SLH0006
Written evidence from Patrick Cash
Demand and Access in Chelsea and Westminster’s Sexual Health Services
Written by Patrick Cash (Patient Champion)
Since September 2017, I’ve obtained direct feedback from over 1000 patients in Chelsea and Westminster’s sexual health waiting rooms. These include the flagship clinics 56 Dean Street and Dean Street Express in Soho, John Hunter Clinic in Chelsea, and 10 Hammersmith Broadway in West London. I’ve also visited clinics outside of central London that currently operate under Chelsea and Westminster’s tender: the Heart of Hounslow, and St Helier’s in Sutton. In each service, I’ve asked the open-ended question: ‘is there anything you find good or bad about this clinic?’
Very few patients refused to speak to me: most appreciated the chance to evaluate their sexual health provision. A year later, I now have a ‘Patient Feedback’ document totalling 39,781 words and 96 pages. When I heard about the HSCC Inquiry, it seemed an apt opportunity to utilise this research, so the HSCC can hear the voice of London patients. In general, patients praised their clinician-patient relationships. However, the recurring negative feedback surrounded the areas of demand and access, directly related to financial pressures on sexual health services.
All feedback was recorded anonymously, and I did not collect empirical demographic data in my research. But 56 Dean Street and Dean Street Express see majority numbers of MSM (men who have sex with men), averaging 7000 of their 11,000 monthly patients. 10 Hammersmith Broadway has a large young heterosexual (15-24 year old) patient cohort, and John Hunter Clinic covers a mixed range of heterosexual, MSM and BME patients. Therefore the feedback presented here represents all these demographics, with an emphasis on MSM and young heterosexual (15-24 year old) cohorts.
The main areas of concern were:
As well as these recurring themes, other individual issues were also cited. These included access to sexual health services for deaf patients, comparison to clinics outside London, and denigration of the patient experience over time: explicitly in terms of demand and access. The phone system at Chelsea and Westminster was also repeatedly mentioned as an area of frustration for patients, although I have assessed this concern as partially an internal problem. If funding is adversely affecting the call centre, it would be in the current lack of plans to expand its capacity.
Patient Responses
For the following responses I shall use the acronyms 56DS (56 Dean Street), DSE (Dean Street Express), 10HB (10 Hammersmith Broadway) and JHC (John Hunter Clinic) to demarcate each clinic. Heart of Hounslow and St Helier’s are written by name.
Booking Appointments
Booking appointments was a major issue at Dean Street Express (DSE), Chelsea and Westminster’s rapid testing clinic. Patients must visit the DSE website at 7pm sharp, in order to book one of a limited number of appointments for the next day. As highlighted in the feedback, a large surplus of patients tries to book a small quota of appointments. This results in website crashes, frustration, and extended waiting times between check-ups. The 350 slots available have recently been cut, due to pressure from local authority commissioners. It could be termed that Dean Street Express has been made a victim of its own success.
