1. Public perceptions of the NHS – calm before the storm? Challenges for communications Dan Wellings, Ipsos MORI Social Research Institute 22 nd November 2011

2. Current levels of satisfaction

3. Concern with NHS is very much relative at the moment NHS Crime/ Law & Order Race/ immi- gration Economy Source: Ipsos MORI Issues Index What do you see as the most/other important issues facing Britain today? Unemployment Base: representative sample of c.1,000 British adults age 18+ each month, interviewed face-to-face in home

4. Issues Facing Britain: NHS / Hospitals / Healthcare Brown Becomes PM General Election – “Battle of Margaret’s shoulder” London Bombs Hewitt heckled at UNISON conference – fears over NHS job cuts Blair tells doctors “not enough” has been done for the NHS – allocates extra £20 billion. Report says waiting lists have doubled under Labour Alan Milburn promises 35,000 more nurses, 40 new hospitals and development of foundation trusts as part of NHS plan Base: representative sample of c.1,000 British adults age 18+ each month, interviewed face-to-face in home Blair – “We have underfunded the NHS for years and we are paying the price for it” – BBC NHS day Lowest score since December 1985 What do you see as the most/other important issues facing Britain today? Source: Ipsos MORI Issues Index Cameron becomes PM

5. 2001 – how different is it a decade on? Mortality lottery in NHS Guardian, 15 Jan 2001 Cancer victim forced to buy her own drugs Daily Mail, 4 April 2001 Care hit by staff shortages, say nurses Guardian, 18 Sept 2001 Huge differences in the number of doctors per bed at hospitals dramatically affect a patient's chances of survival, according to a study. Daily Mail, 15 Dec 2001 Cash crisis is crippling us, say hospitals Daily Mail, 21 Feb 2001 NHS reforms look tarnished BBC, 4 May 2001 NHS rationing on way, say doctors BMA says extra resources not enough to meet demand Observer, 7 Feb 2001

6. Gap opening up again… Source: Reuters/Ipsos MORI Political Monitor 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 health care. Base: c. 1,000-2,000 British adults each month % Labour Conservatives Liberal Democrats Other/None/DK 2010 General Election 2005 General Election 2001 General Election 1997 General Election

7. Satisfaction was high last time but first signs of waning, we’ll see… Q Overall, how satisfied or dissatisfied are you with the running of the National Health Service nowadays? Base: English adults aged 16+ (c.1,000 per wave) % Satisfied Dissatisfied Source: Ipsos MORI/DH Perceptions of the NHS Tracker Net satisfied

8. % Satisfied Base: English adults aged 16+. NHS users (891), Non-users (120) NHS users are those who have been personally been an inpatient, outpatient, A&E patient or used a walk-in clinic or visited an NHS GP within the last year Q Overall, how satisfied or dissatisfied are you with the running of the National Health Service nowadays? Media at work… 61 73 Non-users NHS users Source: Ipsos MORI/DH Perceptions of the NHS Tracker

9. The perception gap remained Q To what extent, if at all, do you agree or disagree with the following statements? Base: English adults aged 16+ (c.1,000 per wave) % Agree The government has the right policies for the NHS The NHS is providing a good service nationally My local NHS is providing me with a good service Source: Ipsos MORI/DH Perceptions of the NHS Tracker

10. “There is a tsunami of anger heading towards the NHS which will overwhelm people paddling in their canoes acting as if nothing is happening” Sir Robert Francis QC

11. Base: 1,003 British adults 18+, 17 th – 19 th June 2011 % Worse% Better Standards of treatment for patients in the NHS The service provided by GPs or family doctors How efficiently the NHS spends public money Source: Reuters/Ipsos MORI Is he right? Thinking about the NHS and from what you know or have heard, do you think the following will get better or worse over the next 12 months or will they stay the same? The length of time patients have to wait before receiving treatment % Stay the same% Don’t know

