Review of Primary Care Interpreting Service in Lambeth, Southwark, and Lewisham CCGs

1. Review of the Primary Care Interpreting & Translation Service in Lambeth, Southwark and Lewisham CCGsEngagement Report Yvonne Davies 18th March 2019 CCG/ Engagement Leads Meeting

2. AGENDA

3. BACKGROUND INFORMATION

4. BACKGROUND INFORMATION - KEY DRIVERS

5. Project Approach - Development and Delivery LSL Commissioners adopted a co-ordinated approach • LSL engagement working group • LSL Engagement Plan • Individual CCG Engagement activity plans/engagement logs • Agreed key messages for all materials, webpages, presentations and reports • Developed LSL branding • Independent provider (interpreters) to reduce conflict of Interest

6. Engagement Approach - Development and Delivery LSL Commissioners adopted a co-ordinated approach • Actively engage with top 5 requested languages in each borough (approx. 62% of all 2017/18 activity) • Actively inform with top 6-10 requested languages in each borough (approx. 14.5% of all 2017/18 activity) • HealthWatch intelligence - Applied findings of previous HW reports to inform of community groups to engage with • Service user Surveys (paper and online) – translated into top languages • Focus groups

7. Engagement Approach -Top requested languages The most requested languages across LSL

8. Engagement Approach – What we asked We asked service users for their views on; Information made available to them about the service The booking process Challenges they may have experienced Waiting times What is good about the service How the service could be improved Views on how technology might improve access

9. Engagement Approach – How we did it

10. Example materials

11. Engagement Approach – TIMELINES Feedback to groups and stakeholders about outcomes of engagement Agree Engagement Plan & approach Engagement report Engagement materials/ resources Online / website uploaded Service Users (GPs, Dentists, Opticians) Locality meetings, letters, surveys, Patient and public engagement (Face to Face and surveys) Options analysis Paper Wider Stakeholder (Briefings, presentation, reports) Report writing The engagement review ran from October 2018 until February 2019

12. Evaluation Approach LSL Commissioners adopted a co-ordinated approach Evaluation report template developed for consistent reporting CCG Reports Individual CCG evaluation report (engagement leads) Engagement activity plan and log (referenced as appendices) Peer to Peer review LSL Reports Detailed Executive summary of LSL findings Individual CCG reports (referenced as appendices) LSL Engagement Plan (referenced as appendices)

13. KEY FINDINGS

14. Key findings The engagement identified : A need for clearer and information for patients about interpreting in all primary care settings. Few people had been offered the service at dentists or opticians. Clearer recording of people’s precise language needs, especially around dialects or regional accents Providers responsibility to recruit suitably skilled staff and monitor performance To continue to view demographic changes and consider emerging languages, such, as Albanian Although people would consider video interpreting the infrastructure required to deliver it was a concern for patients but also especially for Primary Care staff When clinicians are with someone who signs but also lip reads they should try to ensure that the person can see them whilst talking

15. Key findings Summary of suggestions made by respondents

16. KEY FINDINGS Patients and Public

17. Key findings – Patients/Public engaged with a wide range of community groups and organisations Spoke directly with 360 people at 22 events

18. Key findings – Patients/Public Online survey (238 responses) Heard from speakers of all top 10 languages but did not receive online responses from all

19. Key findings – Patients/Public Breakdown of responses by CCG

20. Key findings – Patients/Public Use of and Access to Service A higher % of Lambeth respondents had used ITS at their GP, than in either Southwark or Lewisham. Fewer respondents in Southwark had used interpreting at a dentist. Low usage at opticians was common to all three areas. Higher % of Lambeth respondents had used face to face interpreting The % of respondents who had used telephone interpreting in Lambeth and Lewisham was very similar Significantly fewer Southwark respondents had used telephone interpreting –aligns with higher number of responses overall Southwark responses saying they had not used the ITS Lewisham CCG had two workshop events with a total of 13 users of BSL and these are reported in the individual CCG report.

21. Key findings – Patients/Public Use & experience of Service 57% of Southwark respondents said they had not been told about the service (33% Lew, 24% Lam) Across LSL 47% said that they needed support to book an appointment Lambeth respondents more issues with F2F 34.9% of respondents in Lambeth said they had been told they could not have an interpreter (10.75% in Lewisham and 22.4% in Southwark). 32.7% of respondents in Lambeth had experienced an interpreter not turning up (12.5% in Lewisham and 15.8% in Southwark). Similar percentages of respondents in Lambeth (29.6%) and Southwark (26%) reported being asked to bring family members of friends to interpret. (19.25% Lew)

22. Key findings – Patients/ Public Video Interpreting 69% would consider using a video service

23. Key findings – Patients/Public Comparison of survey response rates for languages by CCG LSL response rates were in line with usage of Spanish, Mandarin, Turkish and Vietnamese. Portuguese was not reflected despite high usage LAMBETH 38% of respondents were Spanish (most requested language) Responses received from 5 out of 10 most requested languages (3 in top 5) No responses from Arabic, Somali, Tigrnya, French or Italian which were among the 10 most requested languages 9 respondents specified they spoke other languages, mainly variations of Spanish, 1 Russian and 1 BSL user

