A Chance to Change Scotland: Chance 2 Change Expert Reference Group with Lived Experience - report

6. The Voices of C2C in Response to SLWG Recommendations

The C2C group discussed the draft recommendations from the SLWG and provided their individual and shared views on these. All of the recommendations can be found at Appendix 4 of this report.

C2C Responses to Empowering and Developing the Primary Care Workforce

“The group unanimously feel that all the recommendations are full of jargon that they now aptly refer to as ‘jaggy words’. They believe this type of language creates a divide between people and professionals, creating inequalities. To understand communities you have to speak the language, you wouldn’t go to Switzerland and change their systems without first learning the language and consulting with the people - so why would you think this approach will produce a positive outcome in our communities?”

C2C Responses to Empowering and Developing the Primary Care Workforce

Put in Place a National Fair Health Scotland Programme

“Good for professionals to have an idea of the ongoing issues people face, but will it work?”

“Will they be in this poor area for a year and listen while they are there but when the year is done forget?”

“What does that training look like?”

“How will this be funded?”

“Who, how, when will this training be delivered?”

“People would benefit from this training too, understanding cultural differences, postcode discrimination would pave the way to healing communities.”

“All doctors would benefit from real life/hands on experience of these issues.”

“Will professionals have the choice to sign up to this programme because everyone needs to do it to have consistency over the board? Experienced doctors/professionals should also be trained and there should be refresher courses.”
“What will it mean in practice?”

“How long until people/communities see the effects?”

“Training in the last year isn’t good enough it should be built into all education from the very beginning to grasp the importance from the start, not an add on at the end.”

“How do you train/teach poverty racism discrimination etc?”

C2C Responses to Empowering and Developing the Primary Care Workforce

Enhanced Service for Health Inequalities

“Who will decide who needs it more than others?”

“How long until people/communities see the effects?”

“What are these additional enhanced services? What will they look like and how will they support me and my family?”

“How will this be funded?”

“Good idea if it works and the additional services are relevant”
“The support of the Community Links Worker and Chance 2 Change are great additional services that I have accessed through my doctor that have really helped me.”

C2C Responses to Empowering and Developing the Primary Care Workforce

Support Primary Health Care Professionals to Work Together

“Creating a joined up care plan for people with complex needs is a great idea but how do you define a complex need and how do you provide that same care to everyone with a complex need?”

“When people work together, we lose fewer lives to the gaps.”

“If done properly it would mean I don’t need to keep repeating myself over and over to different professionals!”

“How do you bring everyone together?”

“It would be easier to achieve this recommendation if every individual had their own named person/ professional within each service/team where it is part of their job to regularly update all other professionals involved.”

“What does the training look like?”

“I am supporting vulnerable people and know that unpaid carers are not treated fairly.”

“Joined up care is a good idea but it would need more professionals, where are they coming from and who is going to pay for this?”

C2C Responses to Empowering and Developing the Primary Care Workforce

Create a National Priority to Reduce Harm

“How do you bring everyone together but more importantly teach people that sharing resources is key for individuals to have choice in how they stay well, creating empowerment.”

“It should be built into GP contracts - but more importantly what does a GP contract actually look like and why have we never heard of them?”

“More money should be invested in trauma and ACES to reduce addiction as well as long term health conditions that result in physical health conditions leading to disability.”

“I’m shocked to hear that this is not already a priority!”

C2C Responses to Empowering and Developing the Primary Care Workforce

Create a National Priority to Reduce Harm – Continued

“I believed that as long as I felt fine there could be nothing wrong with me, so who needs a smear test? Luckily for me my very scary loving mum thought differently and forced me to have this unpleasant test. Unbeknown to my mother, the results showed that at 22 years old I had pre-cancerous cells requiring laser treatment but I felt well/thought I knew everything and believed there was no need for treatment. I don’t like hospitals there was no way I was going to Colposcopy for laser treatment. I binned the letter, stating to call and confirm attending the appointment - I did not! Oddly the day before my appointment a nurse called to ask why I had not confirmed my attendance. I told her, I don’t like hospitals and that there was nothing wrong with me. She calmly explained the severity of my situation and informed me sincerely that if I did not have this procedure I could be dead in the coming years! I know this nurse went above and beyond the call of duty to speak to me and this is not normal procedure but it should be. I am eternally grateful to the nurse that saved my life. If all professionals cared and worked to these standards – how many more lives could be saved?”

