patient telephone survey 2009

Public and Patient views on health services

in the West Midlands

Annual Survey Report 2009

Business Analytics Team

Contents

Executive Summary

Introduction

1. Perceptions of the NHS

2. Priorities for improvement

3. Engaging with local people

4. GP services

5. Understanding the system: choice & navigation

6. Access to information

Appendices

1. Statistical reliability

2. Definition of social grades

3. Mosaic code definitions

4. Reading and interpreting funnel plots

5. GP-led health centres

3

Executive Summary

All NHS organisations have a duty to involve and consult patients and the public in

relation to the planning and development of services, and with regard to decisions

relating to the operation of services (Section 242, NHS Act 2006). The NHS

Constitution also sets out the rights of local people to be involved in the planning of

healthcare services.

NHS West Midlands has conducted a range of market research activities in recent

years, in order to explore public and patient views on local NHS services and the

extent to which they feel informed and involved around service development.

This report presents the findings of the latest telephone survey, conducted in April /

May 2009 and draws upon previous surveys and research to examine how views

have changed over time and to try to explain the factors behind the priorities and

concerns that are highlighted.

The objectives of the representative telephone survey were to:

1. Understand residents’ general perceptions of the NHS

2. Understand their priorities for improvement in healthcare services

3. Explore how far people feel that their local NHS seeks their views and listens to them

4. Explore access to GPs and satisfaction with GP services

5. Look at whether local people understand how the health system works, focusing on choice and navigation

6. Explore the information on health services that residents are able to access, and the opportunities offered in terms of digital modes of communication.

Perceptions of the NHS

Residents’ expectations for the future of their local health services have not changed

substantially since the survey was last conducted in 2008. The greatest proportion of

citizens states that they expect services to remain the same over the next few years

(43%), while over a third expect them to get better (33%), and a fifth think that they

will get worse (21%).

In comparison with the results for last year’s survey, there is less variation between

PCTs in public confidence in the future of the NHS. Although the regional average

has remained unchanged, there has been a narrowing of the range of responses

across PCTs.

At the time of the survey, the ‘credit crunch’ and potential effects on public sector

funding availability were being widely discussed in the media. In order to gauge how

4

this was being perceived by the public, respondents were asked about how

concerned they were about the credit crunch and its effect on the NHS. The findings

indicate that people are worried about funding issues, with three quarters stating

that they are concerned (75%) and around two in five stating that they are very

concerned (44%).

Overwhelmingly, residents in the West Midlands are satisfied with the NHS, with

72% satisfied with the way that the NHS is being run. This is similar to national

findings (DH Tracker 73%), and a substantial improvement from the last time the

question was asked in 2006 (61%).

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

than with national provision and government policies for the NHS. While 79% of

respondents agree that their local NHS is providing them with a good service, 64%

feel that the NHS is providing a good service nationally and 38% agree that the

government has the right policies for the NHS. This is consistent with survey

findings across the country as a whole.

Priorities for improvement

The survey explored the areas where people feel local healthcare services are in

need of improvement. As we have noted, overall satisfaction with NHS services

remains high, but there are clear messages about the areas where the public feels

that extra attention is needed.

Improving cleanliness in hospitals is highlighted by respondents as the factor which

is most in need of improvement, 16% of respondents highlight this as the most

important priority for improvement. Waiting times in A&E are also seen as an

important priority for improvement, with 14% of respondents stating that this is the

most important factor for improvement.

When we compare the results of the survey with the views expressed last year,

there has been an increase in the proportion of people who feel that A&E waiting

times are in need of improvement, however for other aspects, the proportion of

respondents who feel that improvements are needed either remains the same or

has fallen. The proportion of people who feel that access to an NHS dentist is in

need of improvement has decreased, this has been particularly affected by

improved perceptions of access in Herefordshire.

5

Engaging with local people

As part of the survey a set of questions were asked to gain feedback which will help

inform PCTs as part of the World Class Commissioning process. These questions look

at how well local people feel that the NHS helps them to stay healthy, listens to

them and seeks their views on local service development.

A high proportion of respondents to the survey agree that the NHS helps them and

their family to stay healthy (72%) and that there is good communication between

healthcare staff (61%). There are no significant differences between PCTs on the

results for these questions. Older respondents, those with a disability and those

with experience of using certain services are more positive about these aspects of

service provision.

However, the results are less positive around whether local people feel that they are

invited to give their views on local healthcare services. Overall, more people

disagree (44%) that their local NHS asks for their views on services than agree (42%).

Residents in Heart of Birmingham and Coventry are more positive, with 50% and

49% of residents respectively agreeing that they are invited to give their views. As

part of the survey we aimed to look at whether people feel that the NHS is open to

feedback about services and responds to the comments made. This question was

answered slightly more positively than the previous question on whether people are

asked to give their views. Overall, 46% of respondents agree that they feel able to

feedback on health services and believe that their local NHS acts on this feedback.

However, almost a third (32%) disagree, while 9% feel that they don’t know. Again,

residents in Heart of Birmingham were slightly more positive, with 54% agreeing

that they feel able to give feedback and be listened to.

As part of the survey we asked residents whether they feel informed about how

good NHS services are in their local area. The responses show that just over half the

respondents agree that they are well informed (54%), while around a third disagree

(33%). Residents in Walsall answered this question more positively, with 65%

agreeing that they are well informed.

GP Services

Satisfaction with GP services remains very high overall. Areas where there are

particularly high levels of satisfaction are around the appearance of the surgery, the

proximity of services, the accessibility of the surgery and around the medical and

listening skills of GPs. There are more residents who are dissatisfied with the

availability of car parking, the amount of choice available over the date and time of

the appointment, and how easy it is to get through to the surgery to make an

appointment.

While levels of satisfaction are high across the region, there are certain PCTs where

satisfaction is lower. In particular, over a third of residents in Heart of Birmingham

PCT stated that they were dissatisfied with the ease of getting through to the

surgery to make an appointment (34%), the length of time between making the

6

appointment and attending the surgery (34%), the choice of date and time of

appointment (40%) and car parking (37%).

The results show that demand for evening appointments is highest amongst those of

working age. Over 40% of respondents aged between 25-54 state that they would

prefer an evening appointment. In addition, half of those who are working full time

would prefer an evening appointment.

Access to information

The last time we conducted the survey, we found that there was a strong correlation

between an individual feeling informed about what was happening in their local NHS

and feeling confident about the future of services.

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

NHS about plans for developing health services, we found that there had been little

change from 2008 in the proportion of citizens who had received information.

Overall 18% of respondents state that they have received some information, while

the vast majority have not or do not know whether they have received information

(82%). Once again, there was some variation by PCT with a higher proportion of

those living in Walsall and South Birmingham feeling informed about plans for the

development of local services.

We also asked those who had seen plans about whether they had found them

useful. Those who have seen plans tend to think that they had been useful (68%).

However, around a third had not found them useful or could not remember (32%).

As the fact that people feel well informed about local services has an impact on their

confidence for the NHS, we probed into what plans people thought they had seen.

The highest proportion of people refer to hospital developments or

redevelopments, although a wide spectrum of information is mentioned. Thus

although the fact that people feel informed about local plans has an impact on their

confidence for the NHS, it’s difficult to pin down exactly what this relates to. It

seems to be that a general perception about being informed about local

developments in the NHS makes people more positive.

As the NHS is constantly finding new ways to engage with citizens and patients, it is

important to have up-to-date and detailed information on where people access

information on health services. In particular, the potential opportunities offered by

digital modes of communication and engagement need to be fully understood. As

usage of the internet is constantly increasing, it is useful to get an update on this

element on a regular basis.

We asked respondents about whether they have access to the internet. The survey

shows that over three quarters of respondents have access to the internet. As we

would expect, access to the internet varies by age group, with younger age groups

much more likely to have access. Over 90% of those aged 16-44 have access to the

internet, and access is consistent across ethnic groups. A lower proportion of

residents in Sandwell have access to the internet (69%).

7

Although a high proportion of residents within the region have access to the

internet, only around a third of residents use the internet for accessing health

information at least once every month or two, and only 15% do so regularly (at least

every couple of weeks). Hence, there appears to be scope to improve the health

information and services that people are able to access online. The SHA is currently

developing digital services which will give local citizens and staff access to a range of

tools and information to help them manage and improve their health.

8

Introduction

All NHS organisations have a duty to involve and consult patients and the public in

relation to the planning and development of services, and with regard to decisions

relating to the operation of services (Section 242, NHS Act 2006). The NHS

Constitution also sets out the rights of local people to be involved in the planning of

healthcare services.

NHS West Midlands has conducted a range of market research activities in recent

years, in order to explore public and patient views on local NHS services and the

extent to which they feel informed and involved around service development.

This report presents the findings of the latest telephone survey, conducted in April /

May 2009 and draws upon previous surveys and research to examine how views

have changed over time and to try to explain the factors behind the priorities and

concerns that are highlighted.

Background and Objectives

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

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

Herefordshire, Sandwell, Shropshire, Solihull, Staffordshire, Stoke on Trent, Telford

and Wrekin, Walsall, Warwickshire, Wolverhampton and Worcestershire. The SHA is

responsible for ensuring that the £8.4 billion pounds spent on health and health care

across the West Midlands delivers better services for patients and better value for

money for tax payers.

In order to guide the implementation of its Strategic Framework, Investing for

Health, the SHA has commissioned a range of research to understand residents’

attitudes to healthcare. As part of this, a telephone survey with a representative

sample of residents was undertaken.

The objectives of this research were to:

1. Understand residents’ general perceptions of the NHS

2. Understand their priorities for improvement in healthcare services

3. Explore how far people feel that their local NHS seeks their views and listens to them

4. Explore access to GPs and satisfaction with GP services

5. Look at whether local people understand some aspects of how the health system works, focusing on choice and navigation

6. Explore the information on health services that residents are able to access, and the opportunities offered in terms of digital modes of communication.

9

Methodology

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

3,528 telephone interviews with West Midlands residents, each lasting for

around 25 minutes. All interviews were conducted between 8 April and 17

May 2009.

Quotas were set by PCT to ensure that the number of interviews gained in each PCT

is proportional to the size of that PCT in relation to others in the West Midlands.

Further quotas were set on gender, age, working status and ethnicity within each

PCT to ensure that the profile of those interviewed matches the profile of each PCT’s

population as closely as possible, according to the 2001 census.

Data were also weighted by the size of each PCT and then the gender, age, working

status, ethnicity and social class profile within each PCT according to the 2001

census.

Previous research

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

Midlands in 2006 and 2008. The 2008 survey was conducted among 3,564 residents

between 8 April and 13 May 2008. The 2006 survey was conducted between 8

August and 8 September 2006 among 3,535 residents.

In addition, results are given for the December 2008 national tracking survey for the

Department of Health. These results are based on 1,003 face-to-face interviews with

English residents, carried out between 17 November and 15 December 2008.

Comparisons are indicative only as the methodologies differ.

The production of this report

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

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

results of the telephone survey as supplied by Ipsos MORI. Ipsos MORI also supplied

many charts, as indicated, other tables and charts were produced by the Business

Analytics Team.

Presentation and Interpretation of Data

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

the survey. Therefore, all results are subject to sampling tolerances, which means

that not all differences are significant. A guide to statistical reliability is appended,

but as a rule of thumb results based on the full sample are reliable to +2 percentage

points at a 95% level of confidence, while sub-groups will have a wider margin of

error. Any results based on samples of 100 or below have a margin of error of at

least +10 percentage points, and should be treated as indicative only.

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

them in isolation can be artificial. For example, Black and Minority Ethnic

10

communities often have a younger age profile; differences in their views may be just

as much to do with age as they are to do with ethnicity.

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

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

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

zero. Where reference is made to “net” figures, this represents the balance of

opinion on attitudinal questions, and provides a particularly useful means of

comparing the results for a number of variables. In the case of a “net satisfaction”

figure, this represents the percentage satisfied on a particular issue, less the

percentage dissatisfied. For example, if 40% who answer are satisfied and 25%

dissatisfied, the “net satisfaction” figure is +15 points.

Acknowledgements

NHS West Midlands would like to thank Kate Duxbury and Caroline Booth at Ipsos-

MORI for co-ordinating the annual telephone survey fieldwork and providing insights

on the results. Special thanks also go to the 3,564 West Midlands residents who took

the time to take part in this survey.

Report Layout

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

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

Perceptions of the NHS


Engaging with local people

GP services

Understanding the system: choice & navigation

Access to information

© NHS West Midlands

11

1. Perceptions of the NHS

Survey data continually demonstrates how valued the NHS is by local people. The NHS

Constitution emphasises that the NHS belongs to everyone and the importance of local

people being involved in the planning and delivery of care. The survey explored how

confident people feel about local services and their level of satisfaction with the way the

NHS is being run.

This chapter analyses residents’ expectations for local NHS services over the next few

years. The factors which influence these expectations are also explored in detail. General

satisfaction with the NHS is then considered, alongside the factors which are associated

with higher levels of satisfaction.

Will the local NHS get better or worse?

