Public and Patient Views on Health Services in the West Midlands

Public and Patient Views on Health Services

in the West Midlands

Annual Survey Report 2010/11

Business Analytics Team

Contents

Executive Summary

Introduction

1. Perceptions of the NHS

2. Expectations for the future

3. Priorities for improvement

4. Financial challenges

5. Providing good value for money

6. Engagement and access to information

Appendices

1. Statistical reliability

2. Definition of social grades

3. Mosaic code definitions

4. Reading and interpreting funnel plots

3

Executive Summary

Introduction

This report provides a detailed analysis of the results from a telephone survey carried out

with a representative sample of West Midlands’ residents in the winter of 2010. NHS West

Midlands has commissioned a range of surveys with local patients and citizens over the last

four years. These surveys give us an invaluable opportunity to explore patient and public

views on health and healthcare services and to ensure that developments in the NHS are

informed by local people’s concerns and preferences.

The findings of the research presented in this report have been derived from 2000

telephone interviews with West Midlands residents, each lasting for around 25 minutes. All

interviews were conducted between 15 November and 12 December 2010 by Ipsos MORI.

The latest telephone survey was held later than usual this year, to avoid coinciding with the

election period.

Quotas were set on gender, age, working status and ethnicity to ensure that the profile of

those interviewed matched the profile of the region’s population as closely as possible,

according to the 2001 census. Additional quotas were set by PCT Cluster to ensure that the

number of interviewees in each Cluster is proportional to the size of its population, and give

a good geographical spread of responses across the region. Results are also weighted to

population information from the Census by age, gender, working status, ethnicity and PCT

Cluster.

Perceptions of the NHS

Satisfaction with the overall running of the NHS has increased over recent years. In the

latest survey, 77% of those interviewed state that they are fairly satisfied or very satisfied

with how the NHS is being run, this is a significant improvement from the results obtained

last year, when 72% of those questioned said that they were satisfied and a substantial

improvement from the position in 2006 when 61% were satisfied.1 Similarly, satisfaction

with the local NHS has also improved over recent years. When asked whether they agree

that their local NHS is providing them with a good service, the overwhelming majority agree

(82%, compared with 79% in 2009 and 70% in 2006).

As well as looking at satisfaction with health services overall, the survey looked at particular

aspects of service delivery in detail. In relation to the quality of care patients receive in local

hospitals, the results show that two thirds of all respondents are satisfied with the quality of

care patients receive (66%), and around a fifth are very satisfied (22%). Encouragingly, a

higher proportion of those who have been an inpatient recently state that they are very

satisfied with the quality of care available in their local hospital (28%). A higher proportion

of residents in West Mercia Cluster are satisfied with the quality of care found in their local

hospital (71%). In contrast, a lower proportion of respondents in Staffordshire Cluster are

1 This question was not asked in 2008.

4

satisfied (59%), and almost a quarter are dissatisfied with the quality of care available in

their local hospital (24%). In order to probe for views on local services further, respondents

were asked whether they agreed or disagreed with the statement ‘my local hospital treats

patients with dignity and respect’, based on what they know or have heard. Overall, 71%

agree that their local hospital treats patients with dignity and respect, with 14% disagreeing.

On a positive note, those who have recently either been an inpatient or outpatient

themselves are more likely to state that they agree that patients are treated with dignity

and respect (74%), with over a third of this group stating that they strongly agree (37%). A

lower proportion of respondents from Staffordshire agree that their local hospital treats

patients with dignity and respect (64%) and a higher proportion disagree with this

statement (18%, with 9% strongly disagreeing).

The survey findings are representative at Cluster level only, and hence it is not possible to

ascertain which local hospital people are thinking about in relation to their responses on the

quality of care available locally and on whether patients are treated with dignity and

respect. Hence, the results of this survey need to be considered alongside a range of other

information including direct feedback from patients (e.g. CQC survey data and other patient

feedback), local surveys and a range of qualitative insights. 2

Expectations for the future

Residents’ expectations for the future of their local health services have worsened since the

last time the survey was conducted. The largest proportion of citizens state that they expect

services to remain the same over the next few years (41%), while over a quarter expect

them to get better (27%), and almost a third think that they will get worse (30%). In

previous surveys we had seen an improvement in residents’ expectations for the NHS; the

highest levels of optimism were recorded in 2009 when 33% of those questioned expected

services to improve and 21% expected services to worsen.

There are differences between PCT Clusters in terms of expectations for the future.

Respondents in Staffordshire Cluster are more optimistic about the future, compared with

residents in other Cluster areas. In contrast, residents in Arden Cluster are less optimistic

about the way services will develop over the next few years. Across the West Midlands

certain socio-demographic groups are more positive than others in terms of the future of

the NHS. Overall, those in social grades C2, D and E tend to be more positive than those in

social grades A, B and C1, as are ethnic minority residents in comparison with white

respondents.3 4 There are also differences across age-groups with those aged 16-24 the

most optimistic about the future for health services, whilst those aged 45-54 are the most

pessimistic.

Other factors are also linked with respondents’ views on the future of NHS services. Those

who are concerned about economic pressures are much less positive about the future of

2 For example, the latest patient survey results are available at http://www.cqc.org.uk/

3 A definition of social grades can be found in the appendices.

4 Overall, 30% of those in social groups C2DE feel that services will get better, compared with

24% from social groups ABC1. In total, 34% of those from minority ethnic groups feel that services will get better compared with 26% of those from white ethnic groups.

http://www.cqc.org.uk/

5

the NHS; 33% of those who are concerned about economic pressures state that they expect

NHS services to get worse, compared with 11% of those who are not concerned.

Respondents who work in the NHS are also more pessimistic about the future, with 37%

stating that they expect services to get worse over the next few years, compared with 32%

who have family and friends working in the NHS and 28% who are not connected with the

NHS in this way.

Priorities for improvement

We asked respondents which was the main priority for improvement in the local NHS.

Improving waiting times in A&E is highlighted by respondents as the factor which is most in

need of improvement. A similar proportion of residents think this is the most important

priority for improvement as was the case last year. Significant improvements are evident

around perceptions of cleanliness in hospitals. This emerges as the second highest priority

for improvement this year; the first time that it has not been highlighted as the top priority

for improvement since 2008. In addition, the proportion of residents who feel that hospital

cleanliness is the most important factor to improve has fallen from 16% in 2009 to 11% in

2010.

Reducing waiting times in A&E emerges as the most important priority in the Black Country

and Arden, whilst in Staffordshire this is seen as the most important aspect alongside

improving cleanliness of hospitals. In Birmingham and Solihull, cleanliness in hospitals and

GP waiting times are seen as the main priorities for improvement, and in West Mercia A&E

waiting times and mental health support services are seen as the key areas where

improvements need to be targeted.

Financial challenges

In order to gauge how this was being perceived by the public, respondents were asked

whether they were concerned about economic pressures and their potential effect on the

NHS. The findings indicate that people are worried about the impact of wider economic

pressures on the ability of the local NHS to deliver health services, with more than eight in

ten stating that they are concerned and four in ten stating that they are very concerned.

Some variation by demographic group is evident, as older respondents, those with a

disability, and those who have someone in their family with a disability are more likely to

state that they are very concerned about economic pressures.5 In addition, those who have

been an inpatient or outpatient recently are more likely to feel very concerned about these

issues. There seems to be a relationship between perceptions of funding and levels of

confidence for the future of the NHS, as people who expect the NHS to get worse over the

next few years are more likely to be concerned about economic pressures. In total, 59% of

those who expect services to get worse are very concerned about economic pressures

affecting the NHS, compared with 35% of those who expect services to get better.

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

6

Providing good value for money

In order to gauge public understanding around the aim to reduce the number of treatments

of limited clinical value, respondents were asked to what extent they agreed or disagreed

with the following statement: ‘The NHS should stop providing treatments that have little or

no medical benefit for patients’. Over half of all respondents agree with this statement

(57%), while just over a quarter disagree (27%). Those who took part in the survey were

invited to state whether they would support or oppose a range of initiatives which were

aimed at reducing interventions of limited clinical value. Support is greatest for stopping

medicines being prescribed where there is no proven medical benefit (supported by 73%)

and only carrying out hip and knee replacements for people whose condition won’t be

improved by other treatments (supported by 71%).

Since the implementation of ‘Investing for Health’ in July 2007, reducing demand on acute

hospitals has been a key aim within the West Midlands. This agenda is also central to

national policy, and the Operating Framework for 2011/12 cites a commitment to release

capacity from acute services to allow the better use of community services. The results

show that a majority of respondents support the idea of reducing demand on hospitals

(55%). However, a third oppose this as a general principle (33%), with just over a fifth

stating that they strongly oppose it (22%). It is interesting to note that opposition to the

idea of reducing demand on hospitals is correlated with general dissatisfaction with the

NHS.

Once presented with further information, a high proportion of those who initially opposed

the principle of reducing demand on hospitals changed their stance. On average, 74% state

that they would support this idea once they have heard further information on proposed

initiatives. The highest levels of support are found for helping people to stay healthy so they

don’t need to go to hospital (85% of those who previously opposed this idea say that they

now support the principle of reducing demands on hospitals), carrying out some follow-up

appointments in local health centres (83%), and carrying out operations differently so that

people don’t need to stay in hospitals for so long (76%).

Engagement and information

When we asked local residents whether they had received any information from the NHS

about developing local health services, we found that there had been little change from

2008, in terms of the proportion of citizens who had received information. Around a fifth of

respondents recall receiving information from the NHS, while three quarters do not recall

receiving any information.

On the whole, respondents do not feel very informed about how the NHS spends its money

locally, about who makes decisions about how NHS money is spent locally, or what the NHS

is doing locally to provide good value for money to patients and taxpayers (around three

quarters say that they know nothing or very little about these subjects). There is slightly

better awareness around the current proposals for the creation of GP commissioning

consortia, but around two thirds state that they know nothing or very little about these

changes.

7

After respondents were asked about how much they knew on the subjects above, they were

asked on which subjects they would like to receive more information. The most popular

option is further information on how the NHS spends its money locally (57%). A similar

proportion want to know more about what the NHS is doing locally to provide good value

for patients and taxpayers (56%) and the government’s proposals to give more control over

the NHS budget to GPs (55%).

Local residents feel that they are more informed about the quality of local health services

than some other aspects of health service delivery, with half stating that they know a fair

amount or a great deal about this (50%). However, a similar proportion feel that they know

very little or nothing at all about the quality of local services (48%). The results of the survey

show that the main source respondents trust to give them helpful information about the

quality of treatment in local hospitals is their GP (50%). Other people who are trusted are

family and friends (mentioned by 20%), other health professionals (cited by 10%) and NHS

hospitals themselves (mentioned by 8%).

A high proportion of respondents would like to access information on the quality of local

services online or via their mobile (64%). This figure rises to 78% for those aged under 45. In

addition, a higher proportion of people from social groups ABC1 (68%), who are working

(74%) and from minority ethnic groups (74%) would like to access information in this way.

Interestingly a high proportion of staff and their friends and family would like to access

information in this way (76% and 67% respectively).

8

Introduction

NHS West Midlands has commissioned a range of surveys with local patients and citizens

since 2006. These surveys give us an invaluable opportunity to explore patient and public

views on health and healthcare services and to ensure that developments in the NHS are

informed by local people’s concerns and preferences. The latest telephone survey was held

later than usual this year, to avoid coinciding with the election period.

Background and Objectives

NHS West Midlands is the Strategic Health Authority (SHA) for the West Midlands region,

covering an area of 5.4 million people across Birmingham, Coventry, Dudley, Herefordshire,

Sandwell, Shropshire, Solihull, Staffordshire, Stoke on Trent, Telford and Wrekin, Walsall,

Warwickshire, Wolverhampton and Worcestershire. The SHA is responsible for ensuring

that the £8.9 billion pounds spent on health and health care across the West Midlands

delivers better services for patients and better value for money for tax payers.