C2C Responses to Empowering and Developing the Primary Care Workforce
Of all the recommendations this is the one that concerned us the most!

Invest in the Training for Digital Inclusion

“I don’t like it but think it is the way the world now works. I have real concerns for my wee elderly uncle who can’t cope with the internet or anything online, he finds it difficult to make calls. I would like professionals to be aware and understanding of people who will struggle.”

“Good idea especially if we ever go into another lockdown, it would mean professionals could still provide a service.”

“The next step for C2C is to be digitally up-to-date (p.13-14) , we are hoping this project will highlight the barriers people face resulting in a good future learning model for professionals and individuals alike.”

“Consideration needs to be given to people who have experienced trauma/ACES as well as those who have had bad online experiences or have had to give evidence via video link. There will be certain aspects of digital inclusion that will re-traumatise some individuals which professionals could mistake as a reluctance to engage.”

“Who will pay for the training and technology needed for all, not just professionals?”

“Training and resources for professionals is great but if individuals don’t have or can’t afford the technology, what is the point?”

C2C Responses to Empowering and Developing the Primary Care Workforce

Expert Medical Generalist Role

“More should be done to retain good GPs within communities because it is the only barrier stopping our hospitals from collapse.”

“One of our recommendations is: Listen – my opinion matters! However nobody has asked how we feel about this new way of working - which is worried, concerned, anxious and incredibly frightened.”

“People still want to have the reassurance that seeing a GP brings. Would one way of ensuring GPs have more time to devote to patients with complex health issues be to create a Health Centre Hub? This could be comprised of health experts such as the Community Links Worker, Welfare Officer, Mental Health specialist, Yoga Teacher, etc. and staffed by all GPs on a rotational basis to maintain consistency for people used to seeing their own Doctor? For example, if there are 5 GPs in a practice, 4 would be doing the Expert Generalist role and the other would rotate and continue the trusted practice that people already know and understand.”

“Who do you call if not the doctor?”
“Who will see me if not the doctor?”

“Who decides if you need the doctor, how do I know when to see the doctor?”

“If communities/individuals are not part of or consulted about this change, they will be more reluctant to engage in life saving services which totally defeats the purpose.”

“People will stop using healthcare altogether because we won’t know what we are doing.”

C2C Responses to Leadership, Structures and Systems

Expert Medical Generalist Role – Continued

“Doctors have been the frontline for so long, pulling the plug on this way of working too quickly will result in a breakdown of trust as well as mass feeling of ‘I don’t matter’.”

“If trust breaks down with GPs, more people will present themselves at hospitals and potentially collapse an already overwhelmed service.”

“How is this going to be rolled out?”

“People may take advantage of power and ask more personal questions to best place you, it would be like a nosey receptionist all over again.”

“I am frightened because I won’t know where to go or who to call if I have a problem.”

“Will all individuals be aware this is happening and know where to seek help?”
“Good business and organisational models ensure they balance the expectations of service users with innovation/change. Resistance is inevitable during any change process, but cannot take place effectively without actively communicating with and involving the communities/people directly impacted in the decision-making process.”

“Change that affect the community cannot be successful unless the community are involved in the planning. If people are not consulted they will be less likely to engage with services.”

“Health inequalities are a problem in every health department and all professionals should understand and take into account these challenges, not just GPs.”

“Health inequalities should be a core part anyway, regardless of the new role.”

C2C Responses to Leadership, Structures and Systems

Strengthen National Leadership

“Children with breathing difficulties can be traced back to damp houses that breed illness and disease. These houses are rotten and adding to the many health problems that are killing people as well as needlessly stretching the NHS. Will the Commissioner have the remit to address this?”

“Health Inequalities are a problem for all departments where the buck constantly passes, hopefully the new Commissioner would be able to stop this and relevant action taken to provide equity.”

“The rubbish is everywhere causing more rats which is creating more disease. Will the Commissioner have the authority to address this?”

“It is not the first time this idea has been thought of, why has it never been actioned?”

“Great if it works but I think the role is too big for one person.”

“I don’t think it will work because these people never work, they always blame someone/something else and that's where it all falls down.”

“Life and Healthy life expectancy gaps are continually widening and there needs to be someone to hold people to account.”

“The Commissioner should understand situations at all levels, maybe they would benefit from or be part of the new training being developed for the Fellowship Programme.”

