Richmond sleep apnoea care engagement report 2026

1. Executive summary

Between 9 February and 9 March 2026, NHS South West London ICB gathered views from patients receiving sleep apnoea care registered with a Richmond GP, carers, those on waiting lists and Richmond residents to understand their experiences and views on a proposal to bring Richmond’s sleep apnoea care in line with the rest of South West London. The proposal is for St George’s University Hospitals NHS Foundation Trust (St George’s) to become the single NHS commissioned provider of sleep apnoea care in South West London, with patients currently receiving care from the private provider, The Sleeping Disorders Centre (SDCL) transferring to St George’s.

A total of 275 responses were received through online forms, telephone support, and paper submissions, supported by communications from GP practices directly to patients, via local partners and on social media.

Respondents highlighted similar priorities. They value timely support, especially when equipment needs replacing or problems arise with their condition. Many said that remote appointments make it much easier to manage their condition, particularly for those who find travel difficult. Respondents also spoke about the importance of continuity of care, regular follow up and clear communication, which helps them feel confident in managing a long-term condition. Impact on travel was a common concern, especially for disabled residents, older adults, people with work commitments and those living further away from where services are based.

Views on the proposal varied depending on the service patients currently use. People receiving care from SDCL, and who would be directly affected by the proposed change, raised concerns. They described their current service as responsive, consistent and personalised, and questioned whether these strengths could be maintained within a larger hospital setting. Patients already under St George’s expected little change for themselves, but some were unsure how the service would manage any increased demand. Patients from West Middlesex and Charing Cross highlighted the importance of local access and raised concerns about travelling to St George’s if the proposal included them.

Some respondents, particularly SDCL patients, also commented on the clarity and timing of information about the proposal. A number felt that they had not received enough information and early enough in the process. They described wanting to further understand the reasons for the change and what it might mean for their care.

Feedback from other groups, such as disabled residents, carers and people on waiting lists, reflected concerns about the impact on travel. People highlighted the importance of services that are easy to reach, especially for those who find travel difficult. Some on waiting lists describe experiencing long waits and that they don’t always feel they know what is happening with their referral or treatment.

Across all respondents, there is an ask that any future service must remain quick to respond, easy to contact and reach, consistent, and communicate clearly, so they can manage their condition with confidence.

Key findings – consistent themes across respondents

Continuity of care

A strong theme running through the insight is that people feel that continuity is important – the reassurance of being supported by people who know your history, your other conditions, and the nuances of your sleep apnoea journey.

Patients with SDCL view them as a small, consistent team where care feels personal. They describe feeling seen and understood. It was felt that continuity becomes even more important for people living with a disability or other complex health conditions, who say that change can cause uncertainty or setbacks. Feeling known by the clinicians and staff and being treated as an individual rather than “a number” is viewed by patients as key to feeling cared for and confident in the service.

Patients value relationships built over years with a clinical team and see this as not being easily replaced. Several patients link continuity of care to their wellbeing. This sense of trust with SDCL is one of the main reasons given when patients tell us they oppose the proposed change.

The role of remote care and barriers created by travel

Remote care, through telephone calls, video appointments, remote follow-ups, and SMS contact is viewed as essential for many. Patients describe it as enabling them to manage work and caring responsibilities and avoid physically challenging and time-consuming journeys. People said that remote appointments reduce these pressures, and several say they would not be able to access care without them. There is concern that what some patients see as a centralised model at St George’s would require more in-person attendance. Some respondents suggest a hybrid of remote first and in-person appointments when clinically needed but at a local outpatient clinic.

The feedback indicated that people feel that travel is one of the strongest barriers to treatment. For many Richmond residents who responded, particularly in some parts of the borough such as Hampton, Teddington, and Twickenham, reaching St George’s is described as difficult and for some unmanageable. We heard this particularly from older adults, carers, and people with disabilities.

Where services are difficult to reach, are thought to not have enough parking, require lengthy travel, or involve multiple public transport routes, patients say that this can affect their ability to keep appointments and access care.

People would like to see local clinic options and make location suggestions such as at Roehampton, West Middlesex Hospital, Teddington Memorial Hospital, Hampton Hill, or Sheen (Lane). They describe that being able to access support remotely or at a local clinic is what can make ongoing treatment manageable. 

Timely, responsive support for safe care

People describe responsive, rapid support as important for them in feeling safe with their sleep apnoea care. For many, problems with equipment or symptoms can have an immediate effect on their health, energy, and confidence. They value being able to reach someone quickly who can help. Some patients describe getting a reply on the same day and replacement equipment within hours or days helps them to maintain their treatment.

When response times are slower or follow-up is inconsistent, people describe feeling unsure about what to do and anxious about managing symptoms on their own. And when patients experience slower follow up, long waits for reviews or difficulty contacting their service, they describe feeling abandoned or unsafe. 

Equipment quality and reliability

Equipment support is a major theme, with people describing how important CPAP (continuous positive airway pressure) therapy is to their daily lives. This covers access to high quality CPAP equipment, regular replacement parts, and remote monitoring. Patients describe relying on their devices every night and that any interruption or what they view as a potential reduction in the quality of equipment as being a risk for them.

