Richmond Upon Thames boasts a thriving and dedicated voluntary sector formed of over 800 voluntary sector organisations alongside 29 GP surgeries, 45 community pharmacies and 40 care homes supporting the local population 1. Alongside these supporting organisations, the community has an important role to play in building a picture of the health and social care need in Richmond. It is a large and leafy borough, containing over 100 parks and open spaces within its boundary. It is intersected by ten miles of the River Thames and the only London borough to sit on both sides of the river. A full overview of the borough, its population, demographics and key facts can be found in the People chapter.
The role of Public Health and its partners, through the Joint Strategic Needs Assessment (JSNA), is to understand and respond to the needs of local people, implementing services and support, in response to the findings. Government guidance on the role of the JSNA states that decisions regarding services should be made as locally as possible and involve the people who use them and wider community.
The inclusion of the ‘Community Voice’ into the JSNA process has enabled a more thorough consideration of the health and social care needs of Richmond residents. The voice of the local community can further support the development of services which aim to support residents to live healthy, full lives across the borough.
Efforts were made to engage with voluntary and community organisations. Considerable positive feedback was received on the recommendation to include a Community Voice chapter in the Richmond JSNA. However, as a result of the COVID-19 pandemic, it was not possible to obtain contributions from more than a few organisations. Whilst Public Health outlined their request for contributions to the Community Voice chapter in March 2020, few submissions were received. As a result, these unusual circumstances led to a limited engagement, so a pragmatic approach was taken in the completion of this chapter. This involved using the data available, which at this time primarily came from HealthWatch Richmond.
Data was augmented using desk-based research and included input from colleagues at the South West London Health and Care Partnership, Richmond Council for Voluntary Services (RCVS), and Richmond Council’s Prevention and Wellbeing Team. The chapter may not fully reflect the experiences of all communities.
This chapter complements the Start Well, Live Well and Age Well JSNA chapters and includes the community view on health needs across the borough, including the perception of the gaps in health and social care service provision.
Views gathered from the local community will be used to develop the vision of local services in the Health and Wellbeing Strategy. Using both anecdotal evidence and survey data, it is written through the community’s lens, including viewpoints of organisations and individuals based on their experiences to inform health and social care need across the borough.
The findings of this research into the community’s overall views on the health and social care needs highlighted there are many areas in which residents feel their needs are being met. However, if an area of health or social care need was not highlighted during this research, it does not follow that no need exists, simply that it was not reported.
To ensure the health and wellbeing of Richmond residents, the research identified gaps in health and social care provision which require priority focus in the future. Specific areas highlighted include mental health across the life span, additional support needs for carers, people living with disabilities and/or long-term conditions. Wider determinants brought to light by the COVID-19 pandemic included health inequalities and digital exclusion.
The findings reported on peri and postnatal mental health suggest a need to better understand the mental health experiences of new parents. Part of this is recognising the support needed and providing consistent effective signposting to appropriate services.
The research identified that further work is needed to support the mental health needs of lesbian, gay, bisexual, transgender, queer and questioning (LGBTQ+) people in the borough. In addition, reports form the community and voluntary sectors suggest that there is a need for further investigation into the support needed for people with learning disabilities, including the development of more tailored support options. More widely, people with learning disabilities and the organisations that support them, have also reported that the mainstream services which support healthy lifestyles such as smoking cessation and weight loss services are not readily accessible.
For older people living in the borough, tackling digital isolation alongside social exclusion and loneliness, were stated as a priority to ensure healthy ageing and good mental health. Conversations with carers groups identified the need for mental health support and respite for carers of all ages, as well as people of all ages. Given the negative responses received regarding NHS continuing care, there is also a clear need to review this area.
The COVID-19 pandemic has clearly impacted on the community and voluntary groups as well as their users. Many groups struggled with identifying need outside of all-consuming current issues. This resulted in a lower response from community organisations who were primarily focused on supporting residents at a time of crisis. The landscape has altered so much since the onset of the COVID-19 pandemic the priority areas of need have changed.