“Will the Commissioner only deal with inequalities in health or will they be able to assist with all inequalities that can contribute to poor health, such as inequality in Higher Education where Universities receive higher fees for international students and focus their recruitment in this area rather than support for home students, especially those from deprived backgrounds.”

“The Commissioner needs to be someone who has lived experience of inequalities with understanding of the issues and the barriers people face.”

“I don’t know what I think!”

C2C Responses to Leadership, Structures and Systems

Ensure Social and Financial Inclusion

“The majority of the group have never heard of a Community Links Worker, therefore have no idea what their role is, how it would benefit them or how to access that support! Money and time need to be allocated to advertising these great services because they are no use if nobody knows they are there. Poor promotion of a service could be viewed as poor engagement.”

“Great idea - should have this support in all surgeries.”

“Mental health is one of the oldest departments in the National Health Service and it’s never worked!”

“How do you refer? If you self-refer do I have to call, fill in a form or can I choose the format that suits? Do I have to wait for the Doctor to offer this service/support?”

“Current financial support services are awful at filling in benefit forms, they don’t understand illness/medical terms or most importantly the impact it has on me. This new Financial Officer will have access to my medical records with a basic understanding of my condition enabling a more detailed report which could relieve some of the stress that comes with these situations.”

“Services that offer timed support such as six weeks or months is no good, mental health can be long term - I believe I should have the time and support I need to get well.”

“Mental health has always been the weakest service provided by the NHS, sadly since the pandemic this has further deteriorated. Poor services, systems that don’t work and long waiting times are adding to the many lives lost.”

C2C Responses to Leadership, Structures and Systems

Ensure Social and Financial Inclusion – Continued

“Why are paramedics/police the first port of call to a situation of poor mental health? Mental health is an emergency but we are relying on the wrong emergency service, completely overwhelming that service when there should be specialist emergency mental health provision with community bases.”

“Mental health workers in or connected to my surgery are a great 9-5 idea but mental health is 24/7. Can you provide that same joined up consistent service 24/7?”

“It is people who don’t care or understand that work in mental health.”

“Services thrive when the people who need them, build them - listen to the experts.”

“I have seen first-hand, the benefits of the Community Links worker, I can also see the benefit of the Welfare Advisor. I have to be honest in saying that mental health support is still the weakest service provided by the NHS -  ”I have very limited knowledge of services that I can signpost to. These services either do not work or have such long waiting times that suicide rates are further impacted.””

“I’m caught in the in-work poverty gap which obviously affects my finances, impacting every aspect of my life from where I live, what I can afford to eat, what bills can be paid to my mental and physical health. All I need is a regular basic pay to lift me out of this poverty trap but instead I receive irregular ad hoc funding that messes with my benefits keeping me in a cycle of constantly feeling worthless and trapped.”

“The nurse referred me to the Community Links Worker who supported me with many aspects of my life but most importantly they helped me to not feel alone.”

C2C Responses to Leadership, Structures and Systems

Commission Research

“The gaps between healthy life and life expectancy need to be closed - research has been done time and time again - action is well overdue!”

“I have on many occasions asked for help that either doesn't exist or you have to wait years for!”

“Talk to people/communities about how they are affected by this?”

“how do you retain specialist help in regards to a long term health condition (p.17-18)?”

“My anxiety was really bad, shaking out of me and the doctor just sat staring at me! Why did I have to ask for medication? How come it wasn’t offered along with other options?”

“It won’t work unless they have the right information/data, we learned from the HICC that statistics are not always accurately recorded!”

“Unmet needs lead to health inequalities which could be non-existent if we all worked together using the person centred approach.”

“We are all recovering from something, imagine the lives we could save if we all worked together (p.8).”

“Rather than putting money into more research, it should be invested in tackling the problems. For example, the barrier of having to wait significant periods of time for specialists and retaining that support. Invest money into the problems, close the gaps and extinguish health inequalities.”

“We know all this, we need action not more talk or research.”

C2C Responses to Leadership, Structures and Systems

Contracts/Health Inequalities

“Will these new contracts come with resources to support people/professionals in vulnerable communities?”

“What do they look like, why haven't we seen or heard of these contracts before?”
“In the previous contract were objectives achieved because if not, how will the Government ensure that they are in these new contracts?”

“Why do health inequalities have to be written in? Should they not already be part of the contracts?”

“People should be given the care that best supports them, at the time they need it. It should not have to be written into a new contract, it should just be!”

“My understanding is this new contract will help guide GP’s to transition to the new expert medical role (p.42-43), how? What will this look like in practice?”