Many describe being concerned about the possibility of having to switch machines, lose telemetry features or face delays in repairing or replacing equipment. They feel that disruption to equipment could lead to health risks, driving restrictions, worsening fatigue, or increased risks at night.

We heard that continuity of equipment is really important: that if services must change, keeping current equipment is important or that an equivalent is provided without any gaps in supply.

Need for consistent communication and regular follow up

Some patients ask for clearer information about follow up schedules, equipment replacement processes, and how to access support. Those who have gone long periods without review or who find it difficult to get through to their service describe feeling uncertain and poorly supported. Those on waiting lists describe this most often.

In contrast, patients who receive regular updates, annual reviews, or clearly structured follow up describe feeling more confident and better able to manage their condition. 

What would help with any transition

Patients shared what would support a transition process to a different service provider.

• Continuity of equipment and uninterrupted therapy Patients would like to be able to keep their current equipment, or receive new equipment of equivalent quality, with no interruption to supply, and for remote monitoring will continue.
• Maintain their ability to continue treatment, and how remote care can help with this, particularly where people find travel difficult due to a disability or managing work or caring responsibilities.
• Maintaining rapid response times One reason patients value SDCL is the responsiveness of the service and maintaining this element would therefore help them with any transition. 
• Timely, detailed communication Patients are keen to understand when the change will happen, what the new arrangements will be, and how continuity of care will be maintained. They would like to have timely updates and clear instructions on practical issues such as what will happen to their equipment, how data will be transferred, who they will contact, and what to do if something goes wrong.
• A named clinical contact or dedicated point of contact Patients felt this would support with continuity of care. Being able to contact a named person who can access their full history and support them during the transition and beyond.
• Local clinics or outreach options if in-person appointments are required. People felt this would reduce the difficulties of travelling to St George’s and help with ongoing access to treatment for those who would find it difficult to get there. Suggestions include regular clinics at local sites such as Teddington, as well as maintaining home delivery for replacement equipment to avoid long journeys. Some patients attending the St George’s service at Queen Mary’s, Roehampton prefer it to travelling to Tooting but also said a more local option would be easier to get to. 

If change does happen, patients would like to see a seamless, well-planned transition, focusing on safe, accessible, and personalised care.

Concern about the proposed change

While all patient groups expressed some level of uncertainty about the proposed service change, we heard particular concern from patients at SDCL, who would be directly impacted by the proposal. We heard people are concerned about losing a service they describe as highly personal, responsive, and clinically effective.

A common view is that patients feel that St George’s, as a larger hospital, will not be able to match the speed, personal connection or specialist support they currently experience and this will impact the quality of care. Many describe St George’s as difficult to get to, and there is concern that the service at St George’s would require more in person appointments. 

Although a small minority of patients at St George’s, and a few people on waiting lists, can see potential benefits, particularly around joined-up care, most patients are unsure about the change being proposed when their current care is working well.

Some patients are concerned about the process for the proposed change. Several describe unclear communication, limited information about what the change involves and reasons for the proposed change. We also heard concern that decisions had already been made without meaningful engagement.

Patients describe the importance of transparency about the reasons for change; that they would like reassurance that their views will be considered, and that they will be informed before any change is made.

2. Overview of engagement and service proposals

The aim of this engagement was to ensure that Richmond residents including patients registered with a Richmond GP with a diagnosis of sleep apnoea (circa 2,000 patients) and current patients (380+) and those on the wait list of SDCL were able to share their views to inform how the ICB commissions sleep apnoea services for Richmond residents in the future.

Background information

The majority of care for Richmond residents with Ear, Nose and Throat (ENT) and respiratory conditions is provided by their GP practice, local NHS community services and acute (hospital) providers.

One element of the respiratory pathway is for patients with Obstructive Sleep Apnoea (OSA) – a condition where your breathing stops and starts while you sleep. Some people need to use a device called a CPAP machine which gently pumps air into a mask you wear while you sleep.

Currently Richmond sleep apnoea patients are under the care of different clinical teams based on the complexity of their conditions. Some patients are under the care of the Richmond obstructive sleep apnoea (OSA) service provided by SDCL. This service remotely delivers diagnosis and treatment for sleep apnoea only for residents registered with a Richmond GP. Other Richmond residents along with residents in Croydon, Kingston, Merton, Sutton, and Wandsworth are seen by the service at St George’s or services outside of South West London.

Richmond is the only borough in South West London to have a stand-alone sleep apnoea service.

The ICB has been reviewing the commissioning of sleep apnoea services to consider how we better integrate care within the existing ENT and respiratory pathway to support our patients. This has highlighted that the provision of sleep apnoea care in Richmond differs from the other five boroughs meaning that equitable care is not being provided across South West London.

