CHAPTER FOUR: ACCESS AND WAITING
Introduction
4.1 This chapter reports on what the children and young people said about access and waiting. A number of issues are covered, from appointments and car parking to waiting rooms themselves and waiting times. The children and young people had much to say about the inappropriateness of some of the waiting environments that they experienced when accessing health care.
Making an appointment
4.2 The children did not comment on the process of making appointments. Given the age of the children, this was presumably something done by their parent or carer. The young people were asked how easy it was to make an appointment with their doctor, dentist or other health professional. Most of the young people reported that they did not experience difficulty making an appointment. One girl (15), however, found it very difficult to make an appointment. This seemed to have put her off going to see her doctor.
4.3 Most of the young people expressed appreciation of the ability to drop-in to a health care facility, where that was available; by drop-in, the young people seemed to be thinking of an age appropriate, accessible facility - something for young people that you could just turn up at.
Car Parking
4.4 Six of the children and young people talked about car parking, particularly with reference to going to hospital. One young person, for example, described being temporarily unable to walk after breaking her foot, and not being able to get parked on a visit to the hospital.
4.5 Two of the young people felt it was unfair to charge for car parking, as going to the hospital was not a choice. One disabled young person described the parking as 'atrocious' and how his dad become upset when they couldn't get parked. Three of the younger children also mentioned the difficulties with getting parked, with one saying it made her 'feel bad' when they couldn't get parked.
Wheelchair Access
4.6 None of the disabled children mentioned wheelchair access when taking about accessing health services, however they were not asked specifically about wheelchair access. The sibling of a child who used a wheelchair commented that
Some of the hospitals aren't very wheelchair friendly (Millie, 9)
A consideration for future research could be asking children and young people who use wheelchairs directly if they felt access with wheelchairs or walking aids was problematic.
The Waiting Room
4.7 The children and young people made frequent reference to the waiting room in the group discussions. The importance of the waiting room was clear. Often, when asked about going to the doctors, dentist or hospital, they spoke at length about the waiting room. The following aspects of the waiting room were important:
- The toys, activities and magazines in the waiting room
- decor
- How long they had to wait
- The information available in the waiting room
- Sense stimulation in the waiting room - smells, sounds, sights, motion, and feelings
4.8 Many of these aspects are also important in the other health care contexts discussed by the children and young people. There is, therefore, some overlap between this section on the waiting room, and others reported below.
The Toys, Activities and Magazines for 'The People in the Middle' in the Waiting Room
4.9 The most common complaint about the waiting room was that there was nothing to do for their age group. So many of the children and young people commented on this that it is fitting to describe a common feeling that the provision of 'things to do' in the waiting room was not felt to be age-appropriate. All of the children and young people were aged 6 to 16. The common feeling was that provision had been made for the babies and younger children and for the adults, but not for
The people in the middle (Amy, 8)
4.10 Some of the younger children also thought that teenagers, as well as babies and adults, had things to do.
4.11 Many children described the waiting room as 'boring' and made specific comments on the kind of toys and activities they felt to be inappropriate for their age.
It's boring. There are not many toys to play with, they're just for babies, they've got like choo-choo trains and they've got books that are so boring. (Lily, 8)
Because they have like things for small people and the older people and they don't have anything for the people in the middle (Amy, 8)
4.12 The toys and activities were often described as inappropriate because they were 'too babyish' (Tom, 11), although some children also noted that activities (magazines and TV) were also too grown up for their own age group.
The waiting rooms are boring (all others agree with her) (Amy, 8)
Why are the waiting rooms boring?(Nicola Coates-Dutton ( NC))
Well because they either have baby toys or magazines for adults they don't have anything (Amy, 8)
Yeah cause sometimes they have little Iggle Piggle toys, they have baby toys they have baby toys not for 8 year olds (Stuart, 8)
I know they have like builder blocks and things and they have for babies and toddlers and 4 year olds (Tiandra, 6)
At the dentist I HAD to play with baby toys cause I was waiting and I had to play mums and dads and Spot Christmas book and everything (Stuart, 8)
So have they got toys for 8 year olds?( NC)
No!!!! (All)
They don't even let you play a video game or anything cause and they've got a TV they should show it, and they put on like an adult programmes like 'will you marry me Darren or something!' … I wish you had a remote for yourself, the dentist just puts it on by himself (Stuart, 8)
Yeah there's stuff for babies to do and stuff for adults and teenagers to do but there's nothing for anyone else, but that's only in the dentist and the (doctors) waiting room (Amy, 8)
4.13 Children and young people also commented on the absence or poor quality of toys or activities in the waiting room.
I'd like it better if they had well you know like in the waiting rooms they only have like magazines and books, I'd like it better of they had like more toys for children (Leanne, 9)
4.14 Young people felt that the magazines were out of date ('you just sit there doing nothing with magazines from a year ago' Laura, 15, 'All the magazines are like four years old!' Eli, 15) and all would have preferred more up to date magazines in the waiting room.
4.15 Some of the children and young people also highlight examples of waiting areas that they had enjoyed. These examples of 'good practice' contributed to suggestions about how to make things better. Emily (8), for example, described a doctor's surgery with a park right next to it and how 'if it's a sunny day and you don't like waiting inside you can just go out there and play'. Following this Tiandra (6) suggested that a park right beside the doctor's waiting room would be a good idea, as long as 'your mum and dad can see you'. Other suggestions for change included having up to date magazines, a TV with the ability to change the channel, access to the internet, a play room separate from the surgery, and more exciting, age-appropriate toys and activities. One suggestion made by Emily (8) was that there should be different areas for different age groups in the waiting room; one bit for children her age then ' one bit for babies and one bit for teenagers or parents.' Emily's drawing illustrating this idea can be found in Annex 3.
