Public and Patient Views on Health Services in the West Midlands by West Midlands QI

Public and Patient Views on Health Services in the West Midlands Annual Survey Report 2010/11

Business Analytics Team

Contents

Executive Summary Introduction 1. Perceptions of the NHS 2. Expectations for the future 3. Priorities for improvement 4. Financial challenges 5. Providing good value for money 6. Engagement and access to information Appendices 1. Statistical reliability 2. Definition of social grades 3. Mosaic code definitions 4. Reading and interpreting funnel plots

Executive Summary Introduction This report provides a detailed analysis of the results from a telephone survey carried out with a representative sample of West Midlandsâ&#x20AC;&#x2122; residents in the winter of 2010. NHS West Midlands has commissioned a range of surveys with local patients and citizens over the last four years. These surveys give us an invaluable opportunity to explore patient and public views on health and healthcare services and to ensure that developments in the NHS are informed by local peopleâ&#x20AC;&#x2122;s concerns and preferences. The findings of the research presented in this report have been derived from 2000 telephone interviews with West Midlands residents, each lasting for around 25 minutes. All interviews were conducted between 15 November and 12 December 2010 by Ipsos MORI. The latest telephone survey was held later than usual this year, to avoid coinciding with the election period. Quotas were set on gender, age, working status and ethnicity to ensure that the profile of those interviewed matched the profile of the regionâ&#x20AC;&#x2122;s population as closely as possible, according to the 2001 census. Additional quotas were set by PCT Cluster to ensure that the number of interviewees in each Cluster is proportional to the size of its population, and give a good geographical spread of responses across the region. Results are also weighted to population information from the Census by age, gender, working status, ethnicity and PCT Cluster.

Perceptions of the NHS Satisfaction with the overall running of the NHS has increased over recent years. In the latest survey, 77% of those interviewed state that they are fairly satisfied or very satisfied with how the NHS is being run, this is a significant improvement from the results obtained last year, when 72% of those questioned said that they were satisfied and a substantial improvement from the position in 2006 when 61% were satisfied.1 Similarly, satisfaction with the local NHS has also improved over recent years. When asked whether they agree that their local NHS is providing them with a good service, the overwhelming majority agree (82%, compared with 79% in 2009 and 70% in 2006). As well as looking at satisfaction with health services overall, the survey looked at particular aspects of service delivery in detail. In relation to the quality of care patients receive in local hospitals, the results show that two thirds of all respondents are satisfied with the quality of care patients receive (66%), and around a fifth are very satisfied (22%). Encouragingly, a higher proportion of those who have been an inpatient recently state that they are very satisfied with the quality of care available in their local hospital (28%). A higher proportion of residents in West Mercia Cluster are satisfied with the quality of care found in their local hospital (71%). In contrast, a lower proportion of respondents in Staffordshire Cluster are 1

This question was not asked in 2008. 3

satisfied (59%), and almost a quarter are dissatisfied with the quality of care available in their local hospital (24%). In order to probe for views on local services further, respondents were asked whether they agreed or disagreed with the statement ‘my local hospital treats patients with dignity and respect’, based on what they know or have heard. Overall, 71% agree that their local hospital treats patients with dignity and respect, with 14% disagreeing. On a positive note, those who have recently either been an inpatient or outpatient themselves are more likely to state that they agree that patients are treated with dignity and respect (74%), with over a third of this group stating that they strongly agree (37%). A lower proportion of respondents from Staffordshire agree that their local hospital treats patients with dignity and respect (64%) and a higher proportion disagree with this statement (18%, with 9% strongly disagreeing). The survey findings are representative at Cluster level only, and hence it is not possible to ascertain which local hospital people are thinking about in relation to their responses on the quality of care available locally and on whether patients are treated with dignity and respect. Hence, the results of this survey need to be considered alongside a range of other information including direct feedback from patients (e.g. CQC survey data and other patient feedback), local surveys and a range of qualitative insights. 2

Expectations for the future Residents’ expectations for the future of their local health services have worsened since the last time the survey was conducted. The largest proportion of citizens state that they expect services to remain the same over the next few years (41%), while over a quarter expect them to get better (27%), and almost a third think that they will get worse (30%). In previous surveys we had seen an improvement in residents’ expectations for the NHS; the highest levels of optimism were recorded in 2009 when 33% of those questioned expected services to improve and 21% expected services to worsen. There are differences between PCT Clusters in terms of expectations for the future. Respondents in Staffordshire Cluster are more optimistic about the future, compared with residents in other Cluster areas. In contrast, residents in Arden Cluster are less optimistic about the way services will develop over the next few years. Across the West Midlands certain socio-demographic groups are more positive than others in terms of the future of the NHS. Overall, those in social grades C2, D and E tend to be more positive than those in social grades A, B and C1, as are ethnic minority residents in comparison with white respondents.3 4 There are also differences across age-groups with those aged 16-24 the most optimistic about the future for health services, whilst those aged 45-54 are the most pessimistic. Other factors are also linked with respondents’ views on the future of NHS services. Those who are concerned about economic pressures are much less positive about the future of

For example, the latest patient survey results are available at http://www.cqc.org.uk/ A definition of social grades can be found in the appendices. 4 Overall, 30% of those in social groups C2DE feel that services will get better, compared with 24% from social groups ABC1. In total, 34% of those from minority ethnic groups feel that services will get better compared with 26% of those from white ethnic groups. 4 3

the NHS; 33% of those who are concerned about economic pressures state that they expect NHS services to get worse, compared with 11% of those who are not concerned. Respondents who work in the NHS are also more pessimistic about the future, with 37% stating that they expect services to get worse over the next few years, compared with 32% who have family and friends working in the NHS and 28% who are not connected with the NHS in this way.

Priorities for improvement We asked respondents which was the main priority for improvement in the local NHS. Improving waiting times in A&E is highlighted by respondents as the factor which is most in need of improvement. A similar proportion of residents think this is the most important priority for improvement as was the case last year. Significant improvements are evident around perceptions of cleanliness in hospitals. This emerges as the second highest priority for improvement this year; the first time that it has not been highlighted as the top priority for improvement since 2008. In addition, the proportion of residents who feel that hospital cleanliness is the most important factor to improve has fallen from 16% in 2009 to 11% in 2010. Reducing waiting times in A&E emerges as the most important priority in the Black Country and Arden, whilst in Staffordshire this is seen as the most important aspect alongside improving cleanliness of hospitals. In Birmingham and Solihull, cleanliness in hospitals and GP waiting times are seen as the main priorities for improvement, and in West Mercia A&E waiting times and mental health support services are seen as the key areas where improvements need to be targeted.

Financial challenges In order to gauge how this was being perceived by the public, respondents were asked whether they were concerned about economic pressures and their potential effect on the NHS. The findings indicate that people are worried about the impact of wider economic pressures on the ability of the local NHS to deliver health services, with more than eight in ten stating that they are concerned and four in ten stating that they are very concerned. Some variation by demographic group is evident, as older respondents, those with a disability, and those who have someone in their family with a disability are more likely to state that they are very concerned about economic pressures.5 In addition, those who have been an inpatient or outpatient recently are more likely to feel very concerned about these issues. There seems to be a relationship between perceptions of funding and levels of confidence for the future of the NHS, as people who expect the NHS to get worse over the next few years are more likely to be concerned about economic pressures. In total, 59% of those who expect services to get worse are very concerned about economic pressures affecting the NHS, compared with 35% of those who expect services to get better. 5

For example, 50% of those aged 55-64 state that they are very concerned and 46% of those aged 65 and over. Similarly, 50% of those with a disability are very concerned, compared with 41% overall. In total, 45% of those who have been an inpatient or outpatient recently state that they are very concerned about the impact of economic pressures. 5

Providing good value for money In order to gauge public understanding around the aim to reduce the number of treatments of limited clinical value, respondents were asked to what extent they agreed or disagreed with the following statement: ‘The NHS should stop providing treatments that have little or no medical benefit for patients’. Over half of all respondents agree with this statement (57%), while just over a quarter disagree (27%). Those who took part in the survey were invited to state whether they would support or oppose a range of initiatives which were aimed at reducing interventions of limited clinical value. Support is greatest for stopping medicines being prescribed where there is no proven medical benefit (supported by 73%) and only carrying out hip and knee replacements for people whose condition won’t be improved by other treatments (supported by 71%). Since the implementation of ‘Investing for Health’ in July 2007, reducing demand on acute hospitals has been a key aim within the West Midlands. This agenda is also central to national policy, and the Operating Framework for 2011/12 cites a commitment to release capacity from acute services to allow the better use of community services. The results show that a majority of respondents support the idea of reducing demand on hospitals (55%). However, a third oppose this as a general principle (33%), with just over a fifth stating that they strongly oppose it (22%). It is interesting to note that opposition to the idea of reducing demand on hospitals is correlated with general dissatisfaction with the NHS. Once presented with further information, a high proportion of those who initially opposed the principle of reducing demand on hospitals changed their stance. On average, 74% state that they would support this idea once they have heard further information on proposed initiatives. The highest levels of support are found for helping people to stay healthy so they don’t need to go to hospital (85% of those who previously opposed this idea say that they now support the principle of reducing demands on hospitals), carrying out some follow-up appointments in local health centres (83%), and carrying out operations differently so that people don’t need to stay in hospitals for so long (76%).

Engagement and information When we asked local residents whether they had received any information from the NHS about developing local health services, we found that there had been little change from 2008, in terms of the proportion of citizens who had received information. Around a fifth of respondents recall receiving information from the NHS, while three quarters do not recall receiving any information. On the whole, respondents do not feel very informed about how the NHS spends its money locally, about who makes decisions about how NHS money is spent locally, or what the NHS is doing locally to provide good value for money to patients and taxpayers (around three quarters say that they know nothing or very little about these subjects). There is slightly better awareness around the current proposals for the creation of GP commissioning consortia, but around two thirds state that they know nothing or very little about these changes. 6

After respondents were asked about how much they knew on the subjects above, they were asked on which subjects they would like to receive more information. The most popular option is further information on how the NHS spends its money locally (57%). A similar proportion want to know more about what the NHS is doing locally to provide good value for patients and taxpayers (56%) and the governmentâ&#x20AC;&#x2122;s proposals to give more control over the NHS budget to GPs (55%). Local residents feel that they are more informed about the quality of local health services than some other aspects of health service delivery, with half stating that they know a fair amount or a great deal about this (50%). However, a similar proportion feel that they know very little or nothing at all about the quality of local services (48%). The results of the survey show that the main source respondents trust to give them helpful information about the quality of treatment in local hospitals is their GP (50%). Other people who are trusted are family and friends (mentioned by 20%), other health professionals (cited by 10%) and NHS hospitals themselves (mentioned by 8%). A high proportion of respondents would like to access information on the quality of local services online or via their mobile (64%). This figure rises to 78% for those aged under 45. In addition, a higher proportion of people from social groups ABC1 (68%), who are working (74%) and from minority ethnic groups (74%) would like to access information in this way. Interestingly a high proportion of staff and their friends and family would like to access information in this way (76% and 67% respectively).

Introduction NHS West Midlands has commissioned a range of surveys with local patients and citizens since 2006. These surveys give us an invaluable opportunity to explore patient and public views on health and healthcare services and to ensure that developments in the NHS are informed by local people’s concerns and preferences. The latest telephone survey was held later than usual this year, to avoid coinciding with the election period.

Background and Objectives NHS West Midlands is the Strategic Health Authority (SHA) for the West Midlands region, covering an area of 5.4 million people across Birmingham, Coventry, Dudley, Herefordshire, Sandwell, Shropshire, Solihull, Staffordshire, Stoke on Trent, Telford and Wrekin, Walsall, Warwickshire, Wolverhampton and Worcestershire. The SHA is responsible for ensuring that the £8.9 billion pounds spent on health and health care across the West Midlands delivers better services for patients and better value for money for tax payers. In order to guide the local implementation of policy, the SHA has commissioned a range of market research over recent years. As part of this, a telephone survey with a representative sample of residents was undertaken in November and December 2010. The objectives of this research were to: 1. Understand residents’ general perceptions of the NHS and their expectations for the future 2. Understand their priorities for improvement in healthcare services 3. Examine their views about the impact of economic pressures on the NHS and how resources can best be utilised 4. Explore responses to suggested initiatives for getting the most out of NHS resources and providing good value for money 5. Analyse the information on health services that residents are able to access and how they currently obtain this information. In addition, to explore people’s preferences around information and methods of access.

Methodology The findings of the research presented in this report have been derived from 2000 telephone interviews with West Midlands residents, each lasting for around 25 minutes. All interviews were conducted between 15 November and 12 December 2010 by Ipsos MORI. Quotas were set on gender, age, working status and ethnicity to ensure that the profile of those interviewed matched the profile of the region’s population as closely as possible, according to the 2001 census. Additional quotas were set by PCT Cluster to ensure that the number of interviewees in each Cluster is proportional to the size of its population, and give a good geographical spread of responses across the region. Results are weighted to population information from the Census by age, gender, working status, ethnicity and PCT Cluster.

Previous research Similar surveys were previously carried out by Ipsos MORI on behalf of NHS West Midlands in 2006, 2008 and 2009. The 2009 survey was conducted between 8 April and 17 May 2009 and interviews were carried out amongst 3,528 residents. The 2008 survey was conducted among 3,564 residents between 8 April and 13 May 2008. The 2006 survey was conducted between 8 August and 8 September 2006 amongst 3,535 residents. A slightly smaller sample was used for the survey this year, due to the focus on obtaining representative results at the regional level and at PCT Cluster level, rather than at individual PCT level.