In order to guide the local implementation of policy, the SHA has commissioned a range of

market research over recent years. As part of this, a telephone survey with a representative

sample of residents was undertaken in November and December 2010.

The objectives of this research were to:

1. Understand residents’ general perceptions of the NHS and their expectations for the future

2. Understand their priorities for improvement in healthcare services

3. Examine their views about the impact of economic pressures on the NHS and how resources can best be utilised

4. Explore responses to suggested initiatives for getting the most out of NHS resources and providing good value for money

5. Analyse the information on health services that residents are able to access and how they currently obtain this information. In addition, to explore people’s preferences around information and methods of access.

9

Methodology

The findings of the research presented in this report have been derived from 2000

telephone interviews with West Midlands residents, each lasting for around 25 minutes. All

interviews were conducted between 15 November and 12 December 2010 by Ipsos MORI.

Quotas were set on gender, age, working status and ethnicity to ensure that the profile of

those interviewed matched the profile of the region’s population as closely as possible,

according to the 2001 census. Additional quotas were set by PCT Cluster to ensure that the

number of interviewees in each Cluster is proportional to the size of its population, and give

a good geographical spread of responses across the region. Results are weighted to

population information from the Census by age, gender, working status, ethnicity and PCT

Cluster.

Previous research

Similar surveys were previously carried out by Ipsos MORI on behalf of NHS West Midlands

in 2006, 2008 and 2009. The 2009 survey was conducted between 8 April and 17 May 2009

and interviews were carried out amongst 3,528 residents. The 2008 survey was conducted

among 3,564 residents between 8 April and 13 May 2008. The 2006 survey was conducted

between 8 August and 8 September 2006 amongst 3,535 residents. A slightly smaller

sample was used for the survey this year, due to the focus on obtaining representative

results at the regional level and at PCT Cluster level, rather than at individual PCT level.

The production of this report

This report, including the discussion of the findings, has been produced by NHS West

Midlands Business Analytics Team. All the data used in the report is based on the results of

the telephone survey as supplied by Ipsos MORI. Ipsos MORI also supplied many charts, as

indicated, other tables and charts were produced by the Business Analytics Team.

Presentation and interpretation of data

It should be noted that a sample, and not the entire population, has taken part in the

survey. Therefore, all results are subject to sampling tolerances, which means that not all

differences are significant. A guide to statistical reliability is appended, but as a rule of

thumb results based on the full sample are reliable to +2 percentage points at a 95% level

of confidence, while sub-groups will have a wider margin of error. Any results based on

samples of 100 or below have a margin of error of at least +10 percentage points, and

should be treated as indicative only.

It should be borne in mind that demographic sub-groups overlap, and that viewing them in

isolation can be artificial. For example, black and minority ethnic communities often have a

younger age profile; differences in their views may be just as much to do with age as they

are to do with ethnicity.

Where percentages do not sum to 100, this may be due to computer rounding, the

exclusion of “don’t know” categories, or multiple answers. Throughout the report an

10

asterisk (*) denotes any value of less than half of one per cent, but greater than zero.

Where reference is made to “net” figures, this represents the balance of opinion on

attitudinal questions, and provides a particularly useful means of comparing the results for

a number of variables. In the case of a “net satisfaction” figure, this represents the

percentage satisfied on a particular issue, less the percentage dissatisfied. For example, if

40% who answer are satisfied and 25% dissatisfied, the “net satisfaction” figure is +15

points.

Acknowledgements

NHS West Midlands would like to thank Kate Duxbury, Caroline Booth, Chris Marshall and

Phil Westwood at Ipsos MORI for co-ordinating the annual telephone survey fieldwork and

providing insights on the results. Special thanks also go to the 2,000 West Midlands

residents who took the time to take part in this survey.

Report Layout

The report begins with an executive summary, which summarises the key findings and

implications. The main body of the report is divided into six different chapters:

Perceptions of the NHS

Expectations for the future


Financial challenges

Providing good value for money

Engagement and access to information

© NHS West Midlands

11

1. Perceptions of the NHS

The recent white paper ‘Equity and excellence: liberating the NHS’ emphasises the need to

strengthen the collective voice of patients and the public. This section examined the views

of local people and patients about how the NHS is run, satisfaction with local services and

about the quality of care patients receive in local hospitals.

Overall satisfaction with the NHS

Satisfaction with the overall running of the NHS has increased over recent years. In the

latest survey, 77% of those interviewed state that they are fairly satisfied or very satisfied

with how the NHS is being run, this is a significant improvement from the results obtained

last year, when 72% of those questioned said that they were satisfied and a substantial

improvement from the position in 2006 when 61% were satisfied.6

Overall satisfaction with the NHS

% Neither/nor

% Don't know

% Fairly satisfied% Very satisfied

% Fairly dissatisfied % Very dissatisfied

31%

46%

9%

7%5%1%

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

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

WM 2009 – 3,528 West Midlands residents, 8 April – 17 May 2009

WM 2006 – 3,535 West Midlands residents, 8 August – 8 September 2006

WM

2010

WM

2009

WM

2006

Satisfied % 77 72 61

Dissatisfied % 13 18 27

Net satisfied % +64 +53 +34

High levels of satisfaction are found across the region. The chart overleaf shows variations

in satisfaction by Cluster and variations which might be due to sampling error (error that

results from speaking to only a sample of the population rather than doing a census of the

whole West Midlands population). When we account for variation which may be caused by

sampling error, it is evident that the results for individual Clusters are not significantly

different to the regional average. The fact that the markers fall within the control limits

6 This question was not asked in 2008.

12

means that satisfaction is broadly in line with the average across the West Midlands, and

any variation could be a result of sampling error.7

Overall satisfaction with the running of the NHS, by Cluster

(Base: 2000 respondents, 15 November and 12 December 2010, Q: Overall, how satisfied or dissatisfied are you with the

running of the National Health Service nowadays? Weighted data.)

Some differences are evident by age group, those aged 65 and over are the most positive,

as is found throughout the results of the survey (see graph overleaf). In addition,

differences are also found by ethnic group as those from a white ethnic group are more

likely to state that they are satisfied than those from a black and minority ethnic group

(78% compared with 69% from a BME group).

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

Bham & Sol

W. Mercia

Staf fs

B. Country

Arden

60%

65%

70%

75%

80%

85%

300 320 340 360 380 400 420 440 460

% a

nsw

erin

g 'f

airl

y sa

tisf

ied

' or '

very

sat

isfi

ed'

Number of respondents

Cluster

West Midlands

Upper Control Limit (2 sigma)

Lower Control Limit (2 sigma)



13

Differences are also evident based on recent experience of using certain NHS services.

Those who have either been an inpatient in an NHS hospital or who have been an

outpatient are more likely to be very satisfied than those who have not (34% compared

with 26% who are very satisfied amongst those respondents who have been neither an

inpatient nor an outpatient). Overall satisfaction is also linked to optimism about the future

development of services and satisfaction with aspects of service delivery. Those who are

more satisfied with how the NHS is being run are more likely to feel that the NHS will get

better over the next few years; 84% of those who expect NHS services to get better are

satisfied, compared with 61% who expect services to get worse. Those who are satisfied

with the quality of care patients receive at their local hospital are also more likely to say

that they are satisfied with the running of the NHS; 88% of those who are satisfied with

quality of care are satisfied with how the NHS is run, compared with 46% who are

dissatisfied.

We will now focus on how well people feel that NHS services are being delivered, looking at

perceptions of local and national provision.

14

Overall satisfaction with local services

Satisfaction with the local NHS has also improved over recent years. When asked whether

they agree that their local NHS is providing them with a good service, the overwhelming

majority agree (82%, compared with 79% in 2009 and 70% in 2006).

Perceptions of the local NHS

41%

41%

5%7%

5%1%

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”

WM 2010 WM 2009 WM 2006

Agree % 82 79 70

Disagree % 11 14 21

Net Agree % +71 +65 +49

% Neither/nor

% Don't know / no opinion

% Tend to agree% Strongly agree

% Tend to disagree % Strongly disagree




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

national provision.

15

68

82

16

11

Satisfaction with national and local NHS


The NHS is providing agood service nationally

My local NHS is providingme with a good service 70

51

WM 2006% agree% Agree




% Disagree

79

64

WM 2009% agree

As can be seen in the chart below, satisfaction varies by age, with the most positive

residents being found in the oldest and youngest age groups (those over 65 years and

under 25 years respectively). Similarly, levels of satisfaction are higher amongst those who

are not working (85% are satisfied, compared with 79% who are working). In addition,

those from black and minority ethnic minority groups are less likely to feel satisfied, than

those from white ethnic groups (74% compared with 83%). Those who have been an

inpatient or outpatient are more likely to strongly agree that their local NHS is providing

them with a good service than the general public as a whole (44% of those who have

recently been inpatients and outpatients strongly agree, compared with 41% overall).


“My local NHS is providing me with a good service”

16-24

25-34

35-44

45-54

55-64

65+

% Net

Agree

+74

+67

+69

+58

+70

+82

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

(260)

(282)

(367)

(344)

(312)

(435)

% Agree

Perceptions of the local NHS by age

16

The chart below shows the proportion of people in each Cluster who agree that their local

NHS is providing them with a good service. A higher proportion of residents in Arden are

positive about their local NHS, and a lower proportion are satisfied in the Black Country

Cluster.8

Satisfaction with the local NHS, by Cluster

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

8 Clusters with a significantly higher level of satisfaction than the West Midlands average, are shown

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

Bham & Sol

W. Mercia

Staf fs

B. Country

Arden

60%

65%

70%

75%

80%

85%

90%

95%

300 320 340 360 380 400 420 440 460

% a

nsw

eri

ng

'te

nd

to

ag

ree

' or

'str

on

gly

ag

ree

'


Cluster

West Midlands





17

Quality of care

Improving quality is a central aim of the reforms proposed for the NHS, and improving

public and patient perceptions around quality are a key part of this. All those who took part

in the survey were asked whether they were satisfied or dissatisfied with the overall quality

of care patients receive at their local hospital, based on what they know or what they have

heard.

Overall, the results show that two thirds of all respondents are satisfied with the quality of

care patients receive (66%), and around a fifth are very satisfied (22%).

22%

45%

8%

10%

7%

6%2%

Quality of care at hospital

Neither/nor

Very satisfied

Don’t know/Refused

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

Q How satisfied or dissatisfied are you overall with the quality of care patients receive at your local NHS hospital?

Fairly satisfied

Fairly dissatisfied

Very dissatisfied

It depends on what ward or dept you visit

Encouragingly, a higher proportion of those who have been an inpatient recently state that

they are very satisfied with the quality of care available in their local hospital (28%).

However, it is worth noting that a higher proportion are also dissatisfied (20% compared

with 17% overall), and in addition a higher proportion of those who have attended A&E

recently say that they are dissatisfied (19%).

Satisfaction varies by age group, those aged 65 and over are more likely to say that they are

satisfied with the quality of care available locally (70%), and those aged 35-44 are the most

likely to state that they are dissatisfied (21% compared with 17% overall). In addition, there

are variations by ethnic group; a higher proportion of those from ethnic minority groups

state that they are dissatisfied with the quality of care available locally compared with

those from white ethnic groups (22% and 17% respectively). Also views vary by disability

status, as a higher proportion of those with a disability themselves, or who have someone

in their family with a disability, state that they are dissatisfied (20% compared with 16% for

those without disability).

18

The chart below shows that there are variations in perceptions around the quality of care

across the Clusters. A higher proportion of residents in West Mercia Cluster are satisfied

with the quality of care found in their local hospital (71%). In contrast, a lower proportion

of respondents in Staffordshire Cluster are satisfied with the quality of care available in

their local hospital (59%), and almost a quarter are dissatisfied (24%).

Satisfaction with the quality of care available in local hospitals, by Cluster

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

We asked all respondents to give reasons for their views on quality. In terms of those who

are satisfied with the quality of care available, the main reason given is good personal

experience (25%), good service (24%), or that a family member or friend had a good

experience (22%).