‘Tried for three weeks to get an appointment once, but the clinic is awesome. You just have to be ready at 7pm to book your appointment, like Glastonbury tickets’ – Patient A (DSE), 14/09/17
‘The booking can be frustrating, you have to be up and on point right at 7pm. But other than that, brilliant’ – Patient B (DSE), 21/09/17
‘First time, so far it’s okay. Did find trouble in getting an appointment’ – Patient C (DSE), 28/09/17
‘Find it great but getting the appointment is nuts, sometimes I’m there with my phone and my computer at the same time, 1500 people applying for 300 places, nuts!’ – Patient D (DSE), 09/11/17
‘Only problem is booking using the mobile system, but you can be in at 7.01 in the evening and you don’t get anything for the next day, I suppose it’s just a question of implementation of technology, but the rest of the service is great.’ – Patient E (DSE), 09/11/17
‘The website is difficult to book, always down, may be resolved now, too many trying to book appointments, but other than that it’s great.’ – Patient F (DSE), 16/11/17
‘Service friendly, the performance of the doctor is professional, but difficult to get an appointment, the website doesn’t work well and you have to refresh it a lot.’ – Patient G (DSE), 23/11/17
‘With the appointments obviously if you’re not in at 7pm all of them disappear, and you can’t always be online at 7pm, not always easy’ – Patient H (DSE), 30/11/17
‘Booking an appointment is an issue, and even when you get an appointment you might still have the waiting time of up to an hour.’ – Patient I (DSE), 08/12/17
‘I would like extra time, sometimes I’m working evening shifts, another time for 2-3pm in addition to 6-7pm, and not just after 7pm’ – Patient J (DSE), 08/12/17
‘Mostly good, the complaints are familiar about trying to secure an appointment, but other than that it’s fine’ – Patient K (DSE), 21/12/17
‘Quite positive, good service, professional, only negative are the long queues. When booking appointments they go quick, so difficult at times.’ – Patient L (DSE), 04/01/18
‘First time, and it’s been quite a challenge to get an appointment, I’ve been fighting since 3rd January to get an appointment.’ – Patient M (DSE), 18/01/18
‘The whole booking situation needs to be changed, but I know they’re under pressure, maybe there’s a way to have a club or membership for people? Sometimes it’s taken me three weeks to get an appointment’ – Patient N (DSE), 15/02/18
‘You need to use wisdom and logic for the online appointment booking process’ – Patient O (DSE), 08/03/18
‘Booking appointments is difficult, last night waited for the 7pm book, and on the sixth try got through. But that’s a funding issue’ – Patient P (DSE), 15/03/18
‘All good, staff friendly and helpful, but booking appointments is impossible! Not enough slots and too many people’ – Patient Q (DSE), 05/04/18
Oversubscription and Waiting Times
‘I arrived early, was told to come back between 12-1pm, came back at 12.15pm and it was a free-for-all, people coming in one after the other.’ – Patient A (10HB), 14/09/17
‘It would be useful to know what the current waiting time is on the screens. When I arrived I was told it would be 40 minutes to an hour, but they are using their lunch hour to be there, and have no idea how the waiting time has changed since they sat down’ – Patient B (10HB), 14/09/17
‘Waiting time can be 40 minutes to an hour, it would be good if this could be accounted for on the booking system to be more efficient with time’ – Patient C (JHC), 14/09/17
‘First time here, but I’ve been waiting for almost an hour already’ – Patient D (JHC), 14/09/17
‘My appointment was at 3.10, now it’s 3.29. I was told when I came in there was ‘no delay’. I mean, a 20 minute delay is still a delay.’ – Patient E (JHC), 27/09/17
‘Been here five minutes, called for an appointment, and was told I could wait 1 and a half hours instead. I understand it’s busy, but 1 and a half hours seems a lot’ – Patient F (JHC), 27/09/17
‘Last time was okay, other than the wait was long’ – Patient G (56DS), 28/09/17
‘Glad they were slots, because the walk-in was full two days in a row’ – Patient H (10HB), 05/10/17
‘Sometimes you can wait up to 30/40 minutes, but in general fine. The service is friendly.’ – Patient I (56DS), 09/11/17
‘I’m a big champion of this clinic, because coming from a North American context, I feel that people here take time to actually talk to you about contraception, about your health, and are really approachable. This having been said, I was told today it’s been an hour long wait now’ – Patient J (10HB), 09/11/17