The production of this report This report, including the discussion of the findings, has been produced by NHS West Midlands Business Analytics Team. All the data used in the report is based on the results of the telephone survey as supplied by Ipsos MORI. Ipsos MORI also supplied many charts, as indicated, other tables and charts were produced by the Business Analytics Team.

Presentation and interpretation of data It should be noted that a sample, and not the entire population, has taken part in the survey. Therefore, all results are subject to sampling tolerances, which means that not all differences are significant. A guide to statistical reliability is appended, but as a rule of thumb results based on the full sample are reliable to +2 percentage points at a 95% level of confidence, while sub-groups will have a wider margin of error. Any results based on samples of 100 or below have a margin of error of at least +10 percentage points, and should be treated as indicative only. It should be borne in mind that demographic sub-groups overlap, and that viewing them in isolation can be artificial. For example, black and minority ethnic communities often have a younger age profile; differences in their views may be just as much to do with age as they are to do with ethnicity. Where percentages do not sum to 100, this may be due to computer rounding, the exclusion of “don’t know” categories, or multiple answers. Throughout the report an 9

asterisk (*) denotes any value of less than half of one per cent, but greater than zero. Where reference is made to “net” figures, this represents the balance of opinion on attitudinal questions, and provides a particularly useful means of comparing the results for a number of variables. In the case of a “net satisfaction” figure, this represents the percentage satisfied on a particular issue, less the percentage dissatisfied. For example, if 40% who answer are satisfied and 25% dissatisfied, the “net satisfaction” figure is +15 points.

Acknowledgements NHS West Midlands would like to thank Kate Duxbury, Caroline Booth, Chris Marshall and Phil Westwood at Ipsos MORI for co-ordinating the annual telephone survey fieldwork and providing insights on the results. Special thanks also go to the 2,000 West Midlands residents who took the time to take part in this survey.

Report Layout The report begins with an executive summary, which summarises the key findings and implications. The main body of the report is divided into six different chapters: Perceptions of the NHS Expectations for the future Priorities for improvement Financial challenges Providing good value for money Engagement and access to information

1. Perceptions of the NHS The recent white paper ‘Equity and excellence: liberating the NHS’ emphasises the need to strengthen the collective voice of patients and the public. This section examined the views of local people and patients about how the NHS is run, satisfaction with local services and about the quality of care patients receive in local hospitals.

Overall satisfaction with the NHS Satisfaction with the overall running of the NHS has increased over recent years. In the latest survey, 77% of those interviewed state that they are fairly satisfied or very satisfied with how the NHS is being run, this is a significant improvement from the results obtained last year, when 72% of those questioned said that they were satisfied and a substantial improvement from the position in 2006 when 61% were satisfied.6

Overall satisfaction with the NHS Q

Overall, how satisfied or dissatisfied are you with the running of the National Health Service nowadays? % Very satisfied % Fairly dissatisfied

% Fairly satisfied % Very dissatisfied

% Neither/nor % Don't know

5%1% WM 2010

WM 2009

WM 2006

Satisfied %

Dissatisfied %

Net satisfied %

+64

+53

+34

31%

46% Base: WM 2010 – 2,000 West Midlands residents, 15 November – 12 December 2010 WM 2009 – 3,528 West Midlands residents, 8 April – 17 May 2009 WM 2006 – 3,535 West Midlands residents, 8 August – 8 September 2006

High levels of satisfaction are found across the region. The chart overleaf shows variations in satisfaction by Cluster and variations which might be due to sampling error (error that results from speaking to only a sample of the population rather than doing a census of the whole West Midlands population). When we account for variation which may be caused by sampling error, it is evident that the results for individual Clusters are not significantly different to the regional average. The fact that the markers fall within the control limits

This question was not asked in 2008. 11

means that satisfaction is broadly in line with the average across the West Midlands, and any variation could be a result of sampling error.7 Overall satisfaction with the running of the NHS, by Cluster Cluster West Midlands Upper Control Lim it Lower Control Lim it Upper Control Lim it Lower Control Lim it

% answering 'fairly satisfied' or 'very satisfied'

85%

(2 (2 (3 (3

sigm a) sigm a) sigm a) sigm a)

80% W. Mercia

Staf f s

Arden

Bham & Sol

75% B. Country

70%

65%

60%

300

320

340

360

380

400

420

440

Number of respondents

(Base: 2000 respondents, 15 November and 12 December 2010, Q: Overall, how satisfied or dissatisfied are you with the running of the National Health Service nowadays? Weighted data.)

Some differences are evident by age group, those aged 65 and over are the most positive, as is found throughout the results of the survey (see graph overleaf). In addition, differences are also found by ethnic group as those from a white ethnic group are more likely to state that they are satisfied than those from a black and minority ethnic group (78% compared with 69% from a BME group).

Please refer to the appendices for more details on reading and interpreting funnel plots. 12

460

Differences are also evident based on recent experience of using certain NHS services. Those who have either been an inpatient in an NHS hospital or who have been an outpatient are more likely to be very satisfied than those who have not (34% compared with 26% who are very satisfied amongst those respondents who have been neither an inpatient nor an outpatient). Overall satisfaction is also linked to optimism about the future development of services and satisfaction with aspects of service delivery. Those who are more satisfied with how the NHS is being run are more likely to feel that the NHS will get better over the next few years; 84% of those who expect NHS services to get better are satisfied, compared with 61% who expect services to get worse. Those who are satisfied with the quality of care patients receive at their local hospital are also more likely to say that they are satisfied with the running of the NHS; 88% of those who are satisfied with quality of care are satisfied with how the NHS is run, compared with 46% who are dissatisfied. We will now focus on how well people feel that NHS services are being delivered, looking at perceptions of local and national provision.

Overall satisfaction with local services Satisfaction with the local NHS has also improved over recent years. When asked whether they agree that their local NHS is providing them with a good service, the overwhelming majority agree (82%, compared with 79% in 2009 and 70% in 2006).

Perceptions of the local NHS Q

To what extent, if at all, do you agree or disagree with each of the following statements? “My local NHS is providing me with a good service” % Strongly agree % Tend to disagree

% Tend to agree % Strongly disagree

5%1% 7% 5% 41%

Agree %

% Neither/nor % Don't know / no opinion

WM 2010

WM 2009

WM 2006

Disagree %

Net Agree %

+71

+65

+49

41%

Base: WM 2010 – 2,000 West Midlands residents, 15 November – 12 December 2010 WM 2009 – 3,528 West Midlands residents, 8 April – 17 May 2009 WM 2006 – 3,535 West Midlands residents, 8 August – 8 September 2006

As is found in many surveys, satisfaction with the NHS at the local level is higher than with national provision.

Satisfaction with national and local NHS Q

To what extent, if at all, do you agree or disagree with each of the following statements? % Disagree

% Agree

My local NHS is providing me with a good service

The NHS is providing a good service nationally

WM 2009 WM 2006 % agree % agree

As can be seen in the chart below, satisfaction varies by age, with the most positive residents being found in the oldest and youngest age groups (those over 65 years and under 25 years respectively). Similarly, levels of satisfaction are higher amongst those who are not working (85% are satisfied, compared with 79% who are working). In addition, those from black and minority ethnic minority groups are less likely to feel satisfied, than those from white ethnic groups (74% compared with 83%). Those who have been an inpatient or outpatient are more likely to strongly agree that their local NHS is providing them with a good service than the general public as a whole (44% of those who have recently been inpatients and outpatients strongly agree, compared with 41% overall).

Perceptions of the local NHS by age Q

To what extent, if at all, do you agree or disagree with each of the following statements? “My local NHS is providing me with a good service” % Net % Agree

Agree

(260)

16-24

+74

(282)

25-34

+67

(367)

35-44

+69

(344)

45-54

+58

(312)

55-64

+70

(435)

65+

+82

Base: 2,000 West Midlands residents (base size for each age group shown in brackets), 15 November – 12 December 2010

The chart below shows the proportion of people in each Cluster who agree that their local NHS is providing them with a good service. A higher proportion of residents in Arden are positive about their local NHS, and a lower proportion are satisfied in the Black Country 8

Cluster.

Satisfaction with the local NHS, by Cluster Cluster West Midlands Upper Control Lim it Lower Control Lim it Upper Control Lim it Lower Control Lim it

95%

(2 (2 (3 (3

sigm a) sigm a) sigm a) sigm a)

90% % answering 'tend to agree' or 'strongly agree'

Arden

85%

W. Mercia Staf f s

80%

Bham & Sol

B. Country 75%

70%

65%

60%

300

320

340

360

380

400

420

440

Number of respondents

(Base: 2000 respondents, 15 November and 12 December 2010, Q: To what extent, if at all, do you agree or disagree with each of the following statements â&#x20AC;&#x201C; My NHS is providing me with a good service?. Weighted data.)

Clusters with a significantly higher level of satisfaction than the West Midlands average, are shown with a green marker and there is a good chance that this is due to actual differences rather than to sampling error (particularly if the marker is shown in darker green). If a Cluster has a significantly lower level of satisfaction than the West Midlands average, they are shown with a red marker and there is a good chance that this is due to actual differences rather than to sampling error (particularly if the marker is dark red). Please refer to the appendices for more details. 16

460

Quality of care Improving quality is a central aim of the reforms proposed for the NHS, and improving public and patient perceptions around quality are a key part of this. All those who took part in the survey were asked whether they were satisfied or dissatisfied with the overall quality of care patients receive at their local hospital, based on what they know or what they have heard. Overall, the results show that two thirds of all respondents are satisfied with the quality of care patients receive (66%), and around a fifth are very satisfied (22%).

Quality of care at hospital Q How satisfied or dissatisfied are you overall with the quality of care patients receive at your local NHS hospital? It depends on what ward or dept you visit Very dissatisfied Fairly dissatisfied

Neither/nor

Donâ&#x20AC;&#x2122;t know/Refused

6% 7%

Very satisfied

22%

10% 8% 45% Fairly satisfied

Base: 2,000 West Midlands residents, 15 November â&#x20AC;&#x201C; 12 December 2010

Encouragingly, a higher proportion of those who have been an inpatient recently state that they are very satisfied with the quality of care available in their local hospital (28%). However, it is worth noting that a higher proportion are also dissatisfied (20% compared with 17% overall), and in addition a higher proportion of those who have attended A&E recently say that they are dissatisfied (19%). Satisfaction varies by age group, those aged 65 and over are more likely to say that they are satisfied with the quality of care available locally (70%), and those aged 35-44 are the most likely to state that they are dissatisfied (21% compared with 17% overall). In addition, there are variations by ethnic group; a higher proportion of those from ethnic minority groups state that they are dissatisfied with the quality of care available locally compared with those from white ethnic groups (22% and 17% respectively). Also views vary by disability status, as a higher proportion of those with a disability themselves, or who have someone in their family with a disability, state that they are dissatisfied (20% compared with 16% for those without disability).

The chart below shows that there are variations in perceptions around the quality of care across the Clusters. A higher proportion of residents in West Mercia Cluster are satisfied with the quality of care found in their local hospital (71%). In contrast, a lower proportion of respondents in Staffordshire Cluster are satisfied with the quality of care available in their local hospital (59%), and almost a quarter are dissatisfied (24%). Satisfaction with the quality of care available in local hospitals, by Cluster Cluster West Midlands Upper Control Lim it Lower Control Lim it Upper Control Lim it Lower Control Lim it

% answering 'tend to agree' or 'strongly agree'

75%

sigm a) sigm a) sigm a) sigm a)

W. Mercia

Arden

70%

(2 (2 (3 (3

B. Country

65% Bham & Sol

60%

Staf f s

55%

50%

300

320

340

360

380

400

420

440

460

Number of respondents

(Base: 2000 respondents, 15 November and 12 December 2010, Q: From what you have heard or what you know, how satisfied or dissatisfied are you overall with the quality of care patients receive at your local hospital? Weighted data.)

We asked all respondents to give reasons for their views on quality. In terms of those who are satisfied with the quality of care available, the main reason given is good personal experience (25%), good service (24%), or that a family member or friend had a good experience (22%).

Reasons for satisfaction with hospital care Q Why do you say you are satisfied with the overall quality of care patients receive at your local NHS hospital? Top 10 mentions Good personal experience Good service at local hospital Family member/friend had good experience Good quality of care/treatment No problems Efficient/quick service Good/caring/friendly staff Good staff numbers/resources Good level of hygiene/cleanliness

Good attitude/politeness of staff

25% 24% 22% 20% 17% 13% 13% 6%

Base: All who are satisfied with the overall quality of care patients receive at local NHS hospital (1,319), 15 November â&#x20AC;&#x201C; 12 December 2010

For those who are dissatisfied the main reason mentioned is a general perception of poor quality of care / treatment (37%), while some cite problems experienced by family members or friends (27%) and poor / unfriendly / uncaring staff (23%). Experience of problems personally is mentioned by 13% of those who are dissatisfied.

