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Listening to our patients

Patient Experience &

Community Involvement

Highlight Report

October - December 2016

This report provides information on the different ways we collect service

user feedback and experience, what it means, and how we are using it

to improve the service. Included within this report is evidence of

community engagement work, social media activity and our involvement

in public health.

Index

Overview and Summary 2

Patient Stories 3

Patient Experience 4

Community Engagement & Partnerships 5

Views from communities 16

Social media 17

Compliments 18

NHS Direct Wales website 19

Moving forward 22

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Overview

The following provides an insight into patient experience across the Trust. We get

this information from:

Patient Experience

Community involvement work

Compliments

People accessing information on our websites

Surveys

Consultation responses

What was good about all of our work?

People gave us really good feedback, saying:

We treat people with excellent care

Our staff are professional

Our staff are polite and friendly

Engaged with lots of different communities across Wales, promoting first aid,

CPR and awareness of defibrillators

What could be improved?

Feedback from service users to improve:

Response times

Issues in our 999 control room including repetitive questioning; having to

make numerous calls; not knowing when help is going to arrive; and staff

failing to identify the patient’s other needs

Summary

Total number of people engaged with through community

engagement and patient experience 11, 903

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Patient Voices The following patient story was presented at our Annual General

Meeting. You can view other stories on our website.

Quality, Safety & Patient Experience Committee, November 2016

At this meeting, we presented experiences of people in mental health crisis and the

impact of not having consistent approach is having on patients and staff. There was

great debate from lots of different staff including the Safeguarding team and

operational staff. This work is helping to influence our Mental Health Improvement

Plan.

Trust Board, December 2016

Members of the Non Emergency Transport Services team presented a story of a

patient receiving transport to dialysis appointments. The story was a reflection on the

current service provided for dialysis patients, who were reporting a good service.

This information is being used to help improve the Non Emergency Transport

service, which has a large modernisation programme underway, including some of

the following:

Introducing a dedicated management team

Having a single telephone number to cover all of Wales

Enhanced services for some patient groups

Extending the hours they work in the control room

Working more closely with third sector organisations and other community

transport providers to deliver a better service

Dedicated projects to improve pick up and drop off times

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Patient Experience

Non Emergency Transport Service Survey

We sent out 700 surveys to people who had used our Non Emergency Transport

Service in October. The majority of feedback was extremely positive.

When asked what was good, people said that:

Staff are friendly and helpful

They would be unable to attend health appointments if it wasn’t for this

service

Having this service eases the stress and worry of attending appointments

When asked what could be better, people said that:

There are often delays with pick up and drop off times to get home

They want to be informed of any delays

The vehicles are uncomfortable

999 Survey – What people do in a health emergency

People often tell us that they are often unsure about what to do in a health

emergency, and that sometimes they don’t have a choice of services to contact for

help and advice. To help us find out more information, we ran a survey between April

– December 2016. This work helped to provide us with more information on people’s

behaviour when they are making decisions in a health emergency. The survey was

promoted online, through social media and at all community events and engagement

activities. 466 people completed the survey.

The majority of people contacted 999 for things like breathing difficulty, chest pain, falls, unconsciousness, seizures and strokes. A smaller number of people contacted 999 for things like general illness, pregnancy related problems and sports injuries/broken bones.

27% of people contacted another service before contacting 999. The main services contacted included GP, GP Out of Hours, and NHS Direct Wales. The majority of people who did contact another service were told to ring/wait for an ambulance. Some people who called NHS Direct Wales were advised to contact their GP. Some were advised to make their own way to A&E.

The majority of people who did not contact any other service before dialling 999 felt that they were experiencing a life threatening emergency, however some people felt that they were unable to contact any other service as they had no alternative.

42% of people returned the

survey 92% said their overall experience was

very good or excellent

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Engaging with Communities

1353 people engaged with at events

We have spent the last three months engaging with people at a range of events,

open days, health fairs and partnership events. We have undertaken a large scale

first aid and CPR education programme with children & young people during

Shoctober, visiting schools across Wales. We have continued to gather feedback

from patients and members of the public about their experiences and expecations of

us as an Ambulance Service.