W. Mercia

Bham & Sol

B. Country

Staf fs

Arden

50%

55%

60%

65%

70%

75%

300 320 340 360 380 400 420 440 460

% a

nsw

eri

ng

'te

nd

to

ag

ree

' or

'str

on

gly

ag

ree

'


Cluster

West Midlands





19

Reasons for satisfaction with hospital care

Q Why do you say you are satisfied with the overall quality of care

patients receive at your local NHS hospital?

Base: All who are satisfied with the overall quality of care patients receive at local NHS hospital (1,319), 15 November

– 12 December 2010

25%

24%

22%

20%

17%

13%

13%

6%

5%

5%

Good personal experience

Good service at local hospital

Family member/friend had good experience

Good quality of care/treatment

No problems

Efficient/quick service

Good/caring/friendly staff

Good staff numbers/resources

Good level of hygiene/cleanliness

Good attitude/politeness of staff

Top 10 mentions

For those who are dissatisfied the main reason mentioned is a general perception of poor

quality of care / treatment (37%), while some cite problems experienced by family

members or friends (27%) and poor / unfriendly / uncaring staff (23%). Experience of

problems personally is mentioned by 13% of those who are dissatisfied.

Reasons for dissatisfaction with hospital care

Q Why do you say you are dissatisfied with the overall quality of care

patients receive at your local NHS hospital?

37%

27%

23%

19%

19%

18%

16%

13%

11%

6%

Poor quality of care/treatment

Family member/friend has experienced problem

Poor/uncaring/unfriendly staff

Poor staff numbers/resources

Inefficient/slow service

Poor service at local hospital

Poor level of hygiene/cleanliness

Have experienced problems personally

Poor attitude/rudeness of staff

Worsening services

Base: All who are dissatisfied with the overall quality of care patients receive at local NHS hospital (349), 15 November –

12 December 2010

Top 10 mentions

20

Dignity and respect

In order to probe views on local services further, respondents were asked whether they

agreed or disagreed with the statement ‘my local hospital treats patients with dignity and

respect’, based on what they know or have heard. Overall, 71% agree that their local

hospital treats patients with dignity and respect, with 14% disagreeing.

Dignity and respect

Neither/nor

Strongly agree

Don’t know/Refused


Q From what you have heard or what you know, to what extent do you agree or disagree with the following statement?

“My local NHS hospital treats patients with dignity and respect”

Tend to agree

Tend to disagree

It depends on what ward or dept you visit

Strongly disagree

Some differences in perceptions are evident by age group, as respondents aged 16-24 are

the most positive about this question, with 77% agreeing that local patients are treated

with dignity and respect. A higher proportion of those with a disability / who have family

member with a disability or who have caring responsibilities disagree with the statement

(17% for both groups). No other major differences are evident by demographic group.

On a positive note, those who have recently either been an inpatient or outpatient

themselves are more likely to state that they agree that patients are treated with dignity

and respect (74%), with over a third of this group stating that they strongly agree (37%).

However, those who have visited others in hospital, but have not been in hospital

themselves, are much more negative, with 17% disagreeing that patients are treated with

dignity and respect. This reaffirms the findings of other studies which have suggested that

visitors have more negative views about a range of aspects related to patient care.9 It is

worth noting that a slightly higher proportion of those who have attended A&E recently

strongly disagree with the statement (8% compared with 7% overall), however the

responses of this group to this question on dignity and respect are similar to the average

otherwise.

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

http://www.wmqi.westmidlands.nhs.uk/patient-experience/patient-experience-home/report/207

21

37

32

36

38

6

6

7

10

7

7

5

7

Dignity and respect by service usage

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

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

In-patient /

Out-patient

Visited

someone

(1,129)

(418)

% Neither/nor

% Don't know/refused

% Fairly satisfied% Very satisfied

% Very dissatisfied % Fairly dissatisfied% It depends on

what ward you visit

2

*

The results show some geographical variation across the region (see chart overleaf). A

lower proportion of respondents from Staffordshire agree that their local hospital treats

patients with dignity and respect (64%) and a higher proportion disagree with this

statement (18%, with 9% strongly disagreeing).

22

Agreement that local hospital treat patients with dignity and respect, by Cluster

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

Weighted data.)

Alongside their views on how the NHS is being run currently, we also asked people about

how they feel local services will develop in the future. We will look at this aspect of citizens’

views in the next chapter.

Bham & Sol

W. Mercia

Staf fs

B. Country

Arden

50%

55%

60%

65%

70%

75%

80%

300 320 340 360 380 400 420 440 460

% a

nsw

eri

ng

'te

nd

to

ag

ree

' or

'str

on

gly

ag

ree

'


Cluster

West Midlands





23

2. Expectations for the future

For several years NHS West Midlands has tracked public perceptions about how they expect

the NHS to develop over the next few years. This allows us to compare current levels of

satisfaction with expectations for the future.

Will local NHS services get better or worse?

Residents’ expectations for the future of their local health services have worsened slightly

since the last time the survey was conducted. The largest proportion of citizens state that

they expect services to remain the same over the next few years (41%), while over a

quarter expect them to get better (27%), and almost a third think that they will get worse

(30%). In previous surveys we had seen an improvement in residents’ expectations for the

NHS; the highest levels of optimism were recorded in 2009 when 33% of those questioned

expected services to improve and 21% expected services to worsen.

23%

41%

25%

4%4%

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…?

WM

2010

WM

2009

WM

2008

WM

2006*

Better 27 33 33 27

Worse 30 21 22 40

Net

better-3 +12 +11 -13

Stay about the same

Don’t know (3%)

Get worse

Get much worse Get much better

Get better

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

* Please note the question

wording differs in the 2006

survey – “Thinking about health

services in your area over the

next few years, do you expect

them to…”

The results to this question are now analysed in depth to examine how perceptions vary

across the PCT Clusters and between socio-economic groups.

24

Who are the most positive and negative residents?

There are differences between PCT Clusters in terms of expectations for the future.

Respondents in Staffordshire Cluster are more optimistic about the future, compared with

residents in other Cluster areas. In contrast, residents in Arden Cluster are less optimistic

about the way services will develop over the next few years.

Perceptions for the future of local NHS services, analysed by Cluster

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

Across the West Midlands certain socio-demographic groups are more positive than others

in terms of the future of the NHS. Overall, those in social grades C2, D and E tend to be

more positive than those in social grades A, B and C1, as are ethnic minority residents in

comparison with white residents (see graph overleaf).10 11 The chart below shows those

aged 16 -24 are the most optimistic about the future for health services, whilst those aged

45 -54 are the most pessimistic.

10

A definition of social grades can be found in the appendices. 11

Overall, 30% of those in social groups C2DE feel that services will get better, compared with 24% from social groups ABC1. In total, 34% of those from minority ethnic groups feel that services will get better compared with 26% of those from white ethnic groups.

Bham & Sol

W. Mercia

Staf fs

B. Country

Arden

0%

5%

10%

15%

20%

25%

30%

35%

40%

300 320 340 360 380 400 420 440 460

% a

nsw

eri

ng

'te

nd

to

ag

ree

' or

'str

on

gly

ag

ree

'


Cluster

West Midlands





25

7

4

3

3

4

3

37

21

21

15

20

25

41

45

41

40

37

39

11

25

28

35

31

22

2

3

5

5

6

5

2

1

2

2

2

6

16-24

25-34

35-44

45-54

55-64

65+

Expectations by age

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

% Net

Better

+30

-3

-9

-22

-13

+1

(260)

(282)

(367)

(344)

(312)

(435)

% Stay about the same

% Don't know

% Get better% Get much better

% Get worse % Get much worse


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


Young well educated city dwellers

Middle income, suburban housing

Comfortably retired

Small and mid-sized towns

Post industrial owner occupiers

Sufficient income, social housing

State dependent elderly

% Get much better/ get better

Young social renters

Young dependent families

Young parents

Wealthy people and neighbourhoods

Young starters

Isolated rural communities

Suburban professionals

+19

+1

+2

+4

-1

+2

+5

% Net better

-3

-12

-7

-1

-19

-12

-10

-17

Lower income, terraces, diverse areas


26

Other factors are also linked with respondents’ views on the future of NHS services. One of

these is whether the respondent is concerned about the impact of wider economic

pressures on the NHS. Those who are concerned about economic pressures are much less

positive about the future of the NHS; 33% of those who are concerned about economic

pressures state that they expect NHS services to get worse, compared with 11% of those

who are not concerned.

4

5

22

27

38

54

28

10

5

1

3

2

Concerned

Not concerned

% Get much better % Get better % Stay about the same

% Get worse % Get much worse % Don't know

Expectations by economic concern

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

% Net

better

-8

+20

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 . . .?

*

^

* All who say they are very / fairly concerned about the impact of current economic pressures on the ability

of the local NHS to deliver health services

^ All who say they are not very / not at all concerned about the impact of current economic pressures on the

ability of the local NHS to deliver health services

(283)

(1,688)

Respondents who work in the NHS are also more pessimistic about the future, with 37%

stating that they expect services to get worse over the next few years, compared with 32%

who have family and friends working in the NHS and 28% who are not connected with the

NHS in this way. We will now look at some of the reasons given by those people who feel

pessimistic about the future for local health services.

Why will local health services get worse?

Everyone who felt that NHS services would get worse in the future was invited to explain

why they felt this way. The responses were then grouped together in categories. The most

frequently cited reason given by people who are pessimistic about the future for NHS

services is a feeling that there is ‘less money’. Other reasons commonly mentioned are

changes to the NHS, a perception that there is a shortage of staff and doctors, concern

about hospitals being closed and the growing population the NHS has to cater for.

27

18%

17%

15%

10%

9%

7%

7%

6%

4%

Reasons health services will get worse

Q Why do you think it will get worse?

Top 10 mentions

Growing population/ too many people

Too much money wasted

Changes to the NHS/ new Government policies/ reforms

Lack of organisations/ badly run/ poor management

Staff shortages/ fewer doctors/ nurses

Hospital closures/ A&E closures/ fewer hospitals

People from abroad/ foreigners/ asylum seekers

Everything is generally getting worse at the moment

Less money/ cuts (unspecified)

Less money for NHS/ spending cuts

WM 2009

%

17

n/a

n/a

14

9

15

3

8

7

9

31%

Base: All who think local health services will get worse over the next few years (2010 – 606 West Midlands

residents, 15 November – 12 December 2010, and 2009 – 741 West Midlands residents, 8 April – 17 May 2009)

We now turn to look at the areas within the NHS that people feel are in need of

improvement. This helps to identify the main areas of concern amongst the public at the

current time.

28

3. Priorities for Improvement

The Operating Framework for the NHS in England 2011/12 sets out key priorities for the

NHS which include: ‘maintaining performance on key waiting times, continuing to reduce

healthcare associated infections and reducing emergency admissions’.12 Alongside these

priorities, we need to understand what the public and patients perceive to be the most

important local priorities. We asked all those who took part in the survey to outline which

are the most important areas for the NHS to improve, from a list of services and aspects of

services that were presented to them. As we will see, there is significant overlap with the

priorities highlighted within the Operating Framework.

Perceived areas for improvement

Since the survey was undertaken last year there has been little change in the overall areas

where the public feels that the NHS needs to improve. The quality of medical treatment by

GPs remains the area that local residents feel is least in need of improvement. Residents

are also positive about the general condition of hospital buildings, the quality of medical

treatment available in hospitals, information about local health services and access to

services to help people improve their own health. Residents highlight waiting times in A&E,

services to support people with mental health problems and ease of access to NHS

dentists as areas where the most improvement is needed.