Residents’ expectations for the future of their local health services have not changed

substantially since the survey was last conducted in 2008. The largest proportion of citizens

state that they expect services to remain the same over the next few years (43%), while

over a third expect them to get better (33%), and a fifth think that they will get worse

(21%).

27%

43%

17%

3% 7%

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…?

+13

21

33

WM

2009

Net

better

Worse

Better

-9-13+11

364022

272733

DH

Tracker*

WM

2006*

WM

2008

Stay about the same

Don’t know (3%)

Get worse

Get much worse Get much better

Get better

Base: 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 2006DH Tracker – 1,003 English residents, 17 November - 15 December 2008 – please note this

was conducted face-to-face rather than by telephone so results are not strictly comparable

* Please note question wording

differs in these two surveys –

“Thinking about health services

in your area over the next few

years, do you expect them to…”

The context in which the survey took place was very different this year. At the time when

the last survey was conducted in 2008, some of the major concerns and problems relating

12

to the banking sector had not yet emerged. Hence, given that the general economic

environment has changed, the fact that optimism in local NHS services has not been

affected is reassuring.

There are differences in peoples’ expectations for the NHS based on PCT and socio-

demographic groups, which are explored in the section below. Some of the factors which

might drive these differences are also discussed.

Who are the most positive and negative residents?

In comparison with the results for last year’s survey, there is less variation in confidence

between PCTs. Although the regional average has remained unchanged, there has been a

narrowing of the range of responses across PCTs and more PCTs have results which are

similar to the regional average. The chart overleaf shows that respondents in Stoke on

Trent, South Staffordshire, Heart of Birmingham and South Birmingham are more

optimistic than in other PCTs. It is interesting to note that three of these areas have well-

developed plans and new developments – ‘Fit for the Future’ in Stoke on Trent (and North

Staffordshire), ‘2010’ / ‘Right Care Right Here’ in Heart of Birmingham (and Sandwell), and

the new hospital developments in South Birmingham.

The chart overleaf shows variations in expectations by PCT and variations which might be

due to sampling error (error that results from speaking to only a sample of the population

rather than doing a census of the whole West Midlands population). Thus, certain PCTs

have results which vary from the West Midlands average, after taking account of possible

sampling error.

In PCTs with blue markers, optimism is broadly in line with the average across the West

Midlands, and any variation could be a result of this sampling error. In PCTs with green

markers, optimism is higher than the West Midlands average and there is a good chance

this is due to actual differences rather than to sampling error (particularly for the darker

green markers). In PCTs with red markers, optimism is lower than the West Midlands

average and there is a good chance this is due to actual differences rather than to sampling

error (particularly for the darker red markers). Please refer to the appendices for more

details.

13

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

S Staffs

WorcsWarks

BEN

S Bham

DudleyCov

Shrops

Sand

Stoke

HoB

Herefs

N Staffs

T&W

Sol

Wolves

Wals

15%

20%

25%

30%

35%

40%

45%

50%

150 170 190 210 230 250 270 290 310 330

% a

nsw

erin

g 'm

uch

better' or 'better'

Number of respondents

PCT

West Midlands

Upper Control Limit (2 sigma)

Lower Control Limit (2 sigma)



(Base: 3528 respondents, 8 April – 17 May 2009, Q: Thinking about health services in your area over the next few

years, including any plans you area aware of, do you expect them to…?)

We looked at the results for each PCT for 2008 and 2009 to examine whether there had

been any significant change in the proportion of residents who were confident about the

future of NHS services in the local area. If we take into account the variation in results

which could be due to sampling methodology the only PCT which has a significant variation

between the two years is South Staffordshire. The proportion of respondents who say that

they expect services to get better or much better has increased from 27% in 2008 to 42% in

2009. Further analysis would be needed to investigate possible reasons behind this

increase, looking at the impact of lots of factors on public views, including a critical report

on a particular hospital.

So what other factors might account for the variations in expectations? Across the West

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

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

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

white residents (see graph overleaf). 1 2

1 A definition of social grade can be found in the appendices

2 Overall, 36% of those in social groups C2DE feel that services will get better, compared with 30%

from social groups ABC1.

14

6

11

26

34

44

33

18

15

3

3

3

4

White

Ethnic

minority

% Get much better % Get better % Stay about the same% Get worse % Get much worse % Don't know

Expectations by ethnicity

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

Base: 3,118 white West Midlands residents and 402 ethnic minority residents, 8 April – 17 May 2009

Net

better

+11

+27

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.

7

12

10

7

7

6

8

4

5

5

4

31

24

24

29

28

27

26

25

23

27

23

41

46

48

38

42

44

39

50

48

38

48

15

15

13

19

18

16

19

16

18

23

20

2

2

4

3

4

4

2

4

3

3

3

2

4

3

4

3

2

2

4

2

3

% Get much better % Get better % Stay the same% Get worse % Get much worse % Don't know

Expectations by Mosaic group


Net

better

+21

Older people, social housing, high care needs

Educated, young, single, in area of transient pop.

Social housing with uncertain employment

Low income families, estate based social housing

Upwardly mobile families, homes bought from social landlords

Independent older people, relatively active lifestyles

Older families living in suburbia

Close knit, inner city, manufacturing town communities

Career professionals living in sought after locations

Younger families living in newer homes

People living in rural areas far from urbanisation

+21

+14

+19

+14

+12

+14

+5

+12

+7

+5

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

15

Other factors were examined to determine their explanatory potential. One of these was

whether the respondent recalled seeing any plans as to future health care developments in

their areas. Those who felt that they had seen plans, were more positive about the future

of the NHS. Chapter six examines awareness of local plans in more detail.

Expectations – impact of receiving information

Net better

% Worse

% Better

+32

14%

46%

% Stay the same

% Don't know

% Get better% Get much better

% Get much worse % Get worse

11%

35%

36%

11%3%

4%6%

25%

44%

19%

3%3%


Net better

% Worse

% Better

+8

22%

30%

Those who have received

information about local plans (640)

Those who have not received

information about local plans (2,809)


We will now look at some of the reasons given by those people who felt pessimistic about

the future for local health services.

16

Why will local health services get worse?

For those who feel that health services are likely to get worse, the most frequently cited

reason given is that there is less money. Other reasons commonly mentioned are the

growing population the NHS has to cater for and a perception that there is a shortage of

staff and doctors.

17%

15%

14%

12%

11%

9%

9%

8%

7%

7%

Reasons health services will get worse

Base: All who think local health services will get worse over the next few years (2009: 741, 2008: 800)

Q Why do you think it will get worse?

Top 10 mentions

Hospital closures/A&E closures/fewer hospitals

Already getting worse

Staff shortages/fewer doctors/nurses

Lack of organisation/badly run/poor management

Impact of financial problems/credit crunch on funding

Government policies/initiatives

People from abroad/foreigners/asylum seekers

Too much money wasted

Less money (unspecified)

Growing population/too many people

WM 2008

%

13

16

13

n/a

8

17

6

12

7

15

17

The perception that local services will get worse because of financial constraints is a

particular issue for those aged over 35 (for example, 22% of those aged 55-64 give this as a

reason that things will get worse). In addition, people from a white ethnic group are more

likely to cite this as a reason things will get worse (19% compared with 3% from a minority

ethnic group). People from social grades ABC1 who expect services to get worse are more

likely to specifically mention the financial problems or the ‘credit crunch’ as a factor (15%),

compared with people from social grades C2DE (9%) (ABC1 equates to administrative,

managerial and professional occupations – see appendices for further explanation).

Younger people aged (16-24 were also more likely to specifically refer to financial problems

or the ‘credit crunch’ (21%).

It is important to note that this question looks only at the views of those who expect

services to get worse over the next few years. Later in the survey, a question was asked of

everyone to gauge their concern about financial issues in relating to NHS funding overall.

We will now go on to look at the results for this question.

Concerns about funding in the NHS

At the time of the survey, the ‘credit crunch’ and potential effects on public sector funding

availability were being widely discussed in the media. In order to gauge how this was being

perceived by the public, respondents were asked how concerned they were about the

credit crunch and its effect on the NHS. The findings indicate that people are worried about

funding issues, with four in ten stating that they are very concerned (see chart below).

44%

31%

14%

8%3%

Concern about NHS funding

Very concerned

Don’t know

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

Not very concerned

Not at all concerned

Fairly concerned

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

18

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

disability, respondents from an ethnic minority group and those who are carers are more

likely to state that they are ‘very concerned’ about funding issues.3 In addition, for those

who state that they expect the NHS to get worse over the next few years, 59% are very

concerned about the credit crunch affecting the funding for the NHS. The chart below

shows differences in perceptions by age group in detail.

25-34

35-44

45-54

55-64

16-24

65+

28%

36%

45%

49%

50%

52%

38%

32%

29%

30%

30%

29%

20%

19%

15%

12%

10%

9%

9%

10%

7%

6%

7%

7%

5%

3%

3%

3%

2%

4%

Very

concerned

Fairly

concerned

Not very

concerned

Not at all

concerned Don't know

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

Concern about NHS funding by age

Base: 3,528 West Midlands residents (base size for each age group

shown in brackets), 8 April - 17 May 2009

(466)

(541)

(565)

(650)

(589)

(713)

The graph overleaf shows the proportion of residents in each PCT who feel fairly concerned

or very concerned that the credit crunch might affect the funds available for the NHS. It

shows that there are no differences between PCTs – a relatively high proportion in all PCTs

are concerned.

352% of those from ethnic minority groups state that they are very concerned, as do 49% from social groups C2DE, 51% of those with a disability, and 51% of those who are carers, compared with 44% overall.

19

Concern about the effect of the credit crunch on NHS funding, by PCT

S Staf fsWorcs

Warks

BENS Bham

Dudley

Cov

ShropsSand

Sol

Wals

Herefs

Stoke

HoB

WolvesN Staf fsT&W

55%

60%

65%

70%

75%

80%

85%

90%

150 170 190 210 230 250 270 290 310 330

% a

nsw

erin

g 'con

cern

ed' or 'very c

on

cern

ed'


PCT

West Midlands





(Base: 3528 respondents, 8 April – 17 May 2009, Q:How concerned are you, if at all, that the credit crunch might

reduce the funds available for the NHS?)

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

with people in older age groups, people from minority groups, those with a disability and

those who are carers being the most concerned. The results have implications for

communication strategies around changes in service provision, savings and improvements

in efficiency.

Overall satisfaction with the NHS

Overwhelmingly, residents in the West Midlands are satisfied with the NHS. The graph

overleaf demonstrates that 72% are satisfied with the way that the NHS is being run. This is

similar to the national DH tracker figure, and a significant improvement from the last time

the question was asked in 2006 (the question was not asked in 2008).

20

Overall satisfaction with the NHS

2009

% Neither/nor

% Don't know

% Fairly satisfied% Very satisfied

% Fairly dissatisfied % Very dissatisfied

26%

45%

9%

12%

7%1%

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

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

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

DH Tracker – 1,003 English residents, 17 November - 15 December 2008 – please note this was conducted face-to-face rather than by telephone so results are not strictly comparable

WM 2009 WM 2006 DH Tracker

Satisfied 72 61 73

Dissatisfied 18 27 13

Net satisfied +53 +34 +60

High levels of satisfaction are found across the region. When we account for variation

which may be caused by sampling error, it is evident that the results for individual PCTs are

not significantly different to the regional average, with the exception of Solihull where

levels of satisfaction are slightly higher.

21

Overall satisfaction with the NHS, by PCT

S Staffs

Worcs

Warks

BEN

S Bham

Dudley

Cov

Shrops

Sand

Sol

WalsN Staffs

HoB

Wolves

Herefs

T&W

Stoke

50%

55%

60%

65%

70%

75%

80%

85%

150 170 190 210 230 250 270 290 310 330

% a

nsw

erin

g 'stron

gly

agree' or 'agree'


PCT

West Midlands





(Base: 3528 respondents, 8 April – 17 May 2009, Q: Overall, how satisfied or dissatisfied are you with the running of

the National Health Service nowadays?)

The chart overleaf demonstrates that there is a general improvement in satisfaction across

PCTs, although please note that not all changes in the chart are statistically significant.

22

Overall satisfaction with the NHS by PCT

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

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

c. 175 – 300 residents per PCT

31

30

30

30

29

28

28

27

26

26

26

24

24

23

23

21

17

41

43

43

39

50

47

38

43

48

48

45

48

45

48

44

50

50

9

8

12

8

5

7

14

10

9

8

5

6

9

7

11

13

9

13

10

10

14

10

10

14

12

8

11

15

15

11

14

10

9

14

7

6

8

4

7

4

6

7

7

6

5

7

8

11

7

8

5

*

*

2

1

3

2

3

1

2

1

1

2

1

2

1

% Very satisfied % Fairly satisfied

% Neither/nor % Fairly dissatisfied

% Very dissatisfied % Don't know/Refused

Dudley

Heart of Birmingham

Coventry Teaching

Telford & Wrekin


Satisfied

2009

%

72

73

73

69

79

75

66

70

75

74

71

72

70

71

67

71

67

Solihull Care

South Birmingham

South Staffordshire

Sandwell

Birmingham East and North

North Staffordshire

Walsall

Shropshire County

Wolverhampton

Worcestershire

Herefordshire

Stoke on Trent

Warwickshire

Satisfied

2006

%

57

67

59

59

69

61

60

54

68

58

60

61

62

66

71

53

64

Some differences are evident by age group. As is seen in the graph overleaf, those aged 65

and over are the most positive, as is found throughout the results of the survey. Those

who have either been an inpatient in an NHS hospital or who have been an outpatient are

more likely to be very satisfied than those who have not (30% compared with 22%). Those

who are more satisfied with how the NHS is being run are also more likely to feel that the

NHS will get better over the next few years, as 79% of those who are satisfied expect the

NHS to improve, compared with 12% of those who are dissatisfied. Those who have

received information about local plans are also more likely to say that they are satisfied

with the NHS (77%).

