Public and Patient views on health services in the West Midlands
Annual Survey Report 2009
Business Analytics Team
Contents
Executive Summary Introduction 1. Perceptions of the NHS 2. Priorities for improvement 3. Engaging with local people 4. GP services 5. Understanding the system: choice & navigation 6. Access to information Appendices 1. Statistical reliability 2. Definition of social grades 3. Mosaic code definitions 4. Reading and interpreting funnel plots 5. GP-led health centres
Executive Summary All NHS organisations have a duty to involve and consult patients and the public in relation to the planning and development of services, and with regard to decisions relating to the operation of services (Section 242, NHS Act 2006). The NHS Constitution also sets out the rights of local people to be involved in the planning of healthcare services. NHS West Midlands has conducted a range of market research activities in recent years, in order to explore public and patient views on local NHS services and the extent to which they feel informed and involved around service development. This report presents the findings of the latest telephone survey, conducted in April / May 2009 and draws upon previous surveys and research to examine how views have changed over time and to try to explain the factors behind the priorities and concerns that are highlighted. The objectives of the representative telephone survey were to: 1. Understand residents’ general perceptions of the NHS 2. Understand their priorities for improvement in healthcare services 3. Explore how far people feel that their local NHS seeks their views and listens to them 4. Explore access to GPs and satisfaction with GP services 5. Look at whether local people understand how the health system works, focusing on choice and navigation 6. Explore the information on health services that residents are able to access, and the opportunities offered in terms of digital modes of communication.
Perceptions of the NHS Residents’ expectations for the future of their local health services have not changed substantially since the survey was last conducted in 2008. The greatest proportion of citizens states that they expect services to remain the same over the next few years (43%), while over a third expect them to get better (33%), and a fifth think that they will get worse (21%). In comparison with the results for last year’s survey, there is less variation between PCTs in public confidence in the future of the NHS. Although the regional average has remained unchanged, there has been a narrowing of the range of responses across PCTs. At the time of the survey, the ‘credit crunch’ and potential effects on public sector funding availability were being widely discussed in the media. In order to gauge how 3
this was being perceived by the public, respondents were asked about how concerned they were about the credit crunch and its effect on the NHS. The findings indicate that people are worried about funding issues, with three quarters stating that they are concerned (75%) and around two in five stating that they are very concerned (44%). Overwhelmingly, residents in the West Midlands are satisfied with the NHS, with 72% satisfied with the way that the NHS is being run. This is similar to national findings (DH Tracker 73%), and a substantial improvement from the last time the question was asked in 2006 (61%). As is found in many surveys, satisfaction with the NHS at the local level is higher than with national provision and government policies for the NHS. While 79% of respondents agree that their local NHS is providing them with a good service, 64% feel that the NHS is providing a good service nationally and 38% agree that the government has the right policies for the NHS. This is consistent with survey findings across the country as a whole.
Priorities for improvement The survey explored the areas where people feel local healthcare services are in need of improvement. As we have noted, overall satisfaction with NHS services remains high, but there are clear messages about the areas where the public feels that extra attention is needed. Improving cleanliness in hospitals is highlighted by respondents as the factor which is most in need of improvement, 16% of respondents highlight this as the most important priority for improvement. Waiting times in A&E are also seen as an important priority for improvement, with 14% of respondents stating that this is the most important factor for improvement. When we compare the results of the survey with the views expressed last year, there has been an increase in the proportion of people who feel that A&E waiting times are in need of improvement, however for other aspects, the proportion of respondents who feel that improvements are needed either remains the same or has fallen. The proportion of people who feel that access to an NHS dentist is in need of improvement has decreased, this has been particularly affected by improved perceptions of access in Herefordshire.
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Engaging with local people As part of the survey a set of questions were asked to gain feedback which will help inform PCTs as part of the World Class Commissioning process. These questions look at how well local people feel that the NHS helps them to stay healthy, listens to them and seeks their views on local service development. A high proportion of respondents to the survey agree that the NHS helps them and their family to stay healthy (72%) and that there is good communication between healthcare staff (61%). There are no significant differences between PCTs on the results for these questions. Older respondents, those with a disability and those with experience of using certain services are more positive about these aspects of service provision. However, the results are less positive around whether local people feel that they are invited to give their views on local healthcare services. Overall, more people disagree (44%) that their local NHS asks for their views on services than agree (42%). Residents in Heart of Birmingham and Coventry are more positive, with 50% and 49% of residents respectively agreeing that they are invited to give their views. As part of the survey we aimed to look at whether people feel that the NHS is open to feedback about services and responds to the comments made. This question was answered slightly more positively than the previous question on whether people are asked to give their views. Overall, 46% of respondents agree that they feel able to feedback on health services and believe that their local NHS acts on this feedback. However, almost a third (32%) disagree, while 9% feel that they don’t know. Again, residents in Heart of Birmingham were slightly more positive, with 54% agreeing that they feel able to give feedback and be listened to. As part of the survey we asked residents whether they feel informed about how good NHS services are in their local area. The responses show that just over half the respondents agree that they are well informed (54%), while around a third disagree (33%). Residents in Walsall answered this question more positively, with 65% agreeing that they are well informed.
GP Services Satisfaction with GP services remains very high overall. Areas where there are particularly high levels of satisfaction are around the appearance of the surgery, the proximity of services, the accessibility of the surgery and around the medical and listening skills of GPs. There are more residents who are dissatisfied with the availability of car parking, the amount of choice available over the date and time of the appointment, and how easy it is to get through to the surgery to make an appointment. While levels of satisfaction are high across the region, there are certain PCTs where satisfaction is lower. In particular, over a third of residents in Heart of Birmingham PCT stated that they were dissatisfied with the ease of getting through to the surgery to make an appointment (34%), the length of time between making the 5
appointment and attending the surgery (34%), the choice of date and time of appointment (40%) and car parking (37%). The results show that demand for evening appointments is highest amongst those of working age. Over 40% of respondents aged between 25-54 state that they would prefer an evening appointment. In addition, half of those who are working full time would prefer an evening appointment.
Access to information The last time we conducted the survey, we found that there was a strong correlation between an individual feeling informed about what was happening in their local NHS and feeling confident about the future of services. When we asked local residents whether they had received any information from the NHS about plans for developing health services, we found that there had been little change from 2008 in the proportion of citizens who had received information. Overall 18% of respondents state that they have received some information, while the vast majority have not or do not know whether they have received information (82%). Once again, there was some variation by PCT with a higher proportion of those living in Walsall and South Birmingham feeling informed about plans for the development of local services. We also asked those who had seen plans about whether they had found them useful. Those who have seen plans tend to think that they had been useful (68%). However, around a third had not found them useful or could not remember (32%). As the fact that people feel well informed about local services has an impact on their confidence for the NHS, we probed into what plans people thought they had seen. The highest proportion of people refer to hospital developments or redevelopments, although a wide spectrum of information is mentioned. Thus although the fact that people feel informed about local plans has an impact on their confidence for the NHS, it’s difficult to pin down exactly what this relates to. It seems to be that a general perception about being informed about local developments in the NHS makes people more positive. As the NHS is constantly finding new ways to engage with citizens and patients, it is important to have up-to-date and detailed information on where people access information on health services. In particular, the potential opportunities offered by digital modes of communication and engagement need to be fully understood. As usage of the internet is constantly increasing, it is useful to get an update on this element on a regular basis. We asked respondents about whether they have access to the internet. The survey shows that over three quarters of respondents have access to the internet. As we would expect, access to the internet varies by age group, with younger age groups much more likely to have access. Over 90% of those aged 16-44 have access to the internet, and access is consistent across ethnic groups. A lower proportion of residents in Sandwell have access to the internet (69%). 6
Although a high proportion of residents within the region have access to the internet, only around a third of residents use the internet for accessing health information at least once every month or two, and only 15% do so regularly (at least every couple of weeks). Hence, there appears to be scope to improve the health information and services that people are able to access online. The SHA is currently developing digital services which will give local citizens and staff access to a range of tools and information to help them manage and improve their health.
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Introduction All NHS organisations have a duty to involve and consult patients and the public in relation to the planning and development of services, and with regard to decisions relating to the operation of services (Section 242, NHS Act 2006). The NHS Constitution also sets out the rights of local people to be involved in the planning of healthcare services. NHS West Midlands has conducted a range of market research activities in recent years, in order to explore public and patient views on local NHS services and the extent to which they feel informed and involved around service development. This report presents the findings of the latest telephone survey, conducted in April / May 2009 and draws upon previous surveys and research to examine how views have changed over time and to try to explain the factors behind the priorities and concerns that are highlighted.
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 £8.4 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 implementation of its Strategic Framework, Investing for Health, the SHA has commissioned a range of research to understand residents’ attitudes to healthcare. As part of this, a telephone survey with a representative sample of residents was undertaken. The objectives of this research were to: 1. Understand residents’ general perceptions of the NHS 2. Understand their priorities for improvement in healthcare services 3. Explore how far people feel that their local NHS seeks their views and listens to them 4. Explore access to GPs and satisfaction with GP services 5. Look at whether local people understand some aspects of how the health system works, focusing on choice and navigation 6. Explore the information on health services that residents are able to access, and the opportunities offered in terms of digital modes of communication.
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Methodology The findings of the research presented in this report have been derived from 3,528 telephone interviews with West Midlands residents, each lasting for around 25 minutes. All interviews were conducted between 8 April and 17 May 2009. Quotas were set by PCT to ensure that the number of interviews gained in each PCT is proportional to the size of that PCT in relation to others in the West Midlands. Further quotas were set on gender, age, working status and ethnicity within each PCT to ensure that the profile of those interviewed matches the profile of each PCT’s population as closely as possible, according to the 2001 census. Data were also weighted by the size of each PCT and then the gender, age, working status, ethnicity and social class profile within each PCT according to the 2001 census.
Previous research Similar surveys were previously carried out by Ipsos MORI on behalf of NHS West Midlands in 2006 and 2008. 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 among 3,535 residents. In addition, results are given for the December 2008 national tracking survey for the Department of Health. These results are based on 1,003 face-to-face interviews with English residents, carried out between 17 November and 15 December 2008. Comparisons are indicative only as the methodologies differ.
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 9
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 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 and Caroline Booth at IpsosMORI for co-ordinating the annual telephone survey fieldwork and providing insights on the results. Special thanks also go to the 3,564 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 Priorities for improvement Engaging with local people GP services Understanding the system: choice & navigation Access to information
© NHS West Midlands
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1. Perceptions of the NHS Survey data continually demonstrates how valued the NHS is by local people. The NHS Constitution emphasises that the NHS belongs to everyone and the importance of local people being involved in the planning and delivery of care. The survey explored how confident people feel about local services and their level of satisfaction with the way the NHS is being run. This chapter analyses residents’ expectations for local NHS services over the next few years. The factors which influence these expectations are also explored in detail. General satisfaction with the NHS is then considered, alongside the factors which are associated with higher levels of satisfaction.
Will the local NHS get better or worse? Residents’ expectations for the future of their local health services have not changed substantially since the survey was last conducted in 2008. The largest proportion of citizens state that they expect services to remain the same over the next few years (43%), while over a third expect them to get better (33%), and a fifth think that they will get worse (21%).
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 worse Get worse
Get much better
* Please note question wording differs in these two surveys – “Thinking about health services in your area over the next few years, do you expect them to…”
3% 7% Get better
17%
27%
43% Stay about the same
WM 2009
WM 2008
WM 2006*
DH Tracker*
Better
33
33
27
27
Worse
21
22
40
36
Net better
+13
+11
-13
-9
Base: 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 DH Tracker – 1,003 English residents, 17 November - 15 December 2008 – please note this was conducted face-to-face rather than by telephone so results are not strictly comparable
The context in which the survey took place was very different this year. At the time when the last survey was conducted in 2008, some of the major concerns and problems relating 11
to the banking sector had not yet emerged. Hence, given that the general economic environment has changed, the fact that optimism in local NHS services has not been affected is reassuring. There are differences in peoples’ expectations for the NHS based on PCT and sociodemographic groups, which are explored in the section below. Some of the factors which might drive these differences are also discussed.
Who are the most positive and negative residents? In comparison with the results for last year’s survey, there is less variation in confidence between PCTs. Although the regional average has remained unchanged, there has been a narrowing of the range of responses across PCTs and more PCTs have results which are similar to the regional average. The chart overleaf shows that respondents in Stoke on Trent, South Staffordshire, Heart of Birmingham and South Birmingham are more optimistic than in other PCTs. It is interesting to note that three of these areas have welldeveloped plans and new developments – ‘Fit for the Future’ in Stoke on Trent (and North Staffordshire), ‘2010’ / ‘Right Care Right Here’ in Heart of Birmingham (and Sandwell), and the new hospital developments in South Birmingham. The chart overleaf shows variations in expectations by PCT 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). Thus, certain PCTs have results which vary from the West Midlands average, after taking account of possible sampling error. In PCTs with blue markers, optimism is broadly in line with the average across the West Midlands, and any variation could be a result of this sampling error. In PCTs with green markers, optimism is higher than the West Midlands average and there is a good chance this is due to actual differences rather than to sampling error (particularly for the darker green markers). In PCTs with red markers, optimism is lower than the West Midlands average and there is a good chance this is due to actual differences rather than to sampling error (particularly for the darker red markers). Please refer to the appendices for more details.