It is challenging for the community and voluntary sectors to envisage what the future may look like and, whilst so much uncertainly remains, it is challenging to plan future services.
For the purposes of this report, community is defined according to Public Health England 2, which use a definition drawn from community development 3. In this context, the umbrella term ‘community’ is used to describe the relationships, identities, interests and connections which link people or give them a shared interest in an area, culture or activity. The groups and organisations consulted create these links, and identify which are communities in their own right, and their role across the wider Richmond community.
This chapter considers the wellbeing of the population in the widest sense, comprising not only physical and mental health, but also those needs which enable residents to live a full, thriving, healthy life. It seeks to find the common threads which provide a community perspective on health and social care need. However, this may look different for population groups, including the most vulnerable in the borough.
Responding to residents needs ensures the provision of the appropriate best services for local people. It means Richmond Council, South West London Clinical Commissioning Group (SWL CCG), and partners can better understand the local population and respond to the needs accordingly.
During the COVID-19 pandemic, needs will have developed, shifted and evolved, meaning community involvement in developing the JSNA is greater than ever.
For the purposes of this chapter vulnerable groups have been considered for different age groups to reflect the life course approach 4. These include:
Vulnerability need not be a permanent state and is often more fluid and experienced differently across life stages and experiences. It should be noted that the groups outlined above are not exhaustive or exclusive. Residents may move in or out of these situations or be exposed to several vulnerable situations either alone or within their family.
The findings are presented to reflect the structure of the remainder of the Joint Strategic Needs Assessment; Start Well, Live Well and Age Well; and chapters on the wider determinants of health affecting health and social care needs. Responses were gathered via telephone calls and using the Microsoft Teams or Zoom video calling facilities with the stakeholder organisations identified and contacted as a part of the data gathering process. Each section contains key areas of need highlighted by community and voluntary sector organisations in Richmond. Examples of good practice as well as gaps are included.
HealthWatch Richmond provided a summary of the evidence of health and social care need in the borough as identified during their consultation work across the borough over the last five years. This represented 2,200 experiences collected through approximately 250 visits to community groups across the geographic and demographic range of Richmond Borough. It is this large and thorough body of work which forms the basis of this chapter.
The table below lists the individuals contacted during the development of the chapter.
It should be noted that due to the limitations created by the COVID-19 pandemic there may well be areas of need which have not been identified during the research process. The findings presented are drawn from the respondents only.
Start Well covers areas of health and social care need during pregnancy, early years, childhood and adolescence. The main areas of need highlighted by the community respondents include:
The first 1,000 days (conception to 2 years) was identified by respondents to the SW London Health and Care Partnership (SWLHCP) patient and public engagement report in 2019 as being an important area of focus for residents 5. Childhood obesity was not mentioned as an area of need in discussions but remains a priority for the borough in line with national policy.
HealthWatch Richmond reported concerns regarding support for women with poor mental health during and after pregnancy. However, many experiences of mental health support during the antenatal period were positive, with individuals who needed help able to obtain access as well as caring, helpful support from the midwives. Postnatal experiences were mixed. Whilst health visitors gave advice where they were able, some advice was felt to be misguided. New parents reported being told to take antidepressants ‘at their own risk’ whilst breastfeeding, leading to the mother deciding not to take them as they felt unable to weigh up the benefits and risk without guidance from a professional.
Other issues included new parents not feeling listened to regarding their mental health concerns, not having opportunities to discuss their mental health, services being unreliable and often cancelled, and in one case a new mother reaching crisis point due to a lack of access to therapy.
Healthwatch Richmond gathered the views and experiences of 103 local women with due dates ranged from August 2015 to May 2018 who had received antenatal care 6. Overall, 86% of respondents rated their care as very good (44%) or good (42%), felt involved in their care and reported good access to information and emotional support and that the right amount of written and verbal information was given. The report suggested that more work should be done to ensure all women are informed about the available emotional support.