23

22

22

19

21

28

44

51

48

49

49

40

35

12

13

10

8

6

5

8

12

14

14

15

8

5

5

6

7

9

7 1

1

1

1

1

216-24

25-34

35-44

45-54

55-64

65+

% Very satisfied % Fairly satisfied % Neither/nor% Fairly dissatisfied % Very dissatisfied % Don't know

Overall satisfaction with the NHS by age


Base: 3,528 West Midlands residents (base size for each age group shown in brackets), 8 April - 17 May 2009

Net

Satisfied

+61

+53

+47

+49

+45

+64

(466)

(541)

(565)

(650)

(589)

(713)

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

at perceptions of local provision and national policies.

Overall satisfaction with local services

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

national provision and government policies for the NHS. The national DH tracker figure

demonstrates that views in the West Midlands are consistent with those in the country as a

whole.

79%

64%

38%

14%

23%

42%

Satisfaction with national and local NHS

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

The government hasthe right policies for the NHS

The NHS is providing agood service nationally

My local NHS is providingme with a good service 70

51

24

WM 2006% agree

76

65

37

DHTracker

% agree% Agree




% Disagree

24

Satisfaction with the local NHS has increased since the last time the question was asked in

2006. When asked whether they agree that their local NHS is providing them with a good

service, the overwhelming majority agree (79%, compared with 70% in 2006).

Perceptions of the NHS locally

2009

38%

41%

6%

8% 6%

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 2009 WM 2006 DH Tracker

Agree 79 70 76

Disagree 14 21 12

Net Agree +65 +49 +64

% Neither/nor

% Don't know / no opinion

% Tend to agree% Strongly agree

% Tend to disagree % Strongly disagree




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

residents being the oldest and youngest age groups.

81%

76%

74%

78%

79%

84%

Q To what extent, if at all, do you agree or disagree with each ofthe following statements?

My local NHS is providing me with a good service

16-24

25-34

35-44

45-54

55-64

65+

Net

Agree

+71

+61

+57

+63

+62

+73

Base: 3,528 West Midlands residents (base size for each age group shown in brackets), 8 April - 17 May 2009

(466)

(541)

(565)

(650)

(589)

(713)

% Agree

Perceptions of the NHS locally by age

25

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

is providing them with a good service. A higher proportion of residents in South

Birmingham are positive about their local NHS, and a lower proportion in Telford & Wrekin.

Perceptions of the NHS locally, by PCT

S Staffs

Worcs

Warks

BEN

S Bham

Dudley

Cov

Shrops

Sand

HoB

Wals

Herefs

N Staffs

Sol

Wolves

Stoke

T&W

60%

65%

70%

75%

80%

85%

90%

150 170 190 210 230 250 270 290 310 330

% a

nsw

erin

g 'stron

gly

agree' or 'agree'


PCT

West Midlands





(Base: 3528 respondents, 8 April – 17 May 2009, Q: To what extent, if at all, do you agree or disagree with each of

the following statements – My NHS is providing me with a good service?)

There has been a general improvement in satisfaction with the NHS across PCTs compared

with the last time the question was asked. There has been a particularly large increase in

Herefordshire - the proportion of residents who agree that their local NHS is providing

them with a good service has increased by 16 percentage points (66% of respondents

agreed with the statement in 2006, compared with 82% in 2009).

The results from this section of the survey are reassuring, as levels of satisfaction in the

region are in line with those found nationally. In addition, it seems that there is more

consistency in terms of confidence in the NHS across the region.

As overall satisfaction with the NHS is high, we also asked about areas where

improvements are needed. We need to understand the concerns people may have about

local services. We turn to look at this aspect of citizens’ views in the next chapter.

26

2. Priorities for improvement

This chapter looks at the areas where people feel local healthcare services are in need of

improvement. As we have noted, overall satisfaction with NHS services remains high, but

there are clear messages around the areas where the public feels that extra attention is

needed. The results are positive, in that they show that the public are slightly less

concerned about some aspects of service provision, such as access to NHS dentists,

compared with the last time the survey was undertaken. However, there are still some

themes, such as hospital cleanliness, which remain a prominent concern.

Perceived areas for improvement

The Operating Framework for the NHS for 2010/11 sets out the five national priorities for

the NHS as: improving cleanliness and reducing healthcare-associated infections (HCAIs);

improving access through achievement of the 18-week referral to treatment targets, and

improving access to GP services (including at evenings and weekends); keeping adults and

children well, improving patient experience, and staff satisfaction and engagement; and

preparing to respond in a state of emergency, such as an outbreak of a new pandemic.

Alongside these priorities, we need to understand what the public and patients perceive to

be the most important priorities for the NHS to concentrate on. We asked all those who

took part in the survey to outline which were the most important areas for the NHS to

improve, from a list of services and aspects of services that were presented to them. As we

will see, there is significant overlap with the priorities highlighted above.

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

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

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

are also positive about access to services to improve their own health, the time spent

waiting for an ambulance following a 999 call and information on local services. Residents

highlight waiting times in A&E, ease of access to an NHS dentist and cleanliness in hospitals

as areas where the most improvement is needed.

27

59%

56%

52%

48%

44%

43%

42%

36%

35%

35%

34%

30%

30%

27%

23%

21%

18%

13%

29%

36%

42%

42%

37%

34%

25%

63%

61%

55%

38%

64%

61%

55%

75%

40%

60%

50%

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

Need for improvement

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

2008: 3,564 West Midlands residents, 8 April – 13 May 2008

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

% 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 in hospitals*

Quality of medical treatment by GPs

Services for treating cancer

Quality of nursing care in hospitals

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

General condition of hospital buildings

Information about local health care services

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

Services to support people at the end of their lives

Services for supporting people withmental health problems

Hospital waiting lists fornon-emergency operations

Waiting time before getting appointments with hospital consultants

Cleanliness of hospitals

Time spent waiting in A&E Departments

Ease of access to an NHS dentist**

** 2006 wording “Ease of registering with an NHS dentist”* 2006 wording “Quality of medical care in hospitals”

WM 2008 WM 2006

55 57

30 32

62 70

31 21

54 57

39 38

48 60

39 30

47 56

33 29

43 N/A

34 N/A

46 N/A

24 N/A

39 40

59 58

32 35

64 62

29 30

59 63

28 36

35 35

35 38

58 57

24 27

66 66

31 34

52 50

26 25

71 72

21 28

39 39

19 N/A

58 N/A

12 13

47 51

The chart overleaf compares perceived need for improvement in 2008, with the current

results. Those areas in the top right hand corner of the quadrant are those where there is

a perceived high need for improvement and concerns have heightened since 2008. Those

in the bottom right quadrant are areas where there is a perceived high need for

improvement and a decrease in concern compared with 2008.

28

Perceived need for improvement – comparison of results for 2008 & 2009

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

GP appointment waiting times

Gen condition of hospital buildings


Cancer services

Info about local health services

Quality of medical treatment in hospitals

Choice of GP (registration)


-8

-6

-4

-2

0

2

4

6

8

0 10 20 30 40 50 60 70

% c

hang

e in 'a lo

t' o

r a 'fa

ir a

mo

unt' s

ince 2

008

% stating 'a fair amount' or 'a lot' of improvement needed

(Base: 3528 respondents, 8 April – 17 May 2009, 3564 respondents 8 April -13 May 2008. Q:Based on what you know or have heard about the NHS, can you tell me whether you think the NHS in your own local community is: in need of no improvement,

in need of a little improvement, in need of a fair amount of improvement or in need of a lot of improvement?)

.

When we look at the degree to which people feel individual aspects are in need of

improvement we can see that on the whole, respondents are more positive than in

previous surveys. There is an increase in the proportion of people who feel that A&E

waiting times are in need of improvement, however for many other aspects, the

proportion of respondents who feel that improvements are needed either remains the

same or has fallen. The proportion of people who feel that access to an NHS dentist is in

need of improvement has decreased, this has been particularly affected by improved

perceptions of access in Herefordshire.

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

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

waiting times. Perceptions of A&E waiting times have worsened since last year and the

perceived need for improvement is high. In addition, concern around waiting times for

appointments with hospital consultants remains fairly high despite considerable attention

being focussed on this aspect of health care, and 18 week targets being achieved in

December 2008.

Improving perceptions of waiting times

Other survey work we have completed suggests that awareness of reduced waiting times is

fairly low amongst the local population.4 A postal survey was conducted between

November 2008 and January 2009 with patients who had been referred for planned care in

June and July 2008. Across the region, 54% of respondents were concerned about the time

4 Patients’ Experience of Using Planned Care in the West Midlands (2009). (http://www.wmqi.westmidlands.nhs.uk/patient-experience/)

29

they would need to wait when they were first referred for treatment. In contrast, 77% of

those who had started treatment were happy with the amount of time they had to wait for

treatment to start. Focus group work also confirmed that the improvements in waiting

times were taking some time to filter through to the general population.5

If you've got nothing to compare to then it's a bit tricky to have

expectations

Male with long-term condition, Solihull, ABC1, age 35-54

I thought it'd probably be about three months, the general perception

you get from the media and all that sort of thing, but in actual fact it

worked out quicker than that

Male, Solihull, C2DE, age 55+

In addition, this work showed that patients feel more reassured about waiting if they are

given more information about their condition and what they can do to help their recovery

before they see a consultant. This is summed up in the quote below.

More information on what’s wrong with you. What’s wrong with you,

what are the consequences, and how you can alleviate your problem

while you’re waiting

Male, South Asian, Stoke, age 35-54

The results of the postal survey and focus group work have been shared with PCTs who

have developed action plans around improving patient experiences.


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

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

they flagged as needing most improvement. The chart below shows that improving

cleanliness in hospitals is highlighted by respondents as the factor which is most in need of

improvement. Waiting times in A&E have emerged as the second priority for improvement

this year, in contrast to the last time the survey was conducted when access to NHS

dentists was deemed to be a more urgent priority. The decrease in the priority given to

access to NHS dentists reflects improvements in certain PCTs where concerns were high

last year (e.g. Herefordshire).

5 Planned Care Patient Experience (2009) (http://www.wmqi.westmidlands.nhs.uk/patient-experience/)

30

WM 2008

16%

14%

11%

8%

8%

7%

7%

7%

5%

3%

2%

2%

2%

1%

1%

1%

1%

1%

*

*

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


Cleanliness of hospitals 18%

11%

16%

10%

6%

7%

7%

4%

3%

4%

2%

2%

3%

2%

2%

1%

1%

1%

-

-

Time spent waiting in A&E Dept

Ease of access to an NHS Dentist

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

Waiting time before getting appointments

with hospital consultants

Services for treating cancer


Hospital waiting lists for non-emergency operations

Quality of medical treatment in hospitals

Time spent waiting for an ambulance after a 999 call


General condition of hospital buildings

Amount of choice people have about which GP they

can register with

Services for treating heart disease

Information about local healthcare services

Access to services to improve your own health

Care of the elderly

Amount of staff

Base: 2009: 3,528 West Midlands residents; 8 April - 17 May 2009

2008: 3,564 West Midlands residents; 8 April - 13 May 2008


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

aged over 45 are more likely to state that improving hospital cleanliness is the most

important thing for the NHS to improve (18% of those aged 45 and over feel that hospital

cleanliness is the most important priority compared with 13% of those aged under 45).

Younger respondents tend to highlight A&E waiting times as the most important priority

31

for improvement, cited by 18% of those aged under 35. For ethnic minority groups, the

amount of time needed to get an appointment with a GP is the main factor highlighted as

an area for improvement, with 16% highlighting this as the priority. A similar proportion

(15%) state that waiting times in A&E are the most important priority.

The table overleaf sets out the priorities across PCTs. In comparison with last year, fewer

PCTs have ease of access to NHS dentists as one of their top priorities. Last year

respondents in all 17 PCTs had flagged ease of access to NHS dentists as one of their top

priorities, this year it was flagged as one of the top priorities in 11 of the PCTs. However,

more PCTs have A&E waiting times flagged as a top priority this year, and this is identified

as one of the main priorities in all but one of the PCTs. Improving cleanliness in hospitals

remains one of the main priorities in all PCTs.