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Perceptions for the future of local NHS services, analysed by PCT PCT West Midlands Upper Control Lim it (2 sigm a)
50%
Lower Control Lim it (2 sigm a) Upper Control Lim it (3 sigm a)
Stoke
Lower Control Lim it (3 sigm a)
45% % answering 'much better' or 'better'
HoB
40%
S Staffs
S Bham
N Staffs
Wals
BEN
35% Wolves
Sand
30%
Warks
Worcs
Cov Dudley Sol Shrops
25%
Herefs
T&W
20%
15%
150
170
190
210
230
250
270
290
310
Number of respondents
(Base: 3528 respondents, 8 April – 17 May 2009, Q: Thinking about health services in your area over the next few years, including any plans you area aware of, do you expect them to‌?)
We looked at the results for each PCT for 2008 and 2009 to examine whether there had been any significant change in the proportion of residents who were confident about the future of NHS services in the local area. If we take into account the variation in results which could be due to sampling methodology the only PCT which has a significant variation between the two years is South Staffordshire. The proportion of respondents who say that they expect services to get better or much better has increased from 27% in 2008 to 42% in 2009. Further analysis would be needed to investigate possible reasons behind this increase, looking at the impact of lots of factors on public views, including a critical report on a particular hospital. So what other factors might account for the variations in expectations? 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). 1 2
1
A definition of social grade can be found in the appendices Overall, 36% of those in social groups C2DE feel that services will get better, compared with 30% from social groups ABC1. 2
13
330
Expectations by ethnicity 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
White
Ethnic minority
% Get better % Get much worse
6
26
11
% Stay about the same % Don't know
44
34
18
33
Net better
33
+11
15 3 4
+27
Base: 3,118 white West Midlands residents and 402 ethnic minority residents, 8 April – 17 May 2009
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 . . .? % Get much better % Get worse
% Get better % Get much worse
7 31 12 24 Independent older people, relatively active lifestyles 10 24 Close knit, inner city, manufacturing town 29 communities 7 Low income families, estate based social housing 7 28 Older families living in suburbia 6 27 Upwardly mobile families, homes bought from social 26 landlords 8 Younger families living in newer homes 4 25 Career professionals living in sought after locations 5 23 Social housing with uncertain employment 5 27 People living in rural areas far from urbanisation 4 23 Educated, young, single, in area of transient pop. Older people, social housing, high care needs
Base: 3,528 West Midlands residents, 8 April - 17 May 2009
14
% Stay the same % Don't know
41 46 48 38 42 44 39 50 48 38 48
15 23 15 3 13 22 19 4 4 18 33 16 4 4 19 4 3 16 22 18 42 34 23 20 32
Net better +21 +21 +19 +14 +14 +14 +12 +12 +7 +5 +5
Other factors were examined to determine their explanatory potential. One of these was whether the respondent recalled seeing any plans as to future health care developments in their areas. Those who felt that they had seen plans, were more positive about the future of the NHS. Chapter six examines awareness of local plans in more detail.
Expectations – impact of receiving information 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
% Stay the same % Don't know
Those who have received information about local plans
Those who have not received information about local plans
(640)
(2,809)
4% 3% 11% 11%
3% 3%6% 19% 25%
35% 36% 44% % Better
46%
% Better
30%
% Worse
14%
% Worse
22%
Net better
+32
Net better
+8
Base: 3,528 West Midlands residents, 8 April - 17 May 2009
We will now look at some of the reasons given by those people who felt pessimistic about the future for local health services.
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Why will local health services get worse? For those who feel that health services are likely to get worse, the most frequently cited reason given is that there is less money. Other reasons commonly mentioned are the growing population the NHS has to cater for and a perception that there is a shortage of staff and doctors.
Reasons health services will get worse Q Why do you think it will get worse? WM 2008 %
Top 10 mentions Less money (unspecified)
17%
Growing population/too many people
15%
Staff shortages/fewer doctors/nurses
14%
Impact of financial problems/credit crunch on funding
12%
Government policies/initiatives
11%
13 16 13 n/a 8
Hospital closures/A&E closures/fewer hospitals
9%
17
Too much money wasted
9%
6
Lack of organisation/badly run/poor management People from abroad/foreigners/asylum seekers
7%
7
Already getting worse
7%
15
8%
Base: All who think local health services will get worse over the next few years (2009: 741, 2008: 800)
16
12
The perception that local services will get worse because of financial constraints is a particular issue for those aged over 35 (for example, 22% of those aged 55-64 give this as a reason that things will get worse). In addition, people from a white ethnic group are more likely to cite this as a reason things will get worse (19% compared with 3% from a minority ethnic group). People from social grades ABC1 who expect services to get worse are more likely to specifically mention the financial problems or the ‘credit crunch’ as a factor (15%), compared with people from social grades C2DE (9%) (ABC1 equates to administrative, managerial and professional occupations – see appendices for further explanation). Younger people aged (16-24 were also more likely to specifically refer to financial problems or the ‘credit crunch’ (21%). It is important to note that this question looks only at the views of those who expect services to get worse over the next few years. Later in the survey, a question was asked of everyone to gauge their concern about financial issues in relating to NHS funding overall. We will now go on to look at the results for this question.
Concerns about funding in the NHS At the time of the survey, the ‘credit crunch’ and potential effects on public sector funding availability were being widely discussed in the media. In order to gauge how this was being perceived by the public, respondents were asked how concerned they were about the credit crunch and its effect on the NHS. The findings indicate that people are worried about funding issues, with four in ten stating that they are very concerned (see chart below).
Concern about NHS funding Q How concerned are you, if at all, that the credit crunch might reduce the funds available for the NHS? Don’t know Not at all concerned Not very concerned
8%3% 14%
44%
31%
Fairly concerned Base: 3,528 West Midlands residents, 8 April – 17 May 2009
17
Very concerned
Some variation by demographic group is evident, as older respondents, those with a disability, respondents from an ethnic minority group and those who are carers are more likely to state that they are ‘very concerned’ about funding issues.3 In addition, for those who state that they expect the NHS to get worse over the next few years, 59% are very concerned about the credit crunch affecting the funding for the NHS. The chart below shows differences in perceptions by age group in detail.
Concern about NHS funding by age Q How concerned are you, if at all, that the credit crunch might reduce the funds available for the NHS? Very concerned
Fairly concerned
Not very concerned
28%
Not at all concerned
38%
Don't know
9% 5%
20%
(466)
16-24
(541)
25-34
(565)
35-44
(650)
45-54
49%
(589)
55-64
50%
30%
10% 7%2%
(713)
65+
52%
29%
9% 7%4%
36%
32%
45%
19%
29% 30%
10%3%
15% 7%3% 12% 6%3%
Base: 3,528 West Midlands residents (base size for each age group shown in brackets), 8 April - 17 May 2009
The graph overleaf shows the proportion of residents in each PCT who feel fairly concerned or very concerned that the credit crunch might affect the funds available for the NHS. It shows that there are no differences between PCTs – a relatively high proportion in all PCTs are concerned.
352%
of those from ethnic minority groups state that they are very concerned, as do 49% from social groups C2DE, 51% of those with a disability, and 51% of those who are carers, compared with 44% overall. 18
Concern about the effect of the credit crunch on NHS funding, by PCT PCT West Midlands Upper Control Lim it (2 sigm a)
90%
Lower Control Lim it (2 sigm a) Upper Control Lim it (3 sigm a) Lower Control Lim it (3 sigm a)
% answering 'concerned' or 'very concerned'
85%
Wals
80%
N Staffs
75%
T&W Wolves
Cov Dudley Sand
Shrops
Warks
HoB Sol
BEN S Bham
S Staf f s
Worcs
70%
Stoke
Herefs
65%
60%
55% 150
170
190
210
230
250
270
290
310
330
Number of respondents
(Base: 3528 respondents, 8 April – 17 May 2009, Q:How concerned are you, if at all, that the credit crunch might reduce the funds available for the NHS?)
The results suggest that there is a concern around funding issues across the population, with people in older age groups, people from minority groups, those with a disability and those who are carers being the most concerned. The results have implications for communication strategies around changes in service provision, savings and improvements in efficiency.
Overall satisfaction with the NHS Overwhelmingly, residents in the West Midlands are satisfied with the NHS. The graph overleaf demonstrates that 72% are satisfied with the way that the NHS is being run. This is similar to the national DH tracker figure, and a significant improvement from the last time the question was asked in 2006 (the question was not asked in 2008).
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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
2009
7%1% 26%
12% 9%
WM 2009
WM 2006
DH Tracker
Satisfied
72
61
73
Dissatisfied
18
27
13
Net satisfied
+53
+34
+60
45% Base: WM 2009 – 3,528 West Midlands residents, 8 April - 17 May 2009 WM 2006 – 3,535 West Midlands residents, 8 August - 8 September 2006 DH Tracker – 1,003 English residents, 17 November - 15 December 2008 – please note this was conducted face-to-face rather than by telephone so results are not strictly comparable
High levels of satisfaction are found across the region. When we account for variation which may be caused by sampling error, it is evident that the results for individual PCTs are not significantly different to the regional average, with the exception of Solihull where levels of satisfaction are slightly higher.
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Overall satisfaction with the NHS, by PCT PCT West Midlands
Upper Control Limit (2 sigma) Lower Control Limit (2 sigma)
85%
Upper Control Limit (3 sigma) Lower Control Limit (3 sigma)
80% % answering 'strongly agree' or 'agree'
Sol
75%
S Staffs
S Bham
Sand Wolves
Shrops N Staffs
70%
Dudley
Wals
BEN Warks
Cov
Herefs HoB
Worcs
T&W
Stoke
65%
60%
55%
50% 150
170
190
210
230
250
270
290
310
330
Number of respondents
(Base: 3528 respondents, 8 April – 17 May 2009, Q: Overall, how satisfied or dissatisfied are you with the running of the National Health Service nowadays?)
The chart overleaf demonstrates that there is a general improvement in satisfaction across PCTs, although please note that not all changes in the chart are statistically significant.
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Overall satisfaction with the NHS by PCT Q
Overall, how satisfied or dissatisfied are you with the running of the National Health Service nowadays?
% Very satisfied % Neither/nor % Very dissatisfied
% Fairly satisfied % Fairly dissatisfied % Don't know/Refused
Shropshire County
31
41
9
Wolverhampton
30
43
8
Worcestershire
30
43
12
Herefordshire
30
Solihull Care
29
South Staffordshire
28
Stoke on Trent
28
38
14
Warwickshire
27
43
10
South Birmingham
26
48
Sandwell
26
48
Birmingham East and North
26
45
Dudley
24
48
6
15
Coventry Teaching
24
45
9
11
Walsall
23
48
7
14
Heart of Birmingham
23
44
North Staffordshire
21
50
Telford & Wrekin
17
39
13
10 7
67
73
59
8 1
69
59
5 10 4 2
79
69
7 10 7 1
75
61
4 1
66
60
12
6 2
70
54
9
8
7 1
75
68
8
11
7
74
58
3
71
60
5 2
72
61
70
62
71
66
1
67
71
7 *
71
53
67
64
10 6 14
50
14
5
11
15
9
6
10
13
50
2
73
8
47
Satisfied Satisfied 2006 2009 % % 5 1 72 57
7
8 * 11
9 14
3
8
2
Base: 2009 – 3,528 West Midlands residents, 8 April - 17 May 2009 2006 – 3,535 West Midlands residents, 8 August - 8 September 2006 c. 175 – 300 residents per PCT
Some differences are evident by age group. As is seen in the graph overleaf, those aged 65 and over are the most positive, as is found throughout the results of the survey. 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 (30% compared with 22%). Those who are more satisfied with how the NHS is being run are also more likely to feel that the NHS will get better over the next few years, as 79% of those who are satisfied expect the NHS to improve, compared with 12% of those who are dissatisfied. Those who have received information about local plans are also more likely to say that they are satisfied with the NHS (77%).
22
Overall satisfaction with the NHS by age 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
(466)
16-24
22
(541)
25-34
22
(565)
35-44
19
(650)
45-54
21
(589)
55-64
(713)
65+
% Neither/nor % Don't know
51
12
48
13
49
40 44
8 5 2
+61
5 1
+53
12
10
14
6 1
+47
8
14
7 1
+49
15
9 1
+45
5 8
7 1
+64
49
28
Net Satisfied
6 35
Base: 3,528 West Midlands residents (base size for each age group shown in brackets), 8 April - 17 May 2009
We now will focus on how well people feel that local services are being delivered, looking at perceptions of local provision and national policies.
Overall satisfaction with local services As is found in many surveys, satisfaction with the NHS at the local level is higher than with national provision and government policies for the NHS. The national DH tracker figure demonstrates that views in the West Midlands are consistent with those in the country as a whole.
