The NHS, the election and after...

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Ben Page, Chief Executive at Ipsos MORI, speaking at the Future Challenges for the NHS conference at The King's Fund.

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The NHS, the election and after...

  1. 1. The NHS, the Election and after… Ben Page Chief Executive Ipsos MORI Ben.page@ipsos.com
  2. 2. ..the public far less concerned about the NHS than 10 years ago What do you see as the most/other important issues facing Britain today? Economy 70 60 50 Race/ immi- gration 40 30 Crime/ Law & 20 Order NHS 10 Unemployment 0 May May May May May May May May May May May May May May 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Base: representative sample of c.1,000 British adults age 18+ each Source: Ipsos MORI Issues Index month, interviewed face-to-face in home
  3. 3. High satisfaction with NHS…. Overall, how satisfied or dissatisfied are you with the running of the National Health Service nowadays? Are you satisfied or dissatisfied with the way the Government is running the country? 73 70 % Satisfied with current running of NHS 60 50 40 30 25 20 % Satisfied with way government is running the country 10 Dec-06 Jan-07 Feb-07 Mar-07 Apr-07 May-07 Jun-07 Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Dec-07 Jan-08 Feb-08 Mar-08 Apr-08 May-08 Jun-08 Jul-08 Aug-08 Sep-08 Oct-08 Nov-08 Dec-08 Source: Ipsos MORI/DH Public Perceptions of the NHS Tracker, Ipsos MORI Political Monitor Base: NHS satisfaction – c. 1,000 English adults aged 16+ interviewed face-to-face per wave, Government satisfaction – c. 1,000 GB adults aged 18+ interviewed by telephone per wave (N.B interviewed face-to-face until June 2008)
  4. 4. The public still believe there is waste and inefficiency in the NHS Q Please tell me whether on the whole you agree or disagree with each of the following statements: % agree There is waste and 75 72 71 71 71 inefficiency in the NHS 69 65 59 55 51 The NHS provides good 53 49 value for money to 49 taxpayers 45 35 The NHS is getting better at 25 managing its budgets 19 21 22 19 17 15 A 8 Ju 8 D 7 D 8 M 8 S 7 O 7 Ja 7 S 8 O 8 8 N 7 N 8 M 8 Fe 8 08 A 7 A 8 -0 -0 -0 -0 -0 -0 -0 -0 -0 -0 -0 0 -0 -0 0 l-0 l-0 n- n- b- ov ov ar ay ec ec pr ug ep ug ep ct ct Ju Ju Base: 1,003 English adults aged 16+, December 2008 Source: Ipsos MORI/DH Perceptions of the NHS Tracker
  5. 5. Biggest Problems facing the NHS – top 5 Q What do you see as the biggest problems facing the NHS? What else? % 50 45 Lack of resources/ investment 40 35 30 Bureaucracy/ top heavy/ poor management 25 Not enough doctors/nurses/ 20 understaffed Long waiting 15 lists/times Poor standards of 10 cleanliness/super- bugs/ MRSA 5 * Please note that results from March 2007 onwards 0 are not directly comparable to previous data as the Sep-04 Nov-04 Jan-05 Mar-05 May-05 Jul-05 Sep-05 Nov-05 Jan-06 Mar-06 May-06 Jul-06 Sep-06 Nov-06 Jan-07 Mar-07* May-07 Jul-07 Sep-07 Nov-07 Jan-08 Mar-08 May-08 Jul-08 Sep-08 Nov-08 question was placed on different studies Base: English adults age 16+ (c.1,000 per wave) Source: Ipsos MORI/DH Perceptions of the NHS Tracker
  6. 6. Tories and Lib Dems were behind Labour on healthcare % who think issue is ‘very Conservatives Labour Lib Dems important’ in helping them decide how to vote 30% Managing the economy 39 25% 12% 22% Healthcare 20 37% 10% 27% Education 17 29% 15% 22% Unemployment 15 27% 11% 29% Asylum/ immigration 13 15% 10% 25% Taxation 10 23% 18% Crime & anti-social 31% behaviour 6 9% 20% 24% Defence 6 21% 10% Base: 1,003 British adults 18+, 25th-27th September 2009 Source: Ipsos MORI Political Monitor NB. Figures exclude „don‟t know‟, „none‟ and „other‟ responses