12. More informed people are more negative about reform… Neither/nor Much better Don’t know A little worse A little better Much worse Q And thinking about these changes overall, from what you know, how much better or worse do you think services will be for patients? Better: 21% Worse: 52% Source: Ipsos MORI/DH Perceptions of the NHS Tracker Base: 582 English adults aged 16+ who are able to name a change being made to the NHS

13. Public Sector Leaders certainly don’t think things will improve… Source: Ipsos MORI Don’t know Disagree On balance, do you agree or disagree with the statement that "in the long term, this government's policies will improve the state of Britain's public services"? Agree Base: 338 Public Sector Leaders, 27 June – 22 July 2011 Results by sector AllLoc. Gov Cen. Gov HlthEduNDPB Agree262927251933 Disagree636057707152

14. Next challenge: cuts, rationing, prioritisation and efficiencies…

15. In a time of unprecedented investment we still thought funding was the biggest issue

16. % 54 Lack of resources/ investment What do you see as the biggest problems facing the NHS? What else? This was in March 2010! 15 Long waiting lists/times 25 Bureaucracy/top heavy management 24 Not enough doctors /nurses/understaffed 11 Overstretched/ ageing population * Please note that results from March 2007 onwards are not directly comparable to previous data as the question was placed on different studies Base: English adults aged 16+ (c.1,000 per wave) Source: Ipsos MORI/DH Perceptions of the NHS Tracker 13 Overworked staff

17. NHS budget should be ‘ring-fenced’ The NHS/health care Schools The Police Defence Local authority services Benefit payments Social services Care for the elderly Overseas aid QWhich TWO or THREE, if any, of the following main areas of public spending do you think should be protected from any cuts? None of these Don’t know Base: British adults aged 18+ 19-21 June 2009, all who think some services should be protected (773) Source: Ipsos MORI Public Spending Index

18. Coalition commitment “We will guarantee that health spending increases in real terms”

19. So how much funding do we think it should have?

20. Base: British public, 18+ (1,001) 12-17 January 2006 Expectations unrealistically high. People want … Agree Disagree Don’t know There should always be limits on what is spent on the NHS… … unlimited spending... 31% strongly disagree with limits on NHS spending

21. The NHS should provide all drugs and treatments no matter what they cost Base: British public, 18+ (1,001) 12-17 January 2006 … and little concern about value for money The NHS should provide the most effective drugs and treatments no matter what they cost The NHS should provide the most effective drugs and treatments provided they represent good value for money 72% expect NHS to provide drugs no matter what they cost treatments no matter what they cost

22. Source: Reuters/Ipsos MORI Political Monitor Base: c. 1,000 British adults each month Agree Disagree There is a real need to cut spending on public services in order to pay off the very high national debt we now have There has been a decline in the public’s acceptance of the need for public service cuts

23. From what you know, do you think the government has on the whole made the right decisions or the wrong decisions about where spending cuts should be made? More now think the government is making the wrong decisions on spending cuts Source: Reuters/Ipsos MORI Political Monitor Base: 817 British adults 18+, 20 th October 2010 Right decisions Wrong decisions Don’t know Right decisions Wrong decisions Don’t know October 2010 March 2011 Base: 1,000 British adults 18+, 11th - 13th March 2011

24. “The reality is prioritisation is going on all the time and there isn’t an open and honest debate with the public” – Dr Johnny Marshall

25. Fine but not the easiest debate to start especially without support of politicians

26. No decision about me without me

27. We thought we would ask whether people thought it was a good idea Neither/nor Strongly agree Don’t know Tend to disagree Tend to agree Strongly disagree (1%) Base: 1,014 British adults aged 15+, 17 – 23 June 2011 To what extent, if at all, do you agree or disagree that patients should be involved in making decisions about the care they receive from the NHS? Source: Ipsos MORI

28. The confidence is there Base: 1,014 British adults aged 15+, 17 – 23 June 2011 Choosing which GP you see at your surgery for a particular appointment Choosing which hospital you will be treated at Choosing the consultant who treats you at the hospital Choosing which GP surgery you are registered at Choosing the treatment that you receive for your condition Very confidentFairly confident Not very confidentNot at all confidentDon't know For each of the following, if you had a choice, how confident would you feel about....? Source: Ipsos MORI

29. So broad agreement but perhaps not quite as straightforward as it seems…

30. 3 areas to look at Shared decision-making between patient & doctor Choice & informed decisions about where to be treated Becoming involved in decisions about provision of services at a local level

31. Do people want to be more involved than they currently are in making decisions about their own health and healthcare?