The report highlighted that approximately 1:3 women (29%) self-refer to hospital for their initial antenatal appointment and reported better experiences and fewer mistakes 7.
Feeding was reported as an area where there was a gap in antenatal information. A quarter of people who received information reported that they did not receive enough before and after childbirth. In addition, the research highlighted a potential gap in monitoring gestational diabetes as patients reported not receiving follow up blood tests post birth.
HealthWatch Wandsworth provided anecdotal evidence from their discussions with young people around sexual health issues. They highlighted the need for opportunities for young people to discuss and understand risky behaviour. Young people reported that informed conversation helped them to avoid risky behaviour. There is a need to link risky behaviour and mental health support as young people were concerned about feeling safe, and the impact of peer pressure being more significant than the information available to them. There is a need for more information about sexual health through channels used by young people, including social media.
HealthWatch Richmond regularly hold consultation events with Youth Out Loud! (YOL!), a group of young people from Richmond and Kingston who collaborate with HealthWatch to scrutinise local health services available for young people.
Discussions with school-aged children and young people indicated they generally understand what healthy eating is and, a lack of physical activity, and excessive sugar intake/processed food may result in overweight, obesity and dental issues.
Young people reported much of their information on eating healthily comes from school, but little changes as their living environment prevents them from making healthy choices.
Healthy foods were not always available for children at secondary school. Unhealthy snacks were seen as cheaper, more available and more filling than fruit and vegetable options. Young people suggested learning healthy cooking skills in school to support the lessons on healthy eating.
Opportunities to be physically active were reported as being limited by the amount of physical education (PE) hours in their timetable in comparison to sitting in lessons and studying at home. The time spent being inactive tends to increase as they progress further in their education. Young people requested further support in building physical activity into their lives. Lack of opportunities to exercise both in and out of school were highlighted by the SWLHCP research as a part of their patient/public involvement activities6. Respondents felt that there had been a lack of ambition with regard to developing physical activity for young people, and more work was needed for increasing opportunities outside of school.
In 2016, Healthwatch Richmond collected experiences from parents and schools on Richmond’s Child and Adolescent Mental Health Service (CAMHS) 8. The report found that many of the 1580 young people who had used the service felt they needed better emotional wellbeing services in and out of school.
However, the report also highlighted there were barriers to seeking support including stigma around mental health issues, a lack of understanding of their needs, or how to express them, which create obstacles for young people. Long waiting lists and high thresholds for CAMHS were and remain a significant barrier to accessing care. Accessibility to services was described even more difficult for individuals whose sexuality, ethnicity or gender made them less likely to access a service.
Follow up consultation with Youth Out Loud! in 2019 highlighted “Off the Record” as a safe and useful place to seek help or even just ask questions about mental health. People who went there described staff as friendly and helpful. However, the long waiting lists for counselling put people off seeking help. Online services are a useful way of obtaining new information safely, providing there is signposting to the most appropriate service, e.g., self-harming.
In terms of prevention, young people at YOL! and Kingston and Richmond Youth Council (KRYC) reported to HealthWatch Richmond that working together or developing a whole school approach would help them develop resilience and better mental health. Where schools and other agencies communicate effectively and where the staff are friendly and approachable, young people feel able to share their feelings about their mental health. Young people’s suggestions for improvements included support around exam pressure, and a more in-depth approach to their mental health problems. Extra-scholastic activities were greatly valued in terms of time, space and perspective, as well as opportunities to talk to trusted adults. The SWLHCP also highlighted the importance placed on building mental health and resilience among young people in the borough through their patient and public involvement events. This continues to be an area of focus in the borough’s Health and Care plan 9.
Healthwatch Richmond has attended three groups in the community where parents of young people and the young people shared their experiences of transitioning to adulthood.
The survey found that among all services, mental health is one area where young people and their parents do not feel well supported, a finding echoed by experiences reported to Richmond Council for Voluntary Services (RCVS). A main concern was children’s transition into adult services. It can be a vulnerable time for children and their families who felt they lacked support to identify appropriate pathways so children can learn to manage their mental health needs independently. This finding was supported by the Richmond community and voluntary services who reported that seamlessly joining child and adult services is a real problem and a more family-based approach is required.