Reasons for dissatisfaction with hospital care Q Why do you say you are dissatisfied with the overall quality of care patients receive at your local NHS hospital? Top 10 mentions Poor quality of care/treatment Family member/friend has experienced problem Poor/uncaring/unfriendly staff Poor staff numbers/resources Inefficient/slow service Poor service at local hospital Poor level of hygiene/cleanliness Have experienced problems personally Poor attitude/rudeness of staff Worsening services

37% 27% 23% 19% 19% 18% 16% 13% 11% 6%

Base: All who are dissatisfied with the overall quality of care patients receive at local NHS hospital (349), 15 November â&#x20AC;&#x201C; 12 December 2010

Dignity and respect In order to probe views on local services further, respondents were asked whether they agreed or disagreed with the statement ‘my local hospital treats patients with dignity and respect’, based on what they know or have heard. Overall, 71% agree that their local hospital treats patients with dignity and respect, with 14% disagreeing.

Dignity and respect Q From what you have heard or what you know, to what extent do you agree or disagree with the following statement? “My local NHS hospital treats patients with dignity and respect” It depends on what ward or dept you visit

Don’t know/Refused

Strongly disagree Strongly agree

Tend to disagree Neither/nor

Tend to agree Base: 2,000 West Midlands residents, 15 November – 12 December 2010

Some differences in perceptions are evident by age group, as respondents aged 16-24 are the most positive about this question, with 77% agreeing that local patients are treated with dignity and respect. A higher proportion of those with a disability / who have family member with a disability or who have caring responsibilities disagree with the statement (17% for both groups). No other major differences are evident by demographic group. On a positive note, those who have recently either been an inpatient or outpatient themselves are more likely to state that they agree that patients are treated with dignity and respect (74%), with over a third of this group stating that they strongly agree (37%). However, those who have visited others in hospital, but have not been in hospital themselves, are much more negative, with 17% disagreeing that patients are treated with dignity and respect. This reaffirms the findings of other studies which have suggested that visitors have more negative views about a range of aspects related to patient care.9 It is worth noting that a slightly higher proportion of those who have attended A&E recently strongly disagree with the statement (8% compared with 7% overall), however the responses of this group to this question on dignity and respect are similar to the average otherwise.

NHS West Midlands / Ipsos MORI (2010) Perceptions of Quality in Secondary Care http://www.wmqi.westmidlands.nhs.uk/patient-experience/patient-experience-home/report/207 20

Dignity and respect by service usage Q From what you have heard or what you know, to what extent do you agree or disagree with the following statement? “My local NHS hospital treats patients with dignity and respect” % Very satisfied % Very dissatisfied

% Fairly satisfied % Fairly dissatisfied

(1,129)

In-patient / Out-patient

(418)

Visited someone

% Neither/nor % Don't know/refused

% It depends on what ward you visit

6 7

7 5 2

7 *

Base: 2,000 West Midlands residents (base size for each group shown in brackets), 15 November – 12 December 2010

The results show some geographical variation across the region (see chart overleaf). A lower proportion of respondents from Staffordshire agree that their local hospital treats patients with dignity and respect (64%) and a higher proportion disagree with this statement (18%, with 9% strongly disagreeing).

Agreement that local hospital treat patients with dignity and respect, by Cluster Cluster West Midlands Upper Control Lim it Lower Control Lim it Upper Control Lim it Lower Control Lim it

80%

% answering 'tend to agree' or 'strongly agree'

75%

(2 (2 (3 (3

sigm a) sigm a) sigm a) sigm a)

W. Mercia Arden Bham & Sol

70%

B. Country

65% Staf f s

60%

55%

50%

300

320

340

360

380

400

420

440

460

Number of respondents

(Base: 2000 respondents, 15 November and 12 December 2010, Q: From what you have heard or what you know, to what extent do you agree or disagree with the following statement: ‘My local hospital treats patients with dignity and respect’? Weighted data.)

Alongside their views on how the NHS is being run currently, we also asked people about how they feel local services will develop in the future. We will look at this aspect of citizens’ views in the next chapter.

2. Expectations for the future For several years NHS West Midlands has tracked public perceptions about how they expect the NHS to develop over the next few years. This allows us to compare current levels of satisfaction with expectations for the future.

Will local NHS services get better or worse? Residents’ expectations for the future of their local health services have worsened slightly since the last time the survey was conducted. The largest proportion of citizens state that they expect services to remain the same over the next few years (41%), while over a quarter expect them to get better (27%), and almost a third think that they will get worse (30%). In previous surveys we had seen an improvement in residents’ expectations for the NHS; the highest levels of optimism were recorded in 2009 when 33% of those questioned expected services to improve and 21% expected services to worsen.

Expectations for local health services Q

Thinking about health services in your area over the next few years, including any plans you are aware of, do you expect them to…?

Don’t know (3%) Get much better Get much worse

4% 4%

* Please note the question wording differs in the 2006 survey – “Thinking about health services in your area over the next few years, do you expect them to…”

Get better

Get worse

25%

23%

41% Stay about the same

WM 2010

WM 2009

WM 2008

WM 2006*

Better

Worse

Net better

-3

+12

+11

-13

Base: WM 2010 – 2,000 West Midlands residents, 15 November – 12 December 2010 WM 2009 – 3,528 West Midlands residents, 8 April – 17 May 2009 WM 2008 – 3,564 West Midlands residents, 8 April – 13 May 2008 WM 2006 – 3,535 West Midlands residents, 8 August – 8 September 2006

The results to this question are now analysed in depth to examine how perceptions vary across the PCT Clusters and between socio-economic groups.

Who are the most positive and negative residents? There are differences between PCT Clusters in terms of expectations for the future. Respondents in Staffordshire Cluster are more optimistic about the future, compared with residents in other Cluster areas. In contrast, residents in Arden Cluster are less optimistic about the way services will develop over the next few years. Perceptions for the future of local NHS services, analysed by Cluster Cluster West Midlands Upper Control Lim it Lower Control Lim it Upper Control Lim it Lower Control Lim it

40%

(2 (2 (3 (3

sigm a) sigm a) sigm a) sigm a)

35% % answering 'tend to agree' or 'strongly agree'

Staf f s 30% B. Country Bham & Sol 25%

W. Mercia Arden

20%

15%

10%

300

320

340

360

380

400

420

440

460

Number of respondents

(Base: 2000 respondents, 15 November and 12 December 2010, Q: Thinking about health services in your area over the next few years, including any plans you area aware of, do you expect them toâ&#x20AC;Ś? Weighted data.)

Across the West Midlands certain socio-demographic groups are more positive than others in terms of the future of the NHS. Overall, those in social grades C2, D and E tend to be more positive than those in social grades A, B and C1, as are ethnic minority residents in comparison with white residents (see graph overleaf).10 11 The chart below shows those aged 16 -24 are the most optimistic about the future for health services, whilst those aged 45 -54 are the most pessimistic.

A definition of social grades can be found in the appendices. Overall, 30% of those in social groups C2DE feel that services will get better, compared with 24% from social groups ABC1. In total, 34% of those from minority ethnic groups feel that services will get better compared with 26% of those from white ethnic groups. 11

Expectations by age Q

Thinking about health services in your area over the next few years, including any plans you are aware of, do you expect them to…? % Get much better % Get worse

% Get better % Get much worse

(260)

16-24

(282)

25-34 4

(367)

35-44 3

(344)

45-54 3

(312)

55-64 4

(435)

65+ 3

% Stay about the same % Don't know

+30

-3

5 2

-9

5 2

-22

6 2

-13

11 2 2

% Net Better

25 28

5 6

Base: 2,000 West Midlands residents (base size for each age group shown in brackets), 15 November – 12 December 2010

The chart below shows differences in perceptions in terms of Mosaic groups. Mosaic is a classification tool which segments the population according to socio-demographic, lifestyle, cultural and behavioural characteristics. It can be seen, generally, that less affluent and more urban groups are more positive about the future of the NHS. More detailed definitions of the Mosaic groups can be found in the appendices.

Expectations by mosaic group Q

Thinking about health services in your area over the next few years, including any plans you are aware of, do you expect them to…?

Young well educated city dwellers Comfortably retired Small and mid-sized towns Sufficient income, social housing State dependent elderly Lower income, terraces, diverse areas Post industrial owner occupiers Middle income, suburban housing Young social renters Young dependent families Young parents Wealthy people and neighbourhoods Young starters Isolated rural communities Suburban professionals

% Get much better/ get better % Net better +19 +1 +2 +4 -1 +5 +2 -3 -12 -7 -1 -19 -10 -12 -17

Base: 2,000 West Midlands residents, 15 November – 12 December 2010

Other factors are also linked with respondents’ views on the future of NHS services. One of these is whether the respondent is concerned about the impact of wider economic pressures on the NHS. Those who are concerned about economic pressures are much less positive about the future of the NHS; 33% of those who are concerned about economic pressures state that they expect NHS services to get worse, compared with 11% of those who are not concerned.

Expectations by economic concern Q

Thinking about health services in your area over the next few years, including any plans you are aware of, do you expect them to . . .?

% Get much better

% Get better

% Stay about the same

% Get worse

% Get much worse

% Don't know

(1,688)

(283)

Concerned * 4

Not concerned ^ 5

% Net better

-8

10 1 2 +20

Base: 2,000 West Midlands residents (base sizes for each in brackets), 15 November – 12 December 2010 * All who say they are very / fairly concerned about the impact of current economic pressures on the ability of the local NHS to deliver health services ^ All who say they are not very / not at all concerned about the impact of current economic pressures on the ability of the local NHS to deliver health services

Respondents who work in the NHS are also more pessimistic about the future, with 37% stating that they expect services to get worse over the next few years, compared with 32% who have family and friends working in the NHS and 28% who are not connected with the NHS in this way. We will now look at some of the reasons given by those people who feel pessimistic about the future for local health services.

Why will local health services get worse? Everyone who felt that NHS services would get worse in the future was invited to explain why they felt this way. The responses were then grouped together in categories. The most frequently cited reason given by people who are pessimistic about the future for NHS services is a feeling that there is ‘less money’. Other reasons commonly mentioned are changes to the NHS, a perception that there is a shortage of staff and doctors, concern about hospitals being closed and the growing population the NHS has to cater for.

Reasons health services will get worse Q

Why do you think it will get worse? WM 2009 %

Top 10 mentions Less money/ cuts (unspecified)

31%

Less money for NHS/ spending cuts

18%

Changes to the NHS/ new Government policies/ reforms

17%

Staff shortages/ fewer doctors/ nurses

15%

Hospital closures/ A&E closures/ fewer hospitals

n/a n/a 14

10%

Growing population/ too many people

Everything is generally getting worse at the moment Lack of organisations/ badly run/ poor management People from abroad/ foreigners/ asylum seekers

Too much money wasted

6% 4%

7 9

Base: All who think local health services will get worse over the next few years (2010 – 606 West Midlands residents, 15 November – 12 December 2010, and 2009 – 741 West Midlands residents, 8 April – 17 May 2009)

We now turn to look at the areas within the NHS that people feel are in need of improvement. This helps to identify the main areas of concern amongst the public at the current time.

3. Priorities for Improvement The Operating Framework for the NHS in England 2011/12 sets out key priorities for the NHS which include: â&#x20AC;&#x2DC;maintaining performance on key waiting times, continuing to reduce healthcare associated infections and reducing emergency admissionsâ&#x20AC;&#x2122;.12 Alongside these priorities, we need to understand what the public and patients perceive to be the most important local priorities. We asked all those who took part in the survey to outline which are the most important areas for the NHS to improve, from a list of services and aspects of services that were presented to them. As we will see, there is significant overlap with the priorities highlighted within the Operating Framework.

Perceived areas for improvement Since the survey was undertaken last year there has been little change in the overall areas where the public feels that the NHS needs to improve. The quality of medical treatment by GPs remains the area that local residents feel is least in need of improvement. Residents are also positive about the general condition of hospital buildings, the quality of medical treatment available in hospitals, information about local health services and access to services to help people improve their own health. Residents highlight waiting times in A&E, services to support people with mental health problems and ease of access to NHS dentists as areas where the most improvement is needed.

