Doctors Services (focus groups)

1. Doctors Services(focus groups) Positives 14 groups made 41 general positive comments about the Doctors. They found that the doctors on the whole provided a good service (9 groups) Most found that Doctors took time to explain (8 groups)

2. Doctors Instructions An average of 91% of respondents were satisfied that the doctors instructions and advice were clear and easy to follow. Those who were not satisfied made comments such as:- I understand it from the Nurses (Cas) I have a difficulty understanding sometimes. Sometimes my memory is not so good.

3. Helpfulness of Doctor’s Medical Treatment(Clinics, Inpatients, Out Patients, Casualty) An average of 91% of respondents said that the treatment given by the Doctor worked for them. When asked what they would do when the medication did not work, responses included:- Use own remedy. Use own bush medicine. Buy off the shelf from Pharmacy

4. Helpfulness of Doctor’s Medical Treatment(Clinics, Inpatients, Out Patients, Casualty) When asked what they would do when the medication did not work, responses included:- Deal with it myself Go to another doctor I don’t take the medication Go to a doctor overseas (last resort)

5. Doctors Services(focus groups cont’d) Negatives 15 groups also made 62 negative comments about Doctors mainly related to their availability.

6. Doctors Services(focus groups cont’d) KEY CONCERNS:- Not enough Doctors – in terms of specialist skills, available on the hospital compound (12 groups) Doctors have to do hospital rounds, Casualty and Clinics causing long waits, not readily available (7 groups)

7. Doctors Services(focus groups cont’d) Concern over diagnoses being made over the phone. This created a lack of confidence in the system and was seen as an inadequate level of service provision (9 groups) It was felt that there was a language/cultural barrier with Doctors (9 groups)

8. Doctors’ Services(focus groups cont’d) Suggestions Doctors residences should be close to the hospital Need a Doctors room on compound with Kitchenette, TV, Internet, Bed etc so that when Doctor is on call he is readily available Separate Doctor should be assigned to Wards and Casualty and Clinics

9. Pharmacy(focus groups) 17/18 groups commented:- Positives 9 groups felt the service at the public Pharmacy was good and prompt 8 groups felt the service at the private Pharmacy was reasonably good

10. Pharmacy(focus groups cont’d) Negatives It was felt that they do not stock a wide enough range of medical supplies (8 groups) and people have to go overseas to get medicine or to the private Pharmacy) 7 groups felt the public Pharmacy opening time was inconvenient

11. Pharmacy(focus groups cont’d) Key Concerns with Private Pharmacy Lack of competition, expensive (8) Pharmacist not always available and have to come back the next day (4) No privacy at the private Pharmacy Too much expired stock (2)

12. Pharmacy(focus groups cont’d) Suggestions Better links between the two pharmacies so that those exempt can get free medication from the private Pharmacy. Free medication for those who are not exempt but cannot afford (1) Everyone to have access to the hospital Pharmacy and pay a fee (1)

13. Clinics(focus groups) Positives (16/18 commented ) 8 groups felt the service provided was good generally – singling out the following for praise- variety of services available (2) the vaccination programme (3), Child Care (2), Eye Care (2) 5 groups praised the cleanliness of the clinics.

14. Clinics(focus groups cont’d) Negatives Uncomfortable waiting rooms at some clinics (not Cudjoe Head) Issues around the Doctors such as:- --Having to wait too long on Dr days, sometimes not getting to see them, and having to come back another day. Unavailability of specialists at the clinics.

15. Clinics(focus groups cont’d) Suggestions Need for a resident nurse at all Clinics (3) When clinic day falls on a public holiday sometimes have to wait for a whole month – need to have the Doctor visit an extra day to make up for the holiday.

16. Casualty(focus groups) Positive Most had received prompt, good and caring attention from the Nurses and the Doctor.

17. Casualty(focus groups cont’d) Negatives People complained of the long wait (11 groups) Dissatisfaction with diagnosis over the phone (7) The waiting area is uncomfortable and inadequate . Perceived lack of confidentiality.

18. Theatre(focus groups) Positive 5 groups gave 8 positive comments about the service provided Negatives The operating Theatre is not on the hospital compound (9) The need to have a modern, well equipped, spacious Theatre (4).