The proposal is to align NHS sleep apnoea care in Richmond to the rest of South West London. This would mean that in future Richmond residents would have the same options for sleep apnoea treatment as people in the other five boroughs. St George’s would become the sole provider commissioned in South West London, in addition to alternatives available under the NHS Choice Framework.

This would mean that current patients of SDCL would transfer to the service at St George’s unless they make alternative arrangements. The change would mean that care is delivered in a consistent and equitable way across South West London.

3. Methodology

We developed an engagement approach which supported the ICB’s duty to involve the public in its planning and decision-making in respect of proposed changes to services. The approach was designed to gather feedback from current sleep apnoea patients registered with a Richmond GP, Richmond residents, people on waiting lists, and others who may need sleep apnoea care in the future.

The aim of the engagement was to:

• understand what works well about existing sleep apnoea services used by Richmond patients including SDCL,
• gather views on the proposed change to commissioning arrangements, and
• identify what support people might need if care transfers to St George’s in the future.

It builds on patient feedback from 2017/18 from and patient satisfaction survey results for the SDCL service.

The engagement ran for a 4-week period, from the 9 February – 9 March 2026. We used a mixed methodology to support people to participate and share their feedback. This included:

1. Online feedback form – sent directly to patients through Richmond GP Alliance (RGPA), shared via our VCSE contacts, and promoted on social media.
2. Telephone support to complete the feedback form – we offered to speak to people on a 121 basis over the phone to reach to those who are digitally excluded.
3. Written feedback – we sent hard copies of the form when requested.

To make information about the proposal available to Richmond residents beyond those contacted by their GP we had a dedicated section of our website for the proposal. This included background information, as well as FAQs and links to the fact sheet and feedback form.

Alongside engagement activities, we reviewed existing regional and national insight on sleep apnoea services. This would help contextualise local findings and ensure the final analysis reflected wider evidence if available.

4. Who we heard from

Online feedback form

We received 275 responses to the feedback form, two of which were completed over the telephone. MS Forms allows for individuals to provide more than one response, and we have identified a small number of respondents who have provided more than one response where they have provided identifiable information.

The following table shows a breakdown of all respondents by how they described themselves

The table below sets out which service patients are receiving care from or are on the waiting list for.

*Other includes patients receiving care at Charing Cross/Imperial College Healthcare NHS Trust (23), Guy’s & St Thomas’ NHS Foundation Trust – Guy’s (3), Royal Brompton Hospital (10), University College London Hospitals NHS Foundation Trust (UCLH) (3) and Kings (1), private providers not named (2).

71% of responses are from men and 27% from women which goes against the trend of previous surveys where women have been over represented. When it comes to age range the majority of responses are in the 50-64 range at 43% followed by 65-79 at 32% and 25-49 at 16% in keeping with the older age profile for sleep apnoea. 42% of those who responded said that they had a disability or long term condition.

The respondents are predominantly White, with around 83% identifying with a White background and about 17% identifying as non‑White. The three largest individual ethnic groups represented are White British/Northern Irish/Scottish/Welsh (62%), White European (15%), and Indian (3%). This reflects the overall ethnic profile of Richmond upon Thames, where White groups make up about 80.4% of the population and non‑White groups account for around 19.6%.

We received responses across all wards in the borough. The highest number of responses were from Hampton North (24), while Hampton Wick and Richmond & Kew had the fewest, with just one response each.

75% of respondents indicated that they would like to be kept informed about the results of this engagement.

Emails and telephone calls

We received 10 direct calls or emails about the engagement, three to say they received it in error or were no longer receiving sleep apnoea care; one to request a paper copy; two to complete the form over the phone; one confirming they had already completed the form via Facebook after receiving it in the post; one asking for a copy of their responses and two to say they are happy with the service at St George’s and would not be completing the form.

Website and social media

We had 204 views to the webpage based on its title or its URL path. There were 558 interactions which include actions like scrolls and clicks. Users spent an average of 1 minutes and 42 seconds on the page which is significantly higher than the overall website average.

Social media promotion resulted in almost 290,000 impressions with 2,892 interactions and 2,415 clicks.

5. What we heard

The following provides an overview of the insight from patients of services where we received over 20 responses. These are SDCL, St George’s, West Middlesex Hospital (WMH), and Charing Cross/Imperial (Charing Cross).

5.1 What matters most to patients about their care?

Respondents were asked to rank in order of importance three aspects of care: choice of remote or in person appointments, joined up care with other health services and support with equipment.

Overall respondents placed highest importance on:

1. equipment support, followed by
2. choice or remote or in person appointments and lastly
3. how sleep apnoea care is joined up with other health services. 

However, ranking did vary depending on which provider patients received care from. Patients at SDCL and WMH place more importance on choice of appointments, reflecting the value placed on convenience and responsiveness of services. Patients at St George’s and Charing Cross are in line with the overall result ranking equipment support highest.