The Operating Framework for the NHS in England 2011/12, p2. 28

Improvements Q

Based on what you know or have heard about the NHS, can you tell me whether you think the NHS in your own local community is: in need of no improvement, in need of a little improvement, in need of a fair amount of improvement or in need of a lot of improvement? % A least a fair amount

% A little/no need

% WM 2009

Time spent waiting in A&E Departments

34% Services for supporting people with mental health problems Ease of access to an NHS dentist Waiting time before getting appointments with hospital consultants Services to support people at the end of their lives Hospital waiting lists for non-emergency operations Cleanliness of hospitals Length of time it takes to get an appointment with a GP

Services for treating cancer Quality of nursing care in hospitals Information about local healthcare services Amount of choice people have about which GP they can register with Quality of medical treatment by GPs General condition of hospital buildings Quality of medical treatment in hospitals Services for treating heart disease Access to services to improve your own health Time spent waiting for an ambulance after 999 call

30%

53% 47%

45% 47% 44% 46% 44% 38% 41% 42% 39% 55% 38% 60% 30% 42% 29% 63% 28% 66% 27% 60% 26% 72% 25% 71% 25% 67% 22% 46% 18% 63% 10% 55%

Base: 2010: 2,000 West Midlands residents; 15 November â&#x20AC;&#x201C; 12 December 2010 2009: 3,528 West Midlands residents, 8 April â&#x20AC;&#x201C; 17 May 2009

59 29 42 25 56 36 48 42 43 34 44 37 52 42 36 63 34 38 35 55 30 64 27 55 23 75 35 61 30 61 21 40 18 60 13 50

The chart below compares perceptions around whether certain service areas were in need of improvement in 2009 with the latest survey results. It shows that, on the whole, respondents are more positive about most service areas than they were in last yearâ&#x20AC;&#x2122;s survey. For most of the aspects of care we asked about, there has been a decrease in the proportion of people who feel that improvements are needed (we can see that most service areas fall below the zero line on the axis which shows the percentage change in the proportion of respondents who feel that improvements are needed between 2009 and 2010). However, there has been an increase in the proportion of people who feel that services for supporting people with mental health problems are in need of improvement, as is the case with the length of time it takes to get an appointment with a GP, end of life services and the quality of medical treatment by GPs. The proportion of people who feel that hospital cleanliness and ease of access to an NHS dentist are in need of improvement has decreased substantially. The chart shows service areas in the top right hand corner where there is a perceived high need for improvement and where concerns have heightened since 2009. Service areas in the bottom right quadrant are those where there is a perceived high need for improvement and a decrease in concern compared with 2009. Perceived need for improvement â&#x20AC;&#x201C; comparison of results for 2009 & 2010 6 Mental Health services 4

% change in 'a lot' or a 'fair amount' since 2009

Quality of medical treatment by GPs Length of time to get an appointment with a GP End of life services

Services to improve own health

GP choice

Services for treating heart disease

Info about local health care services Waiting lists for nonemergency operations

-2

Waiting times for ambulances after 999 call -4

Cancer services Quality of medical treatment in hospitals

Hospital consultant appointment waiting times

Quality of nursing care in hospitals

-6

A&E waiting times

-8

Gen condition of hospital buildings

-10

Ease of access to NHS dentist

-12 Cleanliness of hospitals

-14 0

% stating 'a fair amount' or 'a lot' of improvement needed (2010)

(Base: 2000 respondents, 15 November and 12 December 2010, Base: 3528 respondents, 8 April â&#x20AC;&#x201C; 17 May 2009. Q:Based on what you know or have heard about the NHS, can you tell me whether you think the NHS in your own local community is: in need of no improvement, in need of a little improvement, in need of a fair amount of improvement or in need of a lot of improvement?)

If we consider the areas where over 35% of residents think that a ‘fair amount’ or ‘a lot’ of improvement is needed, then it is evident that attention might need to be focussed on perceptions of A&E waiting times, although perceptions have improved compared with last year’s results (53% feel this is in need of improvement in the latest survey compared with 59% in 2009). Perceptions of the need for improvement around services for supporting people with mental health problems are less positive this year when compared with the results for 2009. However, if we look back at responses to this issue in previous years we see that the results for 2010 are similar to those for 2008 (47% feel that at least a fair amount of improvement is needed in 2010, compared with 42% in 2009 and 46% in 2008). In addition, concern around waiting times for appointments with GPs has worsened since last year, and is now at similar levels to those found in 2008 (38% of respondents feel that at least a fair amount of improvement is needed in 2010, compared with 36% in 2009, 39% in 2008 and 40% in 2006). Hence, concern around GP waiting times and mental health services seems fairly consistent if we look back over 3 years. Nonetheless, the fact that levels of concern remain fairly high, whilst levels of concern around other issues have fallen, suggests that further consideration is warranted.

Priorities for improvement Once participants had thought about the extent to which services were in need of improvement, we asked them about their priorities for improvement amongst the services they had flagged. The chart below shows that improving waiting times in A&E is highlighted by the highest proportion of respondents as the priority for improvement. The same proportion of residents think this is the most important priority for improvement as was the case last year. Significant improvements are evident around perceptions of cleanliness in hospitals. This emerges as the second highest priority for improvement this year; the first time that it has not been highlighted as the top priority for improvement since 2008. In addition, the proportion of residents who feel that hospital cleanliness is the most important factor to improve has fallen from 16% in 2009 to 11% in 2010.

Priorities for improvement Q Which one of these, if any, is it most important to improve?

WM 2009 %

14% 14

Time spent waiting in accident and emergency departments Cleanliness of hospitals

11%

Length of time it takes to get an appointment with a GP

10%

Services to support people at the end of their lives, for example hospices or supporting people dying at home

Services for supporting people with mental health problems

Waiting time before getting appointments with hospital consultants Services for treating cancer

Quality of nursing care in hospitals

Hospital waiting lists for non-emergency operations

Ease of access to an NHS dentist

Quality of medical treatment by GPs

General condition of hospital buildings

Quality of medical treatment in hospitals

Amount of choice people have about which GP they can 1% register with

N/A

Time spent waiting for an ambulance after a 999 call 1%

Services for treating heart disease 1%

Information about local health care services 1%

Access to services to improve your own health 1%

Don’t know

Base: All who think any improvement is needed (2010 – 1,435 West Midlands residents 15 November – 12 December 2010, and 2009 – 3,345 West Midlands Residents, 8 April to17 May 2009 )

There are variations in the priorities of different respondent groups. In particular, people aged 16-24 are most likely to state that A&E waiting times are the most important aspect of services to improve (24%). In addition, a higher proportion of those who have attended A&E or who have been an inpatient state that this is the most important area for improvement (16% and 17% respectively). For those aged 65 and over, the most important priority is seen as improving end of life care (cited as the top priority by 16% of this age group). For those who have visited someone in hospital but have not been a patient themselves, hospital cleanliness is seen as the most important priority for improvement (cited by 15% of this group). The diagram below sets out the priorities across Clusters. Reducing waiting times in A&E emerges as the most important priority in the Black Country and Arden, whilst in Staffordshire this is seen as the most important aspect alongside improving cleanliness of hospitals. In Birmingham and Solihull, cleanliness in hospitals and GP waiting times are seen as the main priorities for improvement, and in West Mercia A&E waiting times and mental health support services as seen as the key areas where improvements need to be targeted.

Top 5 Priorities for improvement by cluster Q Which one of these, if any, is it most important to improve? Staffordshire (304)

Arden (211)

Birmingham & Solihull (336)

A&E waiting times (17%)

A&E waiting time (16%)

Cleanliness of hospitals (12%)

Cleanliness of hospitals (17%)

End of life support services (13%)

GP appointment waiting times (12%)

End of life support services (10%)

Mental health support services (8%)

A&E waiting times (11%)

GP appointment waiting times (9%)

Hospital consultant waiting times (8%)

Mental health support services (10%)

Services for treating cancer (8%)

End of life support services (10%)

Black Country (291)

West Mercia (293)

A&E waiting times (13%)

Mental health support services (12%)

GP appointment waiting times (10%)

A&E waiting times (12%)

Cleanliness of hospitals (9%)

Services for treating cancer (9%)

Hospital consultant waiting times (9%)

End of life support services (9%)

Services for treating cancer (9%)

Base: All who think improvement is needed in at least one area (base size for each cluster in brackets), 15 November â&#x20AC;&#x201C; 12 December 2010

We now turn to the three main priorities identified in detail. Each priority will be analysed to ascertain geographical and demographic variations.

A&E waiting times The results from the survey indicate slightly less public concern around A&E waiting times compared with last year, although this is still seen as the main priority for improvement for the local NHS. The chart overleaf indicates that a higher proportion of residents in the Black Country and Staffordshire feel that A&E waiting times are in need of improvement when compared with the results for West Mercia and Arden.

Top priorities for improvement by cluster Q

Based on what you know or what you have heard about the NHS, can you tell me whether you think the NHS in your local area is: in need of no improvement, in need of a little improvement, in need of a fair amount of improvement, or in need of a lot of improvement? Time spent waiting in accident and emergency departments (% At least a fair amount)

(397)

Black Country

58%

(406)

Staffordshire

57%

(451)

Bâ&#x20AC;&#x2122;ham & Sol.

56%

(310)

Arden

(436)

West Mercia

49% 46%

Base: 2,000 West Midlands residents (base size for each cluster shown in brackets), 15 November â&#x20AC;&#x201C; 12 December 2010

Cleanliness in hospitals Perceptions around hospital cleanliness seem to have improved this year. Fewer people highlight this as in need of improvement compared with last year and for the first year since public surveys have been conducted across the region, hospital cleanliness is not seen as the main priority for improvement (i.e. since 2006). However, this is still seen as the second most important aspect for improvement. The graph overleaf shows perceived need for improvement by Cluster. A higher proportion of residents in Staffordshire Cluster state that cleanliness in hospitals is in need of a fair amount or a lot of improvement, compared with the results for the region as a whole (47%, compared with 39% for the region). In contrast a higher proportion of residents in West Mercia think that hospital cleanliness is in need of no improvement or a little improvement (62% compared with 55% across the region).

Top priorities for improvement by cluster Q

Based on what you know or what you have heard about the NHS, can you tell me whether you think the NHS in your local area is: in need of no improvement, in need of a little improvement, in need of a fair amount of improvement, or in need of a lot of improvement? Cleanliness of hospitals (% At least a fair amount)

47%

(406)

Staffordshire

(451)

B’ham & Sol.

42%

(397)

Black Country

41%

(310)

Arden

(436)

West Mercia

35% 32%

Base: 2,000 West Midlands residents (base size for each cluster shown in brackets), 15 November – 12 December 2010

Previous research undertaken by NHS West Midlands has demonstrated the factors which help to improve public confidence with regard to hospital cleanliness.13 The findings of this research have been disseminated across the region and is assisting Trusts in communicating with their populations about healthcare acquired infections and measures to improve perceptions around hospital cleanliness. Waiting times for an appointment with a GP In this year’s survey the length of time it takes to get an appointment with a GP is highlighted as the third most important priority for improvement (mentioned by 10% of respondents). However, the proportion of people who highlight this as the main priority has remained fairly static over the last 3 years (in 2008 10% of those interviewed also cited this as the main priority for improvement). The chart below shows that a higher proportion of people in the Black Country think that this aspect is in need of at least a fair amount of improvement.

See: http://www.westmidlands.nhs.uk/ReportsPublications/MORIResearch.aspx 35

Top priorities for improvement by cluster Q

Based on what you know or what you have heard about the NHS, can you tell me whether you think the NHS in your local area is: in need of no improvement, in need of a little improvement, in need of a fair amount of improvement, or in need of a lot of improvement? Length of time it takes to get an appointment with a GP (% At least a fair amount)

(397)

Black Country

(451)

B’ham & Sol.

(310)

Arden

36%

(406)

Staffordshire

35%

(436)

West Mercia

49% 40%

32%

Base: 2,000 West Midlands residents (base size for each cluster shown in brackets), 15 November – 12 December 2010

A higher proportion of residents from black and minority ethnic groups feel that waiting times for GP appointments are in need of improvement (52% compared with 37% of those from white ethnic groups). In addition, a higher proportion of respondents from BME groups feel that this is the most important priority for improvement (16% compared with 10% overall). Other research has highlighted lower levels of satisfaction with access to health services amongst respondents from BME groups particularly with access to primary care.14 We will now consider respondents’ views on the financial challenges facing the NHS and where NHS resources should be focussed.

See DH report on patient survey findings at:

http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_100471.pdf

4. Financial challenges Introduction Although funding for the NHS has been protected, it is facing unprecedented financial challenges. The population is ageing and growing, new technologies and treatments are being introduced and although funding is protected, it is not predicted to increase on a similar scale as has been experienced in the past. These challenges are taking place in a context of wider pressures on public services as attempts are made to balance the country’s financial deficit. As the NHS attempts to deal with the economic challenges it faces, it is important to understand public concerns and communicate effectively around the measures being undertaken. With this in mind, the survey probed a number of areas in relation to public perceptions around economic pressures, NHS resources and how they should be used.

Concerns about economic pressures At the time of the survey, the budget deficit and potential effects on public sector funding availability were being widely discussed in the media. Whilst it was reported that NHS funding is protected, there was also coverage of the challenges being faced. In order to gauge how this was being perceived by the public, respondents were asked whether they were concerned about economic pressures and their potential effect on the NHS. The findings indicate that people are worried about the impact of wider economic pressures on the ability of the local NHS to deliver health services, with more than eight in ten stating that they are concerned and four in ten stating that they are very concerned (see chart below).

Impact of economic pressures Q How concerned are you, if at all, about the impact of current economic pressures on the ability of the local NHS to deliver health services? Don’t know Not at all concerned Very concerned 4%1% Not very concerned 11% WM 2010

WM 2009*

Concerned

Not concerned

Net concerned

+69

+54

41%

43%

Fairly concerned

Base: WM 2010 – 2,000 West Midlands residents, 15 November – 12 December 2010 WM 2009 – 3,528 West Midlands residents, 8 April – 17 May 2009 * Please note that results are not strictly comparable because question wording differs in 2009, “How concerned are you, if at all, that the credit crunch might reduce the funds available for the NHS?”

Some variation by demographic group is evident, as older respondents, those with a disability, and those who have someone in their family with a disability are more likely to state that they are very concerned about economic pressures.15 In addition, those who have been an inpatient or outpatient recently are more likely to feel very concerned about these issues. There seems to be a relationship between funding and levels of confidence for the future of the NHS, as people who expect the NHS to get worse over the next few years are more likely to be concerned about economic pressures than those who expect it to get better. In total, 59% of those who expect services to get worse are very concerned about economic pressures affecting the NHS, compared with 35% of those who expect services to get better. The chart below shows differences in perceptions by Mosaic group in detail, and shows that there are high levels of concern across all groups.