32. B. I was able to choose the treatment or service which best suited my needs Broadly people are relatively satisfied with current situation A. I was involved as much as I wanted to be in decisions about my care or treatment % Neither / nor % Don't know % Tend to agree% Strongly agree % Strongly disagree% Tend to disagree QThinking back to the last time you saw a health professional, such as a GP or hospital doctor, to what extent would you agree or disagree with each of the following statements. Source: Ipsos MORI/DH Perceptions of the NHS Tracker Base: 1,011 English adults aged 16+

33. A wide spectrum Agree much more with statement A QPlease listen to the following pair of statements and decide, on a scale of 1 to 5, which comes closest to your own opinion. A score of 1 means you agree much more with statement A while a score of 5 means you agree much more with Statement B. 2. 3. 4. Agree much more with statement B Source: Ipsos MORI/DH Perceptions of the NHS Tracker Base: 1,011 English adults aged 16+ 1. 5. A – In general, I want a health professional, such as a GP or a consultant, to make decisions about my treatment B – In general, I want to make my own decisions about my treatment, not rely on a health professional, such as a GP or consultant Men are more likely than women to place themselves at 1, as are those aged 65+ and those in lower social grades. Also those with long-term conditions.

34. D2: Which of these statements comes closest to your opinion? Base: All NHS Staff from GfK NOP (Winter ‘10 only - 270), Public on MORI tracker (Winter ’10 - 1,011) Patients want health professionals to make decisions about their treatment (1) 234 Patients want to make their own decisions about treatment and not rely on health professionals (5) I want a health professional to make decisions about my treatment (1) 34I want to make my own decision about treatment and not rely a health professional (5) 2 Interesting difference between the public and Health Professionals

35. All this is unsurprising when we look at how much we trust doctors Q. “For each, would you tell me whether you generally trust them to tell the truth or not?” Base: 1,026 United Kingdom adults aged 15+, 10-16 June 2011Source: Ipsos MORI/BMA

36. Our trust in doctors is wide-ranging To what extent, if at all, would you trust doctors to do the following: % Not very much% Not at all% A fair amount% A great deal Act in the best interests of their patients Decide on the most appropriate treatment for you Give you advice on improving your health Run the health services in your local area Keep your personal information safe Decide which is the best hospital for you Decide which treatments the NHS can and cannot afford Decide how money is spent within your local NHS 91% 90%89% 81%69% 67% 63% Base: 1,026 United Kingdom adults aged 15+, 10-16 June 2011Source: Ipsos MORI/BMA

37. Choice – yes but there are two sides to this

38. Choice? Q. Were you offered a choice of hospital for your first hospital appointment? Base: National Patient Choice Survey wave 1 – wave 18 (May 06 – Jan 10). c.75,000 NHS Patients in England per wave Of the 47% not offered a choice, 47% went to the hospital they wanted to and 40% did not have a preference

39. Choosing a hospital Cleanliness/low levels of infection Quality of care Length of wait to appointment Friendliness of staff Reputation of hospital Location/Transport/Easy to get to Car parking Reputation of consultant Good personal experience Convenience of appointment time Which, if any, of the following factors would be most important to you in choosing a hospital? Source: Ipsos MORI/DHBase: 93,217 respondents from National Patient Choice Survey Wave 17

40. Choosing a hospital Close to your home or work Quality of care Length of wait to appointment Friendliness of staff Reputation of hospital Personal experience of hospital Ability to see consultant of choice Good previous experience Cost of car parking Which was the single most important thing for you when you chose your hospital ? Accessible on public transport/Travel costs GP /assessment centre doctor recommendations Experience of friends/family members Cleanliness/rates of infection Convenience of appointment time Base: 32,554 respondents from National Patient Choice Survey Wave 18Source: Ipsos MORI/DH