12

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

29

53%

47%

45%

44%

44%

41%

39%

38%

30%

29%

28%

27%

26%

25%

25%

22%

18%

10%

34%

30%

47%

46%

38%

42%

55%

60%

42%

63%

66%

60%

72%

71%

67%

46%

63%

55%

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 noimprovement, 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 for an ambulanceafter 999 call

Improvements

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

2009: 3,528 West Midlands residents, 8 April – 17 May 2009

% A least a fair amount % A little/no need

Access to services to improveyour own health

Services for treating heart disease

Quality of medical treatment by GPs

Quality of medical treatment in hospitals

Information about local healthcare services

Quality of nursing care in hospitals

General condition of hospital buildings

Services for treating cancer

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

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

Hospital waiting lists for non-emergency operations

Cleanliness of hospitals

Services to support people at the end of their lives

Waiting time before getting appointments with hospital consultants

Ease of access to an NHS dentist

Time spent waiting in A&E Departments

Services for supporting people with mental health problems

59

29

42

25

56

36

48

42

43

34

44

37

52

42

36

63

34

38

35

55

30

64

27

55

23

75

35

61

30

61

21

40

18

60

13

50

% WM 2009

30

The chart below compares perceptions around whether certain service areas were in need

of improvement in 2009 with the latest survey results. It shows that, on the whole,

respondents are more positive about most service areas than they were in last year’s

survey. For most of the aspects of care we asked about, there has been a decrease in the

proportion of people who feel that improvements are needed (we can see that most

service areas fall below the zero line on the axis which shows the percentage change in the

proportion of respondents who feel that improvements are needed between 2009 and

2010). However, there has been an increase in the proportion of people who feel that

services for supporting people with mental health problems are in need of improvement,

as is the case with the length of time it takes to get an appointment with a GP, end of life

services and the quality of medical treatment by GPs. The proportion of people who feel

that hospital cleanliness and ease of access to an NHS dentist are in need of improvement

has decreased substantially.

The chart shows service areas in the top right hand corner where there is a perceived high

need for improvement and where concerns have heightened since 2009. Service areas in

the bottom right quadrant are those where there is a perceived high need for improvement

and a decrease in concern compared with 2009.

Perceived need for improvement – comparison of results for 2009 & 2010

(Base: 2000 respondents, 15 November and 12 December 2010, 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?)

A&E waiting times

Ease of access to NHS dentist


Hospital consultant appointment waiting times

Waiting lists for non-emergency operations

End of life services

Mental Health services

Length of time to get an appointment with a GP

Gen condition of hospital buildings


Cancer services

Info about local health care services


GP choice


Waiting times for ambulances after 999 call


Services to improve own health

-14

-12

-10

-8

-6

-4

-2

0

2

4

6

0 10 20 30 40 50 60

% c

han

ge

in 'a

lot'

or a

'fair

am

oun

t' sin

ce 2

009

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

31

If we consider the areas where over 35% of residents think that a ‘fair amount’ or ‘a lot’ of

improvement is needed, then it is evident that attention might need to be focussed on

perceptions of A&E waiting times, although perceptions have improved compared with last

year’s results (53% feel this is in need of improvement in the latest survey compared with

59% in 2009). Perceptions of the need for improvement around services for supporting

people with mental health problems are less positive this year when compared with the

results for 2009. However, if we look back at responses to this issue in previous years we

see that the results for 2010 are similar to those for 2008 (47% feel that at least a fair

amount of improvement is needed in 2010, compared with 42% in 2009 and 46% in 2008).

In addition, concern around waiting times for appointments with GPs has worsened since

last year, and is now at similar levels to those found in 2008 (38% of respondents feel that

at least a fair amount of improvement is needed in 2010, compared with 36% in 2009, 39%

in 2008 and 40% in 2006). Hence, concern around GP waiting times and mental health

services seems fairly consistent if we look back over 3 years. Nonetheless, the fact that

levels of concern remain fairly high, whilst levels of concern around other issues have

fallen, suggests that further consideration is warranted.


Once participants had thought about the extent to which services were in need of

improvement, we asked them about their priorities for improvement amongst the services

they had flagged. The chart below shows that improving waiting times in A&E is highlighted

by the highest proportion of respondents as the priority for improvement. The same

proportion of residents think this is the most important priority for improvement as was the

case last year. Significant improvements are evident around perceptions of cleanliness in

hospitals. This emerges as the second highest priority for improvement this year; the first

time that it has not been highlighted as the top priority for improvement since 2008. In

addition, the proportion of residents who feel that hospital cleanliness is the most

important factor to improve has fallen from 16% in 2009 to 11% in 2010.

32

14%

11%

10%

9%

9%

8%

8%

6%

5%

5%

3%

2%

2%

1%

1%

1%

1%

1%

2%


Q Which one of these, if any, is it most important

to improve?

Base: All who think any improvement is needed (2010 – 1,435 West Midlands

residents 15 November – 12 December 2010, and 2009 – 3,345 West Midlands

Residents, 8 April to17 May 2009 )

Time spent waiting in accident and emergency departments

Access to services to improve your own health

Don’t know


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

Services for supporting people with mental health problems

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

Services for treating cancer

Waiting time before getting appointments with hospital consultants


Ease of access to an NHS dentist

Hospital waiting lists for non-emergency operations



General condition of hospital buildings

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

Time spent waiting for an ambulance after a 999 call


Information about local health care services

WM 2009

%

14

16

8

7

8

7

7

5

3

11

2

1

2

N/A

2

1

1

1

2

33

There are variations in the priorities of different respondent groups. In particular, people

aged 16-24 are most likely to state that A&E waiting times are the most important aspect of

services to improve (24%). In addition, a higher proportion of those who have attended

A&E or who have been an inpatient state that this is the most important area for

improvement (16% and 17% respectively). For those aged 65 and over, the most important

priority is seen as improving end of life care (cited as the top priority by 16% of this age

group). For those who have visited someone in hospital but have not been a patient

themselves, hospital cleanliness is seen as the most important priority for improvement

(cited by 15% of this group).

The diagram below sets out the priorities across Clusters. Reducing waiting times in A&E

emerges as the most important priority in the Black Country and Arden, whilst in

Staffordshire this is seen as the most important aspect alongside improving cleanliness of

hospitals. In Birmingham and Solihull, cleanliness in hospitals and GP waiting times are seen

as the main priorities for improvement, and in West Mercia A&E waiting times and mental

health support services as seen as the key areas where improvements need to be targeted.

We now turn to the three main priorities identified in detail. Each priority will be analysed

to ascertain geographical and demographic variations.

Top 5 Priorities for improvement by cluster

Base: All who think improvement is needed in at least one area (base size for each cluster in brackets), 15 November – 12 December 2010

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

A&E waiting times (17%)

Cleanliness of hospitals (17%)

End of life support services (10%)

GP appointment waiting times (9%)

Services for treating cancer (8%)

Staffordshire (304) Arden (211) Birmingham & Solihull (336)

A&E waiting time (16%)


Mental health support services (8%)

Hospital consultant waiting times (8%)







Black Country (291) West Mercia (293)









Hospital consultant waiting times (9%)


34

A&E waiting times

The results from the survey indicate slightly less public concern around A&E waiting times

compared with last year, although this is still seen as the main priority for improvement for

the local NHS. The chart overleaf indicates that a higher proportion of residents in the Black

Country and Staffordshire feel that A&E waiting times are in need of improvement when

compared with the results for West Mercia and Arden.

Cleanliness in hospitals

Perceptions around hospital cleanliness seem to have improved this year. Fewer people

highlight this as in need of improvement compared with last year and for the first year since

public surveys have been conducted across the region, hospital cleanliness is not seen as

the main priority for improvement (i.e. since 2006). However, this is still seen as the second

most important aspect for improvement. The graph overleaf shows perceived need for

improvement by Cluster. A higher proportion of residents in Staffordshire Cluster state that

cleanliness in hospitals is in need of a fair amount or a lot of improvement, compared with

the results for the region as a whole (47%, compared with 39% for the region). In contrast a

higher proportion of residents in West Mercia think that hospital cleanliness is in need of

no improvement or a little improvement (62% compared with 55% across the region).

58%

57%

56%

49%

46%

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

Black Country

Staffordshire

B’ham & Sol.

Arden

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

(397)

(406)

(310)

(436)

Top priorities for improvement by cluster

(451)

Time spent waiting in accident and emergency departments (% At least a fair amount)

West Mercia

35

Previous research undertaken by NHS West Midlands has demonstrated the factors which

help to improve public confidence with regard to hospital cleanliness.13 The findings of this

research have been disseminated across the region and is assisting Trusts in communicating

with their populations about healthcare acquired infections and measures to improve

perceptions around hospital cleanliness.

Waiting times for an appointment with a GP

In this year’s survey the length of time it takes to get an appointment with a GP is

highlighted as the third most important priority for improvement (mentioned by 10% of

respondents). However, the proportion of people who highlight this as the main priority has

remained fairly static over the last 3 years (in 2008 10% of those interviewed also cited this

as the main priority for improvement). The chart below shows that a higher proportion of

people in the Black Country think that this aspect is in need of at least a fair amount of

improvement.

13

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

47%

42%

41%

35%

32%



Black Country(397)

Staffordshire(406)

Arden(310)

(436)

B’ham & Sol.(451)

Cleanliness of hospitals (% At least a fair amount)

West Mercia


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

36

A higher proportion of residents from black and minority ethnic groups feel that waiting

times for GP appointments are in need of improvement (52% compared with 37% of those

from white ethnic groups). In addition, a higher proportion of respondents from BME

groups feel that this is the most important priority for improvement (16% compared with

10% overall). Other research has highlighted lower levels of satisfaction with access to

health services amongst respondents from BME groups particularly with access to primary

care.14 We will now consider respondents’ views on the financial challenges facing the NHS

and where NHS resources should be focussed.

14 See DH report on patient survey findings at: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_100471.pdf

49%

40%

36%

35%

32%



Black Country(397)

Staffordshire(406)

Arden(310)

(436)

B’ham & Sol.(451)

Length of time it takes to get an appointment with a GP (% At least a fair amount)

West Mercia


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

37

4. Financial challenges

Introduction

Although funding for the NHS has been protected, it is facing unprecedented financial

challenges. The population is ageing and growing, new technologies and treatments are

being introduced and although funding is protected, it is not predicted to increase on a

similar scale as has been experienced in the past. These challenges are taking place in a

context of wider pressures on public services as attempts are made to balance the

country’s financial deficit. As the NHS attempts to deal with the economic challenges it

faces, it is important to understand public concerns and communicate effectively around

the measures being undertaken. With this in mind, the survey probed a number of areas in

relation to public perceptions around economic pressures, NHS resources and how they

should be used.

Concerns about economic pressures

At the time of the survey, the budget deficit and potential effects on public sector funding

availability were being widely discussed in the media. Whilst it was reported that NHS

funding is protected, there was also coverage of the challenges being faced. In order to

gauge how this was being perceived by the public, respondents were asked whether they

were concerned about economic pressures and their potential effect on the NHS. The

findings indicate that people are worried about the impact of wider economic pressures on

the ability of the local NHS to deliver health services, with more than eight in ten stating

that they are concerned and four in ten stating that they are very concerned (see chart

below).

43%

11%

4%

41%

1%

Impact of economic pressures

Very concerned

Don’t know

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

Fairly concerned

Not very concerned

Not at all concerned

WM

2010

WM

2009*

Concerned 84 75

Not

concerned15 21

Net

concerned+69 +54



* Please note that results are not strictly comparable because question wording differs in 2009, “How

concerned are you, if at all, that the credit crunch might reduce the funds available for the NHS?”

38

Some variation by demographic group is evident, as older respondents, those with a

disability, and those who have someone in their family with a disability are more likely to

state that they are very concerned about economic pressures.15 In addition, those who have

been an inpatient or outpatient recently are more likely to feel very concerned about these

issues.

There seems to be a relationship between funding and levels of confidence for the future of

the NHS, as people who expect the NHS to get worse over the next few years are more

likely to be concerned about economic pressures than those who expect it to get better. In

total, 59% of those who expect services to get worse are very concerned about economic

pressures affecting the NHS, compared with 35% of those who expect services to get

better. The chart below shows differences in perceptions by Mosaic group in detail, and

shows that there are high levels of concern across all groups.