Satisfaction with national and local NHS Q To what extent, if at all, do you agree or disagree with each of DH the following statements?
WM 2006 Tracker
% Agree My local NHS is providing me with a good service
The NHS is providing a good service nationally
% Disagree
79%
14%
64%
The government has the right policies for the NHS
38%
23%
42%
% agree % agree 70
76
51
65
24
37
Base: WM 2009 – 3,528 West Midlands residents, 8 April - 17 May 2009 WM 2006 – 3,535 West Midlands residents, 8 August - 8 September 2006 DH Tracker – 1,003 English residents, 17 November - 15 December 2008 – please note this was conducted face-to-face rather than by telephone so results are not strictly comparable
23
Satisfaction with the local NHS has increased since the last time the question was asked in 2006. When asked whether they agree that their local NHS is providing them with a good service, the overwhelming majority agree (79%, compared with 70% in 2006).
Perceptions of the NHS locally 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
% Neither/nor % Don't know / no opinion
2009
1% 8% 6% 6%
WM 2009
WM 2006
DH Tracker
Agree
79
70
76
Disagree
14
21
12
Net Agree
+65
+49
+64
38%
41% Base: WM 2009 – 3,528 West Midlands residents, 8 April - 17 May 2009 WM 2006 – 3,535 West Midlands residents, 8 August - 8 September 2006 DH Tracker – 1,003 English residents, 17 November - 15 December 2008 – please note this was conducted face-to-face rather than by telephone so results are not strictly comparable
As can be seen in the chart below, satisfaction varies by age, with the most positive residents being the oldest and youngest age groups.
Perceptions of the NHS locally 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
(466)
16-24
(541)
25-34
(565)
35-44
(650)
45-54
78%
+63
(589)
55-64
79%
+62
(713)
65+
81%
+71 +61
76% 74%
+57
84%
+73
Base: 3,528 West Midlands residents (base size for each age group shown in brackets), 8 April - 17 May 2009
24
The chart below shows the proportion of people in each PCT who agree that their local NHS is providing them with a good service. A higher proportion of residents in South Birmingham are positive about their local NHS, and a lower proportion in Telford & Wrekin.
Perceptions of the NHS locally, by PCT PCT West Midlands
Upper Control Lim it (2 sigm a) Lower Control Lim it (2 sigm a)
90%
Upper Control Lim it (3 sigm a) Lower Control Lim it (3 sigm a)
85% % answering 'strongly agree' or 'agree'
S Bham Sol
Herefs
Dudley
Wolves
Warks
80%
BEN
Shrops Stoke
Worcs
Sand Wals N Staffs
S Staffs
75% HoB
Cov
T&W
70%
65%
60% 150
170
190
210
230
250
270
290
310
Number of respondents
(Base: 3528 respondents, 8 April – 17 May 2009, Q: To what extent, if at all, do you agree or disagree with each of the following statements – My NHS is providing me with a good service?)
There has been a general improvement in satisfaction with the NHS across PCTs compared with the last time the question was asked. There has been a particularly large increase in Herefordshire - the proportion of residents who agree that their local NHS is providing them with a good service has increased by 16 percentage points (66% of respondents agreed with the statement in 2006, compared with 82% in 2009). The results from this section of the survey are reassuring, as levels of satisfaction in the region are in line with those found nationally. In addition, it seems that there is more consistency in terms of confidence in the NHS across the region. As overall satisfaction with the NHS is high, we also asked about areas where improvements are needed. We need to understand the concerns people may have about local services. We turn to look at this aspect of citizens’ views in the next chapter.
25
330
2. Priorities for improvement This chapter looks at the areas where people feel local healthcare services are in need of improvement. As we have noted, overall satisfaction with NHS services remains high, but there are clear messages around the areas where the public feels that extra attention is needed. The results are positive, in that they show that the public are slightly less concerned about some aspects of service provision, such as access to NHS dentists, compared with the last time the survey was undertaken. However, there are still some themes, such as hospital cleanliness, which remain a prominent concern.
Perceived areas for improvement The Operating Framework for the NHS for 2010/11 sets out the five national priorities for the NHS as: improving cleanliness and reducing healthcare-associated infections (HCAIs); improving access through achievement of the 18-week referral to treatment targets, and improving access to GP services (including at evenings and weekends); keeping adults and children well, improving patient experience, and staff satisfaction and engagement; and preparing to respond in a state of emergency, such as an outbreak of a new pandemic. Alongside these priorities, we need to understand what the public and patients perceive to be the most important priorities for the NHS to concentrate on. We asked all those who took part in the survey to outline which were 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 above. Since the survey was undertaken last year there has been little change in the overall areas where the public feel 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 access to services to improve their own health, the time spent waiting for an ambulance following a 999 call and information on local services. Residents highlight waiting times in A&E, ease of access to an NHS dentist and cleanliness in hospitals as areas where the most improvement is needed.
26
Need for improvement 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 2008
WM 2006
55
57
30
32
62
70
31
21
52% 42%
54
57
39
38
48% 42%
48
60
39
30 56
59%
Time spent waiting in A&E Departments
29% 56%
Ease of access to an NHS dentist**
36%
Cleanliness of hospitals Waiting time before getting appointments with hospital consultants Hospital waiting lists for non-emergency operations
44% 37%
47 33
29
Services to support people at the end of their lives
43% 34%
43
N/A
34
N/A
Services for supporting people with mental health problems
42%
46
N/A
24
N/A
39
40
59
58
32
35
64
62
29
30
59
63
28
36
35
35
35
38
58
57
24
27
66
66
31
34
52
50
26
25
71
72
21
28
25%
Length of time it takes to get an appointment with a GP
36%
General condition of hospital buildings
35%
Quality of nursing care in hospitals
35%
63% 61% 55% 34% 38%
Services for treating cancer
30%
Information about local health care services
64% 30%
Quality of medical treatment in hospitals*
61% 27%
Amount of choice people have about with GP they can register with Quality of medical treatment by GPs Services for treating heart disease Access to services to improve your own health Time spent waiting for an ambulance after 999 call Base:
55% 23% 75% 21% 40% 18% 60% 13% 50%
39
39
19
N/A
58
N/A
12
13
47
51
2009: 3,528 West Midlands residents; 8 April – 17 May 2009 2008: 3,564 West Midlands residents, 8 April – 13 May 2008 2006: 3,535 West Midlands residents, 8 August – 8 September 2006 * 2006 wording “Quality of medical care in hospitals” ** 2006 wording “Ease of registering with an NHS dentist”
The chart overleaf compares perceived need for improvement in 2008, with the current results. Those areas in the top right hand corner of the quadrant are those where there is a perceived high need for improvement and concerns have heightened since 2008. Those in the bottom right quadrant are areas where there is a perceived high need for improvement and a decrease in concern compared with 2008.
27
Perceived need for improvement – comparison of results for 2008 & 2009
% change in 'a lot' or a 'f air amount' since 2008
8 Cancer services
6
Quality of nursing care in hospitals
Quality of medical treatment in hospitals
4
A&E waiting times Gen condition of hospital buildings
2
Hospital consultant appointment waiting times
0
End of life services
-2 Quality of medical treatment by GPs
-4
Choice of GP (registration)
Info about local health services
-6
Cleanliness of hospitals GP appointment waiting times Waiting lists for nonemergency operations Mental Health services Ease of access to NHS dentist
-8 0
10
20
30
40
50
60
70
% stating 'a f air amount' or 'a lot' of improvement needed
(Base: 3528 respondents, 8 April – 17 May 2009, 3564 respondents 8 April -13 May 2008. 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?)
. When we look at the degree to which people feel individual aspects are in need of improvement we can see that on the whole, respondents are more positive than in previous surveys. There is an increase in the proportion of people who feel that A&E waiting times are in need of improvement, however for many other aspects, the proportion of respondents who feel that improvements are needed either remains the same or has fallen. The proportion of people who feel that access to an NHS dentist is in need of improvement has decreased, this has been particularly affected by improved perceptions of access in Herefordshire. If we look at 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 A&E waiting times. Perceptions of A&E waiting times have worsened since last year and the perceived need for improvement is high. In addition, concern around waiting times for appointments with hospital consultants remains fairly high despite considerable attention being focussed on this aspect of health care, and 18 week targets being achieved in December 2008. Improving perceptions of waiting times Other survey work we have completed suggests that awareness of reduced waiting times is fairly low amongst the local population.4 A postal survey was conducted between November 2008 and January 2009 with patients who had been referred for planned care in June and July 2008. Across the region, 54% of respondents were concerned about the time 4
Patients’ Experience of Using Planned Care in the West Midlands (2009). (http://www.wmqi.westmidlands.nhs.uk/patient-experience/) 28
they would need to wait when they were first referred for treatment. In contrast, 77% of those who had started treatment were happy with the amount of time they had to wait for treatment to start. Focus group work also confirmed that the improvements in waiting times were taking some time to filter through to the general population.5 If you've got nothing to compare to then it's a bit tricky to have expectations Male with long-term condition, Solihull, ABC1, age 35-54 I thought it'd probably be about three months, the general perception you get from the media and all that sort of thing, but in actual fact it worked out quicker than that Male, Solihull, C2DE, age 55+
In addition, this work showed that patients feel more reassured about waiting if they are given more information about their condition and what they can do to help their recovery before they see a consultant. This is summed up in the quote below. More information on what’s wrong with you. What’s wrong with you, what are the consequences, and how you can alleviate your problem while you’re waiting Male, South Asian, Stoke, age 35-54
The results of the postal survey and focus group work have been shared with PCTs who have developed action plans around improving patient experiences.
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 among the services they flagged as needing most improvement. The chart below shows that improving cleanliness in hospitals is highlighted by respondents as the factor which is most in need of improvement. Waiting times in A&E have emerged as the second priority for improvement this year, in contrast to the last time the survey was conducted when access to NHS dentists was deemed to be a more urgent priority. The decrease in the priority given to access to NHS dentists reflects improvements in certain PCTs where concerns were high last year (e.g. Herefordshire).
5
Planned Care Patient Experience (2009) (http://www.wmqi.westmidlands.nhs.uk/patientexperience/) 29
Priorities for improvement Q
Which one of these, if any, is most important to improve? WM 2008 Cleanliness of hospitals
16% 14%
Time spent waiting in A&E Dept Ease of access to an NHS Dentist
11%
18% 11% 16%
Length of time it takes to get an appointment with a GP
8%
10%
Services for supporting people with mental health problems
8%
6%
Services to support people at the end of their lives
7%
7%
Waiting time before getting appointments with hospital consultants
7%
7%
Services for treating cancer
7%
4%
5%
Quality of nursing care in hospitals Hospital waiting lists for non-emergency operations
3%
3% 4%
Quality of medical treatment in hospitals
2%
2%
Time spent waiting for an ambulance after a 999 call
2%
2%
Quality of medical treatment by GPs
2%
3%
General condition of hospital buildings
1%
2%
Amount of choice people have about which GP they can register with
1%
2%
Services for treating heart disease
1%
1%
Information about local healthcare services
1%
1%
Access to services to improve your own health
1%
1%
Base:
Care of the elderly
*
-
Amount of staff
*
-
2009: 3,528 West Midlands residents; 8 April - 17 May 2009 2008: 3,564 West Midlands residents; 8 April - 13 May 2008 c. 175 – 300 residents per PCT
There are variations in the priorities of different demographic groups. In particular, people aged over 45 are more likely to state that improving hospital cleanliness is the most important thing for the NHS to improve (18% of those aged 45 and over feel that hospital cleanliness is the most important priority compared with 13% of those aged under 45). Younger respondents tend to highlight A&E waiting times as the most important priority
30
for improvement, cited by 18% of those aged under 35. For ethnic minority groups, the amount of time needed to get an appointment with a GP is the main factor highlighted as an area for improvement, with 16% highlighting this as the priority. A similar proportion (15%) state that waiting times in A&E are the most important priority. The table overleaf sets out the priorities across PCTs. In comparison with last year, fewer PCTs have ease of access to NHS dentists as one of their top priorities. Last year respondents in all 17 PCTs had flagged ease of access to NHS dentists as one of their top priorities, this year it was flagged as one of the top priorities in 11 of the PCTs. However, more PCTs have A&E waiting times flagged as a top priority this year, and this is identified as one of the main priorities in all but one of the PCTs. Improving cleanliness in hospitals remains one of the main priorities in all PCTs.