Themes What was good?

Received lots of positive feedback from patients and members of the public

Provided First aid and CPR sessions to 100’s of schools through Shoctober

Engaged with a diverse range of groups and communities

We’ve attended 26 events

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Presentation to Diverse Cymru

In December we provided an update on the Welsh Ambulance Service to the ‘Co-

Creating Healthy Change’ forum at Diverse Cymru. The Co-Creating Healthy

Change project helps people in Cardiff and the Vale to share their views about

health, social care and wellbeing services with the people who run them.

Co-Creating Healthy Change encourages people from diverse communities in Cardiff

and the Vale to get involved in the project and particularly welcome:

Black and minority ethnic people

Carers

Lesbian, gay and bisexual people

Disabled people

Older people

Transgender people

They work with people from these communities in particular as they are less likely to

have their voices heard.

We gave the forum an update of our work, how we’re continuing to change and

improve services and spoke about key messages such as Choose Well.

The forum members were very interested in everything we had to talk about; they

had lots of questions and were keen to share their experiences with us. After the

event we received lots of positive feedback from the group, with members saying

“Really enjoyed having a chance to get my voice heard”, “A great discussion with the

Ambulance Service. Enjoyed the topic and all the participation” and “Everything was

strongly informed. Tutor was fantastic”.

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Lesbian, Gay, Bisexual, Trans* (LGBT)

We attended Swansea Sparkle again

this year. Swansea Sparkle is Wales'

largest Trans* information and public

integration event.

The annual event is focused

on promoting partnership working,

sharing information, raising

awareness of hate crime and most

importantly giving Trans* people an

opportunity to come along and relax

in a safe and informal environment.

Over 60 organisations and groups

attended the event operating information stands. The event was a day not to be

missed and has become one of the biggest in the LGBT calendar.

At the event we were able to talk to members of the Trans* community about their

experiences of using our services. Most people we spoke to hadn’t used the

Ambulance Service before, but people were concerned about how they would be

treated if they do need to use the service in the future. They were concerned about

how much of their gender variance they would need to disclose and how

understanding and well trained our staff would be to deal with this.

Marie Curie Lecture – ‘Hiding who I am’

We attended a lecture and panel discussion in Cardiff given by Marie Curie about the

realities of end of life care experienced by LGBT People. The Lecture was given by

Dr Richard Harding from Kings College London, who led a research programme into

LGBT people’s experiences of end of life care. You can read the research findings in

full here.

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Sensory Loss

Sensory Loss Awareness Month

November was Sensory Loss Awareness Month in Wales. Throughout the month

Health boards and NHS Trusts across the country, including the Welsh Ambulance

Service, held events and took

part in different activities to raise

awareness of the campaign.

During this year’s campaign

month, here at the Welsh

Ambulance Services NHS Trust

we worked with colleagues at

Deafblind Cymru who loaned us

specialist equipment that would

allow us to simulate what it feels

like to live with a sensory loss.

Our staff spent time using the

equipment to find out how they

would cope doing their regular

day jobs and other day to day

tasks like making a cup of tea if

they had a sensory loss.

You can find further information about the ‘It Makes Sense’ campaign here.

Centre for Sign, Sight & Sound visit to Control

In November The Centre for

Sign, Sight & Sound

(previously North Wales Deaf

Association) paid a visit to our

Clinical Contact Centre in

Llanfairfechan.

The group had asked to visit as

they were keen to learn more

about how we respond to 999

calls.

They were impressed to see how the Call Takers and Allocators work together,

taking the essential details from the caller, deciding on the type of response needed

and, if appropriate, dispatching the nearest emergency ambulance, Rapid Response

Vehicle or Community First Responder.

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Sight Loss Groups

We visited a Sight Loss group

in Pontypridd, Ammanford

and Caerphilly, where people

relayed positive experiences

of using our services. The

groups had lots of ideas for

improvement, which included:

A password system for when you ring 999 so that when help arrives a person

with sight loss will know ambulance staff have arrived

Having a Volunteer driver for non emergency transport that helps people with

sight loss to be taken to the right department and not just to the main entrance of

a hospital.