Impact of economic pressures by mosaic group Q

How concerned are you, if at all, about the impact of current economic pressures on the ability of the local NHS to deliver health services? % Net % Concerned

Comfortably retired Small and mid-sized towns Middle income, suburban families Young social renters State dependent elderly Young dependent families Isolated rural communities Suburban professionals Post industrial owner occupiers Young parents, modern housing Young starters Sufficient income, social housing Wealthy people and neighbourhoods Young, well-educated city dwellers Lower income, terraces, diverse areas

concerned +90 94 89 +79 +78 89 88 +75 +77 87 85 +73 +74 85 +69 84 +68 83 +68 83 +66 83 +66 82 +62 81 +66 81 +55 77

Base: 2,000 West Midlands residents, 15 November â&#x20AC;&#x201C; 12 December 2010

The results suggest that there is a concern around funding issues across the population, with people with a disability and recent users of health services being the most concerned. The results have implications for communication strategies around changes in service provision and improvements in efficiency.

15For

example, 50% of those from aged 55-64 state that they are very concerned and 46% of those aged 65 and over. Similarly, 50% of those with a disability are very concerned, compared with 41% overall. In total, 45% of those who have been an inpatient or outpatient recently state that they are very concerned about the impact of economic pressures. 38

Focus of NHS provision At a time of change it’s important to understand the relative importance people give to balancing out local needs against ensuring that everyone has access to the same services. Respondents were asked which of the following statements most closely matched their own opinion ‘The same NHS services should be available everywhere, which means that everyone will get the same services regardless of where they live’ and ‘The availability of NHS services should be based on local need which means that people living in different areas might have different types of services’. It is interesting to note that almost eight in ten respondents feel that it is more important to have the same services everywhere, and that service provision should not be primarily based on local need (78%). This corroborates the findings of other research by Ipsos MORI with regard to the availability of NHS treatments.16

Focus of NHS provision Q Thinking about the services that are available on the NHS, which of these statements more closely match your opinion? Don’t agree with either (1%) The availability of NHS services should be based on local need, which means that people living in different areas might have different types of services

Don’t know (1%)

20%

78%

The same NHS services should be available everywhere, which means that everyone will get the same services regardless of where they live

Base: 2,000 West Midlands residents, 15 November – 12 December 2010

The idea that the same services should be available everywhere is particularly attractive to the following groups (the figures in brackets show the percentage of respondents who agree with this idea): Those who are not working (82%) Those from lower socio-economic backgrounds (C2DE) (83%) Those without caring responsibilities (79%) 16

Research amongst 988 adults in England in November 2008, by Ipsos MORI, revealed that 73% felt that treatments should only be available on the NHS if they are available to everyone and not dependent on where you live, compared with 23% who felt that availability of treatments should be based on local need rather than a ‘one size fits all approach’ across the country. See RSA (2010) What do people want, need and expect from public services, p.14. 39

A higher proportion of people from the groups below felt that services should be tailored to local needs, even if that meant that some areas would have different services (the figures in brackets show the percentage of respondents who agree with this idea, although this option was less popular across all groups): People who are working (23%) People with caring responsibilities (25%) People from more affluent socioeconomic groups (ABC1) (24%) Those who had recently attended a private hospital (26%) The chart below shows that the results are consistent across the region, with no major differences by Cluster.

Focus of NHS provision by cluster Q Thinking about the services that are available on the NHS, which of these statements most closely match your opinion? The same NHS services should be available everywhere…

The availability of NHS services should be based on local need…

Don’t agree with either

Arden

18 11

(397)

Black Country

19 1*

(451)

B’ham & Sol.

(406)

Staffordshire

20 1*

(436)

West Mercia

(310)

Don’t know

Base: 2,000 West Midlands residents (base size for each cluster in brackets), 15 November – 12 December 2010

For almost half of those who feel that the same services should be available everywhere the main reason given for their views is the idea of equality – they feel that ‘everyone is equal / should be treated in the same way / should have equal access to services’ (49%). The other main reason given is that access to services should not be based on postcodes, including some who mentioned the notion of a ‘postcode lottery’ (25%) (see chart overleaf).

Reasons for supporting universal availability Q And why do you say that? (top 10 responses) We are all equal/everyone should be treated the same way/have equal chances to the same level of service Shouldn’t be based on postcodes/where people live/don’t want a postcode lottery

49% 25% 12%

It’s fair/the fairest way/would be unfair otherwise We have all paid in money/paid our taxes/belongs to the taxpayer/anyone who has paid should get their fair treatment People would have to travel too far/easier for travel this way/reduces travel/shouldn’t have to travel to receive help

All hospitals should provide the same services/level of care/treatment should be the same everywhere

Everyone should get what they need/be based on needs/everyone has different needs Needs to be able to have medical attention if you are outside of your area/postcode/wherever you are Shouldn’t discriminate/no preferential treatment/why should some people get better treatment than others? Supposed to be a National Health Service/principle of NHS when it was set up

4% 4% 3% 3%

Base: All who agree that the same NHS services should be available everywhere (1,572), 15 November – 12 December 2010

The respondents who feel that services should be responsive to local needs mainly cite differences in local needs / problems and populations as the main reason for their views (36%). There is also a belief that services should be based around local communities and that services and funding should be focused around needs (19%).

Reasons for supporting service provision based on local need Q And why do you say that? (top 10 responses) Different areas have different needs/problems/demographics play a part

36%

It should be based on local community/focus services/funding where individual need is Rural areas have different needs to inner city/industrial areas No point wasting money where resources not needed/generalised service everywhere is wasteful Some areas have large proportion of elderly/pensioners

19% 8% 8% 6%

Different age groups need different treatments

Ethnic/Asian population need different/specific help compared to other cultures Everyone should have the same care/balanced service

5% 5%

Local people need access/should not have to travel too far/transport to local hospitals

Specialist treatment should be available at larger hospitals/necessarily local

Base: All who agree that the same NHS services should be based on local need (394), 15 November – 12 December 2010

Notions of limits on NHS funding When considering people’s views on how NHS resources should be utilised, it is important to understand their views on fundamental issues, such as whether there should be any limits around what is spent on the NHS. The results to the question show that this issue is something that divides respondents with 50% agreeing that there should not be any limits on what is spent on the NHS and 40% disagreeing. The findings of this study confirm those of a survey conducted in 2006, which reported similar results (44% agreed that there should always be limits on what is spent on the NHS, while 48% disagreed).17 These fundamental divisions do not seem to have changed substantially (see below).

NHS funding Q To what extent do you agree or disagree with each of the following statements? “There should NOT be any limits on what is spent on the NHS” Don’t know 3%

Strongly disagree 16%

30%

Tend to disagree

Strongly agree

24% 20% 7%

Tend to agree

Neither / nor Base: 2,000 West Midlands residents, 15 November – 12 December 2010

In terms of the notion that there should NOT be any limits on what is spent on the NHS, the following groups are more likely to agree – those aged 16-24 (60% agree), those from socioeconomic groups C2DE (55% agree), and people who are not working (55% agree). The following groups are more likely to disagree – those aged 35-54 (46% disagree), people who are working (46% disagree), those from social class ABC1 (46% disagree), those from white ethnic groups (41% disagree). We will now consider public responses to a range of initiatives which are aiming to improve the value for money the NHS achieves from its resources.

Ipsos MORI tracker survey 2006, 1001 British adults aged 18+. 42

5. Providing good value for money In order to meet the challenges associated with a growing population, improvements in technology and associated pressures on resources, the NHS is adopting a range of initiatives to improve quality whilst at the same time ensuring that services offer good value for money.

Treatments of limited clinical value One of the ways the NHS can achieve better value for money is to reduce the number of treatments and operations carried out where evidence suggests that they are of limited clinical value.

Support for the general principle of reducing treatments of limited clinical value In order to gauge public understanding around the aim of stopping the NHS carrying out treatments of limited clinical value, respondents were asked to what extent they agreed or disagreed with the following statement: ‘The NHS should stop providing treatments that have little or no medical benefit for patients’. Over half of all respondents agree with this statement, while just over a quarter disagree (see chart below).

NHS treatments Q To what extent do you agree or disagree with each of the following statements? “The NHS should stop providing treatments that have little or no medical benefit for patients” Don’t know 6%

Strongly disagree 11%

Tend to disagree

29%

Strongly agree

16%

10% 28%

Neither / nor

Tend to agree Base: 2,000 West Midlands residents, 15 November – 12 December 2010

Support for stopping treatments of limited clinical value is highest amongst those aged over 45 (61% agreeing), respondents from white ethnic groups (58%), and those without children (58%).

Funding and treatments by age Q

To what extent do you agree or disagree with each of the following statements? “The NHS should stop providing treatments that have little or no medical benefit for patients” % Net Agree

% Agree (260)

16-24

(282)

25-34

56%

+29

(367)

35-44

55%

+28

(344)

45-54

(312)

55-64

61%

+41

(435)

65+

60%

+37

43%

63%

+37

Base: 2,000 West Midlands residents (base size for each age group shown in brackets), 15 November – 12 December 2010

Interestingly, a higher proportion of people who either have a disability themselves / have someone in their household with a disability strongly agree with the statement (31% compared with 29% overall). The highest proportion of respondents from the following groups disagree with this statement – those aged 16-24 (40%), those from black and ethnic minority groups (38%), and respondents with children (32%).

Support for specific initiatives Those who took part in the survey were invited to state whether they would support or oppose a range of initiatives which were aimed at reducing interventions of limited clinical value. The overall results are shown in the chart below and are discussed in the sections which follow. Support is greatest for reducing prescriptions where there is no proven medical benefit, and opposition is greatest around stopping operations being done where there is no proven medical benefit (e.g. removing varicose veins where this is not being undertaken for medical reasons), although the majority would still support this initiative.

Support for QIPP initiatives Q I am now going to read out some specific options being considered and I’d like you tell me the extent to which you support or oppose each one? % Strongly support % Tend to oppose

% Tend to support % Strongly oppose

% Neither / nor % Don't know

Stopping medicines being prescribed where there is no proven medical benefit Stopping operations being done where there is no proven medical benefit Only carrying out hip and knee replacements when a condition won’t be improved by other treatments Only removing cataracts where a doctor thinks it will make a big improvement to someone’s sight Base: 2,000 West Midlands residents, 15 November – 12 December 2010

Additional feedback from some of the interviewing team at Ipsos MORI included reports that some respondents found the subject matter difficult to contend with. This underlines the sensitivities associated with the questions and the need for on-going work further exploring how best to engage with the public on these issues.

Improving medicines management It can be seen from the chart above that reducing prescriptions for medicines where there is no proven medical benefit receives the most positive response amongst the initiatives described. Almost three-quarters of respondents say that they would support this initiative. Some demographic groups support this initiative more than others, higher than average levels of support are found amongst people who are working, (76% support), respondents from social class ABC1 (76%), and respondents from white ethnic groups (75%). However, there are some social groups with higher levels of opposition to this initiative, this includes people aged 16-24 (27% say they would oppose), people who are not working (22% oppose), those from social grades C2DE (22% oppose) and people from black and minority ethnic groups (28% oppose). Hence, communication strategies around improving medicines management need to take into account the fact that levels of support potentially differ across key groups in local communities.

Only carrying out hip and knee replacements where conditions can’t be improved by other means It is important that medical interventions take place at the right time to ensure maximum benefit for patients. One of the initiatives to improve care for patients involves ensuring that knee and hip replacements only take place where other treatments are not appropriate. Public support for this initiative is fairly high, with almost three quarters of respondents saying they would support only carrying out replacements where conditions could not be improved by other means (71%), while around a fifth would oppose this option (20%). The results for this question are consistent across most demographic groups, with no major differences evident according to age or social class. Respondents with a disability or with a household member with a disability are more likely to oppose this idea (22%) compared with those without a disability (18%). In addition, those from a white ethnic group are more likely to oppose this, compared with those from a minority ethnic group (20% compared with 14%).

Removing cataracts only where this will bring about a big improvement Another of the options described was to only perform operations to remove cataracts where a doctor thinks it will make a big improvement to someone’s sight, while other people would have their vision monitored carefully until an operation is required. Overall, just over two thirds of respondents state that they support this measure (69%), with just under a quarter opposing (23%). Levels of support for this idea are particularly strong amongst those aged 65 and over, with 78% stating that they support it, and 50% strongly in support. In addition, levels of support are higher amongst people who are not working (73%), and from social group C2DE (73%). Similarly, in terms of Mosaic groups the group most in support of this initiative are the ‘state dependent elderly’ (80%). Levels of opposition are highest amongst those aged 35-44 (30%), people who are working (26%), those from social group ABC1 (28%), and residents in West Mercia (28%). This issue seems to divide those with a disability, with a higher proportions strongly supporting (39%) and strongly opposing (16%) compared with the regional average.

Ceasing to carry out operations where there is no proven medical benefit The issue which created more of a mixed response amongst respondents is stopping operations being done where there is no proven medical benefit for the patient. The example given was removing varicose veins for appearances’ sake rather than for a medical reason. While almost two thirds support this idea (61%), almost a third say that they oppose it (30%).18 18

Feedback from some of the interviewers at Ipsos MORI indicated that some respondents found this question difficult to answer and were unclear how the psychological effects of having varicose veins would be covered within notions of ‘medical benefit’.

Views on funding and reducing the volume of treatments of limited clinical value The table below compares the responses of two groups â&#x20AC;&#x201C; those who feel that there should be limits on what is spent on the NHS and those who feel that there should be no limits. It is evident that those who feel that there should be no limits on funding are also more likely to believe that there should not be attempts to focus on treatments which provide proven medical benefit for the patient.