Respondents had the opportunity to provide additional reflections on what matters most to them beyond the aspects of care which they ranked. Consistent areas were:

Reliable access to support and equipment

Patients described being able to access support from a clinician quickly as important for them to maintain their care. “There is always a personal clinician at the end of a direct number.” (SDCL patient)

Continuity of care and established relationships

They describe wanting to maintain established relationships with clinicians and staff who understand their individual history, preferences, and health conditions. Some describe feeling worried about losing this continuity as a result of the proposed change. Others tell us about wanting the reassurance that someone is keeping an eye on their care with regular check ins, rather than the service just handing over a device and stepping back.

• “Working with the same team since I was diagnosed has given me reassurance I am in safe hands.” (SDCL patient)
• “I would like regular reviews annually” (Charing Cross patient)

Local access and convenience

A service that is easy to access is valued by some patients. They describe the that being able to have the choice of remote or in person appointments at a local clinic is important to them to avoid time-consuming travel to St George’s. “Convenience of care, so remote care or a location close to home ….. without having to take annual leave from work.” (SDCL patient)

Equipment quality and continuity

Patients would like to keep access to quality equipment that they see as reliable, familiar, and clinically suitable. They are concerned the proposed change will mean losing access to specialist devices, telemetry features, or rapid replacement processes.

• “The CPAC system takes a while to acclimatise to using, so using the same system is very preferable.” (SDCL patient)
• “If I need a new mask, I need one dispatched within days” (WMH patient)

More innovation and treatment options

A small number of patients commented that services could be more proactive around alternative options for treatment.

• “A more proactive approach to helping patients looking for new ways to manage sleep apnoea using advances in treatment”(SDCL patient) 
• “They don’t have alternative treatments other than CPAP”. (St George’s patient) 

5.2 Current experience of care

Patients tell us that they value services that are responsive, reliable, easy to access and contact and provide:

• clear communication
• timely equipment support, and
• flexible appointment options.

We heard that what works particularly well is quick and responsive help when equipment fails, the reassurance of remote monitoring, and contact with knowledgeable clinical teams.

• “I value being able to contact the SDC via text and to receiving remote follow-up appointments.” (SDCL patient) 
• “They gave me enough time to understand …… and gave me confidence in using it independently at home.” (WMH patient) 

Patients consistently described the importance of being known by their clinical team, receiving timely follow-up, and having confidence in staff expertise.

• “They know me by name, not just a patient on paper.” (SDCL patient)
• “An excellent service, contact with specialist nurse is via SMS and queries responded to on same day.” (SDCL patient) 
• “The service… is excellent for my daughter with complex needs.” (St George’s) 

Feedback shows that SDCL is viewed as offering personal continuity and fast responses, while people feel the larger hospitals may provide broader expertise but with some longer waits or less consistent follow-up.

“They are clearly knowledgeable and provide good quality care.”  (St George’s)
“ .. having to wait nine months to get a first appointment is not ideal.”  (St George’s)

Patients describe travel as a significant barrier to care, with remote appointments and/or local clinics options addressing this.

• “I enjoy the flexibility and remote help I get without having to go in to the hospital which incurs costs and/or taking time out of a very busy job (WMH patient) 
• “I can go to Roehampton Queen Mary’s hospital… which is way more convenient for me.”(St George’s patient) 
• “Remote care and Saturday calls works best for my situation.” (SDCL patient)

Patients across all services said that the following would be helpful:

• clearer, planned reviews and regular follow up
• easier access to and support with replacement parts
• more joined up care with services such as GPs, ENT and weight managment
• reduced waiting times.

Despite differing experiences, patients have similar expectations around responsiveness, continuity, accessibility, and stability when it comes to their sleep apnoea care.

5.3 Views on the proposed change

Patients express uncertainty about the proposal to move care from SDCL to St George’s. They describe the importance of:

• uninterrupted therapy or treatment,
• quick access to equipment support, and
• clear communication.

Many are concerned about:

• longer waiting times,
• slower responses, and
• reduced accessibility, particularly as they say travel to St George’s is difficult for them.

Feedback from SDCL patients

SDCL patients express concerns, about the potential loss of what they view as the personalised and timely support they currently receive. Many are concerned that the proposal would affect the quality of their care as well as the possibility of disruption to their treatment. Some describe the poor experiences they have had in hospital settings.

• “With the number of patients that St George’s already has .. I do not believe they l would be able to provide the same standard of response.”  
• “My experience with a large hospital like St. George’s convinces me that their service would be inferior to that provided by my current clinic”.
• “Concerned as to how easy it would be to get new kit or problems resolved and how responsive the St George’s would be.”

Many patients, particularly older adults, those with other long-term conditions, or managing work commitments or caring responsibilities are concerned about having to travel long distances to get to St George’s.

• “I would find travelling to St George’s very difficult due to my disabilities & my family all work full time.”
• “St George’s is much further away …… I would to have to take a full day off work to attend”
• “It will be very disruptive if remote appointments were not available from the start. Telephone & video appointments are a common occurrence even for GP surgeries.” 

Patients repeatedly describe the value of having long‑standing, trusted relationships with their current clinicians.