Use bigger print for any information we produce, and provide audio information

Having ambulance staff tell nurses that we have a carer for sight loss who needs

to stay with us.

Sensory Loss Clips

Working with The Centre for Sign, Sight & Sound we have developed two new

sensory loss information clips containing important information about the Welsh

Ambulance Service.

The first video clip offers basic information

about the Welsh Ambulance Service, what

we do and how someone with a sensory

loss can contact us. The second video clip

talks about falls, how to avoid falling in the

home and how we respond to fallers.

Each of the clips provides information in

British Sign Language (BSL), audio voice

over and subtitles, making the information

accessible to a wide range of people.

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Children and young people – Shoctober

Throughout October and for the first

time ever, we ran a school campaign

‘Shoctober’ aimed at teaching primary

school children life saving skills.

With help from staff, Community First

Responders (CFR’s) and partners we

reached over 9,500 children across

Wales. During our visit we helped

children to understand:

The difference between a big and little accident

When to dial 999

NHS services that can help other than 999

Children were also able to learn about:

CPR and how to do it

How to deal with someone choking

Using a defibrillator

The recovery position

To make sure everyone got involved, younger children practised CPR on their own

teddies while the older children practised on manikins. To view all the information,

videos and activity packs from the campaign visit the Trust’s youth website ‘The

Room’.

We received lots of positive feedback about the Shoctober campaign from everyone

who’d been involved. Including:

“Shoctober is an amazing thing. Teaching teddy CPR to the young ones who can

tell adults what to do and knowing when to call 999 in the right time and what to

do to save people’s lives” Community First Responder

“I Think Shoctober is a fantastic idea, it teaches kids at a young age, they can

pass this onto other people” Technician, Welsh Ambulance Services

“I think Shoctober is important as it teaches kids a new skill and to phone for us in

an emergency” Paramedic, Welsh Ambulance Services

“We all at Llangennech think that Shoctober is very important as it is raising

awareness to save lives” Teacher, Llanelli

We engaged with 9,500

children

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Learning Disability Community

Anne and Neil, our Learning Disability

Community Champions from Swansea

have recently visited an NHS Direct Wales

Contact Centre, and an Ambulance

station.

They said that “Visiting the call centre was

brilliant and seeing the layout of it. We

were given a great welcome from the staff

and we had the chance to ask questions

and we listened to two ‘mock’ calls. We learnt how they deal with different sorts of

phone calls.

Visiting the ambulance station was really good

and it was really interesting learning about the

equipment on the ambulance and what it is used

for.

We are looking forward to talking to other people

with learning disabilities and telling them about

our visit”

See the ‘Moving Forward’ section at the end of

this report, where we talk about a Celebration

Event in February! Our Champions will be

delivering interactive sessions...

We also attended a ‘Keeping Healthy’ event for adults with learning disabilities in

Prestatyn.

The event included presentations and demonstrations about keeping healthy,

mentally and physically. We provided a display of easy read resources specifically

designed for the Learning Disability

Community and talked to the audience about

the role of Learning Disability Community

Champion.

Sonia Thompson, Head of Operations for

Betsi Cadwaladr presented two of our

Champions with a certificate. James, one of

our champions also facilitated the ‘Big and

Little Accident’ quiz to the audience.

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We attended Vale People First

Annual General Meeting and

Conference where we talked

about our work. This was a

really enjoyable day as

members of Vale People First

talked about opportunities they

had to help them have happy

lives.

Older people

We continue to engage with older people groups and organisations to ask them

about their experiences of using our services, and what kind of service they would

expect to receive from us.

We have been promoting our new ‘Promises’ for older people, which were launched

to celebrate International Day of Older People on the 1 October. You can see a full

list of the Promises here, or contact us for a copy (contact details are at the end).

At a Cwmdare OAP group, people

were keen to give their feedback

about our services. Six people gave

very positive feedback for when they

had called 999 in a health emergency,

including the following:

Without them & the first

responder my husband

wouldn’t be here today.