“For individuals/communities to have confidence and trust in these new contracts (especially the expert medical generalist role, p.42-43) they need to be written in partnership with the people. When systems change with no consultation/warning all that is created is fear and panic resulting in disengagement.”

“Why has nobody ever heard of these contracts?”

C2C Responses to Leadership, Structures and Systems

Funding

“The Primary Care Improvement plan has a legal duty to stop public bodies making decisions without communities but it is clear to see from the new phlebotomy service, the  “Expert Medical Generalist Role” (p.42-43) and the way funding is allocated that communities are not part of the decision making process.”

“People should have a say in the way funding is allocated, for example it is known that GP practices get more money for elderly patients. In deprived areas people don’t have the luxury to grow old, ironically this means there are less doctors/health professionals in the areas that need them the most. In areas with high drug deprivation you can see a person aged 40 who has the body of an 80 year old but there is no available resource to treat the person who will never see old age. The way funding is applied is discriminative adding to the many health inequalities and preventable deaths.”

“Are inequalities considered when funding is allocated?”

“Routine is really important when you suffer from anxiety/depression, when you change systems without communicating with people it doesn't work - waste of money.”

“The new phlebotomy system doesn’t work because you did not ask the people how it could best work for them. The new system as documented in ‘Unmet Need’ (p.15-16), has created unnecessary stress and more inequalities such as transport/costs to get to the other side of the city. In your words, this is one of those “unintended consequences or risks which a new funding model can cause?” Poor monitoring of the new system and not dealing with the issues that arise continues to put people/lives at risk.”

C2C Responses to Leadership, Structures and Systems

Transport and Health

“Circling the car park at surgeries/hospitals for hours trying to get a space is extremely stressful and not environmentally friendly.”

“Poverty is a disease and providing transport to health appointments could slow the spread whilst saving lives.”

“What do you mean about environmentally friendly as most public transport, mini-buses and ambulances are not environmentally friendly?”

“Should also be open to the people who support others, for example unpaid carers equally struggle to find the money to support their loved ones to appointments.”

“In terms of mental health it would be good to have transport to appointments especially in the early days of treatment as I believe this would alleviate some of the stress.”

“I am worried that the money to provide transport which sounds great in theory will end up coming from the appointed health service, such as the stroke unit or physiotherapy clinic. This results in a watered down support which goes against the aim.”

C2C Responses to Leadership, Structures and Systems

Invest in Wellbeing Communities

“GP’s and their patients would benefit from being aware of what support is available in local communities.”

“The way that funding is currently allocated goes against the objective of partnerships/joined up care, see ‘Picking on the Wee Man’ (p.6-7).”

“How do you provide this care/wellbeing to rural Scotland?”

“Good for all professionals to know what is happening around them - Community Links workers are leading the way in terms of building relationships with communities.”

“Peer support without labels should be available for all aspects of life, whether you manage diabetes or bi-polar. There should be wellbeing groups in every community promoting recovery in the person not the condition.”

“There needs to be a clear communication strategy put in place so professionals can directly feed into decision making processes because front-line staff are getting the blame for poor services, leading to people dying in hospital corridors as a result of the government’s lack of investment.”

C2C Responses to Empower and Enable People and Communities

Access to Digital Technology

“The digital project that C2C are undertaking next year has been difficult to get started due to funding in terms of tablets and tutors. Hopefully the project will serve as an educational model highlighting the barriers as well as the positives of digital learning.”

“How do you plan to reach the people who don’t have access to technology?”

“Digital access could improve service and stress levels - for example, people could have the choice to book a telephone consultation the night before (p.15).”

“Digital access can improve health in terms of being able to see/talk to your health professional remotely such as a lock-down or in rural settings. As always if you can’t afford the technology or bus fare to access these services we could create further health inequalities.”

“Libraries used to play a huge role in supporting people to access technology but due to funding cuts and closures, services are very limited.”

C2C Responses to Empower and Enable People and Communities

Develop a Network of Expert Groups

“People should be involved in the policy making from the start, to enable clearer understanding of what is working and what is not but most importantly to balance expectations.”

“The way that the Scottish Government are working with C2C should be the norm not the exception.”
“It is imperative that communities are part of the decisions that affect them because when they are not, they become disengaged creating further issues in regard to unmet need and inequalities.”

“When planning new systems and services, scope needs to be in place for change when things go wrong.”

