shadow Board
Network Scouts Herefordshire
Contents
Executive Summary
Project Participants
Contents
Introduction
Background and purpose
Concerns raised by community - reason for investigation
Methodology
Findings
Survey respondents profile
Mapping services that young people access
Support available to young people for accessing services
Barriers to accessing health and social care services
Finding out about services
Comparison between young people and Young Carers
Transport to and from appointments
Summary
Recommendations
Appendices
Appendix 1
Appendix 2
Appendix 3 - Survey
Appendix 4 – Youth Shadow Board feedback
Appendix 5 – Network Scouts, Herefordshire
Appendix 6 - Comments from young people collected while completing the survey
Additional survey comments
Introduction
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Herefordshire LINk / Young People’s Access to Health and Social Care Dec 2011|Background and purpose
This investigation into young people’s access to health and social care was led byHerefordshire LINk Young People’s Working Group. The scope of thetask was to investigate access to health and social care services for young people, their main points of entry and the barriers to receiving the care that they need.
The target age group was 16 – 25 years and included Young Carers. The aim of the project was primarily to improve access to health and social care services for young people. It aimed to involve young people, giving them a voice into the services that they use. The age group selected reflects the stage where young people are taking greater independence over managing their health care and provides the project with a defined boundary.
The project supported the LINk young peoples’ work plan with the focus for the year 2011 on access to health and social care. It supported the broader aim of Herefordshire LINk to improve and monitor adult health and social care provision in Herefordshire. Recommendations for improving access to health care services are included in the report in response to thequalitative and quantitative data collected. Included are solutions suggested by young people in Herefordshire. The recommendations from the project will enable the LINk Management Board to monitor implementation of improvements for young people when new services are commissioned and strategies are reviewed. This report will be submitted to the Health and Scrutiny Committee, the Health and Wellbeing Board, The County Hospital, Wye Valley NHS Trust and Social Services - Children’s Services.
Many young people contributed their time voluntarily to undertake various tasks related to project activities. Youth workers distributed surveys and recorded feedback from young people. Herefordshire Young Carers enabled feedback through their networks. LINk members contributed time and expertise to support activities. The aim of the project was to determine how young people accessed health services and to find out what barriers existed. The outcomes from the project comprise the report findings leading to recommendations to improve access to health and social care services for young people and Young Carers. The direct involvement of young people in preparing and distributing the survey, choosing focus group questions and running sessions with peer groups to gain feedback, enabled them a voice into the project and ultimately into the services they use.
Concerns raised by community - reason for investigation
Concerns regarding access to health and social care were raised by members of the LINk Young People’s Working Group.Member representing young people includedHCVYS, Noah’s Ark Trust, Herefordshire Carers (Young Carers YAC) and Herefordshire 6thFormCollege. Barriers to accessing health and social care were brought to the attention of the LINk and highlighted for investigation. Initial research indicated that there was little specific information about how young people in Herefordshire accessed health and social care services and what their experiences were. Where research had been undertaken by agencies external to Herefordshire, the information was not available to share. Despite the value of the Young Inspectors programme, funding had been withdrawn so that young people were no longer actively involved in evaluating services in Herefordshire through the scheme. It was necessary to first ‘map’ the services used by young people in order to determine how young peoples’ health care needs were currently being met, what choices they were making and the reasons why.
A workshop undertaken at Hereford 6thFormCollege on 11/12/2010 provided some initial feedback from young people regarding their views and priorities in health and social care. This report together with feedback from representative organisations formed the basis for further investigation and helped define the scope of the project. (Appendix 1)
Engagement activities at Hereford 6thFormCollege identified young peoples’perception of their key priorities in health and social care together with barriers preventingaccess to the care they need. The students identified the Hospital Accident and Emergency service as the most important service provision for them. In addition, the main barriers to accessing health services wereidentifiedinorder of priority.
Main barriers to accessing health services:
- Attitudes
- Access
- Ignorance
- Timings
- Physical Difficulties
- Communication
Some of the feedback received from the students centered on communication and the need for medical staff to be able to communicate well with young people. It was clear from initial investigations that health services were valued by young people and in particular A&E but some areas could be improved such as staff communication and waiting times at A&E. Barriers to accessing timely health care were expressed and it was apparent that difficulties were experienced by some young people.
The point of entry to health care is often through a portal designed by adults for adults. Some of the research undertaken in this report was aimed at finding how this works for young people. To access physiotherapy services, for example, a young person may first contact the GP receptionist in order to make an appointment with a doctor who may then refer them to other services as appropriate. The young person needs to negotiate with the receptionist, manage systems of communication, manage a diary and understand terminology that may be unfamiliar. Although some services have specialist paediatric trained staff, young people first have to pass through the entry portal of a GP in order to access help. Young people use adult health and social care services on a regular basis yet do not have a strong voice into commissioning services or shaping delivery.
The ‘Yes We Can’ plan states the intention to ‘develop a clear plan for child health services…’
(SectionPromoting health and well-being).
Herefordshire Council’s Population Health Overview 2010 Version 1.0, Health and Wellbeing Services, June 2011 states that there are 19,140 young people between the ages of 15 and 24 years old.
Precise numbers of 16 – 25 years old could not be found, however, recommendations from this project have the potential to influence and improve access to health and social care for young people.