Thank you all! “They were clam, considerate and

involved us both in what they were

doing and what was going to happen.

It helped calm the situation…”

“Excellent service….the

paramedics were

wonderful”

“Very helpful and informative on the

telephone. Paramedics are very

caring and efficient”

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Dementia

We have visited a Dementia Service

User Review Panel in Gwent to talk to

the group about our services. The group

had lots of good questions and

comments about the service, including

how we need to increase knowledge

and awareness of staff about

recognising the needs of people with

dementia.

In response to this, we are working with

the group on a visit to our contact centre in Cwmbran, and will be looking to work

together on some learning resources for our staff.

There is also work being progressed on a

Welsh Ambulance Service Dementia

Action Plan as well as how we work in

partnership on the All Wales Dementia

Strategy.

Engaging with Portuguese and Polish Communities

We attended an English for Speakers of

Other Languages (ESOL) class, to talk

to their students.

From the feedback received from this

group it was clear that some individuals

have had poor experiences of using 999

services when calling for an emergency

ambulance.

One person who told us about her

experiences said she had not received

a good service on 3 separate

occasions. On one occasion she rang 999 due to suddenly losing sensation in her

legs. She waited 2 hours, but the ambulance didn’t come, “They said there was

nothing they could do”. She found these experiences sad and scary and although

she later had a stroke, she told us she did not bother to call for an ambulance that

time, even though she did get admitted into Hospital.

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Multicultural Christmas Event

In partnership with Focal Point, we

attended a Christmas event in Merthyr

Tydfil to engage with many Polish

families.

Raising awareness about how we

respond to calls enabled us to explain

how our Ambulance services in Wales

may differ from people’s country of

origin. We also provided practical

sessions on CPR during the event.

Dignity was very important to the people

we spoke to, but most important was

“fast help if my life is in danger”. People

also said they expected kindness,

expert advice and understanding shown about language differences. People said

they wanted fast help for things like chest pains, difficulty breathing,

unconsciousness or choking.

Parkinson’s UK Group, Monmouth

We returned to this group as they asked us to

provide an awareness session on CPR, how to

use a defibrillator and what to do if a person is

choking. This time, with operational support,

our staff ran an interactive session along with

questions and answers, all of which was well

received by the group.

Glifach Goch Breathe Easy Group

In a return visit to the Breathe Easy Group at

Gilfach Goch we were supported by a local

Paramedic who provided a practical

demonstration. He raised awareness of the

signs of Sepsis and answered questions from

the group about how we respond to calls.

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Mental Health

We visited CREST Men’s Group in Swansea, a group of Mental Health Service

users. Many talked about the frustration they felt in coping with the number of

questions the Call Takers ask. This was both in relation to contacting NHS Direct

Wales and calling 999. This frustration, complicated by mental illness, could in some

circumstances contribute to people becoming abusive over the phone and then

receiving a visit from the Police.

While we were able to explain the reasons for asking lots of questions, the group felt

they would like to learn more about the scripts that call takers use during the call.

They felt this would help them to be less stressed in future if they ever needed to use

our services. This is now being explored. Most people reported very positive

experiences of using 999 for an ambulance, but one person highlighted delays

experienced at the emergency department.

As a result of being a member of the Cardiff and the Vale Mental Health Forum we

were invited to a YMCA Hostel Team meeting in Cardiff, where there are calls to 999

in relation to Mental Health needs. With operational ambulance staff in attendance,

there was a good discussion about closer partnership working, particularly around

pathways which are in place for people’s safety. Other helpful advice was shared

about what happens when Ambulance crews are called out for people of no fixed

address.

Partnership working – Promoting Choose Well in Hywel Dda

Working in partnership with the Primary

Care Team from Hywel Dda Health

Board, we hosted a stand at the St Elli

Shopping Centre, Llanelli and Boots the

chemist in Haverfordwest. We promoted

the ‘Choose Well’ message and how to

keep well and healthy this winter.

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Getting views from communities

We have asked people the following questions when we have been out and about

with communities.

What does dignity mean to you?

Treated right, helpful and courteous.