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

94

89

89

88

87

85

85

84

83

83

82

81

81

77

83

Impact of economic pressures by mosaic group

Comfortably retired


Suburban professionals

Small and mid-sized towns

Middle income, suburban families

Isolated rural communities

Young social renters

State dependent elderly

Young dependent families

% Concerned

Post industrial owner occupiers

Young parents, modern housing

Young starters

Sufficient income, social housing

Wealthy people and neighbourhoods

Young, well-educated city dwellers

Lower income, terraces, diverse areas

+90

+79

+78

+75

+77

+74

+73

% Net concerned

+69

+68

+68

+66

+66

+66

+62

+55

The results suggest that there is a concern around funding issues across the population,

with people with a disability and recent users of health services being the most concerned.

The results have implications for communication strategies around changes in service

provision and improvements in efficiency.

15For example, 50% of those from aged 55-64 state that they are very concerned and 46% of those aged 65 and over. Similarly, 50% of those with a disability are very concerned, compared with 41% overall. In total, 45% of those who have been an inpatient or outpatient recently state that they are very concerned about the impact of economic pressures.

39

Focus of NHS provision

At a time of change it’s important to understand the relative importance people give to

balancing out local needs against ensuring that everyone has access to the same services.

Respondents were asked which of the following statements most closely matched their

own opinion ‘The same NHS services should be available everywhere, which means that

everyone will get the same services regardless of where they live’ and ‘The availability of

NHS services should be based on local need which means that people living in different

areas might have different types of services’. It is interesting to note that almost eight in

ten respondents feel that it is more important to have the same services everywhere, and

that service provision should not be primarily based on local need (78%). This corroborates

the findings of other research by Ipsos MORI with regard to the availability of NHS

treatments.16

20%

78%

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

Don’t know (1%)


Q Thinking about the services that are available on the NHS, which of these statements more closely match your opinion?

Don’t agree with either (1%)

The availability of NHS services should be based

on local need, which means that people living in different areas might have different types of services

Focus of NHS provision

The idea that the same services should be available everywhere is particularly attractive to

the following groups (the figures in brackets show the percentage of respondents who

agree with this idea):

Those who are not working (82%)

Those from lower socio-economic backgrounds (C2DE) (83%)

Those without caring responsibilities (79%)

16

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

40

A higher proportion of people from the groups below felt that services should be tailored to

local needs, even if that meant that some areas would have different services (the figures in

brackets show the percentage of respondents who agree with this idea, although this

option was less popular across all groups):

People who are working (23%)

People with caring responsibilities (25%)

People from more affluent socioeconomic groups (ABC1) (24%)

Those who had recently attended a private hospital (26%)

The chart below shows that the results are consistent across the region, with no major

differences by Cluster.

For almost half of those who feel that the same services should be available everywhere

the main reason given for their views is the idea of equality – they feel that ‘everyone is

equal / should be treated in the same way / should have equal access to services’ (49%).

The other main reason given is that access to services should not be based on postcodes,

including some who mentioned the notion of a ‘postcode lottery’ (25%) (see chart

overleaf).

Q Thinking about the services that are available on the NHS, which of these statements most closely match your opinion?

Arden

The same NHS services should be

available everywhere…

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

Black Country

Staffordshire

West Mercia

The availability of NHS services

should be based on local need…

B’ham & Sol.

(310)

(397)

(451)

(406)

(436)

Don’t agree

with either

Don’t

know

Focus of NHS provision by cluster

80

80

76

79

77

18

19

22

20

21

1

1

1

1

1

1

*

1

*

1

41

49%

25%

12%

8%

6%

5%

4%

4%

3%

3%

Reasons for supporting universal availability

We are all equal/everyone should be treated the same way/have

equal chances to the same level of service

Q And why do you say that? (top 10 responses)

Shouldn’t be based on postcodes/where people live/don’t want a

postcode lottery

It’s fair/the fairest way/would be unfair otherwise

We have all paid in money/paid our taxes/belongs to the taxpayer/anyone who has paid should get their fair treatment

People would have to travel too far/easier for travel this way/reduces travel/shouldn’t have to travel to receive help

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

Everyone should get what they need/be based on needs/everyone has different needs

Needs to be able to have medical attention if you are outside of your area/postcode/wherever you are

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

Shouldn’t discriminate/no preferential treatment/why should some people get better treatment than others?

Supposed to be a National Health Service/principle of NHS when it was set up

The respondents who feel that services should be responsive to local needs mainly cite

differences in local needs / problems and populations as the main reason for their views

(36%). There is also a belief that services should be based around local communities and

that services and funding should be focused around needs (19%).

36%

19%

8%

8%

6%

5%

5%

5%

4%

4%

Reasons for supporting service provision based

on local need

Q And why do you say that? (top 10 responses)

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

Different areas have different needs/problems/demographics play a part

It should be based on local community/focus services/funding where individual need is

Rural areas have different needs to inner city/industrial areas

No point wasting money where resources not needed/generalised service everywhere is wasteful

Some areas have large proportion of elderly/pensioners

Different age groups need different treatments

Ethnic/Asian population need different/specific help compared to other cultures

Everyone should have the same care/balanced service

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

Specialist treatment should be available at larger hospitals/necessarily local

42

Notions of limits on NHS funding

When considering people’s views on how NHS resources should be utilised, it is important

to understand their views on fundamental issues, such as whether there should be any

limits around what is spent on the NHS. The results to the question show that this issue is

something that divides respondents with 50% agreeing that there should not be any limits

on what is spent on the NHS and 40% disagreeing. The findings of this study confirm those

of a survey conducted in 2006, which reported similar results (44% agreed that there

should always be limits on what is spent on the NHS, while 48% disagreed).17 These

fundamental divisions do not seem to have changed substantially (see below).

20%7%

24%

3%

30%16%

NHS funding

Strongly agree

Don’t know

Q To what extent do you agree or disagree with each of the following statements?

“There should NOT be any limits on what is spent on the NHS”

Neither / nor

Strongly disagree


Tend to agree

Tend to disagree

In terms of the notion that there should NOT be any limits on what is spent on the NHS, the

following groups are more likely to agree – those aged 16-24 (60% agree), those from socio-

economic groups C2DE (55% agree), and people who are not working (55% agree). The

following groups are more likely to disagree – those aged 35-54 (46% disagree), people who

are working (46% disagree), those from social class ABC1 (46% disagree), those from white

ethnic groups (41% disagree).

We will now consider public responses to a range of initiatives which are aiming to improve

the value for money the NHS achieves from its resources.

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

43

5. Providing good value for money

In order to meet the challenges associated with a growing population, improvements in

technology and associated pressures on resources, the NHS is adopting a range of initiatives

to improve quality whilst at the same time ensuring that services offer good value for

money.

Treatments of limited clinical value

One of the ways the NHS can achieve better value for money is to reduce the number of

treatments and operations carried out where evidence suggests that they are of limited

clinical value.

Support for the general principle of reducing treatments of limited clinical value

In order to gauge public understanding around the aim of stopping the NHS carrying out

treatments of limited clinical value, respondents were asked to what extent they agreed or

disagreed with the following statement: ‘The NHS should stop providing treatments that

have little or no medical benefit for patients’. Over half of all respondents agree with this

statement, while just over a quarter disagree (see chart below).

28%10%

16%

6%

29%11%

NHS treatments

Strongly agree

Don’t know


“The NHS should stop providing treatments that have little or nomedical benefit for patients”

Neither / nor

Strongly disagree


Tend to agree

Tend to disagree

Support for stopping treatments of limited clinical value is highest amongst those aged over

45 (61% agreeing), respondents from white ethnic groups (58%), and those without

children (58%).

44

43%

56%

55%

63%

61%

60%


“The NHS should stop providing treatments that have little or no medical benefit for patients”

16-24

25-34

35-44

45-54

55-64

65+

% Net

Agree

+3

+29

+28

+37

+41

+37

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

December 2010

(260)

(282)

(367)

(344)

(312)

(435)

% Agree

Funding and treatments by age

Interestingly, a higher proportion of people who either have a disability themselves / have

someone in their household with a disability strongly agree with the statement (31%

compared with 29% overall). The highest proportion of respondents from the following

groups disagree with this statement – those aged 16-24 (40%), those from black and ethnic

minority groups (38%), and respondents with children (32%).

Support for specific initiatives

Those who took part in the survey were invited to state whether they would support or

oppose a range of initiatives which were aimed at reducing interventions of limited clinical

value. The overall results are shown in the chart below and are discussed in the sections

which follow. Support is greatest for reducing prescriptions where there is no proven

medical benefit, and opposition is greatest around stopping operations being done where

there is no proven medical benefit (e.g. removing varicose veins where this is not being

undertaken for medical reasons), although the majority would still support this initiative.

45

Support for QIPP initiatives

Stopping medicines being prescribed where there is no proven medical benefit

% Strongly support % Tend to support % Neither / nor% Tend to oppose % Strongly oppose % Don't know


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

Stopping operations being done where there is no proven medical benefit

Only carrying out hip and knee replacements when a condition won’t be

improved by other treatments

Only removing cataracts where a doctor thinks it will make a big improvement to

someone’s sight

Additional feedback from some of the interviewing team at Ipsos MORI included reports

that some respondents found the subject matter difficult to contend with. This underlines

the sensitivities associated with the questions and the need for on-going work further

exploring how best to engage with the public on these issues.

Improving medicines management

It can be seen from the chart above that reducing prescriptions for medicines where there

is no proven medical benefit receives the most positive response amongst the initiatives

described. Almost three-quarters of respondents say that they would support this initiative.

Some demographic groups support this initiative more than others, higher than average

levels of support are found amongst people who are working, (76% support), respondents

from social class ABC1 (76%), and respondents from white ethnic groups (75%). However,

there are some social groups with higher levels of opposition to this initiative, this includes

people aged 16-24 (27% say they would oppose), people who are not working (22%

oppose), those from social grades C2DE (22% oppose) and people from black and minority

ethnic groups (28% oppose). Hence, communication strategies around improving medicines

management need to take into account the fact that levels of support potentially differ

across key groups in local communities.

46

Only carrying out hip and knee replacements where conditions can’t be improved by

other means

It is important that medical interventions take place at the right time to ensure maximum

benefit for patients. One of the initiatives to improve care for patients involves ensuring

that knee and hip replacements only take place where other treatments are not

appropriate. Public support for this initiative is fairly high, with almost three quarters of

respondents saying they would support only carrying out replacements where conditions

could not be improved by other means (71%), while around a fifth would oppose this

option (20%).

The results for this question are consistent across most demographic groups, with no major

differences evident according to age or social class. Respondents with a disability or with a

household member with a disability are more likely to oppose this idea (22%) compared

with those without a disability (18%). In addition, those from a white ethnic group are more

likely to oppose this, compared with those from a minority ethnic group (20% compared

with 14%).

Removing cataracts only where this will bring about a big improvement

Another of the options described was to only perform operations to remove cataracts

where a doctor thinks it will make a big improvement to someone’s sight, while other

people would have their vision monitored carefully until an operation is required. Overall,

just over two thirds of respondents state that they support this measure (69%), with just

under a quarter opposing (23%). Levels of support for this idea are particularly strong

amongst those aged 65 and over, with 78% stating that they support it, and 50% strongly in

support. In addition, levels of support are higher amongst people who are not working

(73%), and from social group C2DE (73%). Similarly, in terms of Mosaic groups the group

most in support of this initiative are the ‘state dependent elderly’ (80%).

Levels of opposition are highest amongst those aged 35-44 (30%), people who are working

(26%), those from social group ABC1 (28%), and residents in West Mercia (28%). This issue

seems to divide those with a disability, with a higher proportions strongly supporting (39%)

and strongly opposing (16%) compared with the regional average.

Ceasing to carry out operations where there is no proven medical benefit

The issue which created more of a mixed response amongst respondents is stopping

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

example given was removing varicose veins for appearances’ sake rather than for a medical

reason. While almost two thirds support this idea (61%), almost a third say that they

oppose it (30%).18

18 Feedback from some of the interviewers at Ipsos MORI indicated that some respondents found

this question difficult to answer and were unclear how the psychological effects of having varicose veins would be covered within notions of ‘medical benefit’.