• “Concerned that the support would not be as good as what I have now”
• “My care has been superb from the sleeping disorders centre… They also have the context and knowledge of my personal circumstances which can’t be replaced by transferring notes.”
• “I worry that I would lose the superb level of personal support.  My current nurse just took over the driving licence renewal issue for me.” 

Several patients describe the potential impact of the proposal on family life, on partners, children and or relatives who support them if their care is disrupted.

• “My condition is managed well, and disruption will have an indirect effect on my daughters and family.”
• “My family have concerns regarding the continuity, particularly the personal care I have from the SDC.”

Some of the feedback describes the potential emotional impact of the proposed change on SDCL patients with particular concerns over having a new provider.

• “As someone who suffers with anxiety ….. starting over with a new team ……would increase the worry, fear of being misunderstood and stress of repeating my personal struggles.” 
• “A change of care would greatly impact my confidence. I worry this would impact my family life.” 
• “I struggle to breathe and the worry of being treated by someone who is not familiar with my medical history is incredibly stressful.” 

Some question why we are proposing a change to a service that works well for them.

• “The consultations with The Sleep Disorder Clinic have transformed my life and I am staggered that you are suggesting changing a working model for an inferior one.” 
• “I just don’t understand why you are trying to fix something that is not broken.” 

Several patients expressed feeling that they should be able to stay with SDCL if they choose. Their feedback raises questions around the impact on patient choice.

• “Explain why some patients can stay with their current provider but SDC patients are being told they will be transferred to St George’s?” 
• “I am not happy the person-centred approach has not been acknowledged, and my freedom of choice will be taken away.” 

Many patients describe what they view as a lack of clarity, transparency and patient involvement in the decision-making process. They feel that they were not informed early enough about the proposal and do not understand the reasons for the proposed change.

• “This does not appear to allow enough time for a full and meaningful consultation to take place and for patients’ wishes and opinions to be taken into account.
• “this entire suggestion seems to be driven by ideology rather than patient benefit. I am completely against it.”
• “this whole “proposal” has been so badly managed and patients have been kept in the dark until the last possible minute.”
• “This engagement exercise should not be used to rubber-stamp a decision that has already been made.” 

Others describe feeling the process as “driven by budgetary considerations” or “a tick box exercise” rather than about patient care.

Only a few respondents can see any potential benefits of the proposed change hoping that it could result in more integration with other NHS services or shorter waits for new patients.

• “It is a good idea for people on waiting lists and future patients needing the service but not the ones who are already catered for.” 

St George’s patients though not directly affected by the proposal have some concerns about the service becoming overstretched and that local appointment options such as at Roehampton will continue. WMH and Charing Cross patients are unsure how the proposal affects them and would like to be reassured that their care will not change. They also share concerns about travel and losing convenient local care.

5.4 Transition and implementation considerations

This section focuses on the views of patients currently with SDCL as they would be most impacted by the proposed change.

Despite opposition to the proposed change some patients did identify elements that they feel would support the transition to a different provider. These focus on continuity, communication, accessibility and maintaining the standard of care they currently receive.

Continuity of equipment and telemetry

Many patients are concerned about the possibility of losing access to their equipment or having to be re‑assessed before receiving replacement equipment. They would like to be reassured that their therapy will continue uninterrupted during the handover. Patients tell us that they rely on their CPAP machine’s telemetry and the ability to view their own data. A smooth transfer of digital records, app access to track usage and assurance that all historical data will be transferred accurately is important for them to manage their condition.

• “The transition must be seamless, with no interruption to therapy.”
• “I would need certainty that I can maintain my existing CPAP machine / headgear which has taken much time to get correct.”
• “guaranteed continuity of equivalent equipment (Löwenstein Prisma Smart Max or comparable or better clinical equivalent with remote telemetry)”

Maintaining remote appointments

Remote care is repeatedly described as an important part of care for people with work commitments, who have disabilities, or find travel difficult. Patients would like confirmation that ongoing access to telephone, or remote monitoring appointments will continue.

• “I would like appointments over the phone to continue and the same level of support.”
• “A guarantee that remotes appointments would continue”
• “Confirmation that all future appointments will be remote, by telephone.”

Clear communication and early notification about any changes

Patients would like transparent, proactive communication about the proposed changes that explain what will happen and when; who will contact them; whether their equipment will change; how their care plan will be transferred; and what to do if issues arise during the transition period.

• “we need to know how this will work and what will happen with our cpac machines as I don’t want to be left without my machine.” 
• “Early explanation about any change of equipment”.
• “… receiving confirmation of being on the waiting list and being given an indication of how long it will be before being seen and assessed would be rather a good thing.”

Named contact or dedicated clinician

A recurring theme for patients is that they would like a named nurse or clinician who can provide continuity and can be easily reached for support, particularly with urgent equipment or clinical issues.

• “A personal service, with named health employees that I can have direct phone and email contacts with.”
• “…. named clinical contact at St George’s with full access to my existing treatment history and data is provided.”
• “An online call with specialist nurse to explain access to service, who to contact for what”.