Several other areas of need were identified by HealthWatch Richmond in the transition from child to adult mental health services including:
During YOL! meetings HealthWatch Richmond reported discussing sexual health with professionals from local providers. The discussion identified young people have many unanswered questions and are not sure where to get the information. They feel embarrassed to talk about taboo issues with adults so the first places they go to are friends and the internet. They feel their friends do not necessarily have the right answers and the internet is hard to navigate.
School sexual health information is not very helpful because the information is too general, and they do not feel comfortable to ask confidential questions. In addition, school-based information was often too focused on sexually transmitted infections (STIs) and very little on other topics such as porn, healthy relationships, self-eroticism and what is normal.
The NHS was considered helpful and reliable. However, young people were not clear on which online sources were available and reliable, suggesting a need to provide this type of information. School nurses were considered a good resource for asking questions, but they are not always available, and their visits were not scheduled.
Live Well covers health and social care for adults of working age. This section covers a wide range of health concerns including physical and mental health, healthy lifestyles, prevention of long term conditions, and living with disabilities.
HealthWatch Richmond gathered feedback from patients receiving care for cardiovascular disease (CVD) between 2017 to April 2020.
Several patients found the information and advice about how to manage their condition, including the cardiac rehabilitation classes, as valuable and contributing to their recovery and understanding of their condition. Although, some felt uninformed as to the risk their condition posed on their health deterioration in relation to their CVD. Patients also reported a gap in provision of medication (anticoagulant) prescribed in hospital which their GP could not prescribe, leaving them low on medication. The responses to HealthWatch consultations were echoed in the SWLHCP patient and public engagement report in which residents with long term conditions reported care was less well developed than other areas of health care in the borough .
People living with diabetes reported to HealthWatch Richmond that there was a need for more information and support for individuals at the pre-diabetic stage of the disease. A focus on prevention was not apparent and people expressed concern.
One person, recently diagnosed with diabetes, who was referred to the Richmond Wellbeing Service was told they were not unwell enough to access the service. This suggests there may be space for greater conversation around the mental health needs of individuals newly diagnosed with diabetes.
The care provided by the diabetes community service including diabetic specialist nurses, district nurses and podiatrists was highly recommended. These services were reported to be accessible and valued by users. However, it was reported that booking for retinal screening at Teddington Memorial Hospital and Kingston Hospital was more challenging.
Between 2017 and 2019, Healthwatch Richmond spoke to 586 patients and carers about their experiences of mental health services in the borough. Patients reported using the Recovery and Support Team (RST) 10 service and the Richmond Wellbeing Service 11.
HealthWatch Richmond reported that, for most people, the Richmond Wellbeing Service provided a high-quality Improving Access to Psychological Therapies (IAPT) service that was in line with NICE recommendations. Respondents appreciated the staff’s ability to pace sessions and build a supportive environment, so they feel comfortable to share their experiences. People with long terms conditions were especially positive about the service, with specific courses to help them live with a long-term condition. Areas of need identified included:
Health Watch Richmond found that many users struggled to access crisis care when they needed it . The report suggested this may be due to the thresholds for referral into services. People approaching a crisis may be unable to access help in order to avoid escalation. Inevitably, this meant more people reported they experienced a crisis. Individuals who had extreme mental health needs were more likely to access care.
One in five respondents highlighted the key role GPs played in supporting people with mental health problems. Patients reported they valued the role GPs play as providers of urgent care services in the borough. Health and social care needs related to crisis care include:
HealthWatch Richmond’s review of mental health services in the borough highlighted several areas of need for specific groups including individuals with dual diagnosis 12.
People described gaps between services where they did not meet the threshold for one team but deemed too high risk for another service. Conflicting service thresholds are of significance for people with dual diagnosis as it can be impossible for them to access the right care.