32

Priorities for improvement for the NHS, by PCT PCT Priority 1 Priority 2 Priority 3 Priority 4

Birmingham East & North

Cleanliness of hospitals (16%)

Waiting times A&E Waiting times for GP appt

(both 11%)

Mental health Services;

End of life services (both 10%)

Coventry Teaching

Waiting times A&E (19%)


Cancer services (9%)

Ease of access to NHS dentist;

Waiting times for GP appt;

Mental health services; Waiting times hospital

consultant (all 7%)

Dudley Waiting times A&E (20%)


Waiting times for GP appt Cancer services

Mental health services (all 8%)

Heart of Birmingham

Waiting times for GP appt (16%)

Waiting times A&E

(13%)


(9%)

Ease of access to NHS dentist;

Waiting times hospital consultant (both 8%)

Herefordshire Ease of access to NHS dentist (23%)



(11%)

End of life services (10%)

North Staffs Waiting times A&E (23%)



(11%)

End of life services (9%)

Sandwell Cleanliness of hospitals (16%)

Waiting times for GP appt

(14%)

Waiting times A&E

(13%)


Shropshire County

Cleanliness of hospitals Ease of access to NHS dentist (both

20%)

Waiting times A&E

(13%)

Waiting times hospital consultant

(9%)

Solihull Care Cleanliness of hospitals (12%)

Waiting times A&E

(11%)

Waiting times hospital consultant Ease of access to NHS dentist

Waiting times for GP appt Mental health services

(all 10%)

South Birmingham

Mental health services (13%)


Waiting times A&E;

Waiting times for GP appt (both 11%)

South Staffs Cleanliness of hospitals (20%)

Waiting times A&E

(14%)


(9%)


Stoke on Trent Waiting times A&E (22%)

Cleanliness of hospitals Ease of access to NHS dentist (both


33

12%)

Telford & Wrekin Ease of access to NHS dentist Cleanliness of hospitals

(both 14%)

Waiting times A&E

(13%)


Walsall Teaching Cleanliness of hospitals (23%)

Waiting times A&E

(12%)


Waiting times for GP appt (7%)

Warwickshire Cleanliness of hospitals (20%)


(14%)

Waiting times A&E

(12%)


End of life services

(both 8%)

Wolverhampton City


Waiting times A&E

(13%)


(9%)

Mental health Services;

End of life services (both 8%)

Worcestershire Ease of access to NHS dentist (18%)



Waiting times A&E (11%)

(Base: 3528 respondents, 8 April – 17 May 2009. Q:Which of these, if any, is most important to improve?)

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

ascertain geographical and demographic variations.

Cleanliness in hospitals

Improving cleanliness in hospitals remains a top priority for improvement for the

population of the West Midlands as a whole. The graph overleaf shows perceived need for

improvement by PCT. A higher proportion of residents in Walsall state that cleanliness in

hospitals is in need of a fair amount or a lot of improvement, compared with the results for

the region as a whole.

34

5153

Need for improvement in cleanliness by PCT

20

18

17

18

18

19

12

16

13

16

13

13

13

11

14

10

16

31

31

32

27

24

26

34

26

28

23

25

25

29

28

25

25

22

15

17

16

18

18

20

24

26

19

22

22

19

22

20

15

18

21

29

26

30

31

31

30

26

27

36

33

33

36

34

35

42

41

39

5

7

5

6

10

4

4

5

4

6

7

7

2

5

4

5

2

% No need % A little % A fair amount % A lot % Don't know

Dudley

Worcestershire

South Birmingham

Walsall Teaching

North Staffordshire


Shropshire County

Herefordshire

Sandwell

Heart of Birmingham

Stoke on Trent

Solihull

Coventry Teaching

Wolverhampton City

Telford & Wrekin

South Staffordshire

Warwickshire

40

56

63

47

45

54

51

56

46

55

62

57

60

58

52

63



45

46

50

49

50

49

56

55

43

56

55

57

60

55

55

59

2009 2008

At least a

fair amount

%




Despite successes in reducing the rate of hospital acquired infections, hospital cleanliness

remains the aspect of care that the public are most concerned about. In response to the

findings from the survey last year, an in-depth study of perceptions of cleanliness in

hospitals was undertaken. The research involved in-depth discussion groups with citizens

from across the West Midlands and included a range of socio-demographic backgrounds.

The research found that people’s perceptions of cleanliness were formed around three

35

main areas: the hospital environment, personal hygiene and accountability. Participants

highlighted a wide range of factors relating to the hospital environment which had an

impact on their perceptions: the state of the walls, ceilings, and doors; the frequency of

seeing cleaning staff mopping up; whether the hospital was housed in a modern building,

had light coloured walls, large windows, good ventilation and comfortable furniture; the

absence of clutter; the hospital smelling clean; and having consistency in terms of

cleanliness – across wards and departments and at different times of the day / days of the

week.

Participants felt that patients, visitors, and healthcare professionals all had a role to play in

maintaining personal hygiene. Participants felt that bottles of hand sanitizers, the presence

of sinks and liquid soaps, frequent bed linen changes, cleaner toilets and more culturally

sensitive toilet facilities helped increase levels of personal hygiene. Furthermore, South

Asian participants felt that fresh, hot and culturally sensitive food was also necessary for

their sense of ‘inner cleanliness’.

Accountability is the third factor which shaped participants’ perceptions of cleanliness,

knowing that someone was taking responsibility for maintaining standards. Participants in

the groups stressed the need for more clarity and visibility around responsibility for

cleanliness at all levels – from individual wards, to the hospital as a whole. People wanted

to feel reassured that someone was accountable for ensuring that the highest levels of

cleanliness were being achieved.

If you don’t have someone responsible for cleanliness in

each ward individually who report back to a head person,

then nothing will get done.

Mixed Ethnicity, Male, C2DE, English speaking group

The research also identified the need for more effective communication around cleanliness

and healthcare acquired infections. Those who had recently been a visitor in a hospital, or

had been in hospital themselves, were better informed about cleanliness and infection

levels. However, those with no personal experience relied on reports that they had heard

in the media and were the most fearful.

The findings of the research are being shared with all organisations around the region to

help them understand the drivers behind patient and public perceptions of cleanliness and

to inform clinical practice and service delivery.

36

A&E Waiting Times

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

compared with last year. The chart below indicates that a high proportion of residents in

Dudley, Stoke on Trent and North Staffordshire feel that A&E waiting times are in need of

improvement.

9

13

10

12

10

9

13

10

10

7

7

5

11

8

5

5

5

24

26

26

26

25

22

20

21

18

22

18

18

16

16

14

18

13

15

20

20

20

19

16

14

18

15

22

25

21

18

18

16

15

27

30

28

30

32

34

39

44

41

45

40

39

44

47

48

52

54

46

21

13

14

10

12

14

9

10

12

8

10

12

8

10

13

8

9

% No need % A little % A fair amount % A lot % Don't know

Dudley

Worcestershire

South Birmingham

Walsall Teaching

North Staffordshire


Shropshire County

Herefordshire

Sandwell

Heart of Birmingham

Stoke on Trent

Solihull

Coventry Teaching

Wolverhampton City

Telford & Wrekin

South Staffordshire

Warwickshire

49

52

50

53

46

58

59

55

63

60

65

64

65

66

69

68

73


Time spent waiting in Accident & Emergency (A&E) Departments At least a

fair amount

%

2009 2008

47

52

50

45

45

64

52

57

53

54

58

57

58

60

69

67

62

Need for improvement in A&E waits by PCT




37

Ease of access to NHS dentists

In the 2008 survey, ease of access to NHS dentists was highlighted as a major concern in

some PCTs. In particular, 72% of residents in Hereford stated that access to NHS dentists

was in need of a lot of improvement, and 37% stated that it was the most important thing

for the NHS to improve. The results in the survey this year indicate that although access is

still seen as a problem, perceptions have improved, particularly in Herefordshire, where

53% say that access is in need of a lot of improvement and 23% say that access to NHS

dentists is the most important thing to improve (compared with 72% and 37% respectively

in 2008).

The graph below compares the proportion of people who have seen a dentist in each PCT

in the last 24 months with the proportion who feel that ease of access to an NHS dentist is

in need of improvement. A weak correlation is evident in that the PCTs with the highest

proportions of people visiting a dentist tend to have the lowest proportions of people

feeling that ease of access is in need of improvement. However, this association is weak

(only around 13% of the variation in one variable could be explained by the variation in the

other). This may be linked to other factors which could have an influence on access and

perceptions of access, such as ease of access to non-NHS dentists which is likely to be

significant in some PCTs such as Solihull.

Perceived need for improvement around NHS dentistry access, analysed against the

proportion of respondents in each PCT who have accessed a dentist recently

BEN

Coventry

Dudley

HoB

Herefs

N Staf fs

Sandwell

Shrops

Solihull

S B'ham

S Staf fs

Stoke

Telford&W

Walsall

Warks

Wolv

Worces

R² = 0.1362

40%

45%

50%

55%

60%

65%

70%

75%

35% 40% 45% 50% 55% 60% 65% 70% 75%

% s

een

NH

S d

en

tist

in la

st 2

4 m

on

ths

% stating 'a fair amount' or 'a lot' of improvement needed

(Base: 3528 respondents, 8 April – 17 May 2009. Q:Based on what you know or have heard about the NHS, can you

tell me whether you think the NHS in your own local community is: in need of no improvement, in need of a little improvement, in need of a fair amount of improvement or in need of a lot of improvement?)

As perceptions of access to NHS dentistry were highlighted as a particular issue in last

year’s survey, further research was commissioned by NHS West Midlands on this theme.6

The research found that perceptions of ease of access are driven by personal experience,

38

by word of mouth and by the media. It is worth noting that some participants based their

views on experiences from some years ago that do not necessarily reflect the situation

now.

In some areas, participants had seen dental practices advertising for new NHS patients

through the local media and even more simply through advertising boards outside their

practices. This had a strong positive impact on their perceptions of access.

People are, you hear of all these on the telly, can’t get a dentist for like six months, twelve months, whatever, can’t find one. But then you can be walking up the High Street and there’s three or four dentists with big banners outside, saying, we’re taking on new NHS patients.

Female, NHS attender, Dudley

Most had little detailed knowledge about the dentist before they started seeing them, and

were not aware of how to access information on the quality of services.

It wasn’t really a choice, it was who was available. I don’t think it is an educated choice, because until you’ve been to them (the dentist), you don’t know what they’re going to be like.

Male, NHS attender, Shropshire

The findings from the research are helping PCTs to improve access and develop information

available for the public about dental services.

6 Understanding public perceptions of information and access to NHS dentistry in the West Midlands (2009), (http://www.wmqi.westmidlands.nhs.uk/patient-experience/)

39

3. Engaging with local people

All NHS organisations have a duty to involve and consult patients and the public in relation

to the planning and development of services, and with regard to decisions relating to the

operation of services (Section 242). The NHS Constitution also emphasises the rights of

local people to be involved in the planning of healthcare services and in decisions affecting

the operation of services.

As part of the survey a set of questions were asked to gain feedback which will help inform

PCTs as part of the World Class Commissioning process. These questions look at how well

local people feel that the NHS listens to them and seeks their views on local service

development. This is linked to the competencies in the World Class Commissioning

Framework, mainly around competency 3 which looks at how well the PCT engages with

the public and patients.

Overview

As can be seen in the slide below, a high proportion of residents agree that the NHS helps

them and their family to stay healthy and that there is good communication between

healthcare staff. However, citizens are less positive about whether the NHS asks for their

views and feedback and keeps them informed about the quality of local services.

72%

61%

54%

46%

42%

17%

27%

33%

32%

44%

World class commissioning

Q For each of the following statements, please tell me how much you agree or disagree . . . .

My local NHS asks for my views about how healthcare services are run and improved

I feel well informed about how good NHS services are in my local area, e.g. hospitals,

ratings on GPs, dentists and pharmacists

I feel able to feedback on health services, and believe my local NHS acts on this

feedback

There is good communication between all the people who provide my healthcare

My local NHS helps me and my family to stay healthy

% Agree


% Disagree

40

Looking at the views of different groups of residents across all of these aspects of world

class commissioning, similar groups tend to be positive and negative. In general the most

positive groups are:

the youngest and oldest age groups (16 to 24 years and over 65s);

residents in social grades C2, D and E

ethnic minority residents;

those who do not work full-time

those who have been inpatients; and

those who have used staying healthy clinics.

The most negative groups tend to be:

those aged 35 to 54 years;

residents in social grades A, B and C1;

those who work full-time;

white residents;

those who have used a private hospital; and

those who have visited Accident and Emergency.

The following sections explore responses to the questions in more detail, examining

possible reasons underlying residents' perceptions on these aspects of the NHS.

41

Helping me and my family to stay healthy

Participants in the survey were asked about whether their local PCT helps them and their

family to stay healthy. As we have noted, respondents were positive about this aspect of

healthcare provision, with 72% agreeing that the NHS helps them and their family to stay

healthy.

The results show higher levels of agreement with this statement among those who are

aged 65 and over, with 82% of this group agreeing, compared with 70% for those aged

under 65. Levels of agreement with this statement are higher for those who have a

disability or who have someone in the family with a disability (74%).