“Bevan would be turning in his grave at the way services are operating as he wanted a joined up service in communities.”

“Not consulting with people who have lived experience is like a trauma councillor with no experience of trauma saying they know how you feel when they don’t.”

“Please do not ask for my opinion or the communities if you are not going to take action? Lived experience matters but we need to see change - lip service is not consulting or listening to the people.”

C2C Responses to Empower and Enable People and Communities

Provide Communities with Data and Knowledge

“To bring change we all have to work together, how often do doctors, professionals or the government actually listen to the people or each other?”

“I can’t even demand my preferred doctor or an allocated time for a telephone consultation but I have to demand change, how?”

“Suicide is something we are all embarrassed and don’t want to know about. Relevant statistics would bring the problem to the forefront, forcing change.”

“Statistics can say what the powers at be want them to say.”

“How will knowing statistics change anything without resources?”

“Knowledge is power that brings change - most people living in a deprived area are completely unaware they are seen as deprived or that their healthy life expectancy is twenty years shorter than their affluent neighbours. We know these gaps exist, we know what works in prosperous areas why are we not incorporating what works in our disadvantaged areas?”

“Who will support us to make these changes? It will cost money - who will pay for it?”
“It is shocking that where you are born determines how long you can have a healthy life - accident of birth!”

“There will always be people who don’t like change. This can be balanced by clear, honest communication and relevant information.”

C2C Responses to Empower and Enable People and Communities

Pilot a Digital Learning Programme for Health

“The digital project that C2C will undertake next year (p.13-14)  is a great idea because it will produce a digital education model highlighting good and bad practice enabling other groups/people to eliminate the barriers, be ready for the challenges as well as see the outcome as achievable.”
“I have concerns for the elderly/people with complex needs, teaching methods may need to be adapted and the model may need to be adjusted to meet individual needs.”

“Our project will hopefully identify the barriers making it easier for people to go digital.”

“I hope the digital empowerment works better than the patient access app. I thought I could find out my latest blood results but it is only designed for making appointments and ordering prescriptions. Another group member added it is more hassle to order your prescription using this method, I prefer the prescription line. Someone else added the app is dreadful, it doesn't work which is not helped with me always forgetting my login details - this is why I am really frightened about everything going digital.”

“It is the way the world is going but not all people have access to technology and learning which could create more inequalities.”

“All members are anxious about what they call this ‘new digital world’ which is one of the many reasons the digital project needs to go ahead,  so people can see that technology is not as frightening as imagined.”

C2C Responses to Data, Evidence and Knowledge

Publish High Quality Accessible Information on Health Inequality

“Ensuring information is clear and easy to find is important but are you going to fund and empower people/communities to be able to use this information for positive change?”
“Different formats need to be available so that information can be accessed by different groups such as sensory impaired or people with complex needs.”

“If I knew my child was going to die 10 years younger than the children living in our affluent neighbouring communities I would want it to change but would not know where to start.”

“Knowledge can sometimes be more frustrating/dis-empowering if not accompanied with the resources and skills to create change.”

“I find all this talk of inequalities really sad but I wouldn't know what to do about it.”

“When talking about accessibility and ensuring “people have more power over the decisions which affect them”, the information needs to be presented in a way that is easy to understand without jargon as just being available is not helpful.”

“NHS Health and Care Experience survey - how and where is it disseminated? How is it possible to record health inequalities in this way? The survey doesn’t capture the health discrimination experienced by vulnerable groups, many of whom would be unable to respond to a survey without support. This is a poor method of data collection that creates gaps rather than fills them.”

“This recommendation states “different forms of inequality can interact and impact each other” understanding that non health inequalities contribute to poor health - will the Commissioner look at all these inequalities?”

C2C Responses to Data, Evidence and Knowledge

Develop Methods for Recording Unmet Health Needs

“At the moment resources are not equally shared in terms of GP surgeries receiving additional money for elderly people when there are communities that do not see old age due to a range of inequalities such as poverty and poor education. Different communities require specific resources - funding should reflect this if we are to close the gaps.”

“Recording, assessing and reporting in unmet need is really important - the analysis and data output needs to be properly funded with experts employed to do this properly and not be an extra burden on already under resourced GPs.”

“Who would I report these unmet needs to? Who actually cares?”

“Build local well-being groups like C2C which will create panels of people with lived experience - listen and work with them.”