Comparison of views on limits to funding with attitudes to treatments of limited clinical value Those who feel that there should be no limits on what is spent on the NHS (995 respondents) (% support statement /initiative)

Those who feel that there should be limits on what is spent on the NHS* (805 respondents) (% support statement /initiative)

Significant difference? (between the two groups)

‘The NHS should stop providing treatments that have little or no clinical value for patients’



Stopping medicines being prescribed where there is no proven medical benefit



Only carrying out hip and knee replacements for people whose condition won’t be improved by other treatments

Only performing operations to remove cataracts where a doctor thinks it will make a big improvement to someone’s sight



Stopping operations being done where there is no proven medical benefit for the patient

(*Please note that this group of respondents disagreed with the statement ‘There should not be any limits on what is spent on the NHS’, hence it is inferred that they therefore feel that there should be limits. ^Note that the proportion of respondents who support this initiative and who also feel that there should be limits on what is spent on the NHS is significantly higher than the overall (average) result).

Reducing demand on hospitals Introduction Since the implementation of ‘Investing for Health’ in July 2007, reducing demand on acute hospitals has been a key aim within the West Midlands. This agenda is also central to national policy, and is cited in the Operating Framework for 2011/12 as a commitment to release capacity from acute services to allow the better use of community services. In order to analyse how these messages can be effectively communicated with residents, we included questions in the survey which probed respondent views on a range of initiatives which aim to reduce demand on acute services.

Reducing demand on hospitals – responses to the overall principle In order to gauge likely public responses to a range of initiatives, we firstly asked respondents whether they supported the principle of reducing demand on hospitals. To make sure that we gained an accurate measure of public reaction, we wanted to make sure that participants fully understood what this might entail. Within the question it was made clear that as a consequence of reducing demand, there might be a reduction in the number of hospital beds and nurses in an acute setting, and that resources would be moved into services in the community. The results for this question show that a majority of respondents support the idea of reducing demand on hospitals (55%). However, a third oppose this as a general principle (33%), with just over a fifth stating that they strongly oppose it (22%).

Support for reducing demand on hospitals Q

The NHS is looking at how to get the most out of the resources it has while improving the care for patients. One idea is to reduce the demand on hospitals and, therefore, reduce the number of hospital beds and nurses. This would be made possible by moving some services out of hospital into the community and by doing other things differently. In principle, to what extent do you support or oppose this idea?

Don’t know

Strongly support Strongly oppose

Tend to oppose Tend to support

Neither/nor Base: 2,000 West Midlands residents, 15 November – 12 December 2010

There are different levels of support and opposition for this principle across demographic groups. Levels of support for reducing demand on hospitals are highest amongst those who are aged under 35 (65% say that they support this principle) and amongst those who do not 49

have a disability / do not have someone with a disability in their household (57% support this principle). Respondents in Arden Cluster are more positive about this initiative compared with people from other Clusters (60% say that they support this principle compared with 50% in Staffordshire Cluster, where support is lowest) (see chart below).

Support for reducing demand on hospitals by cluster Q The NHS is looking at how to get the most out of the resources it has while improving the care for patients. One idea is to reduce the demand on hospitals and, therefore, reduce the number of hospital beds and nurses. This would be made possible by moving some services out of hospital into the community and by doing other things differently. In principle, to what extent do you support or oppose this idea? % Support

% Oppose

% Net Support

(310)

Arden

+29

(451)

Bâ&#x20AC;&#x2122;ham & Sol.

+27

(436)

West Mercia

+21

(397)

Black Country

+18

(406)

Staffordshire

+13

Base: 2,000 West Midlands residents (base size for each cluster in brackets), 15 November â&#x20AC;&#x201C; 12 December 2010

In contrast, higher levels of opposition to the idea of reducing demand on hospitals is found amongst people who are aged 55-65 (39% say that they oppose this principle) and amongst people who either have a disability themselves / have someone in their household with a disability (37% say they oppose this). It is interesting to note that opposition to the idea of reducing demand on hospitals is correlated with general dissatisfaction with the NHS. A higher proportion of respondents state that they are opposed to attempts to reduce demand on hospitals if they are also: dissatisfied with the running of the NHS (43% who are dissatisfied with the running of the NHS say they oppose this principle), dissatisfied with the quality of care patients receive locally (41% who are dissatisfied with quality of care say they oppose reducing demand), disagree that their local hospital treats patients with dignity and respect (41% who disagree that patients are treated with dignity and respect oppose this principle).

Reducing demand on hospitals â&#x20AC;&#x201C; responses to particular initiatives For people who did not agree with the central principle of reducing demand on hospitals, further questions were asked which looked at how their views might change if they had further information on the steps being taken by the NHS. The chart overleaf shows that once presented with further information, a high proportion of those who initially oppose the principle of reducing demand on hospitals change their stance. On average, once they have heard further information on proposed initiatives, 74% state that they would support this idea. The highest levels of support are found when people are told about initiatives to help people to stay healthy so they donâ&#x20AC;&#x2122;t need to go to hospital (85% say that they now support the idea of reducing demands on hospitals), carrying out some follow-up appointments in local health centres (83%), and carrying out operations differently so that people donâ&#x20AC;&#x2122;t need to stay in hospitals for so long (76%). Slightly fewer people feel that they would change their views based on the idea that the NHS would give people extra time before operating on them to make sure that symptoms cannot be improved by other treatments (61%).

Reducing demand Q To what extent would you support or oppose plans to reduce the demand on hospitals and, therefore, reduce the number of hospital beds and nurses . . . ? % Strongly support % Tend to oppose

% Tend to support % Strongly oppose

IF the NHS helps people to stay healthy so that they don’t need to go to hospital

% Neither / nor % Don't know

4361

IF the NHS carries out operations differently so people don’t need to stay in hospital for so long

5 9 82

IF the NHS carries out some followup appointments in local health centres rather than going to hospital, when they can be delivered safely elsewhere

35 7 3

IF the NHS stops some treatments being carried out in local hospitals where these can be delivered most safely at a more specialist hospital

7 9 102

IF the NHS increases the care patients receive closer to home rather than in a hospital

7 11 9 3

IF the NHS gives patients extra time before operating on them to make sure their symptoms can’t be improved by other treatment

9 13 12 4

Base: All who oppose reducing the number of beds and nurses (671), 15 November – 12 December 2010

Helping people to stay healthy This is the most effective initiative in reassuring people around the general principle to reduce demand on hospitals. Overall, 85% of the respondents who had previously said that they would oppose the general principle of reducing acute demand said that they would now support this principle. Respondents who are aged over 65 are particularly enthusiastic around this idea, with 90% stating that they would now support the principle of reducing acute demand if they heard about this initiative. Increasing care closer to home Support for this initiative is again high, with 70% of respondents stating that they would support the general principle of reducing demand on hospitals if they heard about this initiative. The initiative is supported particularly by those from social groups C2DE with 74% saying that they would change to support the idea of reducing demand on hospitals. Giving patients extra time before operating to make sure that symptoms canâ&#x20AC;&#x2122;t be improved by other treatment This is the initiative which made the least impact on respondent views, although 61% state that they would now support the principle having heard further information. Higher levels of support are found amongst those aged 65 plus (73%), those who are not working (68%) and from social group C2DE (66%).

Smoking cessation & alcohol consumption reduction Prevention is a central element within the NHSâ&#x20AC;&#x2122;s drive to improve population health and reduce hospital admissions, and reducing smoking prevalence and excessive alcohol consumption are a key tenet of this work. As part of this, attention is being focussed on reducing smoking rates amongst NHS staff and increasing the interventionist role staff take when treating people who smoke or drink more alcohol than the recommended amount. In order to inform this process, several questions were asked which looked at public views around NHS staff smoking and staff talking to patients about their smoking and drinking. The results indicate that the public do not like to see staff smoking in uniform or smell cigarette smoke on them, and that they would support staff taking a more pro-active role in discussing smoking cessation and reducing alcohol consumption when treating people who smoke or drink excessively.

Views on staff smoking More than two thirds of respondents agree that it is unacceptable for NHS staff to be seen smoking while they are wearing their uniform (69%). A higher proportion of respondents who are aged over 65 agree with this statement (84%), as do respondents who are not working (72%). Interestingly, a high proportion of respondents who work in the NHS agree that this behaviour is unacceptable (82%).

NHS staff and smoking Q To what extent do you agree or disagree with each of the following statements: % Strongly agree % Tend to disagree

% Tend to agree % Strongly disagree

I would not like it if I could smell cigarette smoke on a doctor, nurse or any other health professionals treating me

It is unacceptable for NHS staff to be seen smoking while they are wearing their uniform

% Neither / nor % Don't know

7 7

8 1

12 1

Base: 2,000 West Midlands residents, 15 November â&#x20AC;&#x201C; 12 December 2010

Over three-quarters of the people who took part in the survey agree that they would not like it if they could smell cigarette smoke on a doctor, nurse or any other health professional who is treating them (77%), with just 14% disagreeing. This figure is high across all demographic groups. In particular, almost nine in ten respondents who work in the NHS agree that they would not like this (87%). The main reason given for not liking the smell of cigarette smoke on a health professional is that people do not like the smell (52%). Almost a third feel that it is not very professional if it is evident that a health professional has been smoking (31%), and a similar proportion feel that itâ&#x20AC;&#x2122;s hypocritical for health professionals to smoke when the NHS is trying to stop people smoking (28%). Amongst respondents who work in the NHS, the view that smoking is unprofessional for NHS staff is the main reason cited, and is given by almost half of those who answered the question (47%).

NHS staff and smoking Q You said that you would not like it if you could smell cigarette smoke on a doctor, nurse or any other health professionals treating you. Why do you say that? Don’t like the smell Not very professional Hypocritical when NHS wants people to stop smoking Worried about my health/passive smoking Worried about their health I don’t like smoke/I’m anti-smoking (including I’m an ex-smoker) I don’t like smoke Unhygienic/it’s not clean It’s offensive/disgusting/unpleasant/would be offended Doctors/hospital staff should set a positive example/it’s a bad example Other Don’t know Base: All who said they would not like it if they could smell smoke on someone treating them (1,556), 15 November – 12 December 2010

Views on NHS staff talking to patients about their smoking and drinking NHS staff have a range of interactions with patients who smoke and are being encouraged to talk to patients about their smoking, even if they are seeing them about something which is unconnected to this. The results of the survey suggest that the majority of the public would be supportive of these initiatives. Over two thirds agree that if a person smokes, a hospital doctor, hospital nurse or GP should speak to them about how to stop smoking, even if that person has gone to see them about something completely different (68%). A quarter of residents disagree with this idea (25%). Patients aged over 65 are more likely to agree that staff should take an interventionist role (74%), as are respondents who are not working (70%). It interesting to note that respondents from minority ethnic groups 55

are more likely to state that they strongly agree with this idea (50%, compared with 43% overall). Respondents who are NHS staff are more likely to have strong views on this, with 52% saying that they strongly agree with the statement.

Interventions to reduce smoking and drinking Q To what extent do you agree or disagree with each of the following statements: % Strongly agree % Tend to disagree If a person drinks more alcohol than the recommended limit, a hospital doctor, hospital nurse or GP treating them should speak to them about how to drink less alcohol

If a person smokes, a hospital doctor, hospital nurse or GP treating them should speak to them about how to stop smoking

% Tend to agree % Strongly disagree

% Neither / nor % Don't know

4 11

8 1

12 2

Base: 2,000 West Midlands residents, 15 November â&#x20AC;&#x201C; 12 December 2010

Respondents were also asked about staff taking a more interventionist role with patients who drink more than the recommended amount. There is slightly more support for this idea, with three quarters of respondents agreeing that if a person drinks more alcohol than the recommended limit, a hospital doctor, hospital nurse or GP should speak to them about how to drink less alcohol, even if that person has gone to see them about something completely different (75%). Once again, those aged 65 and over are more likely to agree with this statement (83%), as are respondents who are not working (77%). In addition, respondents living in the Birmingham and Solihull Cluster are also more likely to agree (78%). It is worth noting that a higher proportion of respondents from ethnic minority groups strongly agree with this statement (60% compared with 48% overall). We now turn to consider how informed the public feel about developments in the NHS, decision-making and whether the NHS provides good value for money.

6. Engagement & Access to Information Introduction All NHS organisations have a duty to involve and consult patients and the public in relation to the planning and development of services (NHS Act 2006). This chapter looks at whether local residents recall receiving information from the NHS, what kinds of information they would like to receive and how they would like to access it, particularly around digital modes of communication.

Feeling informed about local developments When we asked local residents whether they had received any information from the NHS about developing local health services, we found that there had been little change from 2008. Around a fifth of respondents recall receiving information from the NHS, while three quarters do not recall receiving any information.

Receiving information from the NHS Q

Have you ever received any information from the NHS about plans for developing health services in your local area? Don’t know

Yes

WM 2010

WM 2009

WM 2008

Yes %

No %

Don’t know %

No Base: WM 2010 – 2,000 West Midlands residents, 15 November – 12 December 2010 WM 2009 – 3,528 West Midlands residents, 8 April – 17 May 2009 WM 2008 – 3,564 West Midlands residents, 8 April – 13 May 2008

There is little variation by Cluster for this question, however, there is some variation by demographic group. Higher proportions of respondents aged 25- 34 are not aware of any plans (80%), as is the case with people from minority ethnic groups (81%). In addition, a higher proportion of people from social groups C2DE don’t recall receiving any information about plans for developing health services in their local area (79%).