In line with the age differences (as Asian residents tend to have a younger age profile),

those from an Asian background are less likely than other ethnic groups to agree that the

NHS helps them and their family to stay healthy .

72%

66%

77%

Asian

Other BME

White


“My local NHS helps me and my family to stay healthy ”

% Agree

Helping people to stay healthy by ethnicity

Base: 3,528 West Midlands residents (base size for each group shown in

brackets), 8 April - 17 May 2009

(3,118)

(261)

(141)

The chart overleaf demonstrates agreement with the statement on staying healthy by PCT.

A lower proportion of residents in Heart of Birmingham PCT agree with this statement.

This is likely to be related to the demographic profile of the population (which is younger

and has a large Asian population).

42

Helping people to stay healthy, by PCT

S Staffs

Worcs

Warks

BEN

S BhamDudley

Cov

Shrops

Sand

Wolves

HoB

Sol

WalsHerefs

N Staffs

Stoke

T&W

50%

55%

60%

65%

70%

75%

80%

85%

150 170 190 210 230 250 270 290 310 330

% a

nsw

erin

g 'stron

gly

agree' or 'agree'


PCT

West Midlands





(Base: 3528 respondents, 8 April – 17 May 2009. Q:For each of the following statements, please tell me how much

you agree or disagree with the following statements- My local NHS helps me and my family to stay healthy?)

The results show that there is a high proportion of respondents who agree with this

statement across nearly all PCTs. We will now turn to look at people’s perceptions about

whether people perceive that there is good communication between all the people who

provide their healthcare.

Receiving ‘joined up’ care

We asked people about their views on the effectiveness of communication between the

people providing their healthcare. Overall, those aged 65+ are the most positive about this

aspect of service provision, with 72% agreeing that there is good communication between

those providing care. In line with other findings, those aged 16-24 are also positive with

66% agreeing that there is good communication. A lower proportion of those aged 25-54

agree with the statement (55%). Residents from social groups C2DE are more likely to say

that communications are good between all the people who provide their healthcare than

residents from groups ABC1 (69% compared with 52%).

43

Respondents with a disability are more likely to feel that there is good communication

(64%) than those without a disability (60%). Finally, those who are not working full time are

more likely to be positive than those who are working full time (66% compared with 53%).

This is likely to be linked with the age profile of these groups.

In terms of service usage, those who have been an inpatient feel that there is good

communication (65%), as do those who have been to staying healthy clinics (69%). Those

who have been to A&E or a private hospital are more likely to disagree that there is good

communication between healthcare staff (30% and 37% respectively).

As can be seen in the slide below, respondents who have an Asian ethnic background

respond positively to this question, while white residents are least positive. This is

interesting given the age profile of the Asian population, and the fact that younger people

tend to be less positive about this aspect of provision.

60%

71%

66%

Asian

Other BME

White


“There is good communication between all the people who provide my healthcare”

% Agree

Joined-up care by ethnicity

(3,118)

(261)

(141)

Base: 3,528 West Midlands residents (base size for each group shown in

brackets), 8 April - 17 May 2009

The chart overleaf gives the detail for each PCT in relation to joined up care. It can be seen

that satisfaction is fairly consistent across all PCTs. However, Sandwell residents are

particularly likely to disagree that communications are good, which might warrant further

investigation (34%, compared with 27% overall).

44

Joined-up care, by PCT

S StaffsWorcs

Warks

BEN

S Bham

Cov

Dudley

Shrops

Sand

HoB

Stoke

T&W

Sol

Wolves

Herefs

N Staffs

Wals

40%

45%

50%

55%

60%

65%

70%

75%

150 170 190 210 230 250 270 290 310 330

% a

nsw

erin

g 'stron

gly

agree' or 'agree'


PCT

West Midlands






you agree or disagree with the following statements-There is good communication between all the people who provide my healthcare?)

Staying on the communication theme, we will now look at the extent to which people feel

that they are invited to give their views by the NHS.

Being invited to share views

As we have seen, residents are positive about the role of the NHS in keeping them healthy

and about communication between frontline healthcare staff. However, the results are less

positive around inviting local people to give their views on local healthcare services.

Overall, more people disagree (44%) that their local NHS asks for their views on services

than agree (42%).

A high proportion of those aged 45-54 disagree that they are invited to give their views

(55%), with a quarter of this group strongly disagreeing (25%). Those from social groups

ABC1 are more likely to disagree (48%), as are white respondents (46%) and those who are

carers (48%).

45

Interestingly, a higher proportion of those who have been an inpatient within the last year

or so agree that they are invited to give their views (47%). Nonetheless, a similar number

disagree (41%) or do not know (5%), hence even those with recent experience of hospital

provision do not feel that they are invited to give their views on service provision.

When we look at responses by PCT, residents in Heart of Birmingham and Coventry are

more likely to answer this question positively. However, it still needs to be borne in mind

that over a third do not feel that they are asked about their views. A slightly lower

proportion of residents in Worcestershire feel that they are asked to give their views on

services.

Asking for residents’ views, by PCT

S Staffs

Worcs

Warks

BEN

S Bham

Dudley

Cov

Shrops

Sand

Wals

Herefs

N Staffs

T&W

HoB

Wolves

Stoke

Sol

25%

30%

35%

40%

45%

50%

55%

150 170 190 210 230 250 270 290 310 330

% a

nsw

erin

g 'stron

gly

agree' or 'agree'


PCT

West Midlands






you agree or disagree with the following statements-My local NHS asks for my views about how healthcare services are run and improved?)

The results from this question seem to indicate that more could be done across the region

to increase opportunities for people to give their views on how healthcare services are run

and improved.

46

Feeding back on health services

As part of the survey we aimed to look at whether people feel that the NHS is open to

feedback about services and responds to the comments made. This question was

answered slightly more positively than the previous question on whether people are asked

to give their views. Overall, 46% of respondents agree that they feel able to feedback on

health services and believe that their local NHS acts on this feedback. However, almost a

third (32%) disagree, while 9% feel that they don’t know.

Once again, those aged 45-54 are the most negative, with 39% disagreeing that they would

be able to give feedback and that this would be acted on. In addition, a higher proportion

from social groups ABC1 (37%) disagree compared with those from C2DE (27%). White

respondents are more likely to disagree than those from ethnic minority groups (33%

compared with 26%). Finally, those who are carers are more likely to feel that they cannot

feed back (36%) than those without caring responsibilities (31%).

We might expect those with recent experience of using services to be more positive about

feeling able to give feedback and for this to be acted upon. To some extent this does seem

to be borne out by the data, as 52% of those who have been an inpatient in the last year or

so agree that they would be able to give feedback and for this to be acted upon (compared

with 46% overall). Those with recent experience of Staying Healthy Clinics are also more

likely to agree (55%).

In terms of feeling able to give feedback on local services, residents in Heart of Birmingham

PCT are the most positive, as can be seen in the slide below. Nonetheless, it does need to

be borne in mind that across all PCTs around a third of respondents disagree with this

statement.

47

Feeling able to feedback on services, by PCT

S StaffsWorcsWarks

BEN

S Bham

Dudley

Cov

Shrops

Sand

Wolves

Stoke

HoB

Sol

Herefs

N Staffs

T&W

Wals

25%

30%

35%

40%

45%

50%

55%

60%

150 170 190 210 230 250 270 290 310 330

% a

nsw

erin

g 'stron

gly

agree' or 'agree'


PCT

West Midlands





(Base: 3528 respondents, 8 April – 17 May 2009. Q:For each of the following statements, please tell me how much you agree

or disagree with the following statements-I feel able to feedback on health services and believe my local NHS acts on this feedback?)

Overall the results suggest that there is a need to increase awareness and confidence

amongst local residents that the NHS welcomes feedback and will act upon this. The fact a

significant proportion of those who have recent experience of health services do not feel

that they are able to give feedback and be listened to warrants further attention.

48

Feeling well informed

Alongside increasing choice, attempts have been made to increase the information

available to members of the public about the quality of services in their local area. The

NHS Constitution gives people the right to information, and pledges that citizens will be

provided with easily accessible, reliable and relevant information to help with making

choices.

As part of the survey we asked residents whether they feel informed about how good NHS

services are in their local area. The responses show that just over half the respondents

agree that they are well informed (54%), while around a third disagree (33%). Once again,

differences emerge across age groups, with those aged over 65 the most likely to agree

(69%). Those from social group C2DE are more likely to feel informed than those from

ABC1 (60% compared with 49%). Interestingly, those who have recently been an inpatient

or have been to a staying healthy clinic are more likely to say that they are well informed

(59% and 62% respectively). However, we do need to bear in mind that around three in ten

of those who have been an inpatient or have been to a staying healthy clinic do not agree

(32% and 27% respectively). A much higher proportion of those who feel informed about

local plans say that they also feel well informed about the quality of local services (71%). As

we have noted, there is a group of residents who do feel well informed about current

services and plans for development.

The chart below shows the results on this question by PCT. It is evident that residents in

Walsall are more likely to agree with this statement. There is some correlation between

this question and the question later in the survey which asks whether residents are aware

of local plans, as around 47% of the variation in one of variables can be explained by the

variation in the other. It is worth noting that a higher proportion of respondents in Heart

of Birmingham PCT strongly disagree with this statement (16%).

49

Feeling well informed, by PCT

S StaffsWorcs

Warks

BEN

S Bham

Dudley

Cov

Shrops

Sand

HoBSol

Wolves

Herefs

N Staffs

Stoke

T&W

Wals

25%

30%

35%

40%

45%

50%

55%

60%

65%

70%

150 170 190 210 230 250 270 290 310 330

% a

nsw

erin

g 'stron

gly

agree' or 'agree'


PCT

West Midlands





(Base: 3528 respondents, 8 April – 17 May 2009. Q:For each of the following statements, please tell me how much you agree or disagree with the following statements-I feel well informed about how good NHS services are in my local area e.g. hospitals

, ratings on GPs, dentists, and pharmacists?)

The results suggest that around a third of the population does not feel well informed about

the quality of local health services. Further work with this group might be helpful in

determining what kinds of information they would find helpful and how they would like to

access it.

We now turn to focus on perceptions around GP services in more depth, examining views

on a range of service aspects.

50

4. GP services

As part of Lord Darzi’s review of the NHS in 2007, access to primary care was highlighted as

an area where improvements were needed. The report highlighted the fact that the most

deprived communities often experience the poorest primary care provision and have the

worst health outcomes.

This chapter looks at residents’ views on the quality of services provided by GP practices,

awareness of extended opening hours and new GP-led health centres. Finally the chapter

examines perceptions about the information available on local GP provision.

Overall satisfaction with GP services

All those who had visited their GP over the last year or so were asked about a range of

factors connected with GP services. The questions asked were similar to those asked in

previous years to allow comparison of the results.

Satisfaction with GP services remains very high overall. As is demonstrated in the chart

overleaf, areas where there are particularly high levels of satisfaction are around the

appearance of the surgery, the proximity of services to residents' homes, the accessibility

of the surgery and the medical and listening skills of GPs. There are more residents who are

dissatisfied with the availability of car parking, the amount of choice available over the date

and time of the appointment, and how easy it is to get through to the surgery to make an

appointment.

It is worth noting that there has been an increase in the proportion of respondents who

state that they are satisfied with the availability of out of hours care. In 2008, 36% of those

we questioned were satisfied with this aspect of provision, this year the figure has risen to

45%.

51

Q To what extent were you satisfied or dissatisfied with each of the following

aspects of the service?

Satisfaction with GP Surgery Services

Base: All who have seen their GP in the last year or so



2006: 3,028 West Midlands residents, 8 August – 8 September 2006

96

95

93

91

90

90

89

87

84

79

79

75

75

63

43

45

3115

17

13

25

22

21

18

19

6

10

9

8

6

7

4

3

3

% Dissatisfied % Satisfied

Overall appearance and

cleanliness of the surgery

* 2006 wording “The friendliness of staff”

The extent to which your GP listens

to you and respects you

The length of time staff spent

with you

The explanations that staff gave you

about your illness and treatment

3436

4445

5860

6872

N/A75

N/A76

8183

8986

8587

% Satisfied

8689

N/A90

N/A90

N/A93

N/A94

9495

WM 2006WM 2008

The distance you have to travel from

your home to your GP surgery

How accessible the GP surgery is

(e.g. a ramp)

Your GP’s medical knowledge

The friendliness of reception staff*

Facilities for patients and children

The length of time between making

your appointment and attending

the GP surgery

How easy it was to get through to

the surgery to make an appointment

Car parking

Public transport to and from

the surgery

The availability of out of

hours care

The availability of home visits

The advice and support you

receive on how to stay healthy

The amount of choice you had about

the date and time of your appt

N/A77

2928

While levels of satisfaction are high across the region, there are certain PCTs where

satisfaction is lower. In particular, over a third of residents in Heart of Birmingham PCT are

dissatisfied with the ease of getting through to the surgery to make an appointment (34%),

the length of time between making the appointment and attending the surgery (34%), the

choice of date and time of appointment (40%) and car parking (37%).