31
Priorities for improvement for the NHS, by PCT PCT Birmingham East & North
Priority 1 Cleanliness of hospitals (16%)
Priority 2
Priority 3
Priority 4
Waiting times A&E Waiting times for GP appt (both 11%)
Mental health Services; End of life services (both 10%) Cancer services Ease of access to NHS (9%) dentist; Waiting times for GP appt; Mental health services; Waiting times hospital consultant (all 7%) Waiting times for GP appt Cancer services Mental health services (all 8%) Cleanliness of Ease of access to NHS hospitals dentist; (9%) Waiting times hospital consultant (both 8%)
Coventry Teaching
Waiting times A&E (19%)
Cleanliness of hospitals (16%)
Dudley
Waiting times A&E (20%)
Cleanliness of hospitals (15%)
Heart of Birmingham
Waiting times for GP appt (16%)
Waiting times A&E (13%)
Herefordshire
Ease of access to NHS dentist (23%)
Cancer services (13%)
Cleanliness of hospitals (11%)
End of life services (10%)
North Staffs
Waiting times A&E (23%)
Cleanliness of hospitals (16%)
Ease of access to NHS dentist (11%)
End of life services (9%)
Sandwell
Shropshire County Solihull Care
Cleanliness of hospitals (16%)
Waiting times for GP appt (14%) Cleanliness of hospitals Ease of access to NHS dentist (both 20%) Cleanliness of Waiting times hospitals (12%) A&E (11%)
South Birmingham
Mental health services (13%)
Cleanliness of hospitals (12%)
South Staffs
Cleanliness of hospitals (20%)
Waiting times A&E (14%)
Stoke on Trent
Waiting times A&E (22%)
Waiting times Cancer services A&E (8%) (13%) Waiting times Waiting times hospital A&E consultant (13%) (9%) Waiting times hospital consultant Ease of access to NHS dentist Waiting times for GP appt Mental health services (all 10%) Waiting times A&E; Waiting times for GP appt (both 11%) Ease of access to NHS dentist (9%)
Cleanliness of hospitals Ease of access to NHS dentist (both
32
Mental health services (8%)
Cancer services (9%)
Telford & Wrekin
Walsall Teaching
Warwickshire
12%) Ease of access to NHS dentist Waiting times Cleanliness of hospitals A&E (both 14%) (13%) Cleanliness of Waiting times Cancer services hospitals (23%) A&E (9%) (12%) Cleanliness of Ease of access to Waiting times hospitals (20%) NHS dentist A&E (14%) (12%)
Wolverhampton City
Cleanliness of hospitals (20%)
Waiting times A&E (13%)
Waiting times for GP appt (9%)
Worcestershire
Ease of access to NHS dentist (18%)
Cleanliness of hospitals (13%)
Mental health services (12%)
Mental health services (9%) Waiting times for GP appt (7%) Waiting times for GP appt End of life services (both 8%) Mental health Services; End of life services (both 8%) Waiting times A&E (11%)
(Base: 3528 respondents, 8 April – 17 May 2009. Q:Which of these, if any, is most important to improve?)
We now turn to the four main priorities identified in detail. Each priority will be analysed to ascertain geographical and demographic variations. Cleanliness in hospitals Improving cleanliness in hospitals remains a top priority for improvement for the population of the West Midlands as a whole. The graph overleaf shows perceived need for improvement by PCT. A higher proportion of residents in Walsall 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.
33
Need for improvement in cleanliness by PCT 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? Cleanliness of hospitals
% No need
% A little
% A fair amount
Coventry Teaching
20
Worcestershire
18
Telford & Wrekin
17
Warwickshire
18
Shropshire County
18
Herefordshire
19
Solihull Heart of Birmingham Wolverhampton City Sandwell
31
43
46
32
16
30
5
46
56
6
49
47
10
49
54
4
50
45
4
50
63
5
53
51
18 18
31 31
20
30
24
26
26
27
55
56
23
22
33
6
55
62
22
33
7
55
52
7
55
58
56
51
5
56
55
42
4
57
57
41
5
59
63
60
60
25
Dudley
13
South Birmingham
11
Base:
7
4
13
16
26
36
Stoke on Trent
Walsall Teaching
17
19
25
10
31
28
13
Birmingham East & North
40
26
16
14
45
34
13
2008
5
26
16
2009 29
24
12
% Don't know
15
27
North Staffordshire
South Staffordshire
% A lot
At least a fair amount %
19
29
22
28 25 25
36 34
20 15 18
22
35
21
39
2
2
2009: 3,528 West Midlands residents; 8 April - 17 May 2009 2008: 3,564 West Midlands residents; 8 April - 13 May 2008 c. 175 – 300 residents per PCT
Despite successes in reducing the rate of hospital acquired infections, hospital cleanliness remains the aspect of care that the public are most concerned about. In response to the findings from the survey last year, an in-depth study of perceptions of cleanliness in hospitals was undertaken. The research involved in-depth discussion groups with citizens from across the West Midlands and included a range of socio-demographic backgrounds. The research found that people’s perceptions of cleanliness were formed around three
34
main areas: the hospital environment, personal hygiene and accountability. Participants highlighted a wide range of factors relating to the hospital environment which had an impact on their perceptions: the state of the walls, ceilings, and doors; the frequency of seeing cleaning staff mopping up; whether the hospital was housed in a modern building, had light coloured walls, large windows, good ventilation and comfortable furniture; the absence of clutter; the hospital smelling clean; and having consistency in terms of cleanliness – across wards and departments and at different times of the day / days of the week. Participants felt that patients, visitors, and healthcare professionals all had a role to play in maintaining personal hygiene. Participants felt that bottles of hand sanitizers, the presence of sinks and liquid soaps, frequent bed linen changes, cleaner toilets and more culturally sensitive toilet facilities helped increase levels of personal hygiene. Furthermore, South Asian participants felt that fresh, hot and culturally sensitive food was also necessary for their sense of ‘inner cleanliness’. Accountability is the third factor which shaped participants’ perceptions of cleanliness, knowing that someone was taking responsibility for maintaining standards. Participants in the groups stressed the need for more clarity and visibility around responsibility for cleanliness at all levels – from individual wards, to the hospital as a whole. People wanted to feel reassured that someone was accountable for ensuring that the highest levels of cleanliness were being achieved. If you don’t have someone responsible for cleanliness in each ward individually who report back to a head person, then nothing will get done. Mixed Ethnicity, Male, C2DE, English speaking group The research also identified the need for more effective communication around cleanliness and healthcare acquired infections. Those who had recently been a visitor in a hospital, or had been in hospital themselves, were better informed about cleanliness and infection levels. However, those with no personal experience relied on reports that they had heard in the media and were the most fearful. The findings of the research are being shared with all organisations around the region to help them understand the drivers behind patient and public perceptions of cleanliness and to inform clinical practice and service delivery.
35
A&E Waiting Times The results from the survey indicate greater public concern around A&E waiting times compared with last year. The chart below indicates that a high proportion of residents in Dudley, Stoke on Trent and North Staffordshire feel that A&E waiting times are in need of improvement.
Need for improvement in A&E waits by PCT 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? Time spent waiting in Accident & Emergency (A&E) Departments
% No need
% A little
Shropshire County
% A fair amount
9
Solihull
13
Worcestershire
10
Warwickshire
12
Herefordshire
10
Sandwell
24
10
18
Walsall Teaching
7
22
Wolverhampton City
7
Telford & Wrekin
Stoke on Trent 5 Dudley 5
2008
46
45
13
49
47
14
50
50
10
52
52
12
53
45
14
55
57
14
44
9
58
64
18
41
10
59
52
12
60
54
8
63
53
10
64
57
12
65
58
8
65
58
10
66
60
68
67
8
69
69
9
73
62
45 40 39
21
44
18
16
13
39
25
16
18
34
22
18
14
32
15
18
8
North Staffordshire 5
Base:
21
11
30
16
20
South Staffordshire
28
19
22
2009 21
20
25
10
Coventry Teaching
30
20
26
South Birmingham
% Don't know
20
26
13
Birmingham East & North 5
15 26
9
Heart of Birmingham
% A lot
At least a fair amount %
47
18
48
16
52
15
13
54
27
46
2009: 3,528 West Midlands residents; 8 April - 17 May 2009 2008: 3,564 West Midlands residents; 8 April - 13 May 2008 c. 175 – 300 residents per PCT
36
Ease of access to NHS dentists In the 2008 survey, ease of access to NHS dentists was highlighted as a major concern in some PCTs. In particular, 72% of residents in Hereford stated that access to NHS dentists was in need of a lot of improvement, and 37% stated that it was the most important thing for the NHS to improve. The results in the survey this year indicate that although access is still seen as a problem, perceptions have improved, particularly in Herefordshire, where 53% say that access is in need of a lot of improvement and 23% say that access to NHS dentists is the most important thing to improve (compared with 72% and 37% respectively in 2008). The graph below compares the proportion of people who have seen a dentist in each PCT in the last 24 months with the proportion who feel that ease of access to an NHS dentist is in need of improvement. A weak correlation is evident in that the PCTs with the highest proportions of people visiting a dentist tend to have the lowest proportions of people feeling that ease of access is in need of improvement. However, this association is weak (only around 13% of the variation in one variable could be explained by the variation in the other). This may be linked to other factors which could have an influence on access and perceptions of access, such as ease of access to non-NHS dentists which is likely to be significant in some PCTs such as Solihull. Perceived need for improvement around NHS dentistry access, analysed against the proportion of respondents in each PCT who have accessed a dentist recently 75%
70%
Sandwell % seen NHS dentist in last 24 months
Wolv 65%
R² = 0.1362
Telf ord&W
60%
Coventry
S B'ham BEN
Warks
Dudley 55%
HoB Walsall
S Staf f s
50%
45%
Stoke N Staf f s Shrops Heref s Worces
Solihull
40% 35%
40%
45%
50%
55%
60%
65%
70%
75%
% stating 'a fair amount' or 'a lot' of improvement needed
(Base: 3528 respondents, 8 April – 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?)
As perceptions of access to NHS dentistry were highlighted as a particular issue in last year’s survey, further research was commissioned by NHS West Midlands on this theme.6 The research found that perceptions of ease of access are driven by personal experience,
37
by word of mouth and by the media. It is worth noting that some participants based their views on experiences from some years ago that do not necessarily reflect the situation now. In some areas, participants had seen dental practices advertising for new NHS patients through the local media and even more simply through advertising boards outside their practices. This had a strong positive impact on their perceptions of access. People are, you hear of all these on the telly, can’t get a dentist for like six months, twelve months, whatever, can’t find one. But then you can be walking up the High Street and there’s three or four dentists with big banners outside, saying, we’re taking on new NHS patients. Female, NHS attender, Dudley Most had little detailed knowledge about the dentist before they started seeing them, and were not aware of how to access information on the quality of services. It wasn’t really a choice, it was who was available. I don’t think it is an educated choice, because until you’ve been to them (the dentist), you don’t know what they’re going to be like. Male, NHS attender, Shropshire
The findings from the research are helping PCTs to improve access and develop information available for the public about dental services.
6
Understanding public perceptions of information and access to NHS dentistry in the West Midlands (2009), (http://www.wmqi.westmidlands.nhs.uk/patient-experience/) 38
3. Engaging with local people All NHS organisations have a duty to involve and consult patients and the public in relation to the planning and development of services, and with regard to decisions relating to the operation of services (Section 242). The NHS Constitution also emphasises the rights of local people to be involved in the planning of healthcare services and in decisions affecting the operation of services. As part of the survey a set of questions were asked to gain feedback which will help inform PCTs as part of the World Class Commissioning process. These questions look at how well local people feel that the NHS listens to them and seeks their views on local service development. This is linked to the competencies in the World Class Commissioning Framework, mainly around competency 3 which looks at how well the PCT engages with the public and patients.
Overview As can be seen in the slide below, a high proportion of residents agree that the NHS helps them and their family to stay healthy and that there is good communication between healthcare staff. However, citizens are less positive about whether the NHS asks for their views and feedback and keeps them informed about the quality of local services.
World class commissioning Q For each of the following statements, please tell me how much you agree or disagree . . . . % Agree My local NHS helps me and my family to stay healthy
% Disagree
72%
There is good communication between all the people who provide my healthcare
61%
17% 27%
I feel well informed about how good NHS services are in my local area, e.g. hospitals, ratings on GPs, dentists and pharmacists
54%
33%
I feel able to feedback on health services, and believe my local NHS acts on this feedback
46%
32%
My local NHS asks for my views about how healthcare services are run and improved
42%
Base: 3,528 West Midlands residents, 8 April – 17 May 2009
39
44%
Looking at the views of different groups of residents across all of these aspects of world class commissioning, similar groups tend to be positive and negative. In general the most positive groups are:
the youngest and oldest age groups (16 to 24 years and over 65s);
residents in social grades C2, D and E
ethnic minority residents;
those who do not work full-time
those who have been inpatients; and
those who have used staying healthy clinics.
The most negative groups tend to be:
those aged 35 to 54 years;
residents in social grades A, B and C1;
those who work full-time;
white residents;
those who have used a private hospital; and
those who have visited Accident and Emergency.
The following sections explore responses to the questions in more detail, examining possible reasons underlying residents' perceptions on these aspects of the NHS.
40
Helping me and my family to stay healthy Participants in the survey were asked about whether their local PCT helps them and their family to stay healthy. As we have noted, respondents were positive about this aspect of healthcare provision, with 72% agreeing that the NHS helps them and their family to stay healthy. The results show higher levels of agreement with this statement among those who are aged 65 and over, with 82% of this group agreeing, compared with 70% for those aged under 65. Levels of agreement with this statement are higher for those who have a disability or who have someone in the family with a disability (74%). In line with the age differences (as Asian residents tend to have a younger age profile), those from an Asian background are less likely than other ethnic groups to agree that the NHS helps them and their family to stay healthy .