  7. 7. But vastly ahead of where they were I would like you to tell me whether you think the Conservative party, the Labour party or the Liberal Democrats has the best policies on... Major Blair elected Brown as PM Labour leader 1997 as PM (Nov 90) (Jun 94) ELECTION (Jun 07) “Health Care” “NHS” Cameron elected (Dec 05) Labour 50 point gap in mid 90s Conservative LibDem* * Liberal in 1978, Liberal SDP Alliance 1983-7 Base: c. 1,000 – 2,000 GB adults aged 18+ Source: Ipsos MORI
  8. 8. MPs in different parties see NHS problems very differently What are the biggest problems facing the NHS? % mentions (over 10%) Lack of resources / investment 46 47 50 32 Ageing population 31 46 43 Bureaucracy 13 47 5 Public health problems 14 40 24 Government influence / targets 8 19 24 Not enough patient choice 4 11 Conservatives 16 Problems prioritising treatment 6 14 Lib Dems 14 Labour Low quality treatment 8 13 88 Cost of care 13 Base: 121 candidate MPs (37 Conservative, 48 Labour, 36 Lib Dem), February-March 2010 Source: Ipsos MORI
  9. 9. Conservative agenda plays well to the crowd Please tell me how strongly you support or oppose each of these possible future changes for the National Health Service? % Strongly support % Tend to support % Tend to oppose % Strongly oppose More control over health services to be given to doctors and nurses rather than 68 22 43 managers and politicians Fewer national targets and more local control 44 36 7 4 Reducing the number of managers in the NHS by a third 49 26 8 6 Requiring patients to change their lifestyle before they are allowed treatment 35 23 16 21 Publishing on the internet all NHS spending over £1,000 20 21 21 18 Freezing pay of all those who work in the NHS 11 11 27 39 Base: 1,006 British adults, 13-15 November 2009 Source: Ipsos MORI Public Spending Index
  10. 10. Coalition commitment “We will guarantee that health spending increases in real terms”
  11. 11. What do the public want? Everything! Which of the following statements best reflects your thinking about the NHS? % 90 The NHS is crucial to 80 73 British society 73 70 and we must 72 do everything 60 to maintain it 50 All ABC1 C2DE The NHS was a 40 great project 30 27 but we 25 probably can‟t 20 23 maintain it in its 10 current form 0 2000 2001 Spring 2002 Winter 2002 Spring 2003 Winter 2003 Spring 2004 Winter 2004 Spring 2005 Winter 2005 Spring 2006 Winter 2006 2007 1st Qtr Base: English adults age 16+ (c.1,000 per wave)
  12. 12. But expectations unrealistically high. People want … … unlimited spending... There should always be limits on what is spent on the NHS… Don‟t know 8% 44% Agree Disagree 48% 31% strongly disagree with limits on NHS spending Base: British public, 18+ (1,001) 12-17 January 2006
  13. 13. … and little concern about value for money The NHS should provide the most effective drugs and treatments provided they represent good value for money 28% 31% The NHS should provide all drugs and treatments no matter what they cost The NHS should provide the most effective drugs and 72% expect NHS to treatments no matter 41% provide drugs no what they cost matter what they cost Base: British public, 18+ (1,001) 12-17 January 2006
  14. 14. The challenges
  15. 15. … growing realisation that spending cuts may be necessary There is a real need to cut spending on public services in order to pay off the very high national debt we now have 60 55 Agree 54 % of respondents 51 50 48 44 45 45 Disagree 44 40 39 39 35 30 Jun-09 Nov-09 Mar-10 Apr-10 Base: c.1000 respondents aged 16+ in England and Wales. Fieldwork dates: Jun 09 – April 10 Source: Ipsos MORI