Responsiveness and support times

Patients would like reassurance about how quickly they will receive replacement equipment; advice about treatment issues; responses to queries and clinical support for urgent concerns. Many believe that responses will be slower in a larger hospital setting compared to the quick responses from their current service.

• “clear assurance of rapid access to clinical advice if problems arise.”
• “are they able to offer the same level of one 2 one support in the same time frame?”
• “Confirmation that [replacements for] faulty equipment will be sent out on the day that it is requested, or by the following day, at the very latest.”

Local clinics or alternatives to avoid long travel distances as many patients describe not being able to travel easily to Tooting or Roehampton, due to disability, mobility issues, work commitments, or caring responsibilities. They would like remote care to continue and any in person appointments to take place at local clinics in locations such as Teddington, West Middlesex, or Queen Mary’s. Their preference is to have courier delivery for equipment and in person appointments only when clinically necessary.

• “more local locations … monthly clinic at Teddington Hospital as an example. This would support patients in the area and would be easier to get to.”
• “would not be able to travel to Tooting regularly for appointments and would need to take a day’s annual leave from work each time.”
• “..remote consultations whenever possible. Based at Queen Mary’s in Roehampton.”

Maintaining the same quality of care

People believe that the prposal could lead to a reduction in the quality of their care which includes equipment, responsiveness, personal support, and the clinical expertise that they currently receive.

• “I would like your assurance that the service received from StGsH will be no less than what my current provider is able to provide.”
• “Keeping the same gold standard of care provided by the Sleeping Disorders Centre” 
• “Ensure the same level of personal service with prompt response times for equipment requests and support for managing the condition”. 

5.5 Insights from patients waiting for sleep apnoea care

Sixteen respondents are on waiting lists for sleep apnoea care and overall provide similar insights to those currently receiving care as set out in this report. Where their insight differs from that of other respondents is that they currently can experience long delays, lack of communication and uncertainty, which they describe as making them feel forgotten in the system. Many respondents say they have waited months, years, or in one case “almost a decade,” without follow-up or clarity about what will happen next. Several describe the waiting experience as distressing, especially when their symptoms continue without treatment. One patient waiting at St Peter’s, Chertsey said, “This is a really scary time… waking at night unable to breathe is very frightening, but they do not seem to be taking it seriously.” Another, waiting under Charing Cross Hospital said, “I have been waiting two years for an appointment.”

A key theme those on waiting lists describe is poor or non-existent communication. People report submitting sleep study results, “hearing nothing back” or discovering that their referral has disappeared or changed without warning. One person, who believed they were originally under the Richmond OSA service, explained that they were informed the clinic had closed and that both they and their son had to restart the referral process. Another respondent waiting at an unknown service said, “My son was diagnosed a year and a half ago… nobody has contacted us for follow up‑ or treatment.”

Joined‑up care is described as an important aspect of care by this group. Several people report being passed between services, including Kingston Hospital, St George’s, Ashford & St Peter’s, and West Middlesex feeling there has not been clear direction. A patient waiting at Ashford & St Peter’s described the pathway as “quite confusing… I would prefer more joined up care.” Another, unsure which service they were under, said: “I need care to be joined up with other NHS services.”

Travel and accessibility are also important and as with other patients can shape their experiences of care. Some respondents are waiting under West Middlesex, St George’s, or Ashford & St Peter’s, but say the journey is difficult, especially for those with disabilities. One patient waiting under St George’s said, “St George’s is terrible… very difficult to get to without a car.” Several say they would prefer more accessible alternatives such as Queen Mary’s Roehampton.

A small number of respondents are more positive about the proposal as it may improve access or create more consistency across services. A parent waiting at St Peter’s hopes the change might “finally bring follow up and treatment” for their son. Another, waiting at St George’s, is positive because their medical notes are already with that Trust.

The overarching message from this group is that they would like faster access to services, clear communication, and reliable contact. Patients repeatedly say that they would like to be kept informed about where they are in the process “I just need to be seen… I’m 64 and could die from this before I get seen.” (waiting at SDCL)

5.6 Insights from other patient groups and communities

Insights from people with a disability or long-term condition

One hundred and thirteen (113) respondents identified as having a disability or long-term condition. These range from mobility issues, chronic pain, fatigue, respiratory or heart conditions, autism, PTSD, or stroke related disability. They value accessible, stable, and personalised care. As with other respondents, travel is a major barrier, and some disabled respondents describe it as physically unmanageable. Some say they could not make the journey to St George’s: “It is impossible for me to attend appointments at St George’s,” and “It’s a long, long bus ride and at almost 80 I struggle.” Those with mobility issues or other complex needs describe having to travel as potentially unsafe for them and not just about inconvenience.

Another theme in line with other respondents is continuity of care with a familiar, responsive team. Many respondents, especially those who are patients with SDCL, describe a service that provides personalised support, quick responses, and staff who understand their complex health backgrounds. “They treat me as an individual,” “I can contact a nurse at any time,” and “I feel very secure.” They are concerned that transferring to a larger hospital service could mean repeating their history, losing tailored support, and receiving slower or less personal care. Some describe the difficult of starting with a new team “I can’t even think about this – it sets off my panic attacks.”