Dignity is very important for me but the most important is fast help if my life is

in danger.

Being treated with respect and civility, kindness and compassion.

How was your experience using 999?

Ambulance attended very quickly but spent 4 hours waiting outside A&E due

to queue. Paramedics only allowed to administer paracetamol which did not

work for the pain son was experiencing. Very distressing having to watch son

suffering.

Call handler was very helpful and professional, giving advice throughout the

call. Paramedics were professional and caring and treated my grandmother

with respect and dignity throughout.

Excellent service – I had to call out the ambulance in July and they were with

me in a few minutes. I had gone to the toilet and suddenly I was sick and felt

dizzy. I called my husband and when he put the light on, the vomit was full of

blood. The paramedics were wonderful, put me at ease and I had to stay in

hospital for 5 days. It turned out I had a tear in the lining of my stomach.

When I call 999 I expect....

Good help, kind talk, expert advice, fast help when I need immediately and

understand me also when my English language is not too good.

Like something is danger for my life, chest pain, difficulty in breathing,

unconsciousness, choking.

A reasonably quick response, according to the situation, and how serious it is.

We are using this feedback to influence the way we engage with communities and

how we use feedback to improve our services. By capturing information in this way,

we have a good picture of what peoples experiences are and what they expect from

us. Monitoring what we are doing with this feedback is really important to us because

we want to see things change for the better as a result of what people tell us.

What does dignity

mean to you?

How was your

experience using 999?

When I call 999 I

expect...

Over 30 people gave us

feedback on these questions!

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Twitter Summary

Tweets:

287

Tweet impressions (how many

people our tweets have reached):

322,400

Profile visits (number of times

people have clicked on our profile):

10,248

Mentions (people who included

@WelshAmbPIH in their tweet):

216

New followers:

126

Social Media – Patient Experience & Engagement

We continue to use social media channels to raise awareness

of specific messages we want to share in an open and instant

way.

Using social media is a great

way for us to share messages

and pictures about our work.

We have continued to increase

our reach to different people

and communities.

We share compliments and

experiences we get and

encourage people to feedback

to us.

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Positive experiences

Compliments - 188

“I just wanted to make contact to let you know how impressed I was with the service

we received from the Welsh Ambulance Service this morning. We called NHS Direct

Wales for some advice regarding my mother who had hugely reduced mobility and

just wasn't feeling quite right. They sent out an ambulance to check her over and the

care received by the two staff who arrived was exemplary.

They treated my mother with such kindness and dignity and put us all immediately at

ease. My father had been initially quite upset and they were also wonderful with him

and he was instantly calm and assured. They were thorough and very careful to ask

my mother her thoughts and permission every step of the way, being mindful not to

ever speak over her.

In a time where all I see is bad press against our health service, I just wanted to let

you know that there are people out there doing an absolutely fantastic job, and we

should appreciate them very much. Thank you for everything that you all do”.

Naomi, North Wales.

0 10 20 30 40 50

Aneurin Bevan

ABMU

Betsi Cadwaladr

Cardiff & Vale

Cwm Taf

Hywel Dda

NHSDW

Powys

The majority of compliments were about:

the good care provided by staff

the professional attitude of staff

polite, cheerful, friendly staff

Learning

We are very grateful to everyone who contacts us to give share their experiences with

us. We have been able to use this feedback to celebrate the great work our staff do

every day. Some of these compliments we have even turned into a story that we are

able to share on our website.

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NHS Direct Wales Website

The website continues to be a popular source of information, particularly with mobile

technology as visitor numbers remain high.

Our online symptom checkers continue to be popular allowing website users to

assess their symptoms in their own time, gaining useful information and signposting

advice on what to do next to help with their problem. These include contacting your

GP, A&E, Pharmacy, NHS Direct Wales or Self Care.