Helping people to stay healthy by ethnicity Q For each of the following statements, please tell me how much you agree or disagree . . . . “My local NHS helps me and my family to stay healthy � % Agree (3,118)
White
(261)
Asian
(141)
Other BME
72%
66%
77%
Base: 3,528 West Midlands residents (base size for each group shown in brackets), 8 April - 17 May 2009
The chart overleaf demonstrates agreement with the statement on staying healthy by PCT. A lower proportion of residents in Heart of Birmingham PCT agree with this statement. This is likely to be related to the demographic profile of the population (which is younger and has a large Asian population).
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Helping people to stay healthy, by PCT PCT West Midlands
Upper Control Limit (2 sigma) Lower Control Limit (2 sigma)
85%
Upper Control Limit (3 sigma) Lower Control Limit (3 sigma)
80% % answering 'strongly agree' or 'agree'
Sol
75%
Warks
Shrops Wolves Herefs
Dudley Cov
Wals
S Bham
Worcs
Stoke
70%
S Staffs
Sand T&W N Staffs
BEN HoB
65%
60%
55%
50% 150
170
190
210
230
250
270
290
310
Number of respondents
(Base: 3528 respondents, 8 April – 17 May 2009. Q:For each of the following statements, please tell me how much you agree or disagree with the following statements- My local NHS helps me and my family to stay healthy?)
The results show that there is a high proportion of respondents who agree with this statement across nearly all PCTs. We will now turn to look at people’s perceptions about whether people perceive that there is good communication between all the people who provide their healthcare.
Receiving ‘joined up’ care We asked people about their views on the effectiveness of communication between the people providing their healthcare. Overall, those aged 65+ are the most positive about this aspect of service provision, with 72% agreeing that there is good communication between those providing care. In line with other findings, those aged 16-24 are also positive with 66% agreeing that there is good communication. A lower proportion of those aged 25-54 agree with the statement (55%). Residents from social groups C2DE are more likely to say that communications are good between all the people who provide their healthcare than residents from groups ABC1 (69% compared with 52%).
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Respondents with a disability are more likely to feel that there is good communication (64%) than those without a disability (60%). Finally, those who are not working full time are more likely to be positive than those who are working full time (66% compared with 53%). This is likely to be linked with the age profile of these groups. In terms of service usage, those who have been an inpatient feel that there is good communication (65%), as do those who have been to staying healthy clinics (69%). Those who have been to A&E or a private hospital are more likely to disagree that there is good communication between healthcare staff (30% and 37% respectively).
As can be seen in the slide below, respondents who have an Asian ethnic background respond positively to this question, while white residents are least positive. This is interesting given the age profile of the Asian population, and the fact that younger people tend to be less positive about this aspect of provision.
Joined-up care by ethnicity Q For each of the following statements, please tell me how much you agree or disagree . . . . “There is good communication between all the people who provide my healthcare� % Agree (3,118)
White
(261)
Asian
(141)
Other BME
60%
71%
66%
Base: 3,528 West Midlands residents (base size for each group shown in brackets), 8 April - 17 May 2009
The chart overleaf gives the detail for each PCT in relation to joined up care. It can be seen that satisfaction is fairly consistent across all PCTs. However, Sandwell residents are particularly likely to disagree that communications are good, which might warrant further investigation (34%, compared with 27% overall).
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Joined-up care, by PCT PCT West Midlands
Upper Control Limit (2 sigma) Lower Control Limit (2 sigma)
75%
Upper Control Limit (3 sigma) Lower Control Limit (3 sigma)
% answering 'strongly agree' or 'agree'
70% Wals
65%
HoB
Dudley Cov
Stoke
BEN Warks
Wolves
60%
Herefs
Sand
Worcs
Sol
55%
S Staffs
S Bham
T&W
Shrops
N Staffs
50%
45%
40% 150
170
190
210
230
250
270
290
310
Number of respondents
(Base: 3528 respondents, 8 April – 17 May 2009. Q:For each of the following statements, please tell me how much you agree or disagree with the following statements-There is good communication between all the people who provide my healthcare?)
Staying on the communication theme, we will now look at the extent to which people feel that they are invited to give their views by the NHS.
Being invited to share views As we have seen, residents are positive about the role of the NHS in keeping them healthy and about communication between frontline healthcare staff. However, the results are less positive around inviting local people to give their views on local healthcare services. Overall, more people disagree (44%) that their local NHS asks for their views on services than agree (42%). A high proportion of those aged 45-54 disagree that they are invited to give their views (55%), with a quarter of this group strongly disagreeing (25%). Those from social groups ABC1 are more likely to disagree (48%), as are white respondents (46%) and those who are carers (48%).
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330
Interestingly, a higher proportion of those who have been an inpatient within the last year or so agree that they are invited to give their views (47%). Nonetheless, a similar number disagree (41%) or do not know (5%), hence even those with recent experience of hospital provision do not feel that they are invited to give their views on service provision. When we look at responses by PCT, residents in Heart of Birmingham and Coventry are more likely to answer this question positively. However, it still needs to be borne in mind that over a third do not feel that they are asked about their views. A slightly lower proportion of residents in Worcestershire feel that they are asked to give their views on services.
Asking for residents’ views, by PCT PCT West Midlands
Upper Control Lim it (2 sigm a) Lower Control Lim it (2 sigm a)
55%
Upper Control Lim it (3 sigm a) Lower Control Lim it (3 sigm a)
50%
HoB
% answering 'strongly agree' or 'agree'
Cov Sand
45%
N Staffs
Sol Wals Wolves
Dudley
Stoke
40%
T&W
BEN S Bham
Herefs
S Staffs
Warks Shrops
35%
Worcs
30%
25% 150
170
190
210
230
250
270
290
310
Number of respondents
(Base: 3528 respondents, 8 April – 17 May 2009. Q:For each of the following statements, please tell me how much you agree or disagree with the following statements-My local NHS asks for my views about how healthcare services are run and improved?)
The results from this question seem to indicate that more could be done across the region to increase opportunities for people to give their views on how healthcare services are run and improved.
45
330
Feeding back on health services As part of the survey we aimed to look at whether people feel that the NHS is open to feedback about services and responds to the comments made. This question was answered slightly more positively than the previous question on whether people are asked to give their views. Overall, 46% of respondents agree that they feel able to feedback on health services and believe that their local NHS acts on this feedback. However, almost a third (32%) disagree, while 9% feel that they don’t know. Once again, those aged 45-54 are the most negative, with 39% disagreeing that they would be able to give feedback and that this would be acted on. In addition, a higher proportion from social groups ABC1 (37%) disagree compared with those from C2DE (27%). White respondents are more likely to disagree than those from ethnic minority groups (33% compared with 26%). Finally, those who are carers are more likely to feel that they cannot feed back (36%) than those without caring responsibilities (31%). We might expect those with recent experience of using services to be more positive about feeling able to give feedback and for this to be acted upon. To some extent this does seem to be borne out by the data, as 52% of those who have been an inpatient in the last year or so agree that they would be able to give feedback and for this to be acted upon (compared with 46% overall). Those with recent experience of Staying Healthy Clinics are also more likely to agree (55%). In terms of feeling able to give feedback on local services, residents in Heart of Birmingham PCT are the most positive, as can be seen in the slide below. Nonetheless, it does need to be borne in mind that across all PCTs around a third of respondents disagree with this statement.
46
Feeling able to feedback on services, by PCT PCT West Midlands
Upper Control Lim it (2 sigm a) Lower Control Lim it (2 sigm a)
60%
Upper Control Lim it (3 sigm a) Lower Control Lim it (3 sigm a)
55%
HoB
% answering 'strongly agree' or 'agree'
Wals Cov
50%
S Bham
Wolves Dudley N Staffs Stoke
45%
T&W
Sol
Sand
BEN
Herefs
Warks
S Staffs
Worcs
40% Shrops
35%
30%
25% 150
170
190
210
230
250
270
290
310
Number of respondents
(Base: 3528 respondents, 8 April – 17 May 2009. Q:For each of the following statements, please tell me how much you agree or disagree with the following statements-I feel able to feedback on health services and believe my local NHS acts on this feedback?)
Overall the results suggest that there is a need to increase awareness and confidence amongst local residents that the NHS welcomes feedback and will act upon this. The fact a significant proportion of those who have recent experience of health services do not feel that they are able to give feedback and be listened to warrants further attention.
47
330
Feeling well informed Alongside increasing choice, attempts have been made to increase the information available to members of the public about the quality of services in their local area. The NHS Constitution gives people the right to information, and pledges that citizens will be provided with easily accessible, reliable and relevant information to help with making choices. As part of the survey we asked residents whether they feel informed about how good NHS services are in their local area. The responses show that just over half the respondents agree that they are well informed (54%), while around a third disagree (33%). Once again, differences emerge across age groups, with those aged over 65 the most likely to agree (69%). Those from social group C2DE are more likely to feel informed than those from ABC1 (60% compared with 49%). Interestingly, those who have recently been an inpatient or have been to a staying healthy clinic are more likely to say that they are well informed (59% and 62% respectively). However, we do need to bear in mind that around three in ten of those who have been an inpatient or have been to a staying healthy clinic do not agree (32% and 27% respectively). A much higher proportion of those who feel informed about local plans say that they also feel well informed about the quality of local services (71%). As we have noted, there is a group of residents who do feel well informed about current services and plans for development. The chart below shows the results on this question by PCT. It is evident that residents in Walsall are more likely to agree with this statement. There is some correlation between this question and the question later in the survey which asks whether residents are aware of local plans, as around 47% of the variation in one of variables can be explained by the variation in the other. It is worth noting that a higher proportion of respondents in Heart of Birmingham PCT strongly disagree with this statement (16%).
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Feeling well informed, by PCT PCT West Midlands
Upper Control Limit (2 sigma) Lower Control Limit (2 sigma)
70%
Upper Control Limit (3 sigma)
65%
% answering 'strongly agree' or 'agree'
Lower Control Limit (3 sigma)
Wals
60%
Dudley Sand
Cov
Wolves
55%
S Bham Warks
Stoke Sol
Shrops
HoB
T&W
S Staffs
BEN
N Staffs
50%
Worcs
Herefs
45%
40%
35%
30%
25% 150
170
190
210
230
250
270
290
310
Number of respondents
(Base: 3528 respondents, 8 April – 17 May 2009. Q:For each of the following statements, please tell me how much you agree or disagree with the following statements-I feel well informed about how good NHS services are in my local area e.g. hospitals , ratings on GPs, dentists, and pharmacists?)
The results suggest that around a third of the population does not feel well informed about the quality of local health services. Further work with this group might be helpful in determining what kinds of information they would find helpful and how they would like to access it.
We now turn to focus on perceptions around GP services in more depth, examining views on a range of service aspects.
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4. GP services As part of Lord Darzi’s review of the NHS in 2007, access to primary care was highlighted as an area where improvements were needed. The report highlighted the fact that the most deprived communities often experience the poorest primary care provision and have the worst health outcomes. This chapter looks at residents’ views on the quality of services provided by GP practices, awareness of extended opening hours and new GP-led health centres. Finally the chapter examines perceptions about the information available on local GP provision.
Overall satisfaction with GP services All those who had visited their GP over the last year or so were asked about a range of factors connected with GP services. The questions asked were similar to those asked in previous years to allow comparison of the results. Satisfaction with GP services remains very high overall. As is demonstrated in the chart overleaf, areas where there are particularly high levels of satisfaction are around the appearance of the surgery, the proximity of services to residents' homes, the accessibility of the surgery and the medical and listening skills of GPs. There are more residents who are dissatisfied with the availability of car parking, the amount of choice available over the date and time of the appointment, and how easy it is to get through to the surgery to make an appointment. It is worth noting that there has been an increase in the proportion of respondents who state that they are satisfied with the availability of out of hours care. In 2008, 36% of those we questioned were satisfied with this aspect of provision, this year the figure has risen to 45%.