C2C Responses to Data, Evidence and Knowledge

Data on Missingness Should be Recorded

“Accurate qualitative data should not be measured from the outside, relationships need to be forged with communities to understand, identify and locate the missing people.”

“In certain cases it is the people/groups who do not engage with services that need them the most!”

“How will the system recognise and document unmet need?”

“Have Knowledge Exchange links been established with Scottish Universities around research that is already being conducted on health behaviours?”

“Services such as the dentist are not taking on any new patients since the pandemic, is it the same with the doctor? If so how do I get myself a doctor or a dentist?”

“People miss appointments because they have to wait so long - they could be dead!”

“Long term/persistent conditions when no one cares or listens makes me feel like a hypochondriac or a mental case encouraging me to be one of the missing people.”

“To understand communities you have to speak their language.”

“More action is needed not more research.”

“Unmet need is the biggest contributing factor in ‘Missingness’.”

“Is there going to be funding available to resource Community Champions within each hard to reach area?”

“People often feel like they are not being listened to/taken seriously which the group believe will account for many missed appointments.”

C2C Responses to Data, Evidence and Knowledge

Develop and Support Better Collaboration

“Sick people do not want to be in a hospital waiting room only to see its 3-6 hours to be seen, equally staff do not want to see that there are 300 patients to go, it makes you feel more down/demotivated. Statistics and data need to be displayed where and when it can be actioned/at the right time.”

“There should be better collaboration between the Government and all relevant medical decision makers because right now they are like two parts of the same brain that don’t work together.”

“Surely information should be shared between everyone, not just professionals.”

“There are less doctors and nurses (per head of the population) dramatically decreasing everyday which can be linked to inequalities and unmet need all over the board. For example lack of financial resources to enable people to study, more interest placed in overseas students, not enough funding given to GP practices resulting in overwhelmed burnt out doctors/nurses - The NHS is like a broken down old banger and it is because the Government made it that way.”

“Queues and waiting times are unacceptable and COVID 19 is being blamed when it was equally as bad before the pandemic, has this been documented?”

“Professionals should be asking each other more relevant questions such as why are there more suicides in my area.”

“This day and age and our NHS has a wobbly wheel with no real appropriate action.”

“We need better monitoring/recording systems, they should be the same as hospital ‘minute by minute’ systems.”

“You have had years to listen, collaborate, take appropriate action but you didn’t listen creating more gaps unnecessary suffering and needless lives lost.”

C2C Responses to Data, Evidence and Knowledge

Improve How Health Data is Recorded

“As mentioned previously in Mental Health, Long-Term Health Conditions and Community Voice, (p.10-11) - data is not recorded properly. To allocate funding to the places that need it most data needs to be accurately recorded/monitored.”

“All GP surgeries record data in different ways meaning there is no consistency or definitive ways to understand patterns and themes - there needs to be a clear monitoring system all over the board.”

“Every sickness/death since lock-down is being recorded as COVID such as urine infections, heart complications. For clear data, root causes have to be recorded.”

“Why only deprived communities? It should be collected across the board so people don’t feel deprived, so we don’t have deprived communities - If you call someone stupid for long enough they will believe they are stupid same goes for deprived!”

“If I can’t get an appointment with my own doctor, which we are all struggling with at the moment, is there anything to record/monitor?”

“GP surgeries need to record data ‘minute by minute’ the same as hospitals, meaning just like hospitals data inputters will need to be funded as local Health Centres do not have the resources to do this.”

C2C Responses to Data, Evidence and Knowledge

SG to Track/Understand Impacts of Policies

“Tracking/monitoring already used in our hospitals should be the same all over the board with funding allocated to data inputters.”

“All new policies/systems need to be tracked/monitored in order to understand benefits and limitations.”

“Only when you address these inequalities can we start to locate the missing people and close the gaps between life and healthy life expectancy.”

“Practice Nurses were in our surgeries to take blood which I felt comfortable with but now we have the new phlebotomy service which is a waste of time. What do nurses do now? Is someone tracking this phlebotomy service because it is awful and creating more inequalities?”

“Great, if you’re recording/monitoring methods work”

“Policies can effect and create health inequalities, this needs to be tracked/monitored to mitigate the risk of losing more unnecessary lives.”

The voices of C2C pose a final question in response to the SLWG recommendations

Sick, dying people are waiting in ambulances or hospital corridors, suicide rates continue to increase along with life and healthy life expectancy gaps which you can’t seem to fix - so how do you plan to fund, develop and implement all of these recommendations?”