In the past our surveys found that those who feel better informed are more positive about the future of local health services. However, the results of the survey this year show that this trend is no longer the case. People who feel informed about local service developments are not more likely to feel more optimistic about the future of local services.

Expectations by information received Q

Thinking about health services in your area over the next few years, including any plans you are aware of, do you expect them to . . .? % Get much better % Get much worse

% Get better % Get worse

Those who have received information about local plans (402)

% Stay the same % Don't know

Those who have not received information about local plans (1,508)

% Better

30%

% Better

26%

% Worse

32%

% Worse

30%

Net better

-2

Net better

-4

Base: 2,000 West Midlands residents (base sizes for each group in brackets), 15 November â&#x20AC;&#x201C; 12 December 2010

Feeling informed about value for money and decision making Awareness overall As is shown in the chart below, on the whole, respondents do not feel very informed about how the NHS spends its money locally, who makes decisions about how NHS money is spent locally, or what the NHS is doing locally to provide good value for money to patients and taxpayers. There is slightly better awareness of the current proposals around GP commissioning, but around two thirds state that they know nothing or very little about these changes as well.

Awareness Q How much, if anything, would you say you know about the following . . .? % A great deal % Nothing at all

% A fair amount % Never heard of

. . . how the NHS spends its money locally

2 16

. . . who makes decisions about how NHS money is spent locally

3 16

. . . what the NHS is doing locally to provide good value for money to patients and taxpayers

2 19

. . . the quality of local health services

. . . the Government’s proposals to give more control over the NHS budget to GPs

% Not very much % Don't know

21 21

47 44

101 1 21

Base: 2,000 West Midlands residents, 15 November – 12 December 2010

Across all of these questions there are two groups of respondents who feel better informed: respondents who have seen plans for local developments and respondents who work in the NHS. Across the areas we asked about 32%-38% of respondents who have seen local plans state that they know at least a fair amount about how the NHS spends its money, who makes the decisions and what the NHS is doing to provide good value for money. In addition, almost half of this group state that they know a fair amount / great deal about the new proposals for GP commissioning (47%). This seems to indicate that there is a group of respondents who feel well informed about the NHS, including how effectively the NHS is using its resources and who makes the decisions.

Awareness by information received Q How much, if anything, would you say you know about the following . . .? % A great deal/a fair amount

Seen plans *

Not seen plans ^

(402)

(1,508)

47%

. . . the Government’s proposals to give more control over the NHS budget to GPs

28%

. . . what the NHS is doing locally to provide good value for money to patients and taxpayers

38% 18% 34%

. . . who makes decisions about how NHS money is spent locally

15% 32%

. . . how the NHS spends its money locally 16%

Base: 2,000 West Midlands residents (base size for each group in brackets), 15 November – 12 December 2010 * All who have received information from the NHS about plans for developing health services in their local area ^ All who have not received information from the NHS about plans for developing health services in their local area

Levels of staff awareness are consistently high, with 46%-51% of respondents who work in the NHS feeling well informed about all of the areas probed, rising to 61% knowing at least a fair amount about the proposals for GP commissioning. 19

Who are the most informed groups? As we have seen, awareness of how the NHS spends its budget locally is fairly low amongst all respondents, and there is little variation across demographic groups (in all groups less than a quarter feel that they know at least a fair amount about this). Similarly, there is not much variation in terms of feeling informed about what the NHS is doing locally to provide good value for money for patients and taxpayers. There is some variation by age-group, with the youngest respondents feeling the least well informed, with 81% of those aged 1624 state that they know nothing or very little about this subject. Awareness about who are the current local decision makers in the NHS is similarly low across all groups. In all demographic groups, over 70% state that they know very little or nothing about who makes decisions about how NHS money is spent locally. As we have seen, slightly more respondents have heard about proposals to give more control over the NHS budget to GPs, with almost a third stating that they know at least a fair amount about this (31%). Some differences in awareness emerge by age, with those aged over 65 more likely to state that they know at least a fair amount about the proposals (37%). Higher levels of awareness are also found amongst those in social group ABC1 (35%), amongst those with no children (34%) and respondents who have a disability / someone in their family with a disability (34%). In addition, residents in Arden Cluster are more likely to state that they know a great deal / fair amount about these proposals (38%).

Awareness by cluster: Government proposals on the NHS budget Q How much, if anything, would you say you know about the following . . .? The Governmentâ&#x20AC;&#x2122;s proposals to give more control over the NHS budget to GPs % A great deal % Nothing at all

% A fair amount % Never heard of

% Not very much % Don't know

(310)

Arden 7

(406)

Staffordshire 7

(436)

West Mercia 5

(451)

Bâ&#x20AC;&#x2122;ham & Sol. 5

(397)

Black Country 4

22 22

4 2 21

Base: 2,000 West Midlands residents (base size for each cluster in brackets), 15 November â&#x20AC;&#x201C; 12 December 2010

Please note that results are not representative of the wider NHS staff population. We do not know who respondents are or where they work. 60

What information would people like to receive? After respondents were asked about how much they knew on the subjects above, they were asked on which subjects they would like to receive more information. The most popular option is further information on how the NHS spends its money locally (57%). A similar proportion would like to know more about what the NHS is doing locally to provide good value for patients and taxpayers (56%) and the government’s proposals to give more control over the NHS budget to GPs (55%).

Information preferences Q On which of these subjects, if any, would you like to receive more information? How the NHS spends its money locally What the NHS is doing locally to provide good value for money to patients and taxpayers The Government’s proposals to give more control over the NHS budget to GPs The quality of local health services

Who makes decisions about how NHS money is spent locally None of these Base: 2,000 West Midlands residents, 15 November – 12 December 2010

Access to the internet The NHS is constantly working to improve the ways it engages with patients and the public. NHS organisations are embracing the opportunities offered by digital modes of communication and engagement. As usage of the internet is constantly increasing, it is useful to get an update on a regular basis.

Direct access We asked residents whether they have access to the internet. The survey shows that almost eight in ten respondents have access to the internet, a slight increase from the last time the question was asked in 2009.

Internet access Q

Do you have access to the internet, or not?

WM 2010

WM 2009

Yes %

No %

Net %

+58

+54

Yes Base: WM 2010 – 2,000 West Midlands residents, 15 November – 12 December 2010 WM 2009 – 3,528 West Midlands residents, 8 April – 17 May 2009

As we would expect, access to the internet varies by age group, with younger age groups much more likely to have access. Access is consistent across ethnic groups. As has been found in previous surveys, there are also differences by social background, with those from social groups ABC1 more likely to have access to the internet (86%), compared with those from C2DE (70%). In addition, those who are working are more likely to have access to the internet compared with those who are not (91% compared with 65%), as are those who have children compared with those without children (91% compared with 72%). It is worth noting that a lower proportion of people who have a disability are able to access the internet, than is found amongst those who do not have a disability (73% compared with 80%). No significant differences are found in levels of internet access by Cluster, however, previous surveys have found significant differences by PCT.

Indirect access Over a third of those who do not have access to the internet themselves, are able to get access to the internet via other family members (38%). This means that around 87% of respondents either have access to the internet themselves or are able to get information via others.

Indirect internet access Q Does someone in your family ever use the internet to get information for you, or not? Don’t know

Yes

Base: All who don’t have access to the internet (447 West Midlands residents), 15 November – 12 December 2010

Accessing information on staying healthy and health services We asked respondents where they would look or who they would speak to if they wanted to find out about staying healthy and how to improve their health and where to access health services. As is seen in the chart overleaf the largest group of respondents would look to their GP for this information. The next most important source of information is non-NHS websites which are cited by over a fifth of respondents.

Information about staying healthy Q If you wanted information about staying healthy and how to improve your health where would you look or who would you speak to? (Top 9) Make an appointment with, or contact, my local GP surgery

55%

Other non-NHS websites Other NHS websites

24% 10%

NHS Choices website

Speak to a friend / colleague / family member Make an appointment with other health professionals

8% 6%

I would not look for more information about this

Call NHS Direct

Ask my local pharmacist

Base: 2,000 West Midlands residents, 15 November â&#x20AC;&#x201C; 12 December 2010

More respondents who are aged over 45 state that they would speak to their GP about information on staying healthy (61% compared with 42% amongst those aged 16-24). A higher proportion of people who either have a disability themselves or who have a family member with a disability state that they would talk to their GP, if they wanted information on this subject (61%), as is the case with people who are not working (57%) and people from social group C2DE (58%). If we combine all cases where a website is mentioned, then 38% of respondents state that they would like to use online sources to find information about staying healthy. Amongst younger age groups online methods of finding information are as popular as consulting their GP. If we combine all those who state that they would look for information on a website, then 59% of those aged 16-34 would consult information via an online source. If respondents wanted to find information on where to access health services, the most popular source is still their local GP, although slightly higher proportions also consider other sources. The GP is the most popular choice for respondents aged over 45, with 57% citing this as a source of information. Similarly, the GP is the most popular choice for people who are not working (54%), those without children (52%), those who either have a disability themselves or have someone in their household with a disability (53%). This source is also mentioned by a high proportion of people who do not have access to the internet (63%). Online sources are also popular overall and are mentioned by 24% of all respondents, rising to 60% of those aged under 35. The main online sources mentioned are non-NHS websites which are cited by 21% respondents overall.

Information about accessing services Q If you wanted information about where to access health services where would you look or who would you speak to? (Top 10) Make an appointment with, or contact, my local GP surgery Other non-NHS websites

49% 21%

Other NHS websites

13%

NHS Choices website

13%

Speak to a friend / colleague / family member

Call NHS Direct

Local PCT / hospital trust website

NHS Local Make an appointment with other health professionals Visit a health centre

3% 2% 2%

Base: 2,000 West Midlands residents, 15 November â&#x20AC;&#x201C; 12 December 2010

Digital health NHS organisations are developing a range of digital tools and information to help citizens manage and improve their health. Respondents were asked about their willingness to undertake a range of activities online or via their mobile, and were reassured that the systems involved would be secure.

Interacting with health service professionals online / via mobile As is shown in the chart below, over half of all respondents would be happy to undertake a range of activities online, including making an appointment to see their GP, ordering repeat prescriptions, receiving test results and emailing their GP. There is less demand for having an online consultation with their GP, which might reflect concerns about equipment or confidentiality or a preference for face-to-face consultations.

Online and mobile applications Q Which of the following things, if any, would you like to do online or online via your mobile? The system for doing this would be secure. Make an appointment to see your GP Order repeat prescriptions Receive test results Email your GP Access your medical records Send updates on your health status to your GP

Have an online consultation with your GP None of these Base: 2,000 West Midlands residents, 15 November â&#x20AC;&#x201C; 12 December 2010

As we might expect, across most of these activities, younger respondents, respondents who are working, and those from social groups ABC1 are more likely to say that they would be willing to use online services.20 However, there are some groups where fairly high proportions state that they would not like to carry out any of these activities online or via their mobile. Amongst those who are aged 65 and over, almost half state that they would not like to do any of these activities online (49%), and a quarter of those aged 55-64 would not like to undertake any of these activities online (25%). Nonetheless it is worth noting that there is some enthusiasm amongst people aged over 55 for undertaking some activities online or via their mobile, mainly around more transactional activities such as making appointments or ordering repeat prescriptions. For example, over a third of people aged over 65 would like to make an appointment to see their GP online (37%), or order repeat prescriptions (36%), although there is less enthusiasm for other kinds of activities, particularly having an online consultation with their GP (17%). In addition, higher proportions of people who are not working, and those who are from social groups C2DE state that they would not like to carry out any of these activities online (31% and 26% respectively). Perhaps unsurprisingly, a high proportion of respondents who do not have access to the internet state that they would not like to carry out any of the activities mentioned online or via their mobile (64%).

For example, 84% of those aged 18-24 state that they would like to make an appointment with their GP online, 77% of respondents who are working, 73% respondents from social group ABC1 and 78% of those who have children, which we would expect given the younger profile of this group. 66

Accessing and sharing information on health issues online / via mobile Over two thirds of the people interviewed state that they would like to find services near to where they work or live either online or via their mobile (67%). The majority of respondents would also like to look at information about the quality of services online (64%) and find out about local and national health news (56%). Lower proportions of respondents state that they would like to access advice and support on health issues from other members of the public, although this option is supported by around two fifths of respondents (41%).

Online and mobile applications Q And which of the following things, if any, would you like to do online or online via your mobile?

67%

Find services near to where you live or work

Look at information about the quality of services to help you decide where to go for treatment

64%

Find out about local and national health news

56%

Share your experiences of local NHS services and read about the experiences others have had

49%

Watch videos, listen to and read about the experiences of others who are living with an illness, undergoing treatment or trying to improve their health in some way

46%

Comment on the experience of others who are living with an illness, undergoing treatment or trying to improve their health in some way

43%

Use an app to help improve your health

42%

Access advice and support on health issues from other members of the public

41%

None of these

19%

Base: 2,000 West Midlands residents, 15 November â&#x20AC;&#x201C; 12 December 2010

As we would expect, younger respondents, those from more affluent backgrounds and those who are working are more enthusiastic across all of the options. For example, 83% of respondents who are aged under 35 state that they like to access information on local 67

services online, 77% of those who are working and 72% from social groups ABC1. More enthusiasm is also found amongst respondents who are members of ethnic minority groups which might reflect their younger age profile, with 76% positive about finding services close to where they live or work online. In contrast, almost half of all respondents aged over 65 state that they would not like to undertake any of these activities online (49%). In addition, almost a third of those who are not working (30%), and a quarter of those from social groups C2DE (25%) state that they would not like to carry out any of these activities online or via their mobile. It is important to note that almost a quarter of those who have a disability would not like to carry out any of these activities online (23%), which might reflect their older age profile. As we would expect, a high proportion of people who do not have access to the internet state that they would not like to carry out any of these activities online (61%).