47

Views on funding and reducing the volume of treatments of limited clinical value

The table below compares the responses of two groups – those who feel that there should

be limits on what is spent on the NHS and those who feel that there should be no limits. It is

evident that those who feel that there should be no limits on funding are also more likely to

believe that there should not be attempts to focus on treatments which provide proven

medical benefit for the patient.

48

Comparison of views on limits to funding with attitudes to treatments of limited clinical

value

Those who feel that there should be no

limits on what is spent on the NHS

(995 respondents) (% support

statement /initiative)

Those who feel that there should be limits

on what is spent on the NHS*

(805 respondents) (% support

statement /initiative)

Significant difference?

(between the two groups)

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

55 61

Stopping medicines being prescribed where there is no proven medical benefit

71 77

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

71 73 X

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

73 66

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

60 64 X^

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

49

Reducing demand on hospitals

Introduction

Since the implementation of ‘Investing for Health’ in July 2007, reducing demand on acute

hospitals has been a key aim within the West Midlands. This agenda is also central to

national policy, and is cited in the Operating Framework for 2011/12 as a commitment to

release capacity from acute services to allow the better use of community services. In order

to analyse how these messages can be effectively communicated with residents, we

included questions in the survey which probed respondent views on a range of initiatives

which aim to reduce demand on acute services.

Reducing demand on hospitals – responses to the overall principle

In order to gauge likely public responses to a range of initiatives, we firstly asked

respondents whether they supported the principle of reducing demand on hospitals. To

make sure that we gained an accurate measure of public reaction, we wanted to make sure

that participants fully understood what this might entail. Within the question it was made

clear that as a consequence of reducing demand, there might be a reduction in the number

of hospital beds and nurses in an acute setting, and that resources would be moved into

services in the community. The results for this question show that a majority of

respondents support the idea of reducing demand on hospitals (55%). However, a third

oppose this as a general principle (33%), with just over a fifth stating that they strongly

oppose it (22%).

Support for reducing demand on hospitals

Neither/nor

Strongly support


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

Tend to support

Tend to oppose

Strongly oppose

Don’t know

There are different levels of support and opposition for this principle across demographic

groups. Levels of support for reducing demand on hospitals are highest amongst those who

are aged under 35 (65% say that they support this principle) and amongst those who do not

50

have a disability / do not have someone with a disability in their household (57% support

this principle).

Respondents in Arden Cluster are more positive about this initiative compared with people

from other Clusters (60% say that they support this principle compared with 50% in

Staffordshire Cluster, where support is lowest) (see chart below).

In contrast, higher levels of opposition to the idea of reducing demand on hospitals is found

amongst people who are aged 55-65 (39% say that they oppose this principle) and amongst

people who either have a disability themselves / have someone in their household with a

disability (37% say they oppose this).

It is interesting to note that opposition to the idea of reducing demand on hospitals is

correlated with general dissatisfaction with the NHS. A higher proportion of respondents

state that they are opposed to attempts to reduce demand on hospitals if they are also:

dissatisfied with the running of the NHS (43% who are dissatisfied with the running

of the NHS say they oppose this principle),

dissatisfied with the quality of care patients receive locally (41% who are

dissatisfied with quality of care say they oppose reducing demand),

disagree that their local hospital treats patients with dignity and respect (41% who

disagree that patients are treated with dignity and respect oppose this principle).

Support for reducing demand on hospitals by cluster


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

50

53

53

59

60

37

35

32

32

30

% Support % Oppose% Net

Support

+13

+29

+27

+21

+18

(406)

(310)

(451)

(397)

(436)

Staffordshire

Arden

B’ham & Sol.

Black Country

West Mercia

51

Reducing demand on hospitals – responses to particular initiatives

For people who did not agree with the central principle of reducing demand on hospitals,

further questions were asked which looked at how their views might change if they had

further information on the steps being taken by the NHS.

The chart overleaf shows that once presented with further information, a high proportion

of those who initially oppose the principle of reducing demand on hospitals change their

stance. On average, once they have heard further information on proposed initiatives, 74%

state that they would support this idea. The highest levels of support are found when

people are told about initiatives to help people to stay healthy so they don’t need to go to

hospital (85% say that they now support the idea of reducing demands on hospitals),

carrying out some follow-up appointments in local health centres (83%), and carrying out

operations differently so that people don’t need to stay in hospitals for so long (76%).

Slightly fewer people feel that they would change their views based on the idea that the

NHS would give people extra time before operating on them to make sure that symptoms

cannot be improved by other treatments (61%).

52

60

44

43

34

31

26

25

32

39

37

39

35

4

5

3

7

7

9

3

9

5

9

11

13

6

8

7

10

9

12

1

2

3

2

3

4

Reducing demand

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

December 2010

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

IF the NHS increases the care patients receive closer to home

rather than in a hospital

% Strongly support % Tend to support % Neither / nor

% Tend to oppose % Strongly oppose % Don't know

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

to hospital

IF the NHS carries out operations differently so people don’t need to

stay in hospital for so long

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

IF the NHS carries out some follow-up appointments in local health

centres rather than going to hospital, when they can be delivered safely

elsewhere

IF the NHS stops some treatments being carried out in local hospitals

where these can be delivered most safely at a more specialist hospital

53

Helping people to stay healthy

This is the most effective initiative in reassuring people around the general principle to

reduce demand on hospitals. Overall, 85% of the respondents who had previously said that

they would oppose the general principle of reducing acute demand said that they would

now support this principle. Respondents who are aged over 65 are particularly enthusiastic

around this idea, with 90% stating that they would now support the principle of reducing

acute demand if they heard about this initiative.

Increasing care closer to home

Support for this initiative is again high, with 70% of respondents stating that they would

support the general principle of reducing demand on hospitals if they heard about this

initiative. The initiative is supported particularly by those from social groups C2DE with 74%

saying that they would change to support the idea of reducing demand on hospitals.

Giving patients extra time before operating to make sure that symptoms can’t be improved

by other treatment

This is the initiative which made the least impact on respondent views, although 61% state

that they would now support the principle having heard further information. Higher levels

of support are found amongst those aged 65 plus (73%), those who are not working (68%)

and from social group C2DE (66%).

Smoking cessation & alcohol consumption reduction

Prevention is a central element within the NHS’s drive to improve population health and

reduce hospital admissions, and reducing smoking prevalence and excessive alcohol

consumption are a key tenet of this work. As part of this, attention is being focussed on

reducing smoking rates amongst NHS staff and increasing the interventionist role staff take

when treating people who smoke or drink more alcohol than the recommended amount. In

order to inform this process, several questions were asked which looked at public views

around NHS staff smoking and staff talking to patients about their smoking and drinking.

The results indicate that the public do not like to see staff smoking in uniform or smell

cigarette smoke on them, and that they would support staff taking a more pro-active role in

discussing smoking cessation and reducing alcohol consumption when treating people who

smoke or drink excessively.

Views on staff smoking

More than two thirds of respondents agree that it is unacceptable for NHS staff to be seen

smoking while they are wearing their uniform (69%). A higher proportion of respondents

who are aged over 65 agree with this statement (84%), as do respondents who are not

working (72%). Interestingly, a high proportion of respondents who work in the NHS agree

that this behaviour is unacceptable (82%).

54

66

57

12

12

7

7

7

10

8

12

1

1

NHS staff and smoking

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

health professionals treating me

% Strongly agree % Tend to agree % Neither / nor% Tend to disagree % Strongly disagree % Don't know


Q To what extent do you agree or disagree with each of the following statements:

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

Over three-quarters of the people who took part in the survey agree that they would not

like it if they could smell cigarette smoke on a doctor, nurse or any other health

professional who is treating them (77%), with just 14% disagreeing. This figure is high

across all demographic groups. In particular, almost nine in ten respondents who work in

the NHS agree that they would not like this (87%).

The main reason given for not liking the smell of cigarette smoke on a health professional is

that people do not like the smell (52%). Almost a third feel that it is not very professional if

it is evident that a health professional has been smoking (31%), and a similar proportion

feel that it’s hypocritical for health professionals to smoke when the NHS is trying to stop

people smoking (28%). Amongst respondents who work in the NHS, the view that smoking

is unprofessional for NHS staff is the main reason cited, and is given by almost half of those

who answered the question (47%).

55

NHS staff and smoking

Q You said that you would not like it if you could smell cigarette smoke on a doctor, nurse or any other health professionals treating you. Why do you say that?

Don’t like the smell

Don’t know

Base: All who said they would not like it if they could smell smoke on someone treating them

(1,556), 15 November – 12 December 2010

Other

Not very professional

Hypocritical when NHS wants people to stop smoking

Worried about my health/passive smoking

Worried about their health

I don’t like smoke/I’m anti-smoking (including I’m an ex-smoker)

I don’t like smoke

Unhygienic/it’s not clean

It’s offensive/disgusting/unpleasant/would be offended

Doctors/hospital staff should set a positive example/it’s a bad example

Views on NHS staff talking to patients about their smoking and drinking

NHS staff have a range of interactions with patients who smoke and are being encouraged

to talk to patients about their smoking, even if they are seeing them about something

which is unconnected to this. The results of the survey suggest that the majority of the

public would be supportive of these initiatives. Over two thirds agree that if a person

smokes, a hospital doctor, hospital nurse or GP should speak to them about how to stop

smoking, even if that person has gone to see them about something completely different

(68%). A quarter of residents disagree with this idea (25%). Patients aged over 65 are more

likely to agree that staff should take an interventionist role (74%), as are respondents who

are not working (70%). It interesting to note that respondents from minority ethnic groups

56

are more likely to state that they strongly agree with this idea (50%, compared with 43%

overall). Respondents who are NHS staff are more likely to have strong views on this, with

52% saying that they strongly agree with the statement.

48

43

27

25

4

6

11

13

8

12

1

2

Interventions to reduce smoking and drinking

% Strongly agree % Tend to agree % Neither / nor% Tend to disagree % Strongly disagree % Don't know


Q To what extent do you agree or disagree with each of the following statements:

If a person drinks more alcohol than the recommended limit, a

hospital doctor, hospital nurse or GP treating them should speak to

them about how to drink less alcohol

If a person smokes, a hospital doctor, hospital nurse or GP

treating them should speak to them about how to stop smoking

Respondents were also asked about staff taking a more interventionist role with patients

who drink more than the recommended amount. There is slightly more support for this

idea, with three quarters of respondents agreeing that if a person drinks more alcohol than

the recommended limit, a hospital doctor, hospital nurse or GP should speak to them about

how to drink less alcohol, even if that person has gone to see them about something

completely different (75%). Once again, those aged 65 and over are more likely to agree

with this statement (83%), as are respondents who are not working (77%). In addition,

respondents living in the Birmingham and Solihull Cluster are also more likely to agree

(78%). It is worth noting that a higher proportion of respondents from ethnic minority

groups strongly agree with this statement (60% compared with 48% overall).

We now turn to consider how informed the public feel about developments in the NHS,

decision-making and whether the NHS provides good value for money.

57

6. Engagement & Access to

Information

Introduction

All NHS organisations have a duty to involve and consult patients and the public in relation

to the planning and development of services (NHS Act 2006). This chapter looks at whether

local residents recall receiving information from the NHS, what kinds of information they

would like to receive and how they would like to access it, particularly around digital modes

of communication.

Feeling informed about local developments

When we asked local residents whether they had received any information from the NHS

about developing local health services, we found that there had been little change from

2008. Around a fifth of respondents recall receiving information from the NHS, while three

quarters do not recall receiving any information.

Receiving information from the NHS

Don’t know

Q Have you ever received any information from the NHS about plans for developing health services in your local area?

Yes

No

WM

2010

WM

2009

WM

2008

Yes % 20 18 20

No % 75 80 74

Don’t know % 5 2 6




There is little variation by Cluster for this question, however, there is some variation by

demographic group. Higher proportions of respondents aged 25- 34 are not aware of any

plans (80%), as is the case with people from minority ethnic groups (81%). In addition, a

higher proportion of people from social groups C2DE don’t recall receiving any information

about plans for developing health services in their local area (79%).