52

The table below analyses satisfaction and dissatisfaction with various elements of GP

services in more detail. The PCTs with levels of satisfaction which differ significantly to

those of the region as a whole are highlighted. It is evident that there are issues around

access to GP services in Heart of Birmingham and Sandwell. There are several factors

which could be linked to these issues, as highlighted in the Equitable Access to Primary

Care Programme which is discussed further below.

53

Satisfaction with GP Surgery Services – significant differences by PCT

Service Area PCTs with higher levels of satisfaction

(% very satisfied / satisfied)

PCTs with higher levels of dissatisfaction

(% dissatisfied / very dissatisfied)

How easy it was to

get through to the

surgery to make an

appointment

Shropshire - 85%

South Staffordshire – 81%

Birmingham East & North – 34%

Heart of Birmingham – 34%

Telford & Wrekin – 35%

The length of time

between making

your appointment

and attending the GP

surgery

South Staffs – 86%

Worcestershire – 85%


Sandwell – 27%

The amount of

choice you had

about the date and

time of your

appointment

South Staffordshire – 80%

Walsall – 83%

Heart of Birmingham– 40%

Sandwell - 29%

Your GP’s medical

knowledge


Walsall – 10%

The extent to which

your GP listens to

you and respects you

Worcestershire – 95% Heart of Birmingham – 15%

Sandwell – 11%

Stoke – 12%

The length of time

staff spent with you


Sandwell- 13%

The explanations

that staff gave you

about your illness

and its treatment


The friendliness of

reception staff

Dudley- 94% Coventry – 15%

The advice and

support you receive

on how to stay

healthy

South Birmingham - 85% Heart of Birmingham – 20%

The availability of

out of hours care

Stoke on Trent- 56%

Telford & Wrekin- 56%

Wolverhampton- 56%


Herefordshire – 28%

The availability of

home visits


Stoke – 22%

Overall appearance

and cleanliness of

the surgery

South Birmingham- 100%

South Staffordshire- 99%

Birmingham East & North- 6%


Wolverhampton – 6%

54

Car parking North Staffordshire – 72%

Shropshire- 74%

Telford & Wrekin – 81%

Dudley – 32%

Heart of Birmingham - 37%

Herefordshire- 37%

Public transport to

and from the surgery

Birmingham East & North – 57%

Coventry- 56%


Sandwell – 61%

South Birmingham – 62%

Wolverhampton – 56%

Herefordshire- 19%

Shropshire- 23%

Worcestershire – 19%

Facilities for patients

and children

Warwickshire – 90% Birmingham East & North – 10%

Coventry- 10%


Sandwell- 11%

The distance you

have to travel from

your home to your

GP surgery

South Staffordshire- 98% Heart of Birmingham – 9%

How accessible the

GP surgery is (e.g. a

ramp)

Birmingham East & North - 7%


(Base: 2939 respondents, 8 April – 17 May 2009. Q:To what extent were you satisfied or dissatisfied with each of the

following aspects of the service?. PCTs highlighted have responses which are significantly different to the regional average at the 95% confidence level.)

The Equitable Access to Primary Care Programme was established to address inequalities in

access to primary care. All PCTs including Sandwell and Heart of Birmingham are working as

part of this programme to increase GP provision through the opening of new surgeries and

GP led health centres. Given the levels of dissatisfaction expressed in the survey, it is

important to ensure that communication about these new services is as effective as

possible.

There are also differences between demographic groups, with a higher proportion of

younger respondents, and those from ethnic minority groups more likely to be dissatisfied

across a range of factors. For example, 28% of those from an ethnic minority group are

dissatisfied with being able to get through to make an appointment with a GP and 32% are

dissatisfied with the length of time between making an appointment and seeing their GP,

compared with 20% and 16% of white residents respectively. Some caution is needed, as

ethnic minority citizens are more likely to be younger and a higher proportion of residents

from ethnic minority groups are found in Heart of Birmingham and Sandwell PCTs. It needs

to be noted that 14% of those from an ethnic minority group are dissatisfied with the

extent to which their GP listens and respects them, compared with 6% of white residents.

55

Awareness of extended GP surgery opening hours

As part of the NHS Operating Framework for 2008/9, the Government has set out a key

priority for improving routine access to GP services in the evenings and at weekends. PCTs

are required to ensure that at least half of practices offer extended opening hours to

patients. In July 2009, 74% of practices in the West Midlands region reported that they had

extended opening hours. As part of the survey we asked respondents whether they were

aware of extended opening hours within their surgery.

The results suggest that only around a third of residents in the region are aware of

extended opening hours for their GP surgeries. As we know that around three quarters of

all surgeries are reporting extended opening hours, this seems to indicate a need for

further communication around extended opening hours.

37%

35%28%

Awareness of extended opening hours

Don't know Yes

No

Q Many GP practices are now extending their opening hours for appointments. Do you know whether your GP practice offers appointments out of hours, for example in the early morning, evening or at the weekend?


Awareness of extended opening hours is higher amongst those who have a disability (40%)

or have someone with a disability in their family (39%). Those who have some contact with

NHS health provision within the last 12 months or so are also more likely to be aware (37-

41% for those who have accessed services such as GP surgeries, inpatient and outpatient

services). As we might expect, those who have friends or family in the NHS are also more

likely to be aware of extended opening hours (38%).

Further analysis by PCT demonstrates that residents in Sandwell and Walsall are more likely

to say that they are aware of extended opening hours than is the case across the West

Midlands as a whole.

56

Awareness of extended opening hours, by PCT

S StaffsWorcsWarks

BEN

S Bham

Dudley

Cov

Shrops

Sand

Herefs

N StaffsHoB

Sol

Wals

Wolves

Stoke

T&W

0%

10%

20%

30%

40%

50%

60%

150 170 190 210 230 250 270 290 310 330

% a

nsw

erin

g 'yes'


PCT

West Midlands





(Base: 3528 respondents, 8 April – 17 May 2009. Q:Many GP practices are now extending their opening hours for

appointments. Do you know whether your GP practice offers appointments out of hours, for example in the early morning, evening or at the weekend?)

Analysis was carried out to understand how levels of awareness correlate with the actual

proportion of surgeries in the PCT which are reported to have extended opening hours. It

was found that there is a correlation, with 54% of variation in the awareness of extended

opening hours being explained by the variation in the actual proportion of surgeries with

extended opening hours. Nonetheless, there does seem scope to increase awareness

across the region as a whole.

The following section looks at demand for extended opening hours, before turning to

consider whether those most likely to require appointments outside of normal office hours

are aware of this opportunity.

57

Demand for extended opening hours

Participants in the survey were asked about their preferences for the time of their

appointment if they needed to see a GP in the next week for a non-urgent reason. As can

be seen in the chart below, a high proportion would prefer to have an appointment outside

of normal office hours.

32%

34%

7%

23%

4%

Demand for extended opening hours

Early morning appointment

Don’t know/no opinion

Q If you needed to see your GP in the next week for a reason that was not urgent, which of the following appointments would you like?

Weekend appointment

Evening appointment

Appointment duringoffice hours


The results show that demand for evening appointments is highest amongst those of

working age. Over 40% of respondents aged between 25-54 state that they would prefer

an evening appointment. The chart overleaf shows that half of those who are working full

time would prefer an evening appointment. Interestingly, weekend appointments are more

popular with those from ethnic minority groups, with 19% stating that they would prefer a

weekend appointment.

58

50%

22%

Q If you needed to see your GP in the next week for a reason that was not urgent, which of the following appointments would you like?

Not working full time

Working full time

Base: 3,528 West Midlands residents (1,423 working full-time; 2,104 not working full-time); 8 April - 17 May 2009

% An evening appointment

Demand for evening appointments by

working status

People who are more likely to require an appointment outside of normal office hours are

not more likely to be aware that their surgery has extended hours. If we consider those

who would prefer an evening appointment, only 37% are aware that their surgery has

extended opening hours. Hence, it seems that more information on extended hours could

be targeted at those who are those who are most likely to use the services, for example

younger age groups and those who are working full time.

Information for comparing GP services

Over half of all respondents state that they are satisfied with the information available to

compare GP services. However, when we consider the high levels of satisfaction expressed

for GP services overall, there do seem to be some issues around accessing information and

the amount of information available, although there have been some improvements since

last year. It is worth noting that there has been a slight increase in the net satisfied figure

for the availability of information. This means that when we compare satisfaction and

dissatisfaction with this aspect of information provision, views are more positive in 2009.

59

15%

19%

18%

53%

52%

51%

Satisfaction with information for comparing GP

surgeries

The amount ofinformation

The availability ofthe information

The quality ofinformation

Satisfied Dissatisfied

Source: Ipsos MORI

Q Thinking about information for comparing your local GP surgery with other surgeries, to what extent are you satisfied or dissatisfied with … ?

+34

+26

+30

Net

satisfied

2008

%

Base: WM 2009 – 3,528 West Midlands residents, 8 April - 17 May 2009WM 2008 – all who would use a source of information to find out how

their local GP compares (3,395); 8 April - 13 May 2008Please note different bases for 2008 and 2009

+37

+33

+33

Net

satisfied

2009

%

Across all of these aspects, the youngest and oldest age groups are the most satisfied

(those aged 16-24 and 65+).7 Those who work full time, are carers and who are from a

higher social grade are less likely to be satisfied with these aspects of information

provision.8

Awareness of new GP-led health centres

As we have noted, Lord Darzis’ interim report on the NHS (2007) highlighted inequalities in

access to primary care, with the poorest communities often experiencing the worst health

outcomes. In response, a programme was set up to improve access to primary care, which

involved establishing new GP practices in the PCTs with the poorest provision and a new

GP-led health centre in each PCT, in an easily accessible location (Equitable Access to

Primary Care Programme DH 2007).

At the time of the survey, some of the health centres had opened. Details of the centres

planned or available in each PCT were made available to interviewers.9 Citizens were asked

whether they knew about the new centres in order to gauge awareness of these new

services in the region. Around three quarters of those interviewed are not aware of their

new GP-led health centre.

7 For example, 57% of both groups are satisfied with the amount of information available, compared

with 51% of respondents overall. 8 For example, 21% of those who work full time are dissatisfied with the availability of information,

20% of those from social grades ABC1 and 23% of those who are carers. In terms of the amount of information, 19% of those from ABC1 are dissatisfied, and 22% of carers. 9 Please refer to the appendices for more details.

60

24%

76%

1%

Awareness of new Health Centres

Yes

Don’t know/can’t remember

Q Are you aware of the new Health Centre planned / opened in …? The health centre is open seven days a week and you do not need to make an appointment.

No


Awareness of the local health centre is higher among those aged 55-64 and 65+, with 28%

and 29% of these groups stating that they knew about their local health centre. There is

some variation in terms of awareness by PCT, with those in Walsall, Coventry, Solihull and

Wolverhampton more likely to be aware of their local centre, as is shown overleaf.

61

63%

51%

35%

31%

28%

27%

25%

23%

19%

19%

19%

16%

15%

13%

13%

12%

11%

Awareness of new health centres by PCT

Dudley

Shropshire County

Herefordshire

Heart of Birmingham

Stoke on Trent

Telford & Wrekin

Warwickshire

Q Are you aware of the new Health Centre planned / opened in …? The health centre is open seven days a week and you do not need to make an appointment.

Solihull Care

South Birmingham

South Staffordshire

Sandwell

Wolverhampton

Worcestershire


North Staffordshire

Walsall

Coventry Teaching

% Yes

Base: 3,528 West Midlands residents, 8 April – 17 May 2009, c.175 – 300 residents per PCT

The differences in awareness levels may reflect the actual opening dates of the centres.

However, PCTs may wish to consider the learning developed by the PCTs with the highest

levels of awareness.

62

5. Understanding the system: choice

and navigation

Choice at referral to hospital was introduced in January 2006, as part of the health reform

programme. This has been extended in subsequent years, and since April 2009 most

patients in England, who are referred by their GP for non-urgent specialist treatment, have

had the right to choose which hospital they go to (The Primary Care Trusts (Choice of

Secondary Care Provider) Directions 2009). Alongside extending choice, attempts have

been made to improve the information available for local people about where they can

access the most appropriate care.

This chapter looks at awareness of choice overall and how well respondents are able to

navigate the system to access appropriate urgent care.

Choice

Choice of care and treatment is a central tenet of the work of the NHS and is further

emphasised in the Constitution. As has been found in other research, awareness of this

choice is not universal amongst patients and the public.10 Although the majority of

respondents think that there is some choice (56%), two in five say they have not very much

choice or no choice at all (40%).

10%

46%29%

11%5%

Choice in the NHS

A great deal Don’t know

Q As someone who uses or might use the NHS, how much choice would you say you are given about what care you receive and where you get it? Would you say… ?

Not very much choice A fair amount

No choice at all


10

Planned Care Postal Survey conducted on behalf of NHS West Midlands by Ipsos MORI 2009.

63

Younger age groups and those who have had recent experience of being an inpatient or an

outpatient are more likely to think that there is at least a fair amount of choice. For

example, 54% of 16-24 year olds feel that there is a fair amount of choice, compared with

46% of residents overall.