‘I booked an appointment for 1.20pm and I’m still here! (current time: 2pm). I have to go back to work, it’s only my second day here, and yes, I’d say more female practitioners too.’ – Patient K (10HB), 16/11/17
‘This point in the waiting room is the longest wait, sometimes it can be 20 minutes or an hour, but can’t do much, because of peak flows and you already have a lot of staff on anyway’ – Patient L (DSE), 30/11/17
‘Good, just waiting time for walk in was quite long, waiting for two hours today’ – Patient M (10HB), 30/11/17
‘Right now I’m an hour over my lunch break already and keep thinking I should leave: I don’t want to leave and then be called’ – Patient N (10HB), 18/01/18
‘I’d change the wait times. Generally it’s too long: on the top floor/3rd floor, up here it’s quite quick, but in the clinic itself you can be waiting for an hour late’ – Patient O (56DS), 18/01/18
‘Sometimes the waiting is too long, booking an appointment can be hard because of availability’ – Patient P (56DS), 07/02/18
‘Good, people friendly, booking an appointment easy, but if you’ve booked for 11.30 you’d expect to be seen at 11.30, it’s now 12, so a long waiting time. I’d want faster and more accurate appointments’ – Patient Q (10HB), 15/02/18
‘I have to wait a long time compared to my first experience’ – Patient R (DSE), 08/03/18
‘It gets really busy at certain times, a lot more than six months ago. I came in at 4.30 last week, and it was standing room only, so I’d try to resolve that’ – Patient S (DSE), 15/03/18
‘Waiting time is long, but I understand why. The staff are very friendly and supportive, nice, and the walk in service is fine. Nothing to change except waiting times.’ – Patient T (10HB), 05/04/18
‘The only thing I dislike are the one hour waiting times, but nothing else to change’ – Patient U (10HB), 03/05/18
‘Waiting time 45 minutes: average, standard, minimum to wait; sometimes it can be one and a half hours. I think more staff are needed’ – Patient V (Heart of Hounslow), 13/06/18
‘I came yesterday and was waiting for over an hour so just left’ – Patient W (HoH), 13/06/18
‘Maybe the waiting time is a bit long, I’ve been waiting for 30 minutes today. This is the 3rd or the 4th time I’ve tried to come here because the other times I come in, they’ve given me a ticket and told me to come back in a couple of hours’ – Patient X (10HB), 14/06/18
‘Time management is an issue: the less people are waiting, the less anxiety. Otherwise people are waiting for an hour!’ – Patient Y (10HB), 19/07/18
‘The waiting times sometimes can be quite long, 2-3 hours’ – Patient Z (St Helier’s), 24/08/18
Displacement of Patients
‘A lot of people are coming to DSE because they can’t get an appointment at 56DS, such a big wait’ – Patient A (DSE), 21/09/18
‘I usually go to Dean Street but they didn’t have any appointments so I had to come here, far away from where I live’ – Patient B (10HB), 16/11/17
‘First time, usually go to 56 Dean Street, never been here before’ – Patient C (10HB), 16/11/17
‘Quite good, easy to use clinic, don’t have to sign up like the one in Soho, impossible to get an appointment at 56 Dean Street’ – Patient D (10HB), 23/11/17
‘First time, went to Dean Street Express before which was good, but came here because it was so hard to get an appointment there’ – Patient E (10HB), 30/11/17
‘I tried to phone and book an appointment at 56 Dean Street and you just can’t get them: here I walked in as I was in the area, and friendly so far. Nothing to change other than the waiting!’ – Patient F (10HB), 15/02/18
‘I tried booking on the phone and found that a couple [of clinics] have closed down. I used the walk-in service, and live in East and the availability of clinics is bad, I think a lot have closed down’ – Patient G (10HB), 19/04/18
‘I just got here, but on other days, [it’d be good] if they halve the queue. The staff are good: my local clinic is Jeffrey’s Clinic, but I come here because 10 Hammersmith Broadway is better’ – Patient H (10HB), 14/06/18
‘Haven’t really been here, no appointments at 56 Dean Street. Staff friendly.’ – Patient I (10HB), 19/07/18
‘The clinic is nice, I came here because I couldn’t get an appointment at the one in Soho.’ – Patient J (10HB), 19/07/18
‘Dean Street Express always rammed. Been waiting 20 minutes and staff friendly here.’ – Patient K (10HB), 02/08/18
Opening Hours
‘Quite straightforward, maybe opening on Sundays would be convenient though’ – Patient A (DSE), 16/11/17
‘Difficult when you work full time, or at least when you work my hours, what about appointments later in the evening or early in the morning?’ – Patient B (DSE), 08/12/17