  16. 16. But public want NHS protected…. Which TWO or THREE, if any, of the following main areas of public spending do you think should be protected from any cuts? The NHS/health care 82% Schools 58% Care for the elderly 46% The Police 35% Social services 15% Defence 13% Benefit payments 8% Local authority services 6% Overseas aid 5% None of these *% Don‟t know 1% Base: All who think some services should be protected (773), 19-21 June 2009 Source: Ipsos MORI Public Spending Index
  17. 17. The public still believe that greater efficiency can do it Making public services more efficient can save enough money to pay off the very high national debt we now have, without damaging services the public receive Strongly agree Tend to agree Neither agree nor disagree Tend to disagree Strongly disagree Don't know Nov „09 March „10 9% 2% 13% 4% 26% 35% 17% 14% 9% 6% 36% 29% Net agree = +36 Net agree = +37 Base: 1,006 British adults, 13-15 November 2009 Base: 1,503 British adults 18+, 19th-22nd March 2010 Source: Ipsos MORI Political Monitor
  18. 18. Coalition commitments “We will … incentivise ways of improving access to primary care in disadvantaged areas” “We will give every patient the power to choose any healthcare provider that meets NHS standards within NHS prices” “We will publish detailed data about the performance of healthcare providers online, so everyone will know who is providing a good service and who is falling behind”
  19. 19. Patients satisfied with ease of access to GP %No % Yes Are you satisfied with how easy it is to get through to someone on the phone at your GP's surgery? 13 87 In the last six months, have you tried to get an appointment with a doctor fairly 23 77 quickly? Were you able to get the appointment on the same or on the next 2 days the 13 87 surgery was open? In the last 6 months have you wanted to book ahead for an appointment with 42 58 a doctor? Last time you wanted to, were you able to get an appointment with a doctor more 23 77 than 2 full days in advance? Base: 1 (1,351,886); 2 (1,012,334); 3 (1,329,542); 4 (1,317,279) 5 (747,599) Source: Ipsos MORI/DH GPPS 2008
  20. 20. Patients also satisfied with booking GP appointments %No % Yes In the last six months, have you ever wanted to make an appointment with a particular 37 63 doctor at your GP surgery? Last time you wanted to, were you able to make an appointment with a particular 12 88 doctor - even if it meant waiting longer? Over the last 6 months or so, were you satisfied with the hours your 18 82 GP surgery was open? Base: 1 (1,317,793); 2 (822,473); 3 (1,946,018) Source: Ipsos MORI/DH GPPS 2008
  21. 21. Majority of inpatients/outpatients satisfied with waiting times How satisfied or dissatisfied were you with how long you had to wait from the time your GP referred you to a hospital to when you actually saw the hospital specialist? Don‟t know / not stated (2%) I do not have an appt date yet Not at all satisfied 4% 7% Not very satisfied 11% 41% Very satisfied Fairly satisfied 35% Base: 93,217 English inpatients/outpatients, March-May 2009 Source: Ipsos MORI / DH National Patient Choice Survey
  22. 22. Increasing awareness of choice
  23. 23. The public are increasingly aware of choice inside and outside the NHS Please tell me whether on the whole you agree or disagree with each of the following statements: % agree 90 Nowadays you can get a wide range of treatment and care outside 80 hospital 75 70 60 59 People have 50 increasing choice about their treatment and care 40 30 Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Dec-07 Jan-08 Feb-08 Mar-08 Apr-08 May-08 Jun-08 Jul-08 Aug-08 Sep-08 Oct-08 Nov-08 Dec-08 Base: 1,006 English adults aged 16+, March 2010 *statement not asked in Dec 08, March 09, June 09 Source: Ipsos MORI/DH Perceptions of the NHS Tracker
  24. 24. Coalition commitment “We will strengthen the power of GPs … by enabling them to commission care”