Q As someone who uses or might use the NHS, how much choice would you say you are given about what care you receive and where you get it? Would you say… ?

25-34

35-44

45-54

55-64

16-24

65+

9%

9%

7%

9%

9%

13%

54%

43%

46%

42%

42%

47%

29%

35%

28%

30%

28%

24%

13%

13%

8%

7%

9%

14%

11%

6%

5%

5%

3%

2%

A great deal A fair amount Not very much choice No choice at all Don't know

Choice in the NHS by age



(466)

(541)

(565)

(650)

(589)

(713)

However, we need to be careful in drawing conclusions about these responses. Other

research commissioned by NHS West Midlands has demonstrated the complexity of the

issues around choice for patients.11 Focus groups with patients who had recently

experienced planned care revealed that many patients do not feel sufficiently informed to

make a choice, particularly around choosing a consultant. At the same time, it was found

that some choices were felt to be important to everyone - such as choosing the time and

day of the appointment.

I don’t feel that I’ve got enough knowledge to make a sensible

informed choice, I’m not a medical guy, I’m relying on them being

professional, competent and interested in what they do

Male with long-term condition, Shropshire, ABC1, age 35-54

They [doctors] should know which is the best hospital that we should

go to

Female, South Asian, Stoke, age 35-54

11 Planned Care Patient Experience (2009) (http://www.wmqi.westmidlands.nhs.uk/patient-experience/)

64

They said when would you prefer to come? I preferred on my day off,

and it worked out

Female, Shropshire, C2DE, age 16-34

Planned care commissioners are working with the findings of the research to further

develop information to support patients to make effective choices.

Navigating the system

The Acute Care Clinical Pathway Group in the West Midlands is working towards a vision

for urgent and emergency care systems in 2012. A key part of this vision is ensuring that

local citizens have the information they need to be able to access the most appropriate

care when they are in need of urgent treatment. In order to assess local people’s current

ability to navigate the health system in the region, they were given a scenario involving

urgent health care needs and asked to select their most likely response.

In the first scenario, an urgent situation involving a child was given. As can be seen in the

chart below, contacting their GP, followed by NHS Direct are the most popular options for

respondents during office hours.

61%

21%

7%

3%

2%

1%

1%

1%

1%

Navigating the system with children (1)

Q If you have a child, or if you were looking after someone else’s child, and they had a very high temperature and kept being sick, and you wanted to get medical advice, what would be your first point of contact during office

hours? (All above 1%)GP/GP Out of Hours

NHS Direct

Accident & Emergency (A&E)

Ambulance Service (999)

Health Centre (or Walk-in Centre)

Family member/neighbour/personally treat child

Shropdoc/NEWDOC/Badger/Careline

Family member/neighbour/personally in the medical profession

Hospital/local hospital

Base: 3,528 West Midlands residents; 8th April to 17th May 2009

However, outside office hours people are more divided in terms of the care they would

seek. Residents are most likely to call NHS Direct, followed by the GPs’ out of hours service

and then A&E (see chart below).

65

39%

24%

18%

4%

4%

2%

1%

1%

1%

Q And what would be your first point of contact in the evening or at the weekend? (All above 1%)

GP/GP Out of Hours

NHS Direct


Ambulance Service (999)


Family member/neighbour/personally treat child

Shropdoc/NEWDOC/Badger/Careline

Hospital/local hospital

Base: 3,528 West Midlands residents; 8 April - 17 May 2009

Primary Care Unit at the hospital

Navigating the system with children (2)

The lower proportion of respondents who would access GP services out of hours might

indicate lower awareness of the services available. Hence, increasing information available

about these services might be considered.

We also asked people what they would do if they personally needed care within the next

few hours but their condition was not life-threatening. In this situation, the majority of

respondents would turn to their local GP or NHS Direct. Nonetheless, one in ten think that

they would go to A&E for help, hence there is scope to increase public awareness of

alternative services, and the type of circumstances when they would definitely need to go

to A&E.

66

44%

21%

12%

11%

8%

3%

GP/GP Out of Hours

NHS Direct



Pharmacy

Minor Injuries Unit

Base: 3,528 West Midlands residents; 8 April - 17 May 2009

Navigating the system for urgent care

Q If you believed you personally needed medical help within 6 hours (but it was certainly not life threatening), which of the following types of services would you go to or contact? (All above 1%)

When we consider differences by demographic groups, males are more likely than females

to state that they would go to or contact A&E (see chart below). Higher proportions of

those who are aged 65+ would go to A&E (15%) compared with those aged under 65 (11%).

Higher proportions of those from social grades C2DE would use A&E (14%) compared with

those from ABC1 (9%). In addition, a higher proportion of people from BME groups would

use A&E (17%) than those from a white ethnic group (11%).

40%

20%

15%

9%

9%

4%

47%

22%

8%

12%

7%

2%

Base: 3,528 West Midlands residents (1,629 men; 1,899 women); 8 April - 17 May 2009

Male Female

Q If you believed you personally needed medical help within 6 hours (but it was certainly not life threatening), which of the following types of services would you go to or contact? (All above 1%)

GP/GP Out of Hours

NHS Direct

Accident and Emergency (A&E)

Pharmacy

Health centre

Minor Injuries Unit

Navigating the system for urgent care by gender

67

The results suggest that there is the potential to improve public understanding of the

health system and how to access the most appropriate care for different kinds of need. We

now turn to look at access to information about health services.

68

6. Access to information

In this chapter we focus on whether people recall having received information from the

local NHS, as our previous research has demonstrated the link between people feeling that

they are well-informed about local services and having confidence in local healthcare

provision. We then move on to look at the use of the internet by local residents, to explore

the potential routes for digital engagement with local residents.

Feeling informed

The last time we conducted the survey, we found that there was a strong correlation

between an individual feeling informed about what was happening in their local NHS and

feeling confident about the future of services.

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

about health services, we found that there had been little change from 2008, in terms of

the proportion of citizens who had received information.

18%

80%

2%

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

2009

WM

2008

Yes 18 20

No 80 74

Don’t know 2 6

Base: WM 2009 – 3,528 West Midlands residents, 8 April - 17 May 2009WM 2008 – 3,564 West Midlands residents, 8 April - 13 May 2008

69

Once again, there is some variation by PCT, with a higher proportion of those living in

Walsall and South Birmingham feeling informed about plans for the development of the

local services.

27%

25%

23%

22%

21%

20%

20%

18%

18%

18%

17%

16%

14%

14%

13%

13%

10%

Receiving information from the NHS

Heart of Birmingham

Telford & Wrekin

Warwickshire


Wolverhampton


Coventry Teaching

Dudley

North Staffordshire

Sandwell

Shropshire County

Walsall

South Birmingham

Stoke on Trent

Solihull Care

Worcestershire

Herefordshire

South Staffordshire

2008

%

27

27

21

14

17

25

14

26

19

23

21

21

21

17

21

14

16

% Yes




Some variation is evident by age group, with those aged 16-24 less likely to be aware of

local plans for the development of services (see chart below). Asian respondents are also

less likely to be aware of any local plans (74%, compared with 80% of white respondents

and 87% of other BME groups). This may be linked to their younger age profile.

70

15%

16%

18%

20%

20%

19%

84%

83%

79%

78%

78%

78% 3%

2%

2%

3%

2%

1%

25-34

35-44

45-54

55-64

16-24

65+

Yes No Don't know


Receiving information from the NHS by age



(466)

(541)

(565)

(650)

(589)

(713)

The chart below looks at views on the future of local health services for people who have

received local plans and compares them with those who have not. It is evident that those

who feel better informed are more positive about the future of local health services.

Expectations – impact of receiving information

Net better

% Worse

% Better

+32

14%

46%

% Stay the same

% Don't know

% Get better% Get much better

% Get much worse % Get worse

11%

35%

36%

11%3%

4%6%

25%

44%

19%

3%3%


Net better

% Worse

% Better

+8

22%

30%

Those who have received

information about local plans (640)

Those who have not received

information about local plans (2,809)


71

As there is a correlation between feeling well informed about local services and confidence

with the NHS, we probed into what plans people thought they had seen. As is shown in the

chart below, most people refer to hospital developments or redevelopments.

30%

13%

11%

7%

7%

5%

4%

3%

3%

Types of information seen

Base: All who have received information from the NHS about plans for developing health

services in the local area (640)

Q Can I just check, what plans have you seen?

Top 9 mentions

Plans for rebuilding University Hospital Birmingham / Queen Elizabeth

An article in the local newspaper

Plans for building a new / rebuildingthe local hospital (other specified)

Plans for building a new walk in health centre (unspecified)

Information about service changes

Advertising health services

Relocating / rebuilding / extending/new build GP surgeries

Plans for building a new / rebuildingthe local hospital (unspecified)

PCT leaflets

A high proportion of those who say they have seen plans in South Birmingham and North

Staffordshire mention hospital redevelopment in some way (69%, and 60% respectively).12

In other PCTs a range of plans were mentioned.

We also asked those who have seen plans whether they had found them useful. Those who

have seen plans tend to think that they had been useful (68%). However, around a third did

not find them useful, did not know or could not remember (32%).

12 Please note - this should be treated with caution as based on a low number of people (58 in South Birmingham and 37 in North Staffordshire).

72

28%

40%

16%

9%7%

Usefulness of plans

Very useful

Don’t know / can’t remember

Q How useful were the plans for you, if at all?

Not very useful

Fairly useful

Not at all useful

Base: All who have received information from the NHS about plans for developing health

services in the local area (640)

Due to the small numbers of people who are actually aware of local plans, it is difficult to

analyse in any detail who found them useful. One interesting result is that those who found

the plans very useful are also more likely to be positive about the future of local services.

Thus although people who say they have seen local plans tend to feel more confident

about the future of the NHS, it is difficult to pin down exactly what this relates to. It seems

to be that a general feeling of being informed about local developments in the NHS is

associated with feeling more positive about healthcare services.

Use of the internet

As the NHS is constantly finding new ways to engage with citizens and patients, it is

important to have up-to-date and detailed information on where people access

information on health services. In particular, the potential opportunities offered by digital

modes of communication and engagement need to be fully understood. In the survey last

year, we asked about where people got their health information from. We know from this

that a high proportion of people rely on their GP or family and friends. As usage of the

internet is constantly increasing, it is useful to get an update on this element on a regular

basis.

We asked residents whether they have access to the internet. The survey shows that over

three quarters of respondents have access to the internet.

73

Internet access

Q Do you have access to the internet, or not?

76%

24%*%

Yes

No

Don’t know


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.

94%

91%

91%

83%

68%

38%

6%

9%

9%

17%

32%

62%

Internet access by age

25-34

35-44

45-54

55-64

16-24

65+

Yes No




(466)

(541)

(565)

(650)

(589)

(713)

74

There are also differences by social background, with those from social groups ABC1 more

likely to have access to the internet (89%), compared with those from C2DE (63%). In

addition, those who do not have a disability are more likely to access the internet than

those who do (79% compared with 66% who do have a disability). This may be related to

age as those who do not have a disability are more likely to be younger.

The chart below demonstrates variations in access by PCT, which is linked to the

demographic profiles of the areas. It can be seen that a lower proportion of residents in

Sandwell have access to the internet (69%).

82%

81%

81%

79%

79%

79%

78%

77%

77%

75%

74%

73%

72%

72%

70%

70%

69%

Internet access by PCT

Dudley

Heart of Birmingham

Telford & Wrekin


Solihull Care

South Birmingham

Sandwell

Wolverhampton


North Staffordshire

Walsall

Coventry Teaching

Worcestershire

Herefordshire

Shropshire County

South Staffordshire

Warwickshire

Stoke on Trent

% Yes

Base: 3,528 West Midlands residents, 8 April – 17 May 2009, c.175 – 300 residents per PCT

Although a high proportion of residents within the region have access to the internet, only

around a third of residents use the internet for accessing health information at least every

month or two, and only 15% do so regularly (at least every couple of weeks).

75

15%

19%

27%

38%

Using the internet for health information

Don’t know (*%)

Never

A couple of times a year or less Base: All who have access to the internet (2,674)

At least every couple of weeks

Every month or two

Q How often, if at all, do you look on the internet for information about health, for example information about local health services or on how to stay healthy?

As we might expect, there are variations by age, with younger people much more likely to

use the internet for accessing health information. Those who are carers are more likely to

use the internet to access information on health more frequently (14% look at least once a

week compared with 8% who are not carers).

76

21%

20%

17%

12%

9%

7%

24%

26%

19%

15%

14%

13%

27%

29%

35%

44%

48%

55%

28%

26%

28%

28%

29%

25%

*

*

*

*

1

At least every

couple of weeks

25-34

35-44

45-54

55-64

16-24

65+

Every month

or twoDon't know

Base: All who have access to the internet (base size for each age group shown in brackets)

(437)

(494)

(515)

(545)

(406)

(274)

Using the internet for health information by age

Q How often, if at all, do you look on the internet for information about health, for example information about local health services or on how to stay healthy?