Respondents also highlight the importance of timely equipment support and not having any gaps in therapy. They describe their dependence on CPAP or IPAP treatment every night, and that they are concerned about disruption, or changes in equipment quality: “I cannot be without my machine,” and “The same level of personal service with prompt responses is essential.” They describe fast access to replacement parts, remote monitoring, and the ability to contact someone directly as important elements of their care. “.. almost impossible for me to get to St George’s hospital so am hoping remote appointments on line will be possible”.

A small number of respondents from this group already receiving care at St George’s are positive about their experience. However, most respondents feel the proposal could result in make services less responsive and travel more difficult, making it more challenging for them to access care. They are concerned about losing remote care that allows them to manage their condition alongside other health issues. “Due to disabilities, it will not be possible to get to St George’s & the level of care will not be the same as at present” Similar to other respondents they value local services that are easy to access.

Insights from carers

A small number of respondents (six) identified as carers. They describe a mix of positive experiences and concerns around accessibility, equipment support, and the practicality of attending appointments. Most value the remote, flexible contact offered by some services, saying it “works best” for the person they care for and avoids unnecessary stress. Others highlight the importance of reliable equipment and choice, noting that a “choice of masks must stay and must not be limited.”

There are concerns that the proposal could result in less reliable equipment and troubleshooting support. One carer at St George’s said the sleep‑study kit “never works” and described a “3‑hour round trip” for equipment that sometimes fails at home without evening support. Travel is also a concern, with several carers saying St George’s is “too far away” for Richmond residents and that they would like local clinic alternatives or remote options instead.

Continuity and responsiveness also matter to carers. Those supporting someone under SDCL describe the service as “excellent” and feel that the proposed change might reduce the personalised support they rely on. Those caring for older relatives, describe remote appointments and couriered equipment to their home as important so they do not have to make unnecessary journeys.

A few say they do not have sufficient information about how to access sleep apnoea care, asking: “Please tell us how we can join this treatment.” For some families, it is not clear how to currently access sleep apnoea care.

Overall, carers want sleep apnoea services that are reliable, easy to access, that can provide quick equipment support and available remotely whenever possible. They are concerned that the proposal, which they see as centralising care at St George’s, could increase stress, travel difficulties, and delays for the people they support.

Insights from patients at other services and Richmond residents

Feedback from patients at other providers including Ashford & St Peter’s, Royal Brompton, University College London Hospitals (UCLH), Guy’s & St Thomas’ and Kings together with Richmond residents largely reinforces the themes already set out in this report. They reiterate that accessible locations, reliable follow‑up, clear communication, and continuity of support are important for sleep apnoea care. Where there are differences in feedback, they relate mainly to individual circumstances. Richmond residents who are not currently receiving treatment focus more on travel and clarity about how to access care. Patients from the other providers focus on gaps in follow‑up or uncertainty about whether the proposal would affect their care in contrast with the concerns raised by SDCL patients earlier in the report.

All groups, regardless of provider or circumstances, share similar expectations that care should remain responsive, consistent, and accessible with local or remote appointment options.

6. Review of existing insights

Overview 

Compared to more common services (like primary care or emergency care), there are few stand-alone insight reports about sleep apnoea care published in the last two years. 

Many sleep service insights are included in wider outpatient or diagnostic feedback rather than in dedicated sleep service reports. Most patient experience platforms and Friends and Family Test (FFT) data do not separate sleep services in their reports so there is limited, trust-specific sleep apnoea feedback publicly available. 

Evidence from previous SDCL patient feedback (2017/18), together with publicly available anecdotal patient experience sources and qualitative research in the last two years highlight several consistent themes in the experience of obstructive sleep apnoea (OSA) services. Patients value services that are accessible, reliable, and easy to navigate, with clear communication and timely support when beginning treatment. However, delays in diagnosis, complex referral pathways and uncertainty about follow-up can create frustration and anxiety. While adapting to CPAP treatment can be challenging at the start of treatment, patients report better outcomes where services provide clear information, responsive communication, and personalised support. This enables patients to adjust to treatment and experience improvements in sleep and daily functioning.

These insights reflect some of the themes emerging from the insight in this report, offering wider context that supports the experiences shared by Richmond patients. They show that the local challenges and priorities described by respondents, like the need for accessible locations, timely communication, and continuity of support, are not unique to Richmond and are relevant to future service planning of sleep apnoea or wider respiratory services.

Accessibility and convenience  

Accessibility and convenience are important factors shaping patient experience. Local feedback from patients using the Richmond Sleeping Disorders Service in 2018 highlighted the importance of service locations that are easy to reach, with straightforward travel routes, affordable parking, and appointment times that fit around work and family responsibilities. Weekend appointments were particularly valued as they allowed patients to attend without taking time off work. 

Patients expressed concern that moving services to larger hospital sites could create barriers such as increased travel time, parking costs, and the need to navigate complex hospital settings. These issues were seen as particularly challenging for people with disabilities or other long-term conditions. 