Methodology
Initial feedback gained from students at Hereford 6thFormCollege through a consensus workshop and 2 focus groups indicated priority areas of health and social care for young people and identified some of the barriers for access. This was followed up by discussion during a lesson with responses noted. Further to this,young volunteers produced and distributed a survey. A LINk member (youth worker intern) involved groups and individual young people both in the city and in rural locations. Respondents included Young Carers and young people with disabilities. During the survey distribution the youth worker made notes of comments provoked by survey questions and encouraged discussion. In order to include the views of Young Carers, aYoung Carer devised questions for a focus group among peers. Feedback from the Young Carers group (YAC) was recorded by a support worker. (Appendix 2) The results were discussed by a group of young people involved with the scouting movement and their feedback noted. Finally, the results from the survey were analysed and submitted to the Youth Shadow Board. The Shadow Board responded to the data, giving their views. They were asked for their solutions to barriers highlighted by the survey.
The objectives of the project were to:
- research existing information about how young people accessed services
- map health services young people accessed over the past 12 months
- identifywhere young people got their health advice and treatment and why they made those choices
- identify barriers that prevented access to health services and advice
- identify recommendations for improvements
Consideration was given to an online survey that could be loaded onto websites or social networking sites, however, it was decided that a paper survey would be more flexible. The plan was to distribute the survey at events, and young peoples’ activities. In addition, some surveys were distributed through retail outlets. The survey mapped health and social care services used by young people. It tested the perception of young people regarding barriers to accessing health and social care. It provided an indication of customer satisfaction and asked questions around young peoples’ confidence at making appointments, including the support available to them. It recorded thenumber of young peopleunable to access healthcare services they needed. (Appendix 3 – survey)
The survey questions wereselected bya young person who had just completed a Health and Social Care ‘A’ Level course. A decision was made to ask questions both around barriers created by the health service structure and delivery and questions around the support available to young people to help them manage their healthcare appointments. Some consideration was given to the fact that accessing health care services requires communication skills both on the part of the young person as well as health care professionals. Some of the questions on the survey aimed to find out where young people obtain information about available health and social care services.
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Herefordshire LINk / Young People’s Access to Health and Social Care Dec 2011|1
Herefordshire LINk / Young People’s Access to Health and Social Care Jan 2012 |Findings
Survey respondents profile
Therespondents subdivided as follows:
Total respondents = 90
Young Carers = 13[1]
With a disability = 3
Male = 37
Female = 53
Mapping services that young people access
The number of respondents in this survey is quite small and this should be taken into account when interpreting the results. For example, the chart below indicates that 34.4% of the young people visited the Accident and Emergency department at the hospital and this equates to 31 people. Whether this result would be reflected in a larger population is uncertain. Of the 90 young people that responded to the survey, the services they used in a 12 month period are listed below in order of most visited service through to least. In other words, 79% of the 90 survey respondents had visited a GP (at least once) in the last 12 month period. The data does not represent the frequency of visits but simply that the person had used that service once in the last 12 months. The base for calculating the percentages is the number of survey respondents rather than the number of people who answered a particular question. As a note of caution, the majority of young people who responded were between the age of 16 and 18 and this is likely to have affected the results. For example, the proportion of respondents who did not feel confident about making appointments might well have been lower if more over 18’s had responded.
Young Peoples’ use of Health Services in a 12 month period: - mapping the services accessed by young people
78.8%GP Services51.1%Dentist/orthodontist
41.1% Hospital
34.4%Accident and Emergency department
33.3%Pharmacy
17.1%Gaol Street clinic
16.6%Getting health Information from the Internet
13.3%School or college nurse
8.8%Asda walk-in clinic / 8.8%Mental health services
7.1%Other Hospital department, not A&E
5.5%Social worker
4.4%Specialist clinic
4.4%Out of hours GP at The County Hospital
4.4%Physiotherapy
4.4%Home support
3.3%NHS Direct
1.1%Medication purchased from the internet
Of the 90 young people between the ages of 16 and 25 who results indicated that the local doctor’s surgery was the main point of access for health care. Nearly 79% of respondents visited their GP in the last 12 months. 51% of young people have visited their dentist or orthodontist in the last year and 34% visited the County Hospital Accident and Emergency department indicating a relatively high use of A&E among this group. This confirmed findings from the 6thFormCollege where students reported that they placed a high priority on hospital Accident and Emergency services. Follow-up discussion indicated that students felt their age group was more likely to suffer sports and other injuries from their active lifestyles. In addition they reported other possible predictive factors including alcohol and drug use.
Research at the 6th form college revealed that young peoples’ perception of pharmacy services indicated it was of secondary importance, however it is the 5th most accessed service according to the LINk survey. In addition dental services were used by 51.1% of respondents within the last 12 months, making dental services the second most accessed service after GP’s. This could be a significant point of referral to other health services for young people and it is possible that the opportunity for signposting to other services may not be fully realized. For instance, do dental practitioners know that the college Student Services department in Hereford offers a quick referral for young people with eating disorders? After the Accident and Emergency Department, dentists and GP’s featured highly in order of importance to the young people who participated in focus groups. The importance of these services for young people was supported by the survey data.
Below are service priorities expressed by 2 focus groups at Hereford 6thFormCollege:
Group A / Group B1st Priority Services / 1st Priority Services
(A&E) Accident and Emergency
GP
Drop-in Clinic
Dentist
CLD
Gaol Street (STI clinic) / (A&E)Accident and Emergency
Dentist
Opticians
GP’s (For further information see Appendix 1)
Support available to young people for accessing services
To find out a bit more about how young people manage their health care, some questions on the survey were aimed at revealing the support available for making appointments and getting advice about services. The survey findings showed that GP services were the main point of access for a majority of young people. Comments offered by students at the 6thFormCollege indicate some of the problems young people experience when booking a visit to a GP. Discussion indicated that making appointments with a GP was challenging for some young people. Some of the comments are highlighted below.
Why it is difficult for young people to access GP surgeries?