A couple of times

a year or less

Never

It seems that there is a lot of potential to increase the extent to which the internet is used

to access information on health. Members of the public are using the internet widely but

are still relying on more traditional sources for health information. This suggests that we

might need to examine in more depth how the public would like to access health

information and the role of digital media within this.

The chart overleaf demonstrates the range of activities which people undertake using the

internet. This suggests there are prospects for utilising the interactive features of the

internet to engage with the public.

77

55%

51%

46%

42%

42%

22%

21%

15%

Internet activity

Q Which of the following things do you and your family do on the internet, if any?

Contribute to discussions in chat rooms

Play games

Update people on what you are doing through a Blog or Twitter

Watch TV, for example onBBC iplayer

Post your ratings for products orservices on sites that ask you to do this

I/we don’t do any of those things

Post on social networking sitessuch as Facebook, or other forums

Watch videos, for examplethrough YouTube

Base: All who have access to the internet (2,674)

The SHA is currently developing digital services which will attempt to give local citizens and staff access to a range of tools and information to help them manage and improve their health.

79

Appendices

80

1. Statistical reliability

Because a sample, rather than the entire population, was interviewed the percentage results are subject to sampling tolerances – which vary with the size of the sample and the percentage figure concerned. For example, for a question where 50% of the people in a (weighted) sample of 3,564 with an effective sample size of 3,362 respond with a particular answer, the chances are 95 in 100 that this result would not vary more than two percentage points, plus or minus, from the result that would have been obtained from a census of the entire population (using the same procedures). An indication of approximate sampling tolerances are given in the table below.

Size of sample on which the survey results are based

Approximate sampling tolerances applicable to percentages at or near these

levels

10% or 90% 30% or 70% 50% ± ± ± 3,362 interviews 1 2 2

For example, with a sample of 3,362 where 30% give a particular answer, the chances are 19 in 20 that the “true” value (which would have been obtained if the whole population had been interviewed) will fall within the range of plus or minus 2 percentage points from the sample result.

Strictly speaking, the tolerances shown here apply only to random samples; in practice good quality quota sampling has been found to be as accurate.

When results are compared between separate groups within a sample, different results may be obtained. The difference may be “real”, or it may occur by chance (because not everyone in the population has been interviewed). To test if the difference is a real one - i.e. if it is “statistically significant”, we again have to know the size of the samples, the percentage giving a certain answer and the degree of confidence chosen. If we assume the “95% confidence interval”, the differences between the two sample results must be greater than the values given in the table below:

Size of samples compared Differences required for significance at or near these percentage levels

10% or 90% +

30% or 70% +

50% +

3,362 (NHS West Mids 2009) vs. 3,276 (NHS West Mids 2008)

1 2 2

200 and 200 (e.g. between PCTs) 6 9 10 2,974 (white residents) vs. 380 (ethnic minority residents)

3 5 5

81

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

82

3. Mosaic groups

Group and type names

Group Type

Code Name Code Name

01 A Career professionals living in sought after locations

01 A01 Financially successful people living in smart flats in cosmopolitan inner city locations

02 A02 Highly educated senior professionals, many working in the media, politics and law

03 A03 Successful managers living in very large houses in outer suburban locations

04 A04 Financially secure couples, many close to retirement, living in sought after suburbs

05 A05 Senior professionals and managers living in the suburbs of major regional centres

06 A06 Successful, high earning couples with new jobs in areas of growing high tech employment

07 A07 Well paid executives living in individually designed homes in rural environments

02 B Younger families living in newer homes

08 B08 Families and singles living in developments built since 2001

09 B09 Well qualified couples typically starting a family on a recently built private estate

10 B10 Financially better off families living in relatively spacious modern private estates

11 B11 Dual income families on intermediate incomes living on modern estates

12 B12 Middle income families with children living in estates of modern private homes

13 B13 First generation owner occupiers, many with large amounts of consumer debt

14 B14 Military personnel living in purpose built accommodation

03 C Older families living in suburbia

15 C15 Senior white collar workers many on the verge of a financially secure retirement

16 C16 Low density private estates, now with self reliant couples approaching retirement

17 C17 Small business proprietors living in low density estates in smaller communities

18 C18 Inter war suburbs many with less strong cohesion than they originally had

19 C19 Attractive older suburbs, typically occupied by families but with increasing singles and childless couples

20 C20 Suburbs sought after by the more successful members of the Asian community

83

Group Type

Code Name Code Name

04 D Close-knit, inner city and manufacturing town communities

21 D21 Mixed communities of urban residents living in well built early 20th century housing

22 D22 Comfortably off manual workers living in spacious but inexpensive private houses

23 D23 Owners of affordable terraces built to house 19th century heavy industrial workers

24 D24 Low income families living in cramped Victorian terraced housing in inner city locations

25 D25 Centres of small market towns and resorts containing many hostels and refuges

26 D26 Communities of lowly paid factory workers, many of them of South Asian descent

27 D27 Multi-cultural inner city terraces attracting second generation settlers from diverse communities

05 E Educated, young, single people living in areas of transient populations

28 E28 Neighbourhoods with transient singles living in multiply occupied large old houses

29 E29 Economically successful singles, many living in privately rented inner city flats

30 E30 Young professionals and their families who have gentrified terraces in pre 1914 suburbs

31 E31 Well educated singles and childless couples colonising inner areas of provincial cities

32 E32 Singles and childless couples in small units in newly built private estates

33 E33 Older neighbourhoods increasingly taken over by short term student renters

34 E34 Halls of residence and other buildings occupied mostly by students

06 F People living in social housing with uncertain employment in deprived areas

35 F35 Young people renting hard to let social housing often in disadvantaged inner city locations

36 F36 High density social housing, mostly in inner London, with high levels of diversity

37 F37 Young families living in upper floors of social housing

38 F38 Singles, childless couples and older people living in high rise social housing

39 F39 Older people living in crowded apartments in high density social housing

40 F40 Older tenements of small private flats often occupied by highly disadvantaged individuals

84

Group Type

Code Name Code Name

07 G Low income families living in estate based social housing

41 G41 Families, many single parent, in deprived social housing on the edge of regional centres

42 G42 Families with school age children, living in very large social housing estates on the outskirts of provincial cities

43 G43 Older people, many in poor health from work in heavy industry, in low rise social housing

08 H Upwardly mobile families living in homes bought from social landlords

44 H44 Manual workers, many close to retirement, in low rise houses in ex-manufacturing towns

45 H45 Older couples, mostly in small towns, who now own houses once rented from the council

46 H46 Residents in 1930s and 1950s council estates, typically in London, now mostly owner occupiers

47 H47 Social housing, typically in 'new towns', with good job opportunities for the poorly qualified

09 I Older people living in social housing with high care needs

48 I48 Older people living in small council and housing association flats

49 I49 Low income older couples renting low rise social housing in industrial regions

50 I50 Older people receiving care in homes or sheltered accommodation

10 J Independent older people with relatively active lifestyles

51 J51 Very elderly people, many financially secure, living in privately owned retirement flats

52 J52 Better off older people, singles and childless couples in developments of private flats

53 J53 Financially secure and physically active older people, many retired to semi rural locations

54 J54 Older couples, independent but on limited incomes, living in bungalows by the sea

55 J55 Older people preferring to live in familiar surroundings in small market towns

56 J56 Neighbourhoods with retired people and transient singles working in the holiday industry

11 K People living in rural areas far from urbanisation

57 K57 Communities of retired people and second homers in areas of high environmental quality

58 K58 Well off commuters and retired people living in attractive country villages

59 K59 Country people living in still agriculturally active villages, mostly in lowland locations

60 K60 Smallholders and self employed farmers, living beyond the reach of urban commuters

61 K61 Low income farmers struggling on thin soils in isolated upland locations

85

4. Reading and Interpreting funnel plots

This report contains a number of funnel plots, otherwise known as cross-sectional control charts. These charts show the variation between PCT results reported against particular questions asked in the telephone survey. The charts help to distinguish real differences between PCTs from those that might be attributable to chance or sampling error (error that results from speaking to only a sample of the population rather than doing a census of the whole West Midlands population)13. This appendix provides information about reading and interpreting these charts.

40%

45%

50%

55%

60%

65%

70%

75%

80%

170 190 210 230 250 270 290 310

Number of respondents/Sample Size for PCT

Resu

lt (

%) f

or P

CT

Each point

respresents

a PCT

The height of point

indicates the result

observed for the PCT

The horizontal position of the point

indicates the sample size on which

the PCT's result is based

The horizontal black line

indicates the result for the

West Midlands as a whole

PCTs represented by (blue) points within

the funnel do not differ significantly from

the West Midlands average. Variation in

this range is to be expected.

PCTs represented by (red or green) points above or below the funnel

differ significantly from the West Midlands average. These are

sometimes called spacial cause variations

The funnel narrows to the right because as sample sizes

increase smaller variations from the West Midlands

average are required to detect significant differences

Each point in the chart represents a PCT. The height of the point indicates the result observed in the survey for that PCT, so PCTs achieving higher results appears higher in the chart. The horizontal position of the point indicates the sample size on which that PCT’s result is based, so PCTs with larger sample sizes appear further to the right.

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

The funnel indicates the degree of variation that can reasonable be attributable to sampling error. The funnel cuts the chart into three distinct regions. PCTs represented by points above the funnel have significantly higher results than the West Midlands average. PCTs represented by points below the funnel have results significantly lower than the West Midlands average. Points above or below the funnel are shaded in red or green.

13 The control charts allow us to analyse factors related to sampling error, but please note

that other factors such as sample design will not be accounted for

86

PCTs represented by points within the funnel do not differ significantly from the West Midlands average – these points are shaded blue. Variation within the funnel can reasonably be attributed to chance and sampling error.

The charts throughout this report also refer to 2 or 3 sigma. The thinner green and red lines closer to the black West Midlands line are based on 2 sigma. This means that there is a 95% chance (a standard confidence level) that values lying beyond this limit do not result from sampling error. The thicker red and green lines are based on 3 sigma – there is a 99.7% chance that values lying beyond this limit do not result from sampling error.

87

5. GP-led health centres

The table below outlines the text used in the question about awareness of the new GP-led health centres for each PCT.

PCT Question


Are you aware of the new Health Centre planned in your local area? The health centre is open seven days a week and you do not need to make an appointment.

Coventry Are you aware of the new Health Centre opened called the Hillfields Primary Care Centre at the Coventry and Warwickshire Hospital, Stoney Stanton Road? The health centre is open seven days a week and you do not need to make an appointment.

Dudley Are you aware of the new Health Centre planned at the Dudley Street Thomas Scheme? The health centre is open seven days a week and you do not need to make an appointment.

Heart of Birmingham Are you aware of the new Health Centre planned in your local area? The health centre is open seven days a week and you do not need to make an appointment.

Herefordshire Are you aware of the new Health Centre planned in your local area? The health centre is open seven days a week and you do not need to make an appointment.

North Staffordshire Are you aware of the new Health Centre opened called the Midway Medical and Walk-in Centre at Morston House, The Midway, Newcastle-under-Lyme? The health centre is open seven days a week and you do not need to make an appointment.

Sandwell Are you aware of the new Health Centre planned called The Malling Health Centre - Sandwell, on Parsonage Street in West Bromwich? The health centre is open seven days a week and you do not need to make an appointment.

South Birmingham Are you aware of the new Health Centre planned called The Selly Oak Health Centre on Katie Road in Selly Oak? The health centre is open seven days a week and you do not need to make an appointment.

Shropshire Are you aware of the new Health Centre planned called the Shropshire GP Health Centre at Whitehall, Monkmoor Road, in Shrewsbury? The health centre is open seven days a week and you

88

do not need to make an appointment.

Solihull Care Trust Are you aware of the new Health Centre opened called the Solihull Healthcare and Walk-in Centre at Solihull Hospital? The health centre is open seven days a week and you do not need to make an appointment.

South Staffordshire Are you aware of the new Health Centre opened called the Burntwood Health and Wellbeing Centre on the High Street, Chasetown, Burntwood? The health centre is open seven days a week and you do not need to make an appointment.

Stoke on Trent Are you aware of the new Health Centre planned for Hanley? The health centre is open seven days a week and you do not need to make an appointment.

Telford & Wrekin Are you aware of the new Health Centre planned for Telford town centre? The health centre is open seven days a week and you do not need to make an appointment.

Walsall Are you aware of the new Health Centre opened called at Walsall walk-in centre on Market Street in Digbeth? The health centre is open seven days a week and you do not need to make an appointment.

Warwickshire Are you aware of the new Health Centre planned called the Camp Hill GP led health centre at Camp Hill Early Years Centre on Hollystiches Road in Camp Hill, Nuneaton? The health centre is open seven days a week and you do not need to make an appointment.

Wolverhampton Are you aware of the new Health Centre planned for Wolverhampton? The health centre is open seven days a week and you do not need to make an appointment.

Worcestershire Are you aware of the new Health Centre planned for Worcestershire? The health centre is open seven days a week and you do not need to make an appointment.

patient telephone survey 2009

Documents

local nhs services

local health services

gp services

development of services

nhs organisations

nhs act

nhs constitution

nhs west midlands