NHS: zadovoljstvo korisnika

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Public Perceptions and Patient Experience

of the NHS:

Winter 2004 Tracking SurveySummary Report

& Computer Tables

Research Study Conducted for

The Department of Health

November - December 2004


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Contents

Introduction 1Background and objectives 1Methodology 2

Volume layout 2Presentation and interpretation of data 3Publication of the findings 4

Executive Summary 5Main Results 8

1. Use of NHS services 82. Overall perceptions of the National Health Service 83. National versus local health services 104. Service satisfaction overall 115. Service satisfaction - last visit 136. Ratings of hospital service specifics 147. Information 16

Summary of Survey Results 21. Summary tables 2

Guide to Statistical Reliability 17Guide to Social Classification 19Sample Profile 20Marked-up Questionnaire 21Appendices

Summary of Survey Results

Guide to Statistical Reliability

Guide to Social Classification

Sample Profile

Marked-up Questionaire

Computer Tables


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For


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Public Perceptions of the NHS Winter 2004 for the Department of Health

1

Introduction

This volume presents the main findings of a survey conducted among the general public by the

MORI Social Research Institute for the Department of Health in November December 2004.

Background and objectives

This Winter 2004 survey follows on from a series of surveys conducted by the MORI SocialResearch Institute for the Department of Health between Spring 2000 and Spring 2004. Thesurvey was initially conducted in 2000, with a follow-up in 2001. It has been conducted twice ayear thereafter, once in the spring and once in the winter.

The aim of the survey is to explore public attitudes towards, and perceptions of, the NHS, aswell as assessing the extent to which public opinion may show signs of seasonal fluctuation. In

addition, the surveys provide a means of tracking public perceptions of the NHS over time. Theresults of this study, taken in combination with other work MORI is doing for the Departmentof Health, is aimed at forming an overall picture of the Department and the NHS as whole.

It should be noted that these surveys are based on a national sample of 1,000 interviews, and soare subject to sampling tolerances as discussed in the appendix. Regardless, the data provide auseful check on public sentiment and patient experience, and complement the larger patientsurveys undertaken by the Healthcare Commission.

The specific issues covered in this survey include:

Overall perception of, and satisfaction with the NHS - including perceptions of therole of the NHS and funding preferences;

Reported use, and perceptions of, specific areas of NHS care - including generalpractice and inpatient, outpatient and accident and emergency (A&E) services; and

Priorities for increased spending, and perceptions of key priorities for the NHS andindicators of service improvement;

Information sources, from which people hear about health services, and the extent towhich they are seen as favourable or critical towards the NHS and to which they arereliable.


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2

Methodology

MORI carried out 994 interviews among a representative sample of adults, aged 16+, living in102 randomly selected enumeration districts (EDs) across the 9 Government Office Regions(GORs) of England. All EDs within each GOR were sorted by ward and by demographic type,

with individual sampling points then selected at random.

Within each ED, quotas were set using 2001 Census data to reflect the profile of theneighbourhood in terms of age, sex, and work status. At the analysis stage, data were weighted tothe population profile in terms of age, sex, working status and GOR.

All interviews were conducted, face-to face and in-home, between 13 November 12 December2004.

Volume layout

This summary report for the Winter 2004 survey contains the following sections:

Executive summary an overview of key survey findings and their implications;

Main Results a summary of the findings to core survey questions, including ananalysis of results by NHS patient subgroups.

Appendices contain summary tables supplementing the main sections of this preliminary report,as well as providing an overview of key survey trends for core Department of Health questions.

This is followed by a guide to statistical reliability (overall results are accurate to within +3percentage points), an explanation of social class definitions, and a sample profile.

Also appended is a copy of the marked-up questionnaire showing topline results from thissurvey. Where tracking data exists, the marked-up questionnaire also presents current surveyresults alongside findings from the Spring 2004, Winter and Spring 2003, Winter and Spring2002, 2001 and 2000 Department of Health surveys.


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Presentation and interpretation of data

It should be remembered at all times that a sample and not the entire population of adults livingin the 9 GORs of England has been interviewed. In consequence, all results are subject tosampling tolerances, which means that not all differences are statistically significant (please refer

to the statistical reliability section in the Appendices).

Where appropriate, this report compares results from the present survey with those obtained inrecent MORI research for the Department of Health (please refer to the Appendices for anexplanation of the sampling tolerances required when comparing results of the present survey

with those conducted in previous years):

Spring 2000: results based on 1,046 face-to-face, and in-home, interviews among arepresentative sample of adults aged 16+ living in 104 EDs between 14 April 7 May2000;

Winter 2001: results based on 1,021 interviews across 104 EDs between 21 November 10 December 2001;

Spring 2002: results based on 1,041 interviews across 108 EDs between 4 May 5June 2002;

Winter 2002: results based on 1,002 interviews across 108 EDs between 21 November 24 December 2002; and

Spring 2003: results are based on 1,000 interviews across 108 EDs between 12 May 8 June 2003.

Winter 2003: results are based on 1,039 interviews across 104 EDs between 18November 2003 18 January 2004.