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Satisfaction with GP Surgery Services Q
To what extent were you satisfied or dissatisfied with each of the following aspects of the service? % Satisfied % Dissatisfied
% Satisfied
WM 2008
WM 2006
Overall appearance and cleanliness of the surgery
3
96
95
94
The distance you have to travel from your home to your GP surgery
3
95
94
N/A
How accessible the GP surgery is (e.g. a ramp)
4
93
93
N/A
The extent to which your GP listens to you and respects you
7
91
90
N/A
Your GP’s medical knowledge
6
90
90
N/A
The length of time staff spent with you
8
90
89
86
The explanations that staff gave you about your illness and treatment
9
89
87
85
The friendliness of reception staff*
10
87
86
89
Facilities for patients and children
6
83
81
79
77
N/A
79
76
N/A
84
The advice and support you receive on how to stay healthy The length of time between making your appointment and attending the GP surgery How easy it was to get through to the surgery to make an appointment
21
75
75
N/A
The amount of choice you had about the date and time of your appt
22
75
72
68
60
58
45
44
36
34
28
29
Car parking Public transport to and from the surgery The availability of out of hours care The availability of home visits
19 18
25
63 13
43
17 15
45 31
* 2006 wording “The friendliness of staff” Base: All who have seen their GP in the last year or so 2009: 2,939 West Midlands residents, 8 April – 17 May 2009 2008: 2,789 West Midlands residents, 8 April – 13 May 2008 2006: 3,028 West Midlands residents, 8 August – 8 September 2006
While levels of satisfaction are high across the region, there are certain PCTs where satisfaction is lower. In particular, over a third of residents in Heart of Birmingham PCT are dissatisfied with the ease of getting through to the surgery to make an appointment (34%), the length of time between making the appointment and attending the surgery (34%), the choice of date and time of appointment (40%) and car parking (37%). 51
The table below analyses satisfaction and dissatisfaction with various elements of GP services in more detail. The PCTs with levels of satisfaction which differ significantly to those of the region as a whole are highlighted. It is evident that there are issues around access to GP services in Heart of Birmingham and Sandwell. There are several factors which could be linked to these issues, as highlighted in the Equitable Access to Primary Care Programme which is discussed further below.
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Satisfaction with GP Surgery Services – significant differences by PCT Service Area
How easy it was to get through to the surgery to make an appointment The length of time between making your appointment and attending the GP surgery The amount of choice you had about the date and time of your appointment Your GP’s medical knowledge The extent to which your GP listens to you and respects you The length of time staff spent with you The explanations that staff gave you about your illness and its treatment The friendliness of reception staff The advice and support you receive on how to stay healthy The availability of out of hours care The availability of home visits Overall appearance and cleanliness of the surgery
PCTs with higher levels of satisfaction (% very satisfied / satisfied) Shropshire - 85% South Staffordshire – 81%
PCTs with higher levels of dissatisfaction (% dissatisfied / very dissatisfied) Birmingham East & North – 34% Heart of Birmingham – 34% Telford & Wrekin – 35%
South Staffs – 86% Worcestershire – 85%
Heart of Birmingham – 34% Sandwell – 27%
South Staffordshire – 80% Walsall – 83%
Heart of Birmingham– 40% Sandwell - 29%
Heart of Birmingham – 11% Walsall – 10% Worcestershire – 95%
Heart of Birmingham – 15% Sandwell – 11% Stoke – 12% Heart of Birmingham – 19% Sandwell- 13% Heart of Birmingham – 23%
Dudley- 94%
Coventry – 15%
South Birmingham - 85%
Heart of Birmingham – 20%
Stoke on Trent- 56% Telford & Wrekin- 56% Wolverhampton- 56%
Heart of Birmingham – 27% Herefordshire – 28%
South Birmingham- 100% South Staffordshire- 99%
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Heart of Birmingham – 29% Stoke – 22% Birmingham East & North- 6% Heart of Birmingham – 7% Wolverhampton – 6%
Car parking
Public transport to and from the surgery
Facilities for patients and children
The distance you have to travel from your home to your GP surgery How accessible the GP surgery is (e.g. a ramp)
North Staffordshire – 72% Shropshire- 74% Telford & Wrekin – 81% Birmingham East & North – 57% Coventry- 56% Heart of Birmingham – 56% Sandwell – 61% South Birmingham – 62% Wolverhampton – 56% Warwickshire – 90%
South Staffordshire- 98%
Dudley – 32% Heart of Birmingham - 37% Herefordshire- 37% Herefordshire- 19% Shropshire- 23% Worcestershire – 19%
Birmingham East & North – 10% Coventry- 10% Heart of Birmingham - 16% Sandwell- 11% Heart of Birmingham – 9%
Birmingham East & North - 7% Heart of Birmingham - 8%
(Base: 2939 respondents, 8 April – 17 May 2009. Q:To what extent were you satisfied or dissatisfied with each of the following aspects of the service?. PCTs highlighted have responses which are significantly different to the regional average at the 95% confidence level.)
The Equitable Access to Primary Care Programme was established to address inequalities in access to primary care. All PCTs including Sandwell and Heart of Birmingham are working as part of this programme to increase GP provision through the opening of new surgeries and GP led health centres. Given the levels of dissatisfaction expressed in the survey, it is important to ensure that communication about these new services is as effective as possible. There are also differences between demographic groups, with a higher proportion of younger respondents, and those from ethnic minority groups more likely to be dissatisfied across a range of factors. For example, 28% of those from an ethnic minority group are dissatisfied with being able to get through to make an appointment with a GP and 32% are dissatisfied with the length of time between making an appointment and seeing their GP, compared with 20% and 16% of white residents respectively. Some caution is needed, as ethnic minority citizens are more likely to be younger and a higher proportion of residents from ethnic minority groups are found in Heart of Birmingham and Sandwell PCTs. It needs to be noted that 14% of those from an ethnic minority group are dissatisfied with the extent to which their GP listens and respects them, compared with 6% of white residents.
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Awareness of extended GP surgery opening hours As part of the NHS Operating Framework for 2008/9, the Government has set out a key priority for improving routine access to GP services in the evenings and at weekends. PCTs are required to ensure that at least half of practices offer extended opening hours to patients. In July 2009, 74% of practices in the West Midlands region reported that they had extended opening hours. As part of the survey we asked respondents whether they were aware of extended opening hours within their surgery. The results suggest that only around a third of residents in the region are aware of extended opening hours for their GP surgeries. As we know that around three quarters of all surgeries are reporting extended opening hours, this seems to indicate a need for further communication around extended opening hours.
Awareness of extended opening hours Q Many GP practices are now extending their opening hours for appointments. Do you know whether your GP practice offers appointments out of hours, for example in the early morning, evening or at the weekend?
Don't know
Yes
28%
35%
37% No
Base: 3,528 West Midlands residents, 8 April – 17 May 2009
Awareness of extended opening hours is higher amongst those who have a disability (40%) or have someone with a disability in their family (39%). Those who have some contact with NHS health provision within the last 12 months or so are also more likely to be aware (3741% for those who have accessed services such as GP surgeries, inpatient and outpatient services). As we might expect, those who have friends or family in the NHS are also more likely to be aware of extended opening hours (38%). Further analysis by PCT demonstrates that residents in Sandwell and Walsall are more likely to say that they are aware of extended opening hours than is the case across the West Midlands as a whole.
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Awareness of extended opening hours, by PCT PCT West Midlands Upper Control Lim it (2 sigm a) Lower Control Lim it (2 sigm a)
60%
Upper Control Lim it (3 sigm a) Lower Control Lim it (3 sigm a)
50%
Sand
% answering 'yes'
Wals Stoke
40%
Dudley
N Staffs Sol
HoB Wolves
Warks
S Staffs
Worcs
S Bham
30% Cov Herefs
BEN
Shrops T&W
20%
10%
0% 150
170
190
210
230
250
270
290
310
Number of respondents
(Base: 3528 respondents, 8 April – 17 May 2009. Q:Many GP practices are now extending their opening hours for appointments. Do you know whether your GP practice offers appointments out of hours, for example in the early morning, evening or at the weekend?)
Analysis was carried out to understand how levels of awareness correlate with the actual proportion of surgeries in the PCT which are reported to have extended opening hours. It was found that there is a correlation, with 54% of variation in the awareness of extended opening hours being explained by the variation in the actual proportion of surgeries with extended opening hours. Nonetheless, there does seem scope to increase awareness across the region as a whole. The following section looks at demand for extended opening hours, before turning to consider whether those most likely to require appointments outside of normal office hours are aware of this opportunity.
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330
Demand for extended opening hours Participants in the survey were asked about their preferences for the time of their appointment if they needed to see a GP in the next week for a non-urgent reason. As can be seen in the chart below, a high proportion would prefer to have an appointment outside of normal office hours.
Demand for extended opening hours Q If you needed to see your GP in the next week for a reason that was not urgent, which of the following appointments would you like? Don’t know/no opinion
Appointment during office hours
Weekend appointment
Early morning appointment
4% 23%
32%
7% 34%
Base: 3,528 West Midlands residents, 8 April – 17 May 2009
Evening appointment
The results show that demand for evening appointments is highest amongst those of working age. Over 40% of respondents aged between 25-54 state that they would prefer an evening appointment. The chart overleaf shows that half of those who are working full time would prefer an evening appointment. Interestingly, weekend appointments are more popular with those from ethnic minority groups, with 19% stating that they would prefer a weekend appointment.
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Demand for evening appointments by working status Q If you needed to see your GP in the next week for a reason that was not urgent, which of the following appointments would you like? % An evening appointment
Working full time
50%
Not working full time
22%
Base: 3,528 West Midlands residents (1,423 working full-time; 2,104 not working full-time); 8 April - 17 May 2009
People who are more likely to require an appointment outside of normal office hours are not more likely to be aware that their surgery has extended hours. If we consider those who would prefer an evening appointment, only 37% are aware that their surgery has extended opening hours. Hence, it seems that more information on extended hours could be targeted at those who are those who are most likely to use the services, for example younger age groups and those who are working full time.
Information for comparing GP services Over half of all respondents state that they are satisfied with the information available to compare GP services. However, when we consider the high levels of satisfaction expressed for GP services overall, there do seem to be some issues around accessing information and the amount of information available, although there have been some improvements since last year. It is worth noting that there has been a slight increase in the net satisfied figure for the availability of information. This means that when we compare satisfaction and dissatisfaction with this aspect of information provision, views are more positive in 2009.
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Satisfaction with information for comparing GP surgeries Q Thinking about information for comparing your local GP surgery with other surgeries, to what extent are you satisfied or dissatisfied with … ? Net Net Satisfied The quality of information
53%
The availability of the information
52%
The amount of information
51%
Dissatisfied 15%
satisfied satisfied 2008 2009 % % +37
+34
19%
+33
+26
18%
+33
+30
Base: WM 2009 – 3,528 West Midlands residents, 8 April - 17 May 2009 WM 2008 – all who would use a source of information to find out how their local GP compares (3,395); 8 April - 13 May 2008 Please note different bases for 2008 and 2009
Source: Ipsos MORI
Across all of these aspects, the youngest and oldest age groups are the most satisfied (those aged 16-24 and 65+).7 Those who work full time, are carers and who are from a higher social grade are less likely to be satisfied with these aspects of information provision.8
Awareness of new GP-led health centres As we have noted, Lord Darzis’ interim report on the NHS (2007) highlighted inequalities in access to primary care, with the poorest communities often experiencing the worst health outcomes. In response, a programme was set up to improve access to primary care, which involved establishing new GP practices in the PCTs with the poorest provision and a new GP-led health centre in each PCT, in an easily accessible location (Equitable Access to Primary Care Programme DH 2007). At the time of the survey, some of the health centres had opened. Details of the centres planned or available in each PCT were made available to interviewers.9 Citizens were asked whether they knew about the new centres in order to gauge awareness of these new services in the region. Around three quarters of those interviewed are not aware of their new GP-led health centre.
7
For example, 57% of both groups are satisfied with the amount of information available, compared with 51% of respondents overall. 8 For example, 21% of those who work full time are dissatisfied with the availability of information, 20% of those from social grades ABC1 and 23% of those who are carers. In terms of the amount of information, 19% of those from ABC1 are dissatisfied, and 22% of carers. 9 Please refer to the appendices for more details. 59
Awareness of new Health Centres Q Are you aware of the new Health Centre planned / opened in …? The health centre is open seven days a week and you do not need to make an appointment. Don’t know/can’t remember Yes
1% 24%
76%
No
Base: 3,528 West Midlands residents, 8 April – 17 May 2009
Awareness of the local health centre is higher among those aged 55-64 and 65+, with 28% and 29% of these groups stating that they knew about their local health centre. There is some variation in terms of awareness by PCT, with those in Walsall, Coventry, Solihull and Wolverhampton more likely to be aware of their local centre, as is shown overleaf.
60
Awareness of new health centres by PCT Q
Are you aware of the new Health Centre planned / opened in …? The health centre is open seven days a week and you do not need to make an appointment. % Yes 63%
Walsall
51%
Coventry Teaching
35%
Solihull Care
31%
Wolverhampton
28%
South Birmingham
27%
North Staffordshire
25%
Telford & Wrekin
23%
Heart of Birmingham Birmingham East and North
19%
Stoke on Trent
19%
Herefordshire
19%
Sandwell Dudley
16% 15%
Shropshire County
13%
Warwickshire
13%
Worcestershire South Staffordshire
12% 11%
Base: 3,528 West Midlands residents, 8 April – 17 May 2009, c.175 – 300 residents per PCT
The differences in awareness levels may reflect the actual opening dates of the centres. However, PCTs may wish to consider the learning developed by the PCTs with the highest levels of awareness.
