People with multiple and complex needs

The experiences of patients with multiple and complex needs as they interact with NHS and Social Care Services in Kirklees

Some of the difficulties experienced by people with multiple and complex needs1 were brought to Healthwatch Kirklees by staff at Huddersfield Mission. The Mission offers a variety of advice and support services to some the most vulnerable people in Huddersfield. Staff there told us that they felt some of their service users did not have equal access to health and care services. As we started to plan this piece of work, Healthwatch England launched their first ever Special Inquiry2 into hospital discharge. As part of this inquiry, they wanted to gather feedback from people who were discharged from hospital or mental health unit who were homeless or had a mental health condition. We felt we could contribute to the Special Inquiry when gathering information from people with multiple and complex needs. We wanted to understand more about the experiences of the most vulnerable and ‘easy to ignore’ people who use health and care services, so developed this piece of work to look at access, quality and discharge in health and social care services in Kirklees.

What we found:

Access to and experience of GP Services
Most people we spoke to had access to a GP and the majority gave positive feedback about the service they receive.
Some people experience problems with getting appointments but this is not unique to people with multiple and complex needs. Access to GP appointments is an issue across Kirklees; Healthwatch Kirklees are very much aware of this and we continue to monitor the efforts of Clinical Commissioning Groups and NHS England who are working to improve access for patients.
The Whitehouse Centre offers drop in sessions, available to vulnerable patients who are registered with them. This gives patients the flexibility to just turn up and be seen without having to remember to attend appointments.

Just over half of the people we spoke to were not registered with a dentist and this was mostly due to the lack of NHS dentists in Kirklees.  Again, this is not just a problem for people with multiple and complex needs; it is a national issue which has received attention from the media recently. Healthwatch Kirklees continue to provide evidence to NHS England, who commission dental services, to pressure them into changing their dental contracts.
Those without an NHS dentist said they would use emergency dental services, go to A&E or go to their GP.
Jutta Zapf from charity, Simon on the Streets says, ‘the system isn’t equipped to deal with people who lead more chaotic and unconventional lives…sadly a lot of people who don’t fit the criteria are left unsupported’. Jutta feels that if people’s needs don’t fit with the service being offered they can end up not receiving a service at all.

85% of the people we spoke to said they had a mental health condition. Some people told us they had depression or anxiety but were reluctant to try and access support, either because they felt they could cope or that they wouldn’t be given help if they asked.

Some people told us about times when they felt their physical or mental health had deteriorated because they hadn’t been able to get access to the appropriate health or care service at the right time.
When this has happened, things got so bad for some people that they attempted suicide or were sectioned.

Half of the people we spoke to had been to A&E in the last 18 months but had only done so in emergency situations, usually being taken there by ambulance.
Most said the service was good.

Almost half of the people we spoke to had been an inpatient in hospital or mental health unit during the last 18 months. Most of these had positive experiences. A few people were unhappy with the food provided. One person felt staff were judgmental, “put on a drip because I’m an alcoholic. Staff look at my records and judge me. Don’t treat me the same as other people”

Some people felt they had been treated unfairly or unequally by staff working in health and care services:
“Social worker – ended up telling me about how much she didn’t like her job! I was ill at the time. Some social workers should not be doing that job. I started having panic attacks. I needed a more experienced social worker. CPN stopped her coming without telling me. Social workers were utterly useless. Trainee social worker told me ‘I’m not here to mother you’. When ill I had very limited contact with people, so the contact I did have needed to be spot on. They are the professionals. For example, social worker came to door, introduced herself and straight away said ‘do you think you’re watching too much tv?’ They put somebody else’s name on my care plan. I asked for something to be changed and this was refused”

Dr Miller from the Whitehouse Centre said services must accept that some patients cannot change to fit with the model offered. Dr Miller also said there are staff and organisations who are prepared to ‘go the extra mile’ for people but this often goes unrecognised and unrewarded.