Several people reported to HealthWatch they were denied access to the Richmond Wellbeing Service (RWS). As a result of the RWS assessment their use of alcohol or drugs was deemed prohibitive to engaging with psychological therapies.
Patients and professionals told us that they would benefit from a publicly available borough policy on patients with substance misuse to ensure consistency of care and equal access. Patients reported differing periods of abstinence before being admitted to the service. This lack of clarity can lead to patients falling between the gaps in services and feeling they have nowhere to turn.
Consultation events run by HealthWatch Richmond identified the local services are meeting the needs of most of their patients12. Some are challenged by workforce issues and, despite efforts to provide good services, the system does not always work for patients. For most people the only thing that will prevent a crisis is getting prompt access to appropriate clinical services. Services need to be:
Wider determinants of health including housing, physical health, income, employment and leisure all affect recovery and independence and should be recognised as contributors to poor mental health and risk of relapse.
In certain circumstances, people with long-term complex health needs qualify for free social care arranged and funded solely by the NHS. This is known as NHS continuing healthcare 13. A significant number of negative experiences were reported to HealthWatch Richmond. The most frequent areas of need were in patients’ experiences of contested changes to care plans, and reports of a lack of information/support within the application process. Patients also reported agreed care plans were not delivered, funding not received, exacerbated by poor responses to queries and complaints made to Richmond Clinical Commissioning Group (CCG).
Age Well considers the health and social care needs of people past retirement age and into older age. Social isolation and loneliness were highlighted by the community as an area of concern, as well as unhealthy ageing, falls and dementia. Some organisations reported older people had a lack of faith in health and care services, often related to problems with transitioning older people into or between services. Difficulties getting GP appointments, problems accessing online services, and a reduction in outpatient services all contributed to frustration of older people. Richmond CVS reported anecdotal evidence regarding older people’s ability to manage daily tasks and there was a need for more daily support for some older people. There was also concern that social prescribing, whilst welcome in the borough, did not always reach people most in need.
HealthWatch Richmond reviewed 47 experiences reported from people living with dementia or their carer/family who had been affected by a fall. Many respondents were positive about the care they received after being taken to hospital. Problems were reported on discharge when help with daily tasks at home was needed, but referral to social care did not always happen. Equally, a lack of referral to the Richmond Response Rehabilitation Team meant a lack of access to physiotherapy and occupational therapy. There were often long waits for adaptations at home such a shower rails, stair handles and hoists.
Feedback about the Falls and Balance Course run by Hounslow and Richmond Community Healthcare was very positive, with patients reporting it was helpful, and it made a difference to their physical health. However, HealthWatch Richmond reported having had queries from residents asking whether this type of support existed, suggesting eligible older people are not being referred.
In addition, HealthWatch heard from community members, concerned for neighbours or friends who are at risk of falling or repeat falling. This suggests the community can identify someone at need of support at home, but there is a lack of awareness of how people at risk can be supported.
HealthWatch Richmond reported on 75 experiences collected via community outreach from people living with dementia, their carers and family members, and professionals who care for dementia. GPs were reported to be sensitive and understanding to individual needs, proving to be reactive in providing urgent care when necessary. There were some reports of experiencing difficulties or distress attending GP surgeries, either due to a lack of suitable transport or reluctance on the part of the patient. Delivering services such as the flu jab via community services such as district nursing could address this need. Other issues include:
Feedback from clinical dementia specialists (via HealthWatch Richmond) also highlighted several areas of unmet need including:
Wider support in the community was valued by . The Kew Gardens Dementia walks were praised for the peer support and were highly valued. Apps were also considered to be useful aids for to help them day to day and ensure they could be found if lost or confused.
Key to mental wellbeing for people 65+ years the ability to build resilience and maintain good mental health is very important. Events such bereavement, loss of confidence through ageing and physical health challenges, were reported as detrimental to their mental health.