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5. Understanding the system: choice and navigation Choice at referral to hospital was introduced in January 2006, as part of the health reform programme. This has been extended in subsequent years, and since April 2009 most patients in England, who are referred by their GP for non-urgent specialist treatment, have had the right to choose which hospital they go to (The Primary Care Trusts (Choice of Secondary Care Provider) Directions 2009). Alongside extending choice, attempts have been made to improve the information available for local people about where they can access the most appropriate care. This chapter looks at awareness of choice overall and how well respondents are able to navigate the system to access appropriate urgent care.
Choice Choice of care and treatment is a central tenet of the work of the NHS and is further emphasised in the Constitution. As has been found in other research, awareness of this choice is not universal amongst patients and the public.10 Although the majority of respondents think that there is some choice (56%), two in five say they have not very much choice or no choice at all (40%).
Choice in the NHS Q As someone who uses or might use the NHS, how much choice would you say you are given about what care you receive and where you get it? Would you say… ?
Don’t know
A great deal
No choice at all 5%10% 11%
Not very much choice
29%
46%
A fair amount
Base: 3,528 West Midlands residents, 8 April – 17 May 2009
10
Planned Care Postal Survey conducted on behalf of NHS West Midlands by Ipsos MORI 2009. 62
Younger age groups and those who have had recent experience of being an inpatient or an outpatient are more likely to think that there is at least a fair amount of choice. For example, 54% of 16-24 year olds feel that there is a fair amount of choice, compared with 46% of residents overall.
Choice in the NHS by age Q As someone who uses or might use the NHS, how much choice would you say you are given about what care you receive and where you get it? Would you say… ? A great deal
A fair amount
Not very much choice
No choice at all
(466)
16-24
9%
(541)
25-34
9%
43%
(565)
35-44
7%
46%
28%
14%
5%
(650)
45-54
9%
42%
30%
13%
5%
(589)
55-64
9%
42%
28%
(713)
65+
13%
54%
Don't know
29% 35%
47%
24%
6% 2% 11%
3%
13% 7% 8% 9%
Base: 3,528 West Midlands residents (base size for each age group shown in brackets), 8 April - 17 May 2009
However, we need to be careful in drawing conclusions about these responses. Other research commissioned by NHS West Midlands has demonstrated the complexity of the issues around choice for patients.11 Focus groups with patients who had recently experienced planned care revealed that many patients do not feel sufficiently informed to make a choice, particularly around choosing a consultant. At the same time, it was found that some choices were felt to be important to everyone - such as choosing the time and day of the appointment. I don’t feel that I’ve got enough knowledge to make a sensible informed choice, I’m not a medical guy, I’m relying on them being professional, competent and interested in what they do Male with long-term condition, Shropshire, ABC1, age 35-54 They [doctors] should know which is the best hospital that we should go to Female, South Asian, Stoke, age 35-54
11
Planned Care Patient Experience (2009) (http://www.wmqi.westmidlands.nhs.uk/patientexperience/)
63
They said when would you prefer to come? I preferred on my day off, and it worked out Female, Shropshire, C2DE, age 16-34
Planned care commissioners are working with the findings of the research to further develop information to support patients to make effective choices.
Navigating the system The Acute Care Clinical Pathway Group in the West Midlands is working towards a vision for urgent and emergency care systems in 2012. A key part of this vision is ensuring that local citizens have the information they need to be able to access the most appropriate care when they are in need of urgent treatment. In order to assess local people’s current ability to navigate the health system in the region, they were given a scenario involving urgent health care needs and asked to select their most likely response. In the first scenario, an urgent situation involving a child was given. As can be seen in the chart below, contacting their GP, followed by NHS Direct are the most popular options for respondents during office hours.
Navigating the system with children (1) Q
If you have a child, or if you were looking after someone else’s child, and they had a very high temperature and kept being sick, and you wanted to get medical advice, what would be your first point of contact during office hours? (All above 1%) GP/GP Out of Hours
61%
NHS Direct
21%
Accident & Emergency (A&E) Ambulance Service (999) Health Centre (or Walk-in Centre)
7% 3% 2%
Family member/neighbour/personally treat child
1%
Shropdoc/NEWDOC/Badger/Careline
1%
Family member/neighbour/personally in the medical profession
1%
Hospital/local hospital
1%
Base: 3,528 West Midlands residents; 8th April to 17th May 2009
However, outside office hours people are more divided in terms of the care they would seek. Residents are most likely to call NHS Direct, followed by the GPs’ out of hours service and then A&E (see chart below). 64
Navigating the system with children (2) Q
And what would be your first point of contact in the evening or at the weekend? (All above 1%) NHS Direct
39%
GP/GP Out of Hours
24%
Accident & Emergency (A&E)
18%
Ambulance Service (999)
4%
Health Centre (or Walk-in Centre)
4%
Shropdoc/NEWDOC/Badger/Careline
2%
Family member/neighbour/personally treat child
1%
Hospital/local hospital
1%
Primary Care Unit at the hospital
1%
Base: 3,528 West Midlands residents; 8 April - 17 May 2009
The lower proportion of respondents who would access GP services out of hours might indicate lower awareness of the services available. Hence, increasing information available about these services might be considered. We also asked people what they would do if they personally needed care within the next few hours but their condition was not life-threatening. In this situation, the majority of respondents would turn to their local GP or NHS Direct. Nonetheless, one in ten think that they would go to A&E for help, hence there is scope to increase public awareness of alternative services, and the type of circumstances when they would definitely need to go to A&E.
65
Navigating the system for urgent care Q
If you believed you personally needed medical help within 6 hours (but it was certainly not life threatening), which of the following types of services would you go to or contact? (All above 1%) GP/GP Out of Hours
44%
NHS Direct
21%
Accident & Emergency (A&E)
12%
Pharmacy
11%
Health Centre (or Walk-in Centre)
8%
Minor Injuries Unit
3%
Base: 3,528 West Midlands residents; 8 April - 17 May 2009
When we consider differences by demographic groups, males are more likely than females to state that they would go to or contact A&E (see chart below). Higher proportions of those who are aged 65+ would go to A&E (15%) compared with those aged under 65 (11%). Higher proportions of those from social grades C2DE would use A&E (14%) compared with those from ABC1 (9%). In addition, a higher proportion of people from BME groups would use A&E (17%) than those from a white ethnic group (11%).
Navigating the system for urgent care by gender Q
If you believed you personally needed medical help within 6 hours (but it was certainly not life threatening), which of the following types of services would you go to or contact? (All above 1%) Male
Female 40% 47%
GP/GP Out of Hours 20% 22%
NHS Direct Accident and Emergency (A&E) Pharmacy Health centre Minor Injuries Unit
15% 8% 9% 12% 9% 7% 4% 2%
Base: 3,528 West Midlands residents (1,629 men; 1,899 women); 8 April - 17 May 2009
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The results suggest that there is the potential to improve public understanding of the health system and how to access the most appropriate care for different kinds of need. We now turn to look at access to information about health services.
67
6. Access to information In this chapter we focus on whether people recall having received information from the local NHS, as our previous research has demonstrated the link between people feeling that they are well-informed about local services and having confidence in local healthcare provision. We then move on to look at the use of the internet by local residents, to explore the potential routes for digital engagement with local residents.
Feeling informed The last time we conducted the survey, we found that there was a strong correlation between an individual feeling informed about what was happening in their local NHS and feeling confident about the future of services. When we asked local residents whether they had received any information from the NHS about health services, we found that there had been little change from 2008, in terms of the proportion of citizens who had received 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 2%
WM 2009
WM 2008
Yes
18
20
No
80
74
Don’t know
2
6
18%
80%
No Base: WM 2009 – 3,528 West Midlands residents, 8 April - 17 May 2009 WM 2008 – 3,564 West Midlands residents, 8 April - 13 May 2008
68
Once again, there is some variation by PCT, with a higher proportion of those living in Walsall and South Birmingham feeling informed about plans for the development of the local services.
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? 2008 %
% Yes 27%
Walsall
25%
South Birmingham
27 27
Coventry Teaching
23%
21
Stoke on Trent
22%
14
North Staffordshire
21%
17
Dudley
20%
25
Heart of Birmingham
20%
14
Sandwell
18%
26
Solihull Care
18%
19
Wolverhampton
18%
23
Worcestershire
17%
21
Shropshire County
16%
21
Herefordshire
14%
21
South Staffordshire
14%
17
Birmingham East and North
13%
21
Warwickshire
13%
14
Telford & Wrekin
10%
16
Base: 2009: 3,528 West Midlands residents; 8 April - 17 May 2009 2008: 3,564 West Midlands residents; 8 April - 13 May 2008 c. 175 – 300 residents per PCT
Some variation is evident by age group, with those aged 16-24 less likely to be aware of local plans for the development of services (see chart below). Asian respondents are also less likely to be aware of any local plans (74%, compared with 80% of white respondents and 87% of other BME groups). This may be linked to their younger age profile.
69
Receiving information from the NHS by age Q Have you ever received any information from the NHS about plans for developing health services in your local area? Yes
No
Don't know
(466)
16-24
15%
84%
1%
(541)
25-34
16%
83%
2%
(565)
35-44
18%
79%
2%
(650)
45-54
20%
78%
3%
(589)
55-64
20%
78%
2%
(713)
65+
19%
78%
3%
Base: 3,528 West Midlands residents (base size for each age group shown in brackets), 8 April - 17 May 2009
The chart below looks at views on the future of local health services for people who have received local plans and compares them with those who have not. It is evident that those who feel better informed are more positive about the future of local health services.
Expectations – impact of receiving information 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
% Stay the same % Don't know
Those who have received information about local plans
Those who have not received information about local plans
(640)
(2,809)
4% 3% 11% 11%
3% 3%6% 19% 25%
35% 36% 44% % Better
46%
% Better
30%
% Worse
14%
% Worse
22%
Net better
+32
Net better
+8
Base: 3,528 West Midlands residents, 8 April - 17 May 2009
70
As there is a correlation between feeling well informed about local services and confidence with the NHS, we probed into what plans people thought they had seen. As is shown in the chart below, most people refer to hospital developments or redevelopments.
Types of information seen Q Can I just check, what plans have you seen? Top 9 mentions Plans for building a new / rebuilding the local hospital (unspecified)
30%
PCT leaflets
13%
An article in the local newspaper
11%
Plans for building a new walk in health centre (unspecified)
7%
Information about service changes
7%
Plans for rebuilding University Hospital Birmingham / Queen Elizabeth Relocating / rebuilding / extending/ new build GP surgeries Plans for building a new / rebuilding the local hospital (other specified)
3%
Advertising health services
3%
5% 4%
Base: All who have received information from the NHS about plans for developing health services in the local area (640)
A high proportion of those who say they have seen plans in South Birmingham and North Staffordshire mention hospital redevelopment in some way (69%, and 60% respectively).12 In other PCTs a range of plans were mentioned. We also asked those who have seen plans whether they had found them useful. Those who have seen plans tend to think that they had been useful (68%). However, around a third did not find them useful, did not know or could not remember (32%).
12
Please note - this should be treated with caution as based on a low number of people (58 in South Birmingham and 37 in North Staffordshire). 71
Usefulness of plans Q How useful were the plans for you, if at all?
Don’t know / can’t remember Not at all useful 9%
Not very useful
Very useful
7% 28%
16%
40%
Fairly useful Base: All who have received information from the NHS about plans for developing health services in the local area (640)
Due to the small numbers of people who are actually aware of local plans, it is difficult to analyse in any detail who found them useful. One interesting result is that those who found the plans very useful are also more likely to be positive about the future of local services. Thus although people who say they have seen local plans tend to feel more confident about the future of the NHS, it is difficult to pin down exactly what this relates to. It seems to be that a general feeling of being informed about local developments in the NHS is associated with feeling more positive about healthcare services.
Use of the internet As the NHS is constantly finding new ways to engage with citizens and patients, it is important to have up-to-date and detailed information on where people access information on health services. In particular, the potential opportunities offered by digital modes of communication and engagement need to be fully understood. In the survey last year, we asked about where people got their health information from. We know from this that a high proportion of people rely on their GP or family and friends. As usage of the internet is constantly increasing, it is useful to get an update on this element on a regular basis. We asked residents whether they have access to the internet. The survey shows that over three quarters of respondents have access to the internet.
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Internet access Q Do you have access to the internet, or not? Don’t know No *% 24%
76%
Yes
Base: 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.
Internet access by age Q Do you have access to the internet, or not? Yes
No 94%
6%
(466)
16-24
(541)
25-34
91%
9%
(565)
35-44
91%
9%
(650)
45-54
(589)
55-64
(713)
65+
83%
17%
68%
32%
38%
62%
Base: 3,528 West Midlands residents (base size for each age group shown in brackets), 8 April - 17 May 2009
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There are also differences by social background, with those from social groups ABC1 more likely to have access to the internet (89%), compared with those from C2DE (63%). In addition, those who do not have a disability are more likely to access the internet than those who do (79% compared with 66% who do have a disability). This may be related to age as those who do not have a disability are more likely to be younger. The chart below demonstrates variations in access by PCT, which is linked to the demographic profiles of the areas. It can be seen that a lower proportion of residents in Sandwell have access to the internet (69%).