19. Theatre(focus groups cont’d) Absence of an intensive care unit means people have to go overseas (2)

20. Physical Facilities(focus groups) Positive 13 groups commented very highly on the cleanliness of medical facilities generally Negatives 12 groups commented on the inadequacy of waiting areas especially when it rains particularly for Lab, Casualty and Pharmacy.

21. Physical Facilities(focus groups cont’d) Lack of proper waiting rooms with protection from the elements (6) Lack of comfort especially for the elderly (10) Not enough seating.

22. Care of the Elderly(focus groups) Positives 8 groups felt the elderly were well taken care of and access to free health care was seen as key Residents from Hill View felt treatment by Doctors and Nurses was good (22 /25 comments)

23. Care of the Elderly(focus groups cont’d) Negatives 6 groups felt the elderly were not always well treated Elderly themselves spoke of their poverty, the difficulty of getting quality food and the links this has with mental and physical deterioration. Hill View residents made 3 complaints about the way they were treated by the caregivers.

24. Do we all receive Equal Access to Care Positives • Vulnerable groups get free health care and this was seen as positive (10) • Health insurance for Government workers was also praised • Treating children first at clinics was also seen as positive because of school • The health care system was seen as better and cheaper than in some other countries

25. Do we all receive Equal Access to Care(Focus Groups cont’d) Negatives Preferential treatment due to who you are Friends, government officials or high status people (6) Because of your contacts, who you know, your links to Ministers (2) Because you are a certain category of work – e.g police

26. Barriers to Care and Equal Treatment(Focus Groups cont’d) Discriminatory behaviour towards certain types of people Elderly, mentally ill, poor – because they have low status Nationality - Non national children have to pay. Anti-foreigner attitude of nurses (2) Non established workers do not have the same health coverage (1)

27. Barriers to Care and Equal Treatment(Focus Groups cont’d) The cost of care/medicine (9) Absence of a medical scheme to cover everyone on island (1) Attitude and mood of personnel (1) Lack of information on the services available.

28. How should Health Care be Financed(Focus Groups) Key Suggestions Development of a National Insurance Scheme (9) More funding from GOM/ Britain specifically for health Coverage through Social Security (2) Health levy and earmarking funding specifically for health. Users should pay/increase charges a bit more (3)

29. X-ray(Focus Groups) 13 groups provided feedback on the X-ray Department Positives 11 groups gave positive feedback. The service provided is seen as efficient and professional. The staff is pleasant, reassuring and polite and take their time to explain what they are doing. (11)

30. X-ray (Focus Groups cont’d) Negatives 4 groups made the following comments:- That the opening hours needed extending (2) That the services were limited (1) Suggestions There needs to be more than one person trained to use the Xray machine (4 groups) A need for a wider variety of X-rays/screening (4)

31. Laboratory (Focus Groups) 12 groups gave comments on the lab Positives 9 groups gave positive feedback. The Lab staff are seen as efficient and well trained both in technical skills and their manner with the patients (7) They were also seen as reliable, on time and always respond when on call (3)

32. Laboratory (Focus Groups cont’d) Negatives Waiting area was seen as uncomfortable with not enough chairs and inadequate especially when it rained. Opening hours were seen as inconvenient – too short , not convenient for people working Some staff needed to be more caring and reassuring.

33. Privacy(Focus Groups) 12 groups talked about the privacy of the physical facilities provided. Positives Some groups (6) felt there was (some) privacy at the various facilities (Casualty, Pharmacy, Wards, Clinics) Xray was considered private, as well as the private doctors.

34. Privacy(Focus Groups cont’d) Negatives A lack of privacy on the Wards (5) No privacy at the private pharmacy when prescriptions are left (3) Lack of privacy at the Homes

35. Mental Health(Focus Groups) Negatives Public perceive there to be a general lack of support and poor treatment (10) There is concern over the treatment of the mentally ill by the police when they administer the injections (7) There is concern over the lack of proper facilities for the mentally ill for support, rest and recuperation. Linked to this the prison is seen as inappropriate.