In 2019 during a Healthwatch Richmond consultation (Strawberry Tea Party) on the mental health of the 65+ age group, several issues and obstacles affecting older people’s mental health were identified:
End of Life care is an intensely personal and emotional aspect of health and social care. A local consultation by Healthwatch Richmond identified that setting a clear and agreed care plan, when the possibility of death is recognised, could improve end of life care experiences.
Ensuring a clear responsive plan means that the patient’s physical and emotional needs are addressed, allowing family members space to look after their own wellbeing and coping strategies.
The consultation highlighted the need to ensure care plans are carried out in an efficient and timely manner, with good co-ordination between services. Delays in care can lead to poorer quality of life and admission to hospital.
GPs were regarded as pivotal in developing end of life care plans. The main unmet need expressed was the lack of home visits and poor co-ordination of services through the GP surgery for people nearing the end of their lives at home.
HealthWatch Richmond holds a database of almost 700 carer experiences. Within this they identified some core areas of need for carers including people caring for people living with dementia or children with special educational needs and disabilities (SEND) needs:
Richmond CVS reported health inequalities are apparent for people living with a learning disability across the borough. There is anecdotal evidence, via consultation events run by HealthWatch Richmond, of significant variation in the percentages of people with learning disabilities registered with GPs and receiving an annual health check. People with learning disabilities and the organisations that support them, have also reported that the mainstream services which support healthy lifestyles (e.g., smoking cessation and weight loss services) are not readily accessible for people with learning disabilities.
HealthWatch Richmond reported on outreach sessions run for people living with learning disabilities. Respondents highlighted that healthcare staff were generally understanding and adaptive to their needs. Specific areas where staff have been supportive include:
However, the sessions also highlighted some outstanding needs, many of which are reflected in Mencap’s Treat Me Well campaign 14. Understanding the range of needs of people with learning disabilities and identifying the preference of individuals is key to delivering appropriate care.
Other areas of need highlighted include:
HealthWatch Richmond’s discussion groups on mental health and well-being, also spoke to parents of children with special educational needs and disabilities (SEND) about their health and social care needs. Responses were varied, with some families feeling well supported whilst other identified gaps in service provision. These included:
Wider determinants of health, also known as social determinants, are defined as a diverse range of social, economic and environmental factors which impact on people’s health 15. These factors can also be influenced by the availability of local or national resources which shape the conditions of daily life.
Health inequalities are disproportionate with avoidable differences in health across the population, and between different groups within society.
They result from the conditions in which people are born, grow, live, work and age, and impact on an individual’s ability to live a healthy life, how they feel and act which affects mental, physical health, and wellbeing. Richmond CVS reported that income and health inequalities persist in the borough, despite the perception that Richmond is solely a higher income area. This reputation has masked inequalities in the borough, which have widened due to the COVID-19 pandemic. They recommended the focus needs to be on reducing inequalities in all its forms, and this should be a key theme across all services in the borough.
Digital exclusion was highlighted by a Richmond Borough Council and the voluntary and community services survey as a significant area of need for older people, particularly as access to services has changed due to COVID-19. The impact of digital exclusion has been magnified by the COVID-19 pandemic, contributing to existing overall inequality for Black Asian and Minority Ethnic groups and older people. In addition, people who are less confident about using digital devices, and accessing the internet, are significantly disadvantaged in accessing care. There is a need to increase access to digital services for older people who are not online. In addition, the provision of training and support to increase skills and confidence in accessing health and social care via digital channels requires development. The survey found that services have not yet had enough time to fully understand how they can develop their services to meet needs through online offers, meaning this is an area of need across health, social and community services.
HealthWatch Richmond reported on 23 recent experiences recounted to them regarding health and social care needs for people who are experiencing homelessness. Professionals and individuals identified access to primary care was challenging for people who are homeless, despite proof of address not being required.
Often, services which rely on face-to-face interactions (e.g., transitioning through or between services), are not designed for remote engagement, making sustained contact challenging.