24. Key findings – Patients/Public Comparison of survey response rates for languages by CCG SOUTHWARK 38% Spanish speakers (most requested language) 2nd highest response rate from Mandarin (2nd most requested language) 1 response from Portuguese (3rd most requested language) No responses from Polish, Albanian, Farsi (8, 9, 10th most requested languages) LEWISHAM Low response rate from Spanish (most requested language) High response rates from Mandarin, Vietnamese and Turkish (2nd 3rd 4th most requested languages) Responses received from 9/10 most requested languages 1 BSL online response 5% respondents were Albanian (emerging local language )

25. Key findings – Demographics of respondents Ethnicity • The main variation between LSL areas in survey respondent’s ethnicity is that Lewisham had a much lower percentage of people identifying as Spanish or Portuguese than Southwark and Lambeth and higher percentages of people identifying as Chinese, Vietnamese and Turkish. Religion • higher numbers of Lewisham respondents identified as Muslim (35%). • Higher numbers of Lambeth respondents (46.6%) identified as Christian. Gender • no significant differences in the percentage of respondents in each area identifying as male or female Sexual Orientation • In Southwark 4.4% of local respondents identified as homosexual and 6.67% identified as bisexual and 1.92% of Lambeth respondents identified as homosexual. No respondents In Lewisham identified as either homosexual or bisexual.

26. Key findings – Demographics of respondents Age • Majority of respondants aged 30-50 (Southwark had higher 51-70 than other CCGs) Carer • 205 people responded to the question about Carers. 25% of respondents in Southwark identified as carers. 21.25% in Lewisham and 14.55% in Lambeth. Disability • There were no significant differences between the three CCGs in numbers of people living with disability or conditions which affected every day living.

27. KEY FINDINGS Primary Care

28. Key findings – Primary Care Staff 255 responses across LSL (88 Lam, 80 South, 87 Lew) Higher responses from GPs, Practice manages than other staff Usage of service Most requested booking types • Telephone identified as most requested, easiest to book & most readily available • Length of time to log-in for telephone booked as an issue echoed across LSL

29. Key findings – Primary Care Staff Access to ITS • 73% of respondents booked double appts (majority Lewisham) • Response rates for BSL low • Patient preference was a significant factor for when choosing F2F • Themes regarding booking times included;

30. Key findings – Primary Care Staff Video Interpreting 221 responses (Q: consideration to use of video interpreting) 57.5% said they would consider using video consultation 14% would not use it & 28.5% were unsure BSL identified as the main group that could benefit from video interpreting Despite high response to using of those comments received majority were negative and had reservations about the quality of signal and requirement to date IT equipment

31. KEY FINDINGS Other Health Care professionals & Health Promotion Clinics (Service Users)

32. Key findings Health Promotion Clinics • 6 / 8 HP clinics identified continue to operate in Lambeth (5) and Lewisham (1) plus 1 LES in Lewisham for Vietnamese • Online responses 4 from Lambeth and 1 from Lewisham • Lewisham actively engaged with patients and interpreters from the 2 practices

33. Key findings Health Care Professionals (BPAS / MSI) • 7 staff responded to online survey / 2 email responses from BPAS • No response from opticians Key Themes • Difficulty in accessing face to face interpreters • The dentist found all services difficult to book • For pregnancy advice services the lack of availability after 5pm was an issue • Would want a future service to have same day telephone interpreting and next day face to face.

34. LESSONS LEARNT

35. Lessons Learnt Lessons learnt log developed Currently awaiting feedback from working group members The LSL report / presentation will be updated accordingly

36. COST

37. INTERPRETING COSTS Please note that the following are indicative interpreting costs* for the development/ delivery and evaluation of the engagement review** Final costs will be shared in due course once confirmed by the interpreting provider. In some cases CCGs were able to use interpreters available via community groups to support delivery * Includes room hire/refreshments **Does not include additional costs incurred by CCG e.g. management, engagement resources etc.

38. NEXT STEPS Engagement Report

39. NEXT STEPS FUTURE COMMISSIONING CONTRACTS Contracts with Providers have been extended for 12 months (exp 31/03/20) CCGs to sign MOU for 2019/20 for ongoing contractual arrangements SERVICE MODEL • CCG commissioning leads to outline approach to long term commissioning arrangements • Draft options paper to inform decisions

40. Next Steps - Considerations for options paper

41. Next Steps Other models/commissioning arrangements LSL is the only SEL CCG that commissions the service to specifically cover dental/ optometrists/ BPAS /MSI Dental / Optometrists – other CCGs have their activity recharged back to NHSE BPAS/ MSI – use their ITS provider for non LSL patients and recharge CCG

42. QUESTIONS