36. Mental Health (Focus Groups cont’d) Negatives (cont’d) Concerns over the adequacy of the injections and whether patients are given differentiated treatment catering to their individual needs (7 groups) Concerns over administering the injection without patients having food first (3 groups)

37. Mental Health (Focus Groups cont’d) Suggestions Proper facilities for rest, recuperation and treatment (8 groups, 14 comments) including activity and recreation centres (2) Proper regular counseling services and follow up care for the mentally ill with a support group for the mentally ill (1) Proper training for staff dealing with the mentally ill including the police, doctors and nurses (5 groups) Public awareness and education (3) Attention focused on their whole well-being including ensuring they have a proper diet (3), recreation (6) contact with other people(3)

38. Cost/Affordability of Health Care(Focus Groups) Key issues raised All groups recognized that the elderly, children, Hypertensives and Diabetics do have access to free health care Some feel that they do not have access to health care because they cannot afford it (6) Health care especially medicine is regarded as expensive for many people (9)

39. Cost/Affordability of Health Care(Focus Groups cont’d) Low waged non exempt find it difficult to pay and therefore access proper health care (5) They do not provide a service for those who cannot afford to pay except those over 60 Non national children to get free medical treatment

40. AmbulanceService(Focus Groups) Suggestions Better equipped/modern ambulances (7) With proper communication equipment (radio) on board (3) Personnel should be trained in first aid (3) and supported by a nurse/assistant (2) With more drivers/ambulances for prompt service (and in case of an emergency) Ambulance should have a siren (1) Should have a bed to drive on and off the ambulance (10

41. Comments about Ambulance Service (Main Survey) 51% of persons who responded had used the ambulance before. Purpose of Use Emergency Call Out – 37% Transport to Theatre – 37% Discharge from Hospital – 11% Other – 15% Response Time of Ambulance 0-5 minutes – 29% 5-10 minutes – 30% 10-30 minutes – 35% Over 30 minutes – 6%

42. Comments about Ambulance Service (Main Survey cont’d) It was difficult to do cross comparisons for these as some persons did not indicate where they requested the ambulance from and some indicated home. Professionalism of Ambulance Service Very Good – 35% Good – 40% Fair – 15% Poor – 5% Was there Capable and Sufficient Staff on Board Yes – 60% No – 40%

43. Comments about Ambulance Service (Main Survey cont’d) If you had an emergency would you request the ambulance Yes – 72% No – 28%

44. Medical Records(Focus Groups) Overall comments were positive All groups commended staff on politeness, helpfulness, professionalism and efficiency The service was also seen as confidential (3 groups) Suggestions Need a computerized system (1) Patient records should be at Casualty as well as the main office Complaints One person experienced a 3 year delay in getting a bill Some felt the appointment system was not effective (2)

45. Health Education (Focus Groups) General perception was that people were not aware of all the services on offer and that there needed to be more information and education so that people could access health care (5)

46. Health Education (Focus Groups cont’d) Suggestions More public education on healthy lifestyles starting at preschool, in the nursery, in the workplace and accessing the whole community (7) More education on Hypertension and Diabetes linked to healthy diets (2) Public education on mental illness (2) More counseling available to the entire community (2) Drug abuse awareness (1) More information on health insurance and health benefit schemes

47. Comments about Health Education (Main Survey) How relevant is the Health Education Information you receive? Very Relevant – 29% Relevant – 62% Not Relevant – 9% Is Health Information Given Accurate Yes – 62% No – 13%

48. Comments about Health Education (Main Survey cont’d) Is Health Information Easy to Understand? Yes – 90.6% No – 9.4% Which Sectors of the Community are Left Out in Health Education? Antenatal Food Handling Maternal & Child Health School Children Sexual Activity Spanish Speakers

49. Access to Care(% of Difficulty)

50. Barriers in Accessing Care • Reasons for not having access included:- • My mother was there (SA) • Nurse not living close by (SA) • No stick was there to test urine (SA) • No equipment (SA) • No Medicine (SA) • Lab early closing hours • I was told to go to a Clinic (but had no transport) • I am not quite sure what services I am entitled to on the Ward, should be published • Had to leave and return (Pharm)