The lack of a permanent address remains a barrier and leads to gaps in several areas of health and social care including:
It was clear from responses to this research that COVID-19 has had a significant impact on the community and voluntary sector as well as the people they represent. Many organisations reported having to alter, reduce or move services to digital only. Richmond Borough Council and the voluntary and community services survey found that the sector is rising to the challenge of creating the necessary capacity to meet the demands this crisis has put upon communities and organisations. However, areas of need exist through gaps in engagement mechanisms and service delivery, impacted by community venue closures reducing capacity for community and prevention work. In addition, the survey reported an increase in issues around stress caused by isolation.
In general, organisations report there is uncertainty about the future in terms of the pandemic and its economic consequences. Respondents indicated there is insufficient information on the number of people on the NHS diagnostic pathways affected by the pandemic. Wider determinants of health linked to COVID-19 include housing, debt, financial hardship, an increased demand for counselling for clients, staff, and volunteers. The community and voluntary sector organisations also highlighted several groups whose health and social care had been specifically affected by the COVID-19 pandemic including:
Richmond community and voluntary services reported unpaid carers have been significantly affected by COVID-19 as support mechanisms for them and people they support, have been diminished. In addition, some carers have chosen not to use paid carers on account of COVID-19 related risk. This finding was echoed by the Richmond survey which highlighted that providers were seeing an increase in the number of people moving into caring as a result of the COVID-19 pandemic.
It was reported that carers have been neglecting their own health needs due to the increased pressures. Young carers dealing with additional pressures from school, peers, work and family were also adversely affected by isolation. Without opportunity for respite, unpaid carers reported increased stress and exhaustion. This echoes a wider concern from respondents regarding health deterioration and safeguarding. It is likely residents, especially those not currently in touch with community organisations, will need ongoing support to stay healthy, engage with meaningful activities, and manage their wellbeing. There is concern for carers of people with dementia, as it has been reported conditions related to dementia have worsened during lockdown, and people with dementia have been found to be particularly vulnerable to COVID-19.
The aim of the desk-based research was to understand the story of the community sector in Richmond. As such we were able to contact some of the main voluntary sector co-ordination organisations who provided us with their research, reports, feedback and opinion on what they see as the health and social care needs of their users.
Healthwatch is the independent national champion for people who use health and social care services. HealthWatch Richmond works with to ensure that local NHS, Council, and community services are considering the needs of their users and responding to those needs.
Healthwatch Richmond carries out research, interviews, focus groups and consultation as well as an extensive programme of community engagement in order to understand people’s experiences of health and social care and be able to act on issues of importance to the community. Since April 2019, they have delivered 75 face-to-face outreach sessions targeting four demographic groups: under 21 year olds, over 65 year olds, the working age population, and disadvantaged and seldom heard groups. These sessions resulted in conversations with 1007 residents, recording 933 experiences of health and social care making their database is a rich resource in providing a voice for the local community.
Richmond Borough Council works to support the voluntary sector in Richmond providing a range of services including advice and support, fundraising and providing a voice for the sector. They act as a champion for the voluntary sector including the strategic lead for the children and young people’s voluntary sector. Richmond Borough also works to support the quality of local community voice and they manage a volunteer placement service.
The RCVS is an independent infrastructure organisation providing dedicated support to the many across the borough. Richmond CVS supports all charity, community and voluntary activity in the London Borough of Richmond upon Thames.
The NHS South West London Health and Care Partnership (formerly NHS Richmond CCG) commission most community - based health services, mental health and learning disability services as well as urgent care, rehabilitation services and non-emergency hospital care. The group cover the geographical area including Richmond, Wandsworth, Kingston, Sutton, Merton and Croydon.
Community and Partnerships Team and Prevention & Wellbeing Team (Commissioning), and Richmond Council also provided input, most particularly through the Community and Voluntary Sector survey conducted in May 2020, including responses from RUILS Independent Living, Richmond Carers Centre, Richmond Aid, HealthWatch, Cruse Bereavement Care, Age UK Richmond, Crossroads Care and Alzheimer’s Society Richmond.