During this period, the most popular Symptom Checkers were:

Stomach Pain 78,522

Cold & Flu 49,777

Generally Unwell 46,573

You Said We Did

To keep up to date with changes we’ve made to the website based on feedback, visit

the ‘You Said We Did’ section on our homepage. Here are just some examples:

LGBT* Health Information

Research has shown that Lesbian Gay Bisexual and Trans* (LGBT) people have

poorer health outcomes and are at greater risk of ill health due to higher usage rates

of smoking, alcohol and other substances; mental health; eating disorders; domestic

abuse and low uptake of screening services. Based on public feedback and to show

our commitment to the LGBT community, we are working in partnership with

Rainbow Research, Stonewall Cymru and the NHS Centre for Equality and Human

Rights to develop new LGBT content. We look forward to promoting it in 2017.

Visits Top Page Viewed

October 236,853 Stomach Pain Symptom Checker

November 236,723 Stomach Pain Symptom Checker

December 215,473 Stomach Pain Symptom Checker

Total 689,052

December 2016: You fed back to say that we had no picture of shingles in our skin rash slideshow.

We have added a picture of shingles to the slideshow and to the shingles topic in our encyclopaedia.

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Better access to information for the Deaf community

Following feedback, we are currently discussing with the Deaf community and Public

Health Wales ways we can improve accessibility to health information available on

the NHS Direct Wales website.

Public Education

As part of our ongoing work with

Public Health Wales, in support of the

Beat Flu campaign, we saw Jack, the

Welsh Ambulance Service mascot

chasing off the flu bug, encouraging

others to get protected with their free

vaccine!

#beatflu

During the festive season, it can be

easy to leave things until last minute

but some things can be easily

forgotten when looking after your own

and your family’s health.

To give everyone a helping hand, we

developed 12 steps to a healthy

Christmas. In each window are hints

and tips to ensure you have a stress

free time including ordering repeat

prescriptions, getting your flu vaccine,

stocking up on your medicine cabinet

and first aid box, details of local NHS

services available, food safety and a

reminder to Choose Well!

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Social Media – NHS Direct Wales

We continue to use social media to promote the NHS Direct Wales

website and signpost the public to the tools, information available on

through the website and appropriate organisations

Encouraging self care, supporting ‘Choose Well’ and raising awareness of

health promotion campaigns and public health issues, continues to be the

primary aim.

Twitter Summary

Tweets

273

Tweet impressions

(how many people our

tweets have reached)

140,400

Profile visits (number of

times people have

clicked on our profile)

3,475

Mentions (people who

included

@NHSDirectWales in

their tweet)

212

New followers

235

Social media allows us to engage and respond to the public & organisations in real time

and keep the NHS Direct Wales service in the minds of the users.

It’s also a great way to capture feedback, share compliments, signpost visitors and

demonstrate how users’ feedback can influence service delivery and website content.

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Moving Forward

Learning Disability Celebration event – coming in 2017!

We continue to work with Caerphilly County Council on a celebration and learning

event, with and for people with learning disabilities. This event will be on the 28th

February, and will celebrate the work we have done in partnership with the learning

disability community. We are working with a Drama group ‘The Sirens’ and are

holding regular rehearsals to prepare for the event.

Carers event – Bridgend

We are delighted to be working with Bridgend Carers Service on a partnership event

on the 8th March in Bridgend. The event will aim to bring together different carers of

all ages from the Bridgend and surrounding areas to focus on their health and

wellbeing. There will be lots of information and activities available through the day

including health information, support services, free therapy tasters, and exercise

sessions.

Working with Sight Cymru

We will be working with Sight Cymru to explore the possibility of shadowing patients

with sight loss when they use our Non Emergency Patients Transport Services,

allowing us greater insight into the problems and difficulties they face.

Children and Young People’s National Participation Standards

The Children and Young People’s National Participation Standards were launched in

November 2016. These will help us identify key issues that we should be aware of

when working with children and young people. 2017 will see us working in

partnership with the Children’s Commissioner and a broad range of organisations

and children themselves on a list of Promises.

Get involved – give us your feedback

If you want to join our Network, please visit our website, call 01792 311773 or email

peci.team@wales.nhs.uk.

Follow us on Twitter

@WelshAmbPIH

@NHSDirectWales

‘Like’ us on Facebook

www.facebook/welshambulanceservice

www.facebook/NHSDirectWales