Patients also emphasised the importance of continuity of care, particularly when services change provider or location. Maintaining familiar equipment, ensuring reliable supply of CPAP parts, and avoiding unnecessary reassessment were viewed as important in maintaining confidence and engagement with treatment. 

Implication for services: Accessible locations, flexible appointment times and continuity of care can significantly influence whether patients stay engaged with sleep services. 

Delays in diagnosis and access to sleep studies 

Delays in diagnosis and access to sleep studies are a reported concern. Anecdotal patient reports show that individuals may wait extended periods for diagnostic testing or for results to be communicated. Patients also describe difficulty contacting sleep clinics for updates and uncertainty about the status of their referral or test results. 

Some online discussions highlight perceived complexity in referral pathways, including situations where multiple consultations occur before referral to specialist services or where several steps are needed before testing is arranged. These experiences can create a sense that the pathway is slow or difficult to navigate while symptoms continue to affect daily life. 

Qualitative research findings are consistent with this theme. In one study exploring patient experience of CPAP pathways, participants described delays in diagnosis and initial appointments as points where patients might become discouraged or disengage from the process (Jones et al., 2024). 

Implication for services: Clearer pathways, timely communication of results, and proactive follow-up may help reduce patient anxiety and improve engagement with treatment. 

Early experience of CPAP treatment 

The early stages of CPAP therapy are often described as a period of adjustment. Patients report practical challenges such as mask comfort, machine noise, and difficulty sleeping while using the device. Some also report that fatigue and other symptoms may persist during the initial weeks of treatment, making it harder to judge whether the therapy is effective. 

Qualitative interview studies offer further insight into this adjustment period. Participants described waking during the night to adjust or temporarily switch off the device as they became accustomed to it, illustrating the learning process involved in adapting to CPAP therapy (Jeppesen et al., 2025). 

Despite these challenges, many patients report that once they adapt to treatment, they experience significant improvements in sleep quality, energy levels, and daytime functioning. 

Implication for services: Early support and realistic expectations about the adjustment period can help patients persist with treatment and achieve longer-term benefits. 

Communication, follow-up and ongoing support 

Communication with sleep services plays an important role in shaping patient experience. Patients value clear explanations about diagnosis, treatment options and what to expect from CPAP therapy. Where communication is slow or unclear, patients report uncertainty and frustration about their care. 

Access to advice when difficulties arise is also important. In qualitative research exploring patient experiences of CPAP use, participants described the ability to contact clinics by telephone or email as important for reassurance and practical support. It enabled them to resolve problems quickly and continue using the device (Jeppesen et al., 2025). 

Implication for services: Responsive communication and accessible follow-up support are key enablers of patient confidence and treatment adherence. 

Patient involvement and personalised care 

Some patients report that treatment decisions can appear driven by process, with limited opportunity to discuss their individual experience of symptoms or treatment. Anecdotal patient reports show that people would like their lived experience to be considered alongside clinical test results when decisions are made about treatment or equipment. 

Where services provide personalised education and involve patients in decision-making, individuals report greater confidence in their treatment and clearer expectations about what CPAP therapy can achieve. 

Implication for services: Supporting shared decision-making and acknowledging the patient’s lived experience can strengthen engagement with treatment. 

Impact of treatment on daily life 

When CPAP treatment is effective, patients often report meaningful improvements in their quality of life, including better sleep, increased daytime alertness, and improved ability to function at work and in daily activities. 

Qualitative research also highlights the wider social impact of treatment. For some patients, CPAP therapy restores shared sleeping arrangements that had been disrupted by severe snoring or breathing disturbances (Jeppesen et al., 2025). 

At the same time, some individuals initially feel self-conscious about using CPAP equipment or find that it changes routines at home. Over time, however, many patients adapt and incorporate the device into their nightly routine. 

Implication for services: Acknowledging the social and emotional impact of treatment may help services better support patients during the adjustment period 

Organisation and clarity of service pathways 

Patients sometimes describe sleep service pathways as unclear or fragmented, particularly when moving between primary care, diagnostic testing, and specialist services. Experiences shared in online patient forums highlight uncertainty about referral processes, timelines for receiving results and the steps involved in follow-up care. 

Implication for services: Providing clear information about the care pathway, expected timelines and points of contact may improve patient understanding and confidence in the service. 

Sources 

Local patient feedback:  Feedback from patients of the Richmond Sleeping Disorders Service shared during a patient information session and from complaints regarding a proposal to close the service. (2018). 

Anecdotal patient experience sources: 

• Patient stories on Care Opinion relating to sleep services 

• Patient discussions on Reddit sleep apnoea forums describing experiences of NHS sleep service pathways within the last two years. 

Qualitative research studies: 

• Jeppesen et al. (2025). Barriers and facilitators to successful CPAP treatment: qualitative interviews. 

• Jones et al. (2024). Patient experience of CPAP use with or without telemedicine during COVID-19.