Internet access by PCT Q
Do you have access to the internet, or not? % Yes Solihull Care
82%
Coventry Teaching
81%
Worcestershire
81%
Herefordshire
79%
Shropshire County
79%
South Staffordshire
79%
Telford & Wrekin
78%
South Birmingham
77%
Warwickshire
77%
Stoke on Trent
75%
North Staffordshire
74%
Heart of Birmingham
73%
Birmingham East and North
72%
Dudley
72%
Walsall
70%
Wolverhampton
70%
Sandwell
69%
Base: 3,528 West Midlands residents, 8 April – 17 May 2009, c.175 – 300 residents per PCT
Although a high proportion of residents within the region have access to the internet, only around a third of residents use the internet for accessing health information at least every month or two, and only 15% do so regularly (at least every couple of weeks).
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Using the internet for health information Q How often, if at all, do you look on the internet for information about health, for example information about local health services or on how to stay healthy? Don’t know (*%) At least every couple of weeks 15%
Never 38%
19%
Every month or two
27%
Base: All who have access to the internet (2,674)
A couple of times a year or less
As we might expect, there are variations by age, with younger people much more likely to use the internet for accessing health information. Those who are carers are more likely to use the internet to access information on health more frequently (14% look at least once a week compared with 8% who are not carers).
75
Using the internet for health information by age Q How often, if at all, do you look on the internet for information about health, for example information about local health services or on how to stay healthy? Every month or two
At least every couple of weeks
A couple of times a year or less
Never
(437)
16-24
21%
24%
28%
27%
(494)
25-34
20%
26%
26%
29%
(515)
35-44
(545)
45-54
12%
(406)
55-64
9% 14%
(274)
65+
17%
28%
19% 15%
7% 13%
28% 29%
35% 44% 48%
25%
55%
Don't know
* * * * 1
Base: All who have access to the internet (base size for each age group shown in brackets)
It seems that there is a lot of potential to increase the extent to which the internet is used to access information on health. Members of the public are using the internet widely but are still relying on more traditional sources for health information. This suggests that we might need to examine in more depth how the public would like to access health information and the role of digital media within this. The chart overleaf demonstrates the range of activities which people undertake using the internet. This suggests there are prospects for utilising the interactive features of the internet to engage with the public.
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Internet activity Q Which of the following things do you and your family do on the internet, if any? Post on social networking sites such as Facebook, or other forums
55%
Watch videos, for example through YouTube
51%
Play games
46%
Watch TV, for example on BBC iplayer
42%
Post your ratings for products or services on sites that ask you to do this
42%
Contribute to discussions in chat rooms
22%
Update people on what you are doing through a Blog or Twitter
21%
I/we don’t do any of those things
15%
Base: All who have access to the internet (2,674)
The SHA is currently developing digital services which will attempt to give local citizens and staff access to a range of tools and information to help them manage and improve their health.
77
78
Appendices
79
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 3,564 with an effective sample size of 3,362 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
3,362 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 3,362 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
3,362 (NHS West Mids 2009) vs. 3,276 (NHS West Mids 2008) 200 and 200 (e.g. between PCTs) 2,974 (white residents) vs. 380 (ethnic minority residents)
Differences required for significance at or near these percentage levels 10% or 90% 30% or 70% 50% + + + 1 2 2 6 3
9 5
10 5
80
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
A
Upper Middle Class
Higher managerial, administrative or professional
B
Middle Class
Intermediate managerial, administrative or professional
C1
Lower Middle Class
Supervisor or clerical and junior managerial, administrative or professional
C2
Skilled Working Class
Skilled manual workers
D
Working Class
Semi and unskilled manual workers
16.9
E
Those at the lowest levels of subsistence
State pensioners, etc, with no other earnings
11.7
2.9
18.9
27.0
22.6
81
3. Mosaic groups Group and type names Group
Type
Code
Name
Code
Name
01
A Career professionals living in sought after locations
01
A01 Financially successful people living in smart flats in cosmopolitan inner city locations
02
A02 Highly educated senior professionals, many working in the media, politics and law
03
A03 Successful managers living in very large houses in outer suburban locations
04
A04 Financially secure couples, many close to retirement, living in sought after suburbs
05
A05 Senior professionals and managers living in the suburbs of major regional centres
06
A06 Successful, high earning couples with new jobs in areas of growing high tech employment
07
A07 Well paid executives living in individually designed homes in rural environments
08
B08 Families and singles living in developments built since 2001
09
B09 Well qualified couples typically starting a family on a recently built private estate
10
B10 Financially better off families living in relatively spacious modern private estates
11
B11 Dual income families on intermediate incomes living on modern estates
12
B12 Middle income families with children living in estates of modern private homes
13
B13 First generation owner occupiers, many with large amounts of consumer debt
14
B14 Military personnel living in purpose built accommodation
15
C15 Senior white collar workers many on the verge of a financially secure retirement
16
C16 Low density private estates, now with self reliant couples approaching retirement
17
C17 Small business proprietors living in low density estates in smaller communities
18
C18 Inter war suburbs many with less strong cohesion than they originally had
19
C19 Attractive older suburbs, typically occupied by families but with increasing singles and childless couples
20
C20 Suburbs sought after by the more successful members of the Asian community
02
03
B Younger families living in newer homes
C Older families living in suburbia
82
Group
Type
Code
Name
Code
Name
04
D Close-knit, inner city and manufacturing town communities
21
D21 Mixed communities of urban residents living in well built early 20th century housing
22
D22 Comfortably off manual workers living in spacious but inexpensive private houses
23
D23 Owners of affordable terraces built to house 19th century heavy industrial workers
24
D24 Low income families living in cramped Victorian terraced housing in inner city locations
25
D25 Centres of small market towns and resorts containing many hostels and refuges
26
D26 Communities of lowly paid factory workers, many of them of South Asian descent
27
D27 Multi-cultural inner city terraces attracting second generation settlers from diverse communities
28
E28 Neighbourhoods with transient singles living in multiply occupied large old houses
29
E29 Economically successful singles, many living in privately rented inner city flats
30
E30 Young professionals and their families who have gentrified terraces in pre 1914 suburbs
31
E31 Well educated singles and childless couples colonising inner areas of provincial cities
32
E32 Singles and childless couples in small units in newly built private estates
33
E33 Older neighbourhoods increasingly taken over by short term student renters
34
E34 Halls of residence and other buildings occupied mostly by students
35
F35 Young people renting hard to let social housing often in disadvantaged inner city locations
36
F36 High density social housing, mostly in inner London, with high levels of diversity
37
F37 Young families living in upper floors of social housing
38
F38 Singles, childless couples and older people living in high rise social housing
39
F39 Older people living in crowded apartments in high density social housing
40
F40 Older tenements of small private flats often occupied by highly disadvantaged individuals
05
06
E Educated, young, single people living in areas of transient populations
F People living in social housing with uncertain employment in deprived areas
83
Group
Type
Code
Name
Code
Name
07
G Low income families living in estate based social housing
41
G41 Families, many single parent, in deprived social housing on the edge of regional centres
42
G42 Families with school age children, living in very large social housing estates on the outskirts of provincial cities
43
G43 Older people, many in poor health from work in heavy industry, in low rise social housing
44
H44 Manual workers, many close to retirement, in low rise houses in ex-manufacturing towns
45
H45 Older couples, mostly in small towns, who now own houses once rented from the council
46
H46 Residents in 1930s and 1950s council estates, typically in London, now mostly owner occupiers
47
H47 Social housing, typically in 'new towns', with good job opportunities for the poorly qualified
48
I48 Older people living in small council and housing association flats
49
I49 Low income older couples renting low rise social housing in industrial regions
50
I50 Older people receiving care in homes or sheltered accommodation
51
J51 Very elderly people, many financially secure, living in privately owned retirement flats
52
J52 Better off older people, singles and childless couples in developments of private flats
53
J53 Financially secure and physically active older people, many retired to semi rural locations
54
J54 Older couples, independent but on limited incomes, living in bungalows by the sea
55
J55 Older people preferring to live in familiar surroundings in small market towns
56
J56 Neighbourhoods with retired people and transient singles working in the holiday industry
57
K57 Communities of retired people and second homers in areas of high environmental quality
58
K58 Well off commuters and retired people living in attractive country villages
59
K59 Country people living in still agriculturally active villages, mostly in lowland locations
60
K60 Smallholders and self employed farmers, living beyond the reach of urban commuters
61
K61 Low income farmers struggling on thin soils in isolated upland locations
08
09
10
11
H Upwardly mobile families living in homes bought from social landlords
I Older people living in social housing with high care needs
J Independent older people with relatively active lifestyles
K People living in rural areas far from urbanisation
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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 results reported against particular questions asked in the telephone survey. The charts help to distinguish real differences between PCTs 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)13. This appendix provides information about reading and interpreting these charts. 80% Each point respresents a PCT
PCTs represented by (red or green) points above or below the funnel differ significantly from the West Midlands average. These are sometimes called spacial cause variations
75% The height of point indicates the result observed for the PCT
Result (%) for PCT
70%
The funnel narrows to the right because as sample sizes increase smaller variations from the West Midlands average are required to detect significant differences
65% The horizontal black line indicates the result for the West Midlands as a whole
60% PCTs represented by (blue) points within the funnel do not differ significantly from the West Midlands average. Variation in this range is to be expected.
55%
50% The horizontal position of the point indicates the sample size on which the PCT's result is based
45%
40% 170
190
210
230
250
270
290
310
Number of respondents/Sample Size for PCT
Each point in the chart represents a PCT. The height of the point indicates the result observed in the survey for that PCT, so PCTs achieving higher results appears higher in the chart. The horizontal position of the point indicates the sample size on which that PCT’s result is based, so PCTs 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 reasonable be attributable to sampling error. The funnel cuts the chart into three distinct regions. PCTs represented by points above the funnel have significantly higher results than the West Midlands average. PCTs 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. 13
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 85
PCTs represented by points within the funnel do not differ significantly from the West Midlands average – 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 – there is a 99.7% chance that values lying beyond this limit do not result from sampling error.
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5. GP-led health centres The table below outlines the text used in the question about awareness of the new GP-led health centres for each PCT. PCT
Question
Birmingham East & Are you aware of the new Health Centre planned in your local North area? The health centre is open seven days a week and you do not need to make an appointment. Coventry
Are you aware of the new Health Centre opened called the Hillfields Primary Care Centre at the Coventry and Warwickshire Hospital, Stoney Stanton Road? The health centre is open seven days a week and you do not need to make an appointment.
Dudley
Are you aware of the new Health Centre planned at the Dudley Street Thomas Scheme? The health centre is open seven days a week and you do not need to make an appointment.
Heart of Birmingham
Are you aware of the new Health Centre planned in your local area? The health centre is open seven days a week and you do not need to make an appointment.
Herefordshire
Are you aware of the new Health Centre planned in your local area? The health centre is open seven days a week and you do not need to make an appointment.
North Staffordshire
Are you aware of the new Health Centre opened called the Midway Medical and Walk-in Centre at Morston House, The Midway, Newcastle-under-Lyme? The health centre is open seven days a week and you do not need to make an appointment.
Sandwell
Are you aware of the new Health Centre planned called The Malling Health Centre - Sandwell, on Parsonage Street in West Bromwich? The health centre is open seven days a week and you do not need to make an appointment.
South Birmingham
Are you aware of the new Health Centre planned called The Selly Oak Health Centre on Katie Road in Selly Oak? The health centre is open seven days a week and you do not need to make an appointment.
Shropshire
Are you aware of the new Health Centre planned called the Shropshire GP Health Centre at Whitehall, Monkmoor Road, in Shrewsbury? The health centre is open seven days a week and you 87
do not need to make an appointment. Solihull Care Trust
Are you aware of the new Health Centre opened called the Solihull Healthcare and Walk-in Centre at Solihull Hospital? The health centre is open seven days a week and you do not need to make an appointment.
South Staffordshire
Are you aware of the new Health Centre opened called the Burntwood Health and Wellbeing Centre on the High Street, Chasetown, Burntwood? The health centre is open seven days a week and you do not need to make an appointment.
Stoke on Trent
Are you aware of the new Health Centre planned for Hanley? The health centre is open seven days a week and you do not need to make an appointment.
Telford & Wrekin
Are you aware of the new Health Centre planned for Telford town centre? The health centre is open seven days a week and you do not need to make an appointment.
Walsall
Are you aware of the new Health Centre opened called at Walsall walk-in centre on Market Street in Digbeth? The health centre is open seven days a week and you do not need to make an appointment.
Warwickshire
Are you aware of the new Health Centre planned called the Camp Hill GP led health centre at Camp Hill Early Years Centre on Hollystiches Road in Camp Hill, Nuneaton? The health centre is open seven days a week and you do not need to make an appointment.
Wolverhampton
Are you aware of the new Health Centre planned for Wolverhampton? The health centre is open seven days a week and you do not need to make an appointment.
Worcestershire
Are you aware of the new Health Centre planned for Worcestershire? The health centre is open seven days a week and you do not need to make an appointment.
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