Spring 2004: results are based on 1,031 interviews across 104 EDs between 4 June 6July 2004

It is worth bearing in mind that the survey deals with public perceptions at the time of the survey ratherthan facts; in particular, these perceptions may or may not accurately reflect levels and quality ofservice actually being delivered by the NHS.

In this report, reference may be made to net figures. This represents the balance of opinion onattitudinal 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 percentagesatisfied on a particular issue less the percentage dissatisfied. For example, if an issue records40% satisfied and 25% dissatisfied, the net satisfaction score is +15 points.

Where percentages do not sum to 100, this may be due to computer rounding, the exclusion ofdont knowcategories, or multiple answers. Throughout the volume an asterisk (*) denotes any

value of less than half of one percent but greater than zero.


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Publication of the findings

As the Department of Health has engaged MORI to undertake an objective programme ofresearch, it is important to protect the interests of both organisations by ensuring that it isaccurately reflected in any press release or publication of findings. As part of our standard terms

and conditions of contract, the publication of the findings of this research is therefore subject toadvance approval of MORI. Such approval will only be refused on the grounds of inaccuracy ormisrepresentation.


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5

Executive Summary

Overall, the Winter 2004 scores find satisfaction with most measures consistent or slightly higher

than those from Spring 2004, with only a few decreases in satisfaction. The data are starting toshow across the board improvements in perception, although there is room for more progress incommunicating the Departments role in these improvements. The NHS is seen as steadilyimproving on those measures which matter most to the public, such as local service provisionand improved waiting times. There has been an especially sharp improvement (10%) in inpatientsatisfaction with their last visit. Satisfaction remains high across patient groups, especially recentinpatients, and as with previous waves of the survey, user satisfaction is notably higher than thatof the general public. Access to NHS dentists remains a key and growing area of public concern.

Source: MORI

0%

10%

20%

30%

40%50%

60%

70%

80%

90%

100%

Spring

2002

Winter

2002

Spring

2003

Winter

2003

Spring

2004

Winter

2004

Patient Satisfaction with Last Visit

Against Public Perceptions Overall% satisfied

Out-patientsA&E

GP

In-patients

NHS Overall

Satisfaction with A&E, Outpatient and NHS Direct are broadly in line with those recorded inthe Spring 2004 tracking survey (see above graph), as is satisfaction with waiting times in general:

Satisfaction with the running of the NHS overall (62% satisfied among thepublic as a whole; an increase of 3% from six months ago) This increase is notstatistically significant, but does maintain the upward satisfaction trend that hascontinued from the start of this Tracker survey in 2000;

GP services recent user satisfaction has remained steady (87% satisfied compared to88% six months ago), and most service specific attributes (among users) remainsteady;


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A&E services user satisfaction has not changed significantly, up 1 percentage pointto 70% satisfied, although this does represent a notable improvement over the lastfew years (up 17% from 53% in Spring 2002);

Waiting times these figures improved notably in the Spring 2004 tracker, and

remain steady at their new rates this winter. There is no more than a two percent netchange for any of: hospital waiting lists for non-emergency operations (29% net, 27%in Spring 2004), waiting time to get an appointment with a hospital consultant (26%net, no change at all from Spring 2004), time spent waiting in A&E (28% net, 27% inSpring 2004) or waiting times for non-emergency operations (33% net, 31% in Spring2004);

Outpatient services a high satisfaction level is maintained among users (85%).

There are a few areas where satisfaction is down slightly, namely in dentistry and physical accessto services. Hospital car parking, the availability of GP home visits and the availability of out of

hours care have all decreased slightly in satisfaction. The only one of these drops that issignificant is dentistry, where net satisfaction has dropped 11 percentage points.

There have, however, been some significant improvements made in inpatient satisfactionespecially among recent users and also in user satisfaction with Walk-in clinics:

Inpatient services satisfaction with last visit to a hospital as an inpatient has risen10%, from 82% in Spring 2004 to 92% currently. This is the largest jump for thisquestion since it was first asked in Spring 2002, and is among the highest satisfactionfigures MORI has recorded for patient services. In addition, satisfaction with most

service-specific attributes (among users) are generally steady or improved;

Walk In Clinics overall satisfaction among the general public has remainedgenerally steady, and user satisfaction on the whole has jumped twelve percentagepoints, from 73% in the spring to 85% now. Dissatisfaction has dropped as well,yielding a netsatisfaction increase of 19%.

These findings are largely in line with other research MORI conducts on similar topics. Forexample, in MORIs monthly Political Monitor, the NHS is no longer always found to be thetop issue facing Britain today other issues take precedence as the NHS is seen as lessproblematic. Similarly, satisfaction with the running of the NHS is seen to be improving,

according the Monthly Health Monitor run for the Department of Health. Finally, the positivenature of these findings is very much in keeping with the findings of the HealthcareCommissions Patient Surveys, which show patients to be overwhelmingly positive about thecare they receive.