Décor in the waiting room
4.16 Discussion about decor in the waiting room was often in the context of the way hospitals were decorated more generally. A more complete discussion of decor will therefore be included in the later section looking at the hospital environment. With reference to waiting rooms, children made comments about decor being inappropriate for their age group while both children and young people often said they disliked the bland or colourless spaces of the waiting rooms, consulting rooms or (adult) hospital wards.
Sometimes they're kind of like Winnie the Pooh and stuff that babies like but they're kind of boring for us cause they just have stuff like baby stuff pans and that (Lily, 8)
Well I don't like the decoration because it's boring and they put these carpets that are all blue and not like a bright colour they're like dark blue (Emily,8)
How long they had to wait
4.17 Some of the children and young people talked about having to wait a long time ( 'you have to wait ages' Helen, 15) in the waiting room. This was either in the context of waiting before a doctor or dentist appointment, or waiting to be admitted to a bed or ward after an admission to A & E.
Sometimes when you go to the doctors they just make you sit and you get bored cause once Emily was getting her teeth pulled out at the dentist and I had to wait for like 2 hours and I hate waiting (Stuart, 8)
4.18 As will be discussed in the section dealing with the 'emotional support' domain, sometimes waiting or travelling long journeys to the doctor or hospital can make a child or young person feel anxious. Waiting therefore may not merely result in boredom. Without anything to help pass the time, the child or young person can become anxious.
4.19 Several of the young people described having to wait a long time in A & E to be seen. Eli (15) described how she 'had to wait 2 hours' after breaking her arm in the waiting room at A & E. She also described how the room 'wasn't very nice inside'
I wasn't comfy and no-one came to tell us what was going on. I was in so much pain (Eli, 15)
4.20 The younger children were all asked what their favourite and least favourite room of the hospital was. For Amy (8), it was the waiting area in A & E where she had to spend her first night of a two week stay in hospital.
It was noisy and it was my first night so they kept waking me up to do stuff and I didn't like it there (Amy,8)
This area she said she had to wait in before being allocated a bed was the least favourite part of the hospital for her.
The information available in the waiting room
4.21 The young people were keen to be able to access helpful information leaflets in waiting areas. A discussion of information leaflets follows below in the section on the 'better information' domain. Here, it is noted that the waiting room at the doctors, dentist, hospital or other health care was a place the young people said they would like to see more (and better) leaflets.
Sense stimulation in the waiting room - smells, sounds, sights, motion, and feelings
4.22 In our study the children and young people made reference to smell, sight, sound, motion/balance and feeling - both positive and negative comments, as a way of describing their healthcare experience. While a fuller discussion of data relating to sense-stimulation will be covered in later sections of this report (in the 'physical environment' domain), it is worth including here some examples of how the children and young people reported their experiences of waiting rooms with reference to the stimulation of their senses. The most common sense the children and young people talked about was smell, with many negative associations reported regarding the smell of healthcare settings. Examples of these, and references to other senses, are noted below with a full discussion in the later section looking at physical environment.
(smell)
The doctor's surgery when you're waiting smells funny…they need to put some air fresheners in! (Claire, 15)
Does the smell really bother you?( NC)
Yeah it makes me feel sick … it just smells weird it smells like old people (Claire, 15)
(sound)
You have to be quiet (in the waiting room), it's too quiet (Laura, 15)
(feelings)
(waiting- anticipating seeing the doctor on long car journey) It gives you time to worry about what you think they're going to do to you, cause if you're going for like a check up and then you thought what are they going to do if something's bad with the check up or something. It gives you time to get it fixed in your mind (Emily, 8)
What puts Young People off going to the doctor's
4.23 Several of the young people shared what puts them off going to the doctors. One girl described difficulty making appointments (as noted above). For another 3 of the young people, going to the doctors was seen as something to be worried about and they described feeling worried, nervous or afraid. The emotional impact for children and young people on accessing healthcare will be discussed in the 'emotional support' domain, and is introduced here with reference to obstacles to accessing health care.
How do you feel about going to the doctors?( NC)
Sometimes I get nervous cause you don't know what they're going to say to you, they could say you're dying (Claire,15)
So do you worry about going to the doctors? ( NC)
Yeah all the time. I was meant to go to the doctors last week but I didn't go. This lump is sore here (Claire, 15)
4.24 Claire also reported that she didn't like speaking to different people and telling them what was wrong, while Amanda (15) didn't get on with her doctor which put her off going.
Summary
4.25 This chapter has identified features of access and waiting that were important to the children and young people participating in this study. Although appointment times did not seem to be relevant to their experience, access in terms of car parking or wheel chair access certainly was. Most prominent though were the discussions around waiting, both in terms of time and environment. Various features of waiting rooms/areas were described: the toys, activities and magazines in the waiting room were often seen as not age appropriate; the décor was bland or for small children; and other dimensions such as noise or smell were also bothersome. Waiting times were described as long in some cases too. The young people suggested that appropriate information in waiting rooms would be helpful.
4.26 The following chapter describes how the children and young people talked about wanting better information.