41. Choice versus Uniform Standards Choice Uniform quality

42. Choice relies on information – do we know where to go?

43. 54% say they know where to get information – sound high until you think about it People have increasing choice about their treatment and care % agree QPlease tell me whether on the whole you agree or disagree with each of the following statements: Source: Ipsos MORI/DH Perceptions of the NHS Tracker I know where to get information about the quality of local health care services *statement not asked in Dec 08, March 09, June 09 Base: 1,011 English adults aged 16+, December 2010 The NHS is doing more these days to help people live healthier lives

44. 44 Base: 4,031 GB adults aged 15+: Nov 2010 and Jan/Apr/July 2011 % Accessing the internet by gender and social grade in 2010/2011 Source: Ipsos MORI All15-2425-3435-4445-5455-6465+ Females76919390867438 Females AB89100 98958957 Females C186979694958647 Females C276969193886732 Females DE53728570554023 All15-2425-3435-4445-5455-6465+ Males83959492838156 Males AB95100 981009678 Males C191969996908967 Males C27694 81807642 Males DE6791858350 27 Internet access 80-100% 50-79% 0-49% The information revolution: A charter for the connected

45. Do we want to be involved in shaping services?

46. The public say they want to be consulted Decisions about which NHS treatments and services are available should be made solely by qualified health professionals and not the general public. Don’t know The public should be consulted on decisions shaping which NHS treatments and services should be available but the final decisions should be made by qualified health professionals And thinking of how decisions about treatments and services should be made, which of these statements most closely matches your opinion? Base: 988 English adults (18+), November 2008 The general public should be much more actively involved in shaping which NHS treatments and services are available e.g. deciding local priorities and allocating budgets. Source: Ipsos MORI/Social Market Foundation

47. Involvement No Depends Yes Don’t know Base: All resps who support the idea (835) Big support for getting involved – though in practice… Don’t know/no opinion Yes, support No, oppose Support 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? Base: All residents (1,021) Actual Proportion - 2%

48. Do we want National or Local? OR We want national standards with local control

49. Local versus National Please read each pair of statements and decide which comes closest to your own opinion A. Standards of public services should be the same everywhere in Britain B. The people who live in different parts of Britain should be able to decide for themselves what standard of public services should be provided in their area Base: 2,019 British adults, 9 May-5 June 2008 Source: Ipsos MORI Real Trends

50. This is a challenge for the localism agenda Don’t know The availability of NHS treatments should be based on local need rather than a ‘one size fits all’ approach across the country. Treatments should only be available on the NHS if they are available to everyone and not dependent on where you live Base: 988 English adults (18+), November 2008 And thinking of the treatments that are available on the NHS, which of these statements most closely matches your opinion? Source: Ipsos MORI/Social Market Foundation

51. Partly driven by a national obsession with the “postcode lottery” – try entering the term into newspaper search engines…

52. …a lot of news coverage of “postcode lotteries” “Over 100 items” “637 items” But this is NOT just a media obsession. It is driven by real concerns about fairness. With greater local control people will need more reassurance about minimum standards and support for the less able “A lot!”

53. Even if entirely reasonable the press will pick up on it – will CCGs exacerbate situation?

54. Bringing it all together…

55. “The challenge for the NHS next year can be summed up in three words; reconfiguration, reconfiguration and reconfiguration” Alastair Mclellan

56. Challenges  Reconfiguration brings all these challenges together  Partial versus General will  Transparency  Honesty – not NHS good or NHS bad  Need for leadership  Early involvement  Politicians on board  Changing social contract  Glasnost!

57. “We now expect more of government than we do of God” 52% of the public agree…. This is one figure we need to be lower…

58. Thank you dan.wellings@ipsos.com dan.wellings@ipsos.com