This document was researched and developed during the COVID-19 pandemic of 2020 which strongly influenced data collection and outcome measures. Prior to the nationwide lockdown on 23rd March 2020, the aim was to collect data via community consultation events such as the Voluntary Sector Forum, allowing for the opportunity to interact directly with the community and receive input.
However, whilst a presentation on the JSNA and its role in determining public health priorities was delivered to the Richmond Voluntary Sector Forum in early March 2020, due to the emergence of the COVID-19 pandemic, there was little opportunity to follow up with subsequent consultation events. As a result, data collection to inform this chapter has been limited to desk- based research and interviews with people who had attended or represented those attending the presentations. On recommendation from these bodies, further organisations who represented vulnerable groups were contacted via email or phone.
It should be noted that some of the need identified during this process was via the opinion of these community group co-ordinators during conversation, having been asked to speak on behalf of their users. In addition, where no need was identified by respondent organisation for specific public health issues, this does not necessarily mean there are not further needs in this area, simply that they were not highlighted during consultation at this time. Further needs relating to specific public health interventions and outcomes have been identified throughout the JSNA by service users, data or public health initiatives.
Responses to requests for information were limited by the impact of the COVID-19 pandemic. A survey by the Councils’ Prevention and Wellbeing team done with Richmond Borough Council and VCS COVID-19 Response Group highlighted that much of voluntary and community sector is simply coping with COVID-19, a viewpoint echoed by Richmond CVS. This change in circumstances has shown the innovation and flexibility in the sector. The survey found that barriers have been broken and new connections made quickly, with organisations willing and quick to adapt. However, this situation has meant that the sector lacked space and opportunity to contribute fully to this part of the JSNA.
Research questions: Research questions for determining community views on the health and social needs were intentionally open, allowing respondents to provide an overview of the issues they see as relevant to their users.
Respondents were asked:
London Borough of Richmond Upon Thames, 2020. Voluntary and Community Sector. URL: https://www.richmond.gov.uk/services/voluntary_and_community_sector ↩︎
Public Health England, 2015. A guide to community centred approaches for health and well-being, London: Public Health England.↩︎
Yenbury, H., 2011. Vocabularies of community. Community Development Journal, pp. 47(2):184-98.↩︎
More on vulnerable groups can be found in Vulnerable Groups JSNA chapter.↩︎
SW London Health & Care Partnership, 2019. Developing a health and care plan for Richmond - Patient and public engagement report 2019, London: SW London Health and Care Partnership.↩︎
HealthWatch Richmond, 2018. Care During Pregnancy (Antenatal Care), London: HealthWatch Richmond.↩︎
HealthWatch Richmond Upon Thames, 2015. Improving Emotional Wellbeing for Young People in 2016, London: HealthWatch Richmond Upon Thames.↩︎
SW London Health & Care Partnership, 2019. The London Borough of Richmond upon Thames Health and Care Plan 2019-2021, London: SW London Health & Care Partnership.↩︎
HealthWatch Richmond, 2019. Recovery and Support Team Review, London: HealthWatch Richmond Upon Thames.↩︎
HealthWatch Richmond Upon Thames, 2018. Richmond Well-being Service Review, London: HealthWatch Richmond Upon Thames.↩︎
HealthWatch Richmond upon Thames, 2020. Richmond’s Crisis Care Report, London: HealthWatch Richmond upon Thames.↩︎
NHS, 2020. NHS continuing healthcare. URL: https://www.nhs.uk/conditions/social-care-and-support-guide/money-work-and-benefits/nhs-continuing-healthcare ↩︎
Mencap, 2020. Treat me well. URL: https://www.mencap.org.uk/get-involved/campaign-mencap/treat-me-well ↩︎
OHID, 2023. Wider Determinants of Health. URL: https://fingertips.phe.org.uk/profile/wider-determinants ↩︎
Up to: Joint Strategic Needs Assessment (JSNA)
Updated: 08 July 2024
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