58

In the past our surveys found that those who feel better informed are more positive about

the future of local health services. However, the results of the survey this year show that

this trend is no longer the case. People who feel informed about local service developments

are not more likely to feel more optimistic about the future of local services.

Expectations by information received

% Better 30%

% Worse 32%

Net better -2

% Stay the same

% Don't know

% Get better% Get much better

% Get much worse % Get worse

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 . . .?

% Better 26%

% Worse 30%

Net better -4

Those who have received

information about local plans (402)

Those who have not received

information about local plans (1,508)

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

December 2010

Feeling informed about value for money and decision making

Awareness overall

As is shown in the chart below, on the whole, respondents do not feel very informed about

how the NHS spends its money locally, who makes decisions about how NHS money is

spent locally, or what the NHS is doing locally to provide good value for money to patients

and taxpayers. There is slightly better awareness of the current proposals around GP

commissioning, but around two thirds state that they know nothing or very little about

these changes as well.

59

2

3

2

6

5

16

16

19

44

26

49

42

47

38

44

29

35

28

10

21

2

2

2

1

3

Awareness

. . . how the NHS spends its money locally

% A great deal % A fair amount% Never heard of

% Not very much% Nothing at all % Don't know


Q How much, if anything, would you say you know about the following . . .?

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

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

. . . the quality of local health services

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

1

1

1

1

1

Across all of these questions there are two groups of respondents who feel better

informed: respondents who have seen plans for local developments and respondents who

work in the NHS. Across the areas we asked about 32%-38% of respondents who have seen

local plans state that they know at least a fair amount about how the NHS spends its

money, who makes the decisions and what the NHS is doing to provide good value for

money. In addition, almost half of this group state that they know a fair amount / great deal

about the new proposals for GP commissioning (47%). This seems to indicate that there is a

group of respondents who feel well informed about the NHS, including how effectively the

NHS is using its resources and who makes the decisions.


47%

38%

34%

32%

28%

18%

15%

16%

Awareness by information received

. . . how the NHS spends its money locally

Seen plans * Not seen plans ^

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

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

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

taxpayers

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

(402) (1,508)

* All who have received information from the NHS about plans for developing health services in their local area

^ All who have not received information from the NHS about plans for developing health services in their

local area

% A great deal/a fair amount

60

Levels of staff awareness are consistently high, with 46%-51% of respondents who work in

the NHS feeling well informed about all of the areas probed, rising to 61% knowing at least

a fair amount about the proposals for GP commissioning. 19

Who are the most informed groups?

As we have seen, awareness of how the NHS spends its budget locally is fairly low amongst

all respondents, and there is little variation across demographic groups (in all groups less

than a quarter feel that they know at least a fair amount about this). Similarly, there is not

much variation in terms of feeling informed about what the NHS is doing locally to provide

good value for money for patients and taxpayers. There is some variation by age-group,

with the youngest respondents feeling the least well informed, with 81% of those aged 16-

24 state that they know nothing or very little about this subject.

Awareness about who are the current local decision makers in the NHS is similarly low

across all groups. In all demographic groups, over 70% state that they know very little or

nothing about who makes decisions about how NHS money is spent locally. As we have

seen, slightly more respondents have heard about proposals to give more control over the

NHS budget to GPs, with almost a third stating that they know at least a fair amount about

this (31%). Some differences in awareness emerge by age, with those aged over 65 more

likely to state that they know at least a fair amount about the proposals (37%). Higher levels

of awareness are also found amongst those in social group ABC1 (35%), amongst those with

no children (34%) and respondents who have a disability / someone in their family with a

disability (34%). In addition, residents in Arden Cluster are more likely to state that they

know a great deal / fair amount about these proposals (38%).

19

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

7

7

5

4

31

25

25

24

25

42

43

47

44

46

18

22

19

22

22

2

2

3

4

2

5

Awareness by cluster: Government proposals on

the NHS budget

Arden


Q How much, if anything, would you say you know about the following . . .? The Government’s proposals to give more control over the NHS budget to GPs

West Mercia

Black Country

Staffordshire

B’ham & Sol.

1

1

1

2

1

(310)

(406)

(436)

(451)

(397)

% A great deal % A fair amount% Never heard of

% Not very much% Nothing at all % Don't know

61

What information would people like to receive?

After respondents were asked about how much they knew on the subjects above, they

were asked on which subjects they would like to receive more information. The most

popular option is further information on how the NHS spends its money locally (57%). A

similar proportion would like to know more about what the NHS is doing locally to provide

good value for patients and taxpayers (56%) and the government’s proposals to give more

control over the NHS budget to GPs (55%).

Information preferences

How the NHS spends its money locally


Q On which of these subjects, if any, would you like to receive more information?

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

None of these

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

The quality of local health services

Who makes decisions about how NHS money is spent locally

Access to the internet

The NHS is constantly working to improve the ways it engages with patients and the public.

NHS organisations are embracing the opportunities offered by digital modes of

communication and engagement. As usage of the internet is constantly increasing, it is

useful to get an update on a regular basis.

Direct access

We asked residents whether they have access to the internet. The survey shows that

almost eight in ten respondents have access to the internet, a slight increase from the last

time the question was asked in 2009.

62

Internet access

Q Do you have access to the internet, or not?

Yes

No



WM 2010 WM 2009

Yes % 79 76

No % 21 24

Net % +58 +54

As we would expect, access to the internet varies by age group, with younger age groups

much more likely to have access. Access is consistent across ethnic groups. As has been

found in previous surveys, there are also differences by social background, with those from

social groups ABC1 more likely to have access to the internet (86%), compared with those

from C2DE (70%). In addition, those who are working are more likely to have access to the

internet compared with those who are not (91% compared with 65%), as are those who

have children compared with those without children (91% compared with 72%). It is worth

noting that a lower proportion of people who have a disability are able to access the

internet, than is found amongst those who do not have a disability (73% compared with

80%). No significant differences are found in levels of internet access by Cluster, however,

previous surveys have found significant differences by PCT.

63

Indirect access

Over a third of those who do not have access to the internet themselves, are able to get

access to the internet via other family members (38%). This means that around 87% of

respondents either have access to the internet themselves or are able to get information

via others.

Indirect internet access

No

Yes

Don’t know

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

Q Does someone in your family ever use the internet to get information for you, or not?

Accessing information on staying healthy and health services

We asked respondents where they would look or who they would speak to if they wanted

to find out about staying healthy and how to improve their health and where to access

health services. As is seen in the chart overleaf the largest group of respondents would look

to their GP for this information. The next most important source of information is non-NHS

websites which are cited by over a fifth of respondents.

64

55%

24%

10%

9%

8%

6%

4%

3%

3%

Information about staying healthy

Make an appointment with, or contact, my local GP surgery


Q If you wanted information about staying healthy and how to improve your health where would you look or who would you speak to? (Top 9)

Call NHS Direct

Other non-NHS websites

I would not look for more information about this

NHS Choices website

Speak to a friend / colleague / family member

Make an appointment with other health professionals

Other NHS websites

Ask my local pharmacist

More respondents who are aged over 45 state that they would speak to their GP about

information on staying healthy (61% compared with 42% amongst those aged 16-24). A

higher proportion of people who either have a disability themselves or who have a family

member with a disability state that they would talk to their GP, if they wanted information

on this subject (61%), as is the case with people who are not working (57%) and people

from social group C2DE (58%). If we combine all cases where a website is mentioned, then

38% of respondents state that they would like to use online sources to find information

about staying healthy. Amongst younger age groups online methods of finding information

are as popular as consulting their GP. If we combine all those who state that they would

look for information on a website, then 59% of those aged 16-34 would consult information

via an online source.

If respondents wanted to find information on where to access health services, the most

popular source is still their local GP, although slightly higher proportions also consider other

sources. The GP is the most popular choice for respondents aged over 45, with 57% citing

this as a source of information. Similarly, the GP is the most popular choice for people who

are not working (54%), those without children (52%), those who either have a disability

themselves or have someone in their household with a disability (53%). This source is also

mentioned by a high proportion of people who do not have access to the internet (63%).

Online sources are also popular overall and are mentioned by 24% of all respondents, rising

to 60% of those aged under 35. The main online sources mentioned are non-NHS websites

which are cited by 21% respondents overall.

65

49%

21%

13%

13%

8%

7%

3%

3%

2%

2%

Information about accessing services



Q If you wanted information about where to access health services where would you look or who would you speak to? (Top 10)

Call NHS Direct


NHS Choices website



Other NHS websites

Local PCT / hospital trust website

NHS Local

Visit a health centre

Digital health

NHS organisations are developing a range of digital tools and information to help citizens

manage and improve their health. Respondents were asked about their willingness to

undertake a range of activities online or via their mobile, and were reassured that the

systems involved would be secure.

Interacting with health service professionals online / via mobile

As is shown in the chart below, over half of all respondents would be happy to undertake a

range of activities online, including making an appointment to see their GP, ordering repeat

prescriptions, receiving test results and emailing their GP. There is less demand for having

an online consultation with their GP, which might reflect concerns about equipment or

confidentiality or a preference for face-to-face consultations.

66

Online and mobile applications

Make an appointment to see your GP


Q Which of the following things, if any, would you like to do online or online via your mobile? The system for doing this would be secure.

None of these

Order repeat prescriptions

Receive test results

Have an online consultation with your GP

Email your GP

Access your medical records

Send updates on your health status to your GP

As we might expect, across most of these activities, younger respondents, respondents who

are working, and those from social groups ABC1 are more likely to say that they would be

willing to use online services.20

However, there are some groups where fairly high proportions state that they would not

like to carry out any of these activities online or via their mobile. Amongst those who are

aged 65 and over, almost half state that they would not like to do any of these activities

online (49%), and a quarter of those aged 55-64 would not like to undertake any of these

activities online (25%). Nonetheless it is worth noting that there is some enthusiasm

amongst people aged over 55 for undertaking some activities online or via their mobile,

mainly around more transactional activities such as making appointments or ordering

repeat prescriptions. For example, over a third of people aged over 65 would like to make

an appointment to see their GP online (37%), or order repeat prescriptions (36%), although

there is less enthusiasm for other kinds of activities, particularly having an online

consultation with their GP (17%). In addition, higher proportions of people who are not

working, and those who are from social groups C2DE state that they would not like to carry

out any of these activities online (31% and 26% respectively). Perhaps unsurprisingly, a high

proportion of respondents who do not have access to the internet state that they would

not like to carry out any of the activities mentioned online or via their mobile (64%).

20

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

67

Accessing and sharing information on health issues online / via mobile

Over two thirds of the people interviewed state that they would like to find services near to

where they work or live either online or via their mobile (67%). The majority of respondents

would also like to look at information about the quality of services online (64%) and find

out about local and national health news (56%). Lower proportions of respondents state

that they would like to access advice and support on health issues from other members of

the public, although this option is supported by around two fifths of respondents (41%).

67%

64%

56%

49%

46%

43%

42%

41%

19%

Online and mobile applications

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

Find services near to where you live or work

None of these


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

treatment

Find out about local and national health news

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

had

Watch videos, listen to and read about the experiences of others who are living with an

illness, undergoing treatment or trying to improve their health in some way

Comment on the experience of others who are living with an illness, undergoing

treatment or trying to improve their health in some way

Use an app to help improve your health

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

As we would expect, younger respondents, those from more affluent backgrounds and

those who are working are more enthusiastic across all of the options. For example, 83% of

respondents who are aged under 35 state that they like to access information on local

68

services online, 77% of those who are working and 72% from social groups ABC1. More

enthusiasm is also found amongst respondents who are members of ethnic minority groups

which might reflect their younger age profile, with 76% positive about finding services close

to where they live or work online.