This survey continues to support the finding from previous Tracker surveys that there is adifference in the minds of the public between the national health service they hear/readnegative stories about in the media, and local health services which they and theirfamily/friends use and are broadly positive about. In addition, it works to feed into andcomplement the body of patient surveys undertaken by the Healthcare Commission.

The public remain more likely to agree with the statement, My local NHS is providingme with a good service (67%) than with, The NHS is providing a good servicenationally (51% - up from 47% in Spring 2004).


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This notion is extended further when the public are asked for their reaction to thestatement, The government has the right policies for the NHS, with which less thanone in three people agree (32%).

In addition, the sources of information through which the public obtains information on the

NHS may affect their perception of the organisation. National media such as TV/radio andnewspapers are among the most common sources of information for the public about the NHS(45% and 39% respectively), and they are also the most critical of the NHS (51% and 64%critical). They are not seen as the mostreliable sources although 54% do categorise TV/radio asreliable) but they are heard and viewed more than most other sources.

MORI/J23620

Ben Page

Julia Clark


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8

Main Results

1. Use of NHS services

In line with previous waves of the tracking survey, GP services are the most widely used NHSservice asked about in this survey. The number of people who have visited their GP hasincreased slightly from Spring 2004 (77% compared to 72% previously - see Table 1 in the

Appendices). As with previous waves of the survey, this is followed some way behind byOutpatient (40%) and A&E (24%) services. Just under one in five have personally been aninpatient within the last year (18%), and still fewer have used NHS Walk-in clinics (14%). Usageof NHS Direct has risen somewhat, from 14% in Spring 2004 to 18% currently.

2. Overall perceptions of the National Health Service

The publics level of satisfaction with the running of the NHS nowadays has beenincreasing slowly in the last few waves of this Tracker survey. Satisfaction is now at the highest ithas ever been as tracked on this survey, at 62% satisfied (see chart below ) and 19% dissatisfied.

This balance of opinion is broadly shared across all patient subgroups (see Table 2 in theAppendices), although satisfaction is highest among inpatients (68%). Dissatisfaction is highestamong NHS Direct users, at 24%. Dissatisfaction is relatively even between other patientsubgroups, and encouragingly, the level of dissatisfaction among A&E users, in previous yearsthe most dissatisfied group, continues to fall. Only one in five (21%) A&E users now reportbeing dissatisfied with the NHS overall, compared to a third a year ago (34%) and 28% in Winter2003.

Source: MORI

Public perception of NHSSatisfaction up 3% to 62%

0

10

20

30

40

5060

70

80

90

100

2000

Spring

2001

Winter

2002

Spring

2002

Winter

2003

Spring

2003

Winter

2004

Spring

2004

Winter

%

satisfied


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The chart below shows that the proportion of respondents who agree with the statement thatthe NHS was a great project but we probably cant maintain it in its current form issimilar to Spring 2004 (20%) a proportion that is consistent across all patient subgroups. Thismeasure has been decreasing slightly since Spring 2003. The overwhelming majority ofrespondents continue to agree that the NHS is critical to British society and we must do

everything to maintain it (78% - up one point).

Source: MORI

79 75 77 73 75 77 78

19 23 2025 22 21 20

0

10

20

30

40

5060

70

80

2000 2001 2002 Spring

2003

Winter

2003

Spring

2004

Winter

2004

The NHS is crucial

to British society

and we must doeverything we can

to maintain it

Q Which of the following statements best reflects your thinking about theNHS?

NHS Role

Dont know

The NHS was a great projectbut we probably cant maintain

it if its in its current form


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3. National versus local health services

There are a few measures in place on this survey to test whether the public rate the NHS morepositively at a local rather than national level.

In line with trends over previous waves of tracking research, the chart below shows that thepublic are more likely to agree with the statement, My local NHS is providing me with agood service (67%) than with, The NHS is providing a good service nationally (51%).However, the latter figure is up 4% from Spring 2004 (from 47%). The concept of nationalhealth services is explored still further by presenting the statement, The government has theright policies for the NHS, which only one in three people agree with (32%), which probablyreflects distrust of the government as much as it does disapproval of the policies.

When considered against other measures, the difference between national and local become evenmore polarised. Agreement with the statement, I am satisfied that the government is doingits job well overall (from MORIs Political Monitor)is the lower than all the statements in thissurvey (31%), while satisfaction with the last hospital visit is the highest of all (81% agreement).

This measure is improving slowly, however, as disagreement with the statement is down to 39%from 44% last year, and agreement is up from 30% to 32%.

Source: MORI

Provision of Service Locally and Nationally

81%

67%

51%

32%

31%

-39%

-59%

13%

16%

Base: All respondents

The government has theright policies for the NHS

% Agree

Q To what extent, if at all, do you agree or disagree with the followingstatements?

The NHS is providing agood service nationally

My local NHS is providingme with a good service

% Disagree

(-36)

(+22)

(+68)

I am satisfied with theway the Government isdoing its job overall*

I was satisfied with mylast visit to hospital

(-7)

(+51)

-29%

*From MORIs monthly Political Monitor (2,003 adults 18+ across Great Britain, 2 - 6 December 2004)


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4. Service satisfaction overall

Generally, net levels