‘And maybe have an emergency walk-ins system, or sort by symptoms, it’s easy to see why it’s so popular, because the good system is in demand, the nurses and doctors are amazingly good, but could you have more options?’ – Patient C (DSE), 21/12/17
‘I’d also change the opening hours to the weekends: because of working times, it’d be more convenient to come in on a Saturday.’ – Patient D (DSE), 18/01/18
‘It’s friendly and there’s nothing I’d change except extend the opening hours’ – Patient E (10HB), 07/02/18
Demand for More Clinics
‘It’d be great if there were more NHS clinics like this.’ – Patient A (DSE), 30/11/17
‘Nothing to change, but more of these clinics!’ – Patient B (DSE), 08/03/18
‘I agree [with Patient B], more clinics! It’s very good, I’m from Manchester, and you don’t have these clinics there, so I always try to come here.’ – Patient C (DSE), 08/03/18
‘The waiting time doesn’t hugely bother me, because I know how busy it is and you’re aware that’s what you get, you need more services like this’ – Patient D (DSE), 05/04/18
‘The staff are friendly and put your mind at ease but the clinic itself needs to be bigger!’ – Patient E (DSE), 05/04/18
Funding Cuts
‘More appointments could be good, found it easier for the walk in. The service is friendly, but you need more funding.’ – Patient A (DSE), 18/01/18
‘FOH staff needs improvement: when it’s busy and there’s only one person on reception it’s frustrating. You need 2 or 3’ – Patient B (DSE), 18/01/18
‘I think what you offer is good, but you could put on one or two more nurses and doctors, so there’s less of a wait’ – Patient C (10HB), 01/02/18
‘The staff and approach are friendly, very good, booking appointments can take a long time, but I know there’s a shortage of clinics in London’ – Patient D (DSE), 15/02/18
‘There are constraints for booking appointments with the online booking system, but that’s a funding issue, the staff are friendly. Nothing to change, other than the opening hours, but that’s also a funding issue!’ – Patient E (DSE), 15/03/18
‘Last night waited for the 7pm book, and on the sixth try got through. But that’s a funding issue’ – Patient F (DSE), 15/03/18
‘I am concerned that the drop-in services here and at Hammersmith are to be cut though… And what impact that will have on the services in London.’ – Patient G (DSE), 15/03/18
‘There are some vaccinations that there’s no funding to offer anymore’ – Patient H (DSE), 05/04/18
‘Sometimes I feel they are understaffed and put under pressure. Less money, so they have to work harder which is not fair’ – Patient I (10HB), 02/08/18
Conclusion
Financial pressures on sexual health services have left a poor legacy. Some patients explicitly note a discernible decline in their sexual health provision within the last year. ‘It’s more difficult to get slots now than six months ago,’ said one patient at Dean Street Express in March; ‘I have to wait a long time compared to my first experience,’ commented another. Together with the concerns detailed in this report, it seems a rigorous overhaul of London’s sexual health funding is required.
The pressure does not just affect patients, but also the sexual health staff themselves. When I spoke to one 10 Hammersmith Broadway staff member in September 2017, they said anonymously: ‘Things are terrible. There’s no money, you can’t do your job properly, you can’t see enough people. Haringey have just closed down their services, St George’s in 15 days, and 10HB has now closed down its Saturday service. The patients need to start shouting for their services.’
And lastly, the pressure on staff to meet the commissioners’ targets can affect the quality of caring for people’s sexual health itself. One patient at 10HB told me in November 2017: ‘I went in to see somebody last time, and I’d been in before 3 months previously, and the consultant said that I came too regularly and shouldn’t be coming that often. I thought that was unprofessional, as I actually had something that time and if I hadn’t come in to get it checked out, it wouldn’t have got picked up.’
If we listen to the patients’ voices themselves, we’ll respond with more clinics like Dean Street Express and 10 Hammersmith Broadway in other boroughs, and more staff and availability of appointments to reduce waiting times and extend opening hours. Creating Dean Street Express models would not exponentially increase costs, but redistribute demand across the capital, easing the costs from DSE itself. Ultimately, these improvements will facilitate the heart of good healthcare: space for clinicians to treat their patients as people, rather than numbers.
September 2018