Accessing information on quality A range of questions were asked throughout the survey which aimed to look at how well informed respondents are about the quality of local services and what information they would like to access.

How well informed local respondents feel about quality Local residents feel that they are more informed about the quality of local health services than some other aspects of health service delivery, with half stating that they know a fair amount or a great deal about this (50%). However, a similar proportion feel that they know very little or nothing at all about the quality of local services (48%).

Awareness of the quality of local health services Q How much, if anything, would you say you know about the following . . .? “The quality of local health services” Never heard of (1%)

Don’t know (1%)

Nothing at all

10%

Not very much

A great deal

44%

38%

Base: 2,000 West Midlands residents, 15 November – 12 December 2010

52% say they would like more information about the quality of local health services

A fair amount

Respondents from more affluent backgrounds are more likely to feel informed about the quality of local health services, with 54% from social group ABC1 stating that they know at least a fair amount. Respondents from Staffordshire Cluster are also more likely to feel that they know about the quality of local services with 56% stating that they know a lot / a fair amount. It is worth noting that a higher proportion of those who have a disability themselves or who have a household member with a disability feel that they are informed about the quality of local services (54%), as are those who are carers (57%), those who work in the NHS (72%) and their friends and family (55%). In addition, those who are aware of local plans for the development of services are also more likely to know at least a fair amount (67%).

The desire for more information around quality We asked respondents whether they would like more information on a range of subjects including the quality of local health services. Over half the respondents feel that they would like more information about the quality of local services (see page 61). The desire for more information on the quality of local services is consistent across demographic groups.

Accessing information around quality of treatment in local hospitals If patients want to find out about the quality of treatment available in local hospitals the main source they would turn to is their GP (30%). However, if we combine all cases where websites are mentioned, 40% of respondents would look to the internet for information on the quality of treatment in hospitals. The main online sources mentioned are non-NHS websites (by 21%), NHS websites (by 11%) and NHS choices (by 10%). A high proportion of those aged over 65 state that they would talk to their GP about the quality of local services (41%), as is the case for those who are not working (36%) and for those with a disability (34%). Similarly the GP is the main source of information mentioned by those who do not have internet access (46%).

Information about quality of treatment in hospitals Q If you wanted information about the quality of treatment in hospitals where would you look or who would you speak to? (Top 9) Make an appointment with, or contact, my local GP surgery Other non-NHS websites

30% 21%

Speak to a friend / colleague / family member

17%

Other NHS websites

11%

NHS Choices website Make an appointment with other health professionals Local PCT / hospital trust website

10% 4%

Call NHS Direct

NHS Local 2% I would not look for more information about this 2% Base: 2,000 West Midlands residents, 15 November â&#x20AC;&#x201C; 12 December 2010

Who do people trust to give them information about the quality of treatment in local hospitals The results of the survey show that the main person respondents trust to give them helpful information about the quality of treatment in local hospitals is their GP (50%). Other people who are trusted are family and friends (mentioned by 20%), other health professionals (cited by 10%) and NHS hospitals themselves (mentioned by 8%).

Trusted sources of information Q Which one of the following, if any, would you trust the most to give you helpful information about the quality of treatment in hospitals? Your GP

Information from friends or family Other health professionals, for example hospital doctors and nurses NHS hospitals Other organisations outside the NHS Private hospitals The media Other NHS organisations None of these Base: 2,000 West Midlands residents, 15 November â&#x20AC;&#x201C; 12 December 2010

Willingness to access information on quality online / via mobile A high proportion of respondents would like to access information on the quality of local services online or via their mobile (64%) (see page 67). This figure rises to 78% for those aged under 44. In addition, a higher proportion of people from social groups ABC1 (68%), who are working (74%) and from minority ethnic groups (74%) would like to access information this way. Interestingly, a high proportion of respondents who are NHS staff, and their friends and family, would like to access information in this way (76% and 67% respectively).

Appendices

1. Statistical reliability Because a sample, rather than the entire population, was interviewed the percentage results are subject to sampling tolerances – which vary with the size of the sample and the percentage figure concerned. For example, for a question where 50% of the people in a (weighted) sample of 2,000 with an effective sample size of 1,980 respond with a particular answer, the chances are 95 in 100 that this result would not vary more than two percentage points, plus or minus, from the result that would have been obtained from a census of the entire population (using the same procedures). An indication of approximate sampling tolerances are given in the table below. Size of sample on which the survey results are based

1,980 interviews

Approximate sampling tolerances applicable to percentages at or near these levels 10% or 90% 30% or 70% 50% ± ± ± 1 2 2

For example, with a sample of 1,980 where 30% give a particular answer, the chances are 19 in 20 that the “true” value (which would have been obtained if the whole population had been interviewed) will fall within the range of plus or minus 2 percentage points from the sample result. Strictly speaking, the tolerances shown here apply only to random samples; in practice good quality quota sampling has been found to be as accurate. When results are compared between separate groups within a sample, different results may be obtained. The difference may be “real”, or it may occur by chance (because not everyone in the population has been interviewed). To test if the difference is a real one i.e. if it is “statistically significant”, we again have to know the size of the samples, the percentage giving a certain answer and the degree of confidence chosen. If we assume the “95% confidence interval”, the differences between the two sample results must be greater than the values given in the table below: Size of samples compared

1,980 (NHS West Mids 2010) vs. 3,362 (NHS West Mids 2009) 307 (Arden Cluster) and 446 (Birmingham & Solihull Cluster) 1,751 (white residents) vs. 230 (ethnic minority residents)

Differences required for significance at or near these percentage levels 10% or 90% 30% or 70% 50% + + + 2 3 3 4

2. Definition of social grades The grades detailed below are the social class definitions as used by the Institute of Practitioners in Advertising, and are standard on all surveys carried out by Ipsos MORI (Market & Opinion Research International Limited). Social Grades Social Class

Occupation of Chief Income Earner

Percentage of Population

Upper Middle Class

Higher managerial, administrative or professional

Middle Class

Intermediate managerial, administrative or professional

Lower Middle Class

Supervisor or clerical and junior managerial, administrative or professional

Skilled Working Class

Skilled manual workers

Working Class

Semi and unskilled manual workers

16.9

Those at the lowest levels of subsistence

State pensioners, etc, with no other earnings

11.7

2.9

18.9

27.0

22.6

3. Mosaic groups Group and type names Group

Description

Type

Description

Residents of isolated rural communities

A01

Rural families with high incomes, often from city jobs

A02

Retirees electing to settle in environmentally attractive localities

A03

Remote communities with poor access to public and commercial services

A04

Villagers with few well paid alternatives to agricultural employment

B05

Better off empty nesters in low density estates on town fringes

B06

Self employed trades people living in smaller communities

B07

Empty nester owner occupiers making little use of public services

B08

Mixed communities with many single people in the centres of small towns

C09

Successful older business leaders living in sought-after suburbs

C10

Wealthy families in substantial houses with little community involvement

C11

Creative professionals seeking involvement in local communities

C12

Residents in smart city centre flats who make little use of public services

D13

Higher income older champions of village communities

D14

Older people in large houses in mature suburbs

D15

Well off commuters living in spacious houses in semi rural settings

D16

Higher income families concerned with education and careers

E17

Comfortably off suburban families weakly tied to their local community

E18

Industrial workers living comfortably in owner occupied semis

E19

Self reliant older families in suburban semis in industrial towns

E20

Upwardly mobile South Asian families living in inter war surburbs

E21

Middle aged families living in less fashionable inter war suburban semis

F22

Busy executives in town houses in dormitory settlements

F23

Early middle aged parents likely to be involved in their childrenâ&#x20AC;&#x2122;s education

F24

Young parents new to their neighbourhood, keen to put down roots

F25

Personnel reliant on the Ministry of Defence for public services

G26

Well educated singles living in purpose built flats

G27

City dwellers owning houses in older neighbourhoods

Residents in small and mid-sized towns with strong local roots

Wealthy people living in the most sought after neighbourhoods

Successful professionals living in suburban or semi-rural homes

Middle income families living in moderate suburban semis

Couples with young children in comfortable modern housing

Young, well-educated city dwellers

Group

Description

Couples and young singles in small modern starter homes

Lower income workers in urban terraces in often diverse areas

Owner occupiers in older-style housing in ex-industrial areas

Residents with sufficient incomes in rightto-buy social housing

Active elderly people living in pleasant retirement locations

Elderly people reliant on state support

Young people renting flats in high density social housing

Type

Description

G28

Singles and sharers occupying converted Victorian houses

G29

Young professional families settling in better quality older terraces

G30

Diverse communities of well educated singles living in smart, small flats

G31

Owners in smart purpose built flats in prestige locations, many newly built

G32

Students and other transient singles in multi-let houses

G33

Transient singles, poorly supported by family and neighbours

G34

Students involved in college and university communities

H35

Childless new owner occupiers in cramped new homes

H36

Young singles and sharers renting small purpose built flats

H37

Young owners and rented developments of mixed tenure

H38

People living in brand new residential developments

I39

Young owners and private renters in inner city terraces

I40

Multi-ethnic communities in newer suburbs away from the inner city

I41

Renters of older terraces in ethnically diverse communities

I42

South Asian communities experiencing social deprivation

I43

Older town centre terraces with transient, single populations

I44

Low income families occupying poor quality older terraces

J45

Low income communities reliant on low skill industrial jobs

J46

Residents in blue collar communities revitalised by commuters

J47

Comfortably off industrial workers owning their own homes

K48

Middle aged couples and families in right-to-buy homes

K49

Low income older couples long established in former council estates

K50

Older families in low value housing in traditional industrial areas

K51

Often indebted families living in low rise estates

L52

Communities of wealthy older people living in large seaside houses

L53

Residents in retirement, second home and tourist communities

L54

Retired people of modest means commonly living in seaside bungalows

L55

Capable older people leasing/ owning flats in purpose built blocks

M56

Older people living in social housing estates with limited budgets

M57

Old people in flats subsisting on welfare payments

M58

Less mobile older people requiring a degree of care

M59

People living in social accommodation designed for older people

N60

Tenants in social housing flats on estates at risk of serious social problems

Group

Description

Families in low-rise social housing with high levels of benefit need

Type

Description

N61

Childless tennants in social housing flats with modest social needs

N62

Young renters in flats with a cosmopolitan mix

N63

Multicultural tenants renting flats in areas of social housing

N64

Diverse homesharers renting small flats in densely populated areas

N65

Young singles in multi-ethnic communities, many in high rise flats

N66

Childless, low income tenants in high rise flats

O67

Older tenants in low rise social housing estates where jobs are scarce

068

Families with varied structures living in low rise social housing estates

069

Vulnerable young parents needing substantial state support

4. Reading and Interpreting funnel plots This report contains a number of funnel plots, otherwise known as cross-sectional control charts. These charts show the variation between PCT Cluster results reported against particular questions asked in the telephone survey. The charts help to distinguish real differences between Clusters from those that might be attributable to chance or sampling error (error that results from speaking to only a sample of the population rather than doing a census of the whole West Midlands population)21. This appendix provides information about reading and interpreting these charts. Illustrated example of a funnel plot showing Cluster results Clusters represented by (blue) points within the funnel do not differ significantly from the average.

40% Each point represents a Cluster.

Results (%) for Cluster

35%

30% The horizontal black line indicates the result for the West Midlands as a whole.

25%

The height of the point indicates the result observed for the Cluster. 20% The funnel narrows to the right because as sample sizes increase smaller variations from the West Midlands average are required to detect significant differences.

15%

The horizontal position of the point indicates the sample size on which the Cluster's result is based.

10%

Clusters represented by (red or green) points above or below the funnel differ significantly from the West Midlands average. These are sometimes called special cause variations.

0% 310

330

350

370

390

410

430

450

Number of respondents/ Sample size for Cluster

Each point in the chart represents a Cluster. The height of the point indicates the result observed in the survey for that Cluster, so Clusters achieving higher results appears higher in the chart. The horizontal position of the point indicates the sample size on which that Clusterâ&#x20AC;&#x2122;s result is based, so Clusters with larger sample sizes appear further to the right. The central horizontal black line indicates the result for the West Midlands as a whole. The funnel indicates the degree of variation that can reasonably be attributable to sampling error. The funnel cuts the chart into three distinct regions. Clusters represented by points above the funnel have significantly higher results than the West Midlands average. Clusters 21

The control charts allow us to analyse factors related to sampling error, but please note that other factors such as sample design will not be accounted for. 78

represented by points below the funnel have results significantly lower than the West Midlands average. Points above or below the funnel are shaded in red or green.

Clusters represented by points within the funnel do not differ significantly from the West Midlands average â&#x20AC;&#x201C; these points are shaded blue. Variation within the funnel can reasonably be attributed to chance and sampling error. The charts throughout this report also refer to 2 or 3 sigma. The thinner green and red lines closer to the black West Midlands line are based on 2 sigma. This means that there is a 95% chance (a standard confidence level) that values lying beyond this limit do not result from sampling error. The thicker red and green lines are based on 3 sigma â&#x20AC;&#x201C; there is a 99.7% chance that values lying beyond this limit do not result from sampling error.