In contrast, almost half of all respondents aged over 65 state that they would not like to

undertake any of these activities online (49%). In addition, almost a third of those who are

not working (30%), and a quarter of those from social groups C2DE (25%) state that they

would not like to carry out any of these activities online or via their mobile. It is important

to note that almost a quarter of those who have a disability would not like to carry out any

of these activities online (23%), which might reflect their older age profile. As we would

expect, a high proportion of people who do not have access to the internet state that they

would not like to carry out any of these activities online (61%).

Accessing information on quality

A range of questions were asked throughout the survey which aimed to look at how well

informed respondents are about the quality of local services and what information they

would like to access.

How well informed local respondents feel about quality

Local residents feel that they are more informed about the quality of local health services

than some other aspects of health service delivery, with half stating that they know a fair

amount or a great deal about this (50%). However, a similar proportion feel that they know

very little or nothing at all about the quality of local services (48%).


“The quality of local health services”

6%

44%38%

10%

Awareness of the quality of local health services

A great deal


A fair amount

Not very much

Nothing at all

Don’t know (1%)Never heard of (1%) 52% say they

would like more

information about

the quality of local

health services

69

Respondents from more affluent backgrounds are more likely to feel informed about the

quality of local health services, with 54% from social group ABC1 stating that they know at

least a fair amount. Respondents from Staffordshire Cluster are also more likely to feel that

they know about the quality of local services with 56% stating that they know a lot / a fair

amount. It is worth noting that a higher proportion of those who have a disability

themselves or who have a household member with a disability feel that they are informed

about the quality of local services (54%), as are those who are carers (57%), those who

work in the NHS (72%) and their friends and family (55%). In addition, those who are aware

of local plans for the development of services are also more likely to know at least a fair

amount (67%).

The desire for more information around quality

We asked respondents whether they would like more information on a range of subjects

including the quality of local health services. Over half the respondents feel that they would

like more information about the quality of local services (see page 61). The desire for more

information on the quality of local services is consistent across demographic groups.

Accessing information around quality of treatment in local hospitals

If patients want to find out about the quality of treatment available in local hospitals the

main source they would turn to is their GP (30%). However, if we combine all cases where

websites are mentioned, 40% of respondents would look to the internet for information on

the quality of treatment in hospitals. The main online sources mentioned are non-NHS

websites (by 21%), NHS websites (by 11%) and NHS choices (by 10%). A high proportion of

those aged over 65 state that they would talk to their GP about the quality of local services

(41%), as is the case for those who are not working (36%) and for those with a disability

(34%). Similarly the GP is the main source of information mentioned by those who do not

have internet access (46%).

70

30%

21%

17%

11%

10%

4%

4%

3%

2%

2%

Information about quality of treatment in hospitals



Q If you wanted information about the quality of treatment in hospitals where would you look or who would you speak to? (Top 9)

Call NHS Direct


NHS Choices website



Other NHS websites

Local PCT / hospital trust website

NHS Local

I would not look for more information about this

Who do people trust to give them information about the quality of treatment in

local hospitals

The results of the survey show that the main person respondents trust to give them helpful

information about the quality of treatment in local hospitals is their GP (50%). Other people

who are trusted are family and friends (mentioned by 20%), other health professionals

(cited by 10%) and NHS hospitals themselves (mentioned by 8%).

Trusted sources of information

Your GP


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

Other health professionals, for example hospital doctors and nurses

None of these

Information from friends or family

NHS hospitals

Other organisations outside the NHS

Private hospitals

The media

Other NHS organisations

71

Willingness to access information on quality online / via mobile

A high proportion of respondents would like to access information on the quality of local

services online or via their mobile (64%) (see page 67). This figure rises to 78% for those

aged under 44. In addition, a higher proportion of people from social groups ABC1 (68%),

who are working (74%) and from minority ethnic groups (74%) would like to access

information this way. Interestingly, a high proportion of respondents who are NHS staff,

and their friends and family, would like to access information in this way (76% and 67%

respectively).

72

Appendices

73

1. Statistical reliability

Because a sample, rather than the entire population, was interviewed the percentage

results are subject to sampling tolerances – which vary with the size of the sample and the

percentage figure concerned. For example, for a question where 50% of the people in a

(weighted) sample of 2,000 with an effective sample size of 1,980 respond with a particular

answer, the chances are 95 in 100 that this result would not vary more than two

percentage points, plus or minus, from the result that would have been obtained from a

census of the entire population (using the same procedures). An indication of approximate

sampling tolerances are given in the table below.

Size of sample on which the survey results are based

Approximate sampling tolerances applicable to percentages at or near these

levels

10% or 90% 30% or 70% 50% ± ± ± 1,980 interviews 1 2 2

For example, with a sample of 1,980 where 30% give a particular answer, the chances are 19 in 20 that the “true” value (which would have been obtained if the whole population had been interviewed) will fall within the range of plus or minus 2 percentage points from the sample result.

Strictly speaking, the tolerances shown here apply only to random samples; in practice good quality quota sampling has been found to be as accurate.

When results are compared between separate groups within a sample, different results may be obtained. The difference may be “real”, or it may occur by chance (because not everyone in the population has been interviewed). To test if the difference is a real one - i.e. if it is “statistically significant”, we again have to know the size of the samples, the percentage giving a certain answer and the degree of confidence chosen. If we assume the “95% confidence interval”, the differences between the two sample results must be greater than the values given in the table below:

Size of samples compared Differences required for significance at or near these percentage levels

10% or 90% +

30% or 70% +

50% +

1,980 (NHS West Mids 2010) vs. 3,362 (NHS West Mids 2009)

2 3 3

307 (Arden Cluster) and 446 (Birmingham & Solihull Cluster)

4 7 7

1,751 (white residents) vs. 230 (ethnic minority residents)

4 6 7

74

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

2.9

B Middle Class Intermediate managerial, administrative or professional

18.9

C1 Lower Middle Class

Supervisor or clerical and junior managerial, administrative or professional

27.0

C2 Skilled Working Class Skilled manual workers

22.6

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

75

3. Mosaic groups

Group and type names

Group Description Type Description

A Residents of isolated rural communities A01 Rural families with high incomes, often from city jobs

A02 Retirees electing to settle in environmentally attractive localities

A03 Remote communities with poor access to public and commercial services

A04 Villagers with few well paid alternatives to agricultural employment

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

B05 Better off empty nesters in low density estates on town fringes

B06 Self employed trades people living in smaller communities

B07 Empty nester owner occupiers making little use of public services

B08 Mixed communities with many single people in the centres of small towns

C Wealthy people living in the most sought after neighbourhoods

C09 Successful older business leaders living in sought-after suburbs

C10 Wealthy families in substantial houses with little community involvement

C11 Creative professionals seeking involvement in local communities

C12 Residents in smart city centre flats who make little use of public services

D Successful professionals living in suburban or semi-rural homes

D13 Higher income older champions of village communities

D14 Older people in large houses in mature suburbs

D15 Well off commuters living in spacious houses in semi rural settings

D16 Higher income families concerned with education and careers

E Middle income families living in moderate suburban semis

E17 Comfortably off suburban families weakly tied to their local community

E18 Industrial workers living comfortably in owner occupied semis

E19 Self reliant older families in suburban semis in industrial towns

E20 Upwardly mobile South Asian families living in inter war surburbs

E21 Middle aged families living in less fashionable inter war suburban semis

F Couples with young children in comfortable modern housing

F22 Busy executives in town houses in dormitory settlements

F23 Early middle aged parents likely to be involved in their children’s education

F24 Young parents new to their neighbourhood, keen to put down roots

F25 Personnel reliant on the Ministry of Defence for public services

G Young, well-educated city dwellers G26 Well educated singles living in purpose built flats

G27 City dwellers owning houses in older neighbourhoods

76


G28 Singles and sharers occupying converted Victorian houses

G29 Young professional families settling in better quality older terraces

G30 Diverse communities of well educated singles living in smart, small flats

G31 Owners in smart purpose built flats in prestige locations, many newly built

G32 Students and other transient singles in multi-let houses

G33 Transient singles, poorly supported by family and neighbours

G34 Students involved in college and university communities

H Couples and young singles in small modern starter homes

H35 Childless new owner occupiers in cramped new homes

H36 Young singles and sharers renting small purpose built flats

H37 Young owners and rented developments of mixed tenure

H38 People living in brand new residential developments

I Lower income workers in urban terraces in often diverse areas

I39 Young owners and private renters in inner city terraces

I40 Multi-ethnic communities in newer suburbs away from the inner city

I41 Renters of older terraces in ethnically diverse communities

I42 South Asian communities experiencing social deprivation

I43 Older town centre terraces with transient, single populations

I44 Low income families occupying poor quality older terraces

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

J45 Low income communities reliant on low skill industrial jobs

J46 Residents in blue collar communities revitalised by commuters

J47 Comfortably off industrial workers owning their own homes

K Residents with sufficient incomes in right-to-buy social housing

K48 Middle aged couples and families in right-to-buy homes

K49 Low income older couples long established in former council estates

K50 Older families in low value housing in traditional industrial areas

K51 Often indebted families living in low rise estates

L Active elderly people living in pleasant retirement locations

L52 Communities of wealthy older people living in large seaside houses

L53 Residents in retirement, second home and tourist communities

L54 Retired people of modest means commonly living in seaside bungalows

L55 Capable older people leasing/ owning flats in purpose built blocks

M Elderly people reliant on state support M56 Older people living in social housing estates with limited budgets

M57 Old people in flats subsisting on welfare payments

M58 Less mobile older people requiring a degree of care

M59 People living in social accommodation designed for older people

N Young people renting flats in high density social housing

N60 Tenants in social housing flats on estates at risk of serious social problems

77


N61 Childless tennants in social housing flats with modest social needs

N62 Young renters in flats with a cosmopolitan mix

N63 Multicultural tenants renting flats in areas of social housing

N64 Diverse homesharers renting small flats in densely populated areas

N65 Young singles in multi-ethnic communities, many in high rise flats

N66 Childless, low income tenants in high rise flats

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

O67 Older tenants in low rise social housing estates where jobs are scarce

068 Families with varied structures living in low rise social housing estates

069 Vulnerable young parents needing substantial state support

78

4. Reading and Interpreting funnel plots

This report contains a number of funnel plots, otherwise known as cross-sectional control

charts. These charts show the variation between PCT Cluster results reported against

particular questions asked in the telephone survey. The charts help to distinguish real

differences between Clusters from those that might be attributable to chance or sampling

error (error that results from speaking to only a sample of the population rather than doing

a census of the whole West Midlands population)21. This appendix provides information

about reading and interpreting these charts.

Illustrated example of a funnel plot showing Cluster results

Each point in the chart represents a Cluster. The height of the point indicates the result

observed in the survey for that Cluster, so Clusters achieving higher results appears higher

in the chart. The horizontal position of the point indicates the sample size on which that

Cluster’s result is based, so Clusters with larger sample sizes appear further to the right.

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

The funnel indicates the degree of variation that can reasonably be attributable to sampling

error. The funnel cuts the chart into three distinct regions. Clusters represented by points

above the funnel have significantly higher results than the West Midlands average. Clusters

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

0%

5%

10%

15%

20%

25%

30%

35%

40%

310 330 350 370 390 410 430 450

Res

ults

(%) f

or C

lust

er

Number of respondents/ Sample size for Cluster

Clusters represented by (blue) points

within the funnel do not differ significantly

from the average.

Each point represents a Cluster.

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

Clusters represented by (red or green) points above or below

the funnel differ significantly from the West Midlands average. These are

sometimes called special cause variations.

The height of the point indicates the result observed for the Cluster.

The horizontalposition of the point indicates

the sample size on which the Cluster's result is based.

The funnel narrows to the right because as sample sizes increase

smaller variations from the West Midlands average are required to detect significant

differences.

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represented by points below the funnel have results significantly lower than the West

Midlands average. Points above or below the funnel are shaded in red or green.

Clusters represented by points within the funnel do not differ significantly from the West

Midlands average – 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.

Documents

Public and Patient Views on Health Services in the West Midlands