  25. 25. Support for PBC among GPs In general, to what extent do you support or oppose Practice Based Commissioning (PBC) as a policy? Support Oppose 70 62 64 62 64 63 64 60 59 57 50 40 % 30 20 20 17 17 15 15 15 14 13 10 0 Wave 1 Wave 2 Wave 3 Wave 4 Wave 5 Wave 6 Wave 7 Wave 8 Base: Wave 8: 1,698 practices (3 June – 28 August 2009); Wave 7: 1,797 practices (3 April - 5 June 2009); Wave 6: 1,898 practices (1 December 2008 - 27 February 2009); Wave 5: 1,833 practices (19 September - 16 November 2008); Wave 4: 1,891 practices (2 June - 5 August 2008); Wave 3: 1,988 practices (15 Jan - 7 March 2008); Wave 2: 1,398 practices (10 Sept - 23 Nov 2007) and Wave 1: 1,198 practices (18 June - 06 Aug 2007)
  26. 26. Has PBC improved patient care acc to GPs?? To what extent do you agree or disagree that PBC has improved patient care? Agree Disagree Too early to tell 50 46 40 37 36 37 31 31 31 32 30 30 29 29 29 30 27 27 % 22 20 19 18 18 16 13 12 13 10 0 Wave 1 Wave 2 Wave 3 Wave 4 Wave 5 Wave 6 Wave 7 Wave 8 Base: Wave 8: 1,698 practices (3 June – 28 August 2009); Wave 7: 1,797practices (3 April - 5 June 2009; Wave 6: 1,898 practices (1 December 2008 - 27 February 2009); Wave 5: 1,833 practices (19 September - 16 November 2008); Wave 4: 1,891 practices (2 June - 5 August 2008); Wave 3: 1,988 practices (15 Jan - 7 March 2008); Wave 2: 1,398 practices (10 Sept - 23 Nov 2007) and Wave 1: 1,198 practices (18 June - 06 Aug 2007)
  27. 27. New services How many new services, if any, has your practice or PBC group commissioned as a direct result of PBC? Any new services No new services 100 90 80 70 61 62 64 60 60 59 56 % 50 52 49 46 40 41 33 36 30 32 29 26 25 20 10 NB wording change Wave 4 to Wave 5 … your practice… …your PBC group … 0 Wave 1 Wave 2 Wave 3 Wave 4 Wave 5 Wave 6 Wave 7 Wave 8 Base: Wave 8: 1,698 practices (3 June – 28 August 2009); Wave 7: 1,797 practices (3 April 5 - June 2009; Wave 6: 1,898 practices (1 December 2008 - 27 February 2009); Wave 5: 1,833 practices (19 September - 16 November 2008); Wave 4: 1,891 practices (2 June - 5 August 2008); Wave 3: 1,988 practices (15 Jan - 7 March 2008); Wave 2: 1,398 practices (10 Sept - 23 Nov 2007) and Wave 1: 1,198 practices (18 June - 06 Aug 2007)
  28. 28. PCT management support for PBC How would you rate the quality of managerial support for PBC provided by your PCT? Good Poor 60 50 51 50 49 49 48 49 48 46 44 40 42 41 43 40 40 39 37 %30 20 10 0 Wave 1 Wave 2 Wave 3 Wave 4 Wave 5 Wave 6 Wave 7 Wave 8 Base: Wave 8: 1,698 practices (3 June – 28 August 2009); Wave 7: 1,797 practices (3 April - 5 June 2009; Wave 6: 1,898 practices (1 December 2008 - 27 February 2009); Wave 5: 1,833 practices (19 September - 16 November 2008); Wave 4: 1,891 practices (2 June - 5 August 2008); Wave 3: 1,988 practices (15 Jan - 7 March 2008); Wave 2: 1,398 practices (10 Sept - 23 Nov 2007) and Wave 1: 1,198 practices (18 June - 06 Aug 2007)
  29. 29. Coalition commitments “We will ensure there is a stronger voice for patients locally through directly elected individuals on the boards of their local PCT” “The local PCT will act as champion for patients”
  30. 30. The public say they want to be consulted And thinking of how decisions about treatments and services should be made, which of these statements most closely matches your opinion? Don‟t know Decisions about which NHS treatments and The general public should 5% services are available should be made solely be much more actively 20% by qualified health involved in shaping which professionals and not NHS treatments and 20% the general public. services are available e.g. deciding local priorities and allocating budgets. The public should be consulted on decisions shaping which NHS treatments and services should be available but 54% the final decisions should be made by qualified health professionals Base: 988 English adults (18+), November 2008 Source: Ipsos MORI/Social Market Foundation
  31. 31. Most want standard treatment available across the country And thinking of the treatments that are available on the NHS, which of these statements most closely matches your opinion? Don‟t know The availability of NHS treatments 4% should be based 23% on local need Treatments should rather than a only be available on ‘one size fits all’ the NHS if they are approach across available to everyone and not the country. dependent on where you live 73% Base: 988 English adults (18+), November 2008 Source: Ipsos MORI/Social Market Foundation
  32. 32. On balance, public support for prioritising services How should NHS budget shortfalls be addressed? Don‟t know Taxation should increase 10% 18% NHS should 29% 13% Individuals should prioritise contribute 30% Government should prioritise Base: 988 English adults (18+), November 2008 Source: Ipsos MORI/Social Market Foundation
  33. 33. Big support for getting involved – though in practice… In principle, would you support or oppose extending Community Partnerships to other parts of the Borough? And would you personally be interested in getting involved? Support Involvement Don’t know/no Don’t know opinion Depends 2% No, oppose 12% Yes 18% 26% 6% Yes, support 82% 54% No Base: All residents (1,021) Base: All resps who support the idea (835)
  34. 34. Three key questions  Should NHS be based on national standards or local need?  everyone driven by “fairness” – but different interpretations  ¾ say national standards – yet propose local variation  the meaning of “postcode lottery” more subtle than appears  How do the public want to address the spending gap?  most people say “prioritisation” – but means different things  for some, based on clinical assessment of where money best spent  for others, it‟s about focusing on more large scale interventions  Do the public want to be more involved in decision making?  in principle yes, but unlikely in practice  not a hunger to be consulted on everything – focus should be on wide reach services needing public buy in  if there is objective, clinical evidence, public happy not to be engaged  concerns it will let in subjectivity and vested interests – less “fair” Source: Ipsos MORI/Social Market Foundation
  35. 35. Coalition commitment “We will give front-line staff more control of their working environment”
  36. 36. Getting staff on board key – staff bad mouthing one of the key drivers of patient dissatisfaction Greatest drivers of Personal experience of overall satisfaction NHS services Support for Government Believe NHS is changing Feel safe in NHS care Staff bad-mouthing Weaker drivers of overall National newspaper satisfaction coverage Mis-management/ bureaucracy in NHS Perceptions of social care Gender, age, region
  37. 37. In recent years, the NHS had some of the highest levels of negative staff advocacy in the public sector Critical Favourable -3 Doctors 70% 3% -2 GPs 71% 7% -13 47% 15% Practice nurses New Hospital nurses 42% 10% -37 New NHS senior clinical managers 40% 23% NB. NHS managers net % change shows the difference between general managers (Aug 06) and senior clinical managers (Dec 06). Drs = both groups, GPs = both groups
  38. 38. All your powers of leadership and persuasion will be tested
  39. 39. Good leaders engage their staff % Agreeing that Factor is being delivered 56% I understand my role 52% and how it fits into 47% Healthcare Commission the bigger picture 34% quality Rating Excellent 38% Senior managers care Good 35% about me and my work Fair 32% 28% Weak 59% I am able to realise 54% my potential 53% 43% Base: 37 NHS Trusts, August 2007
  40. 40. Thank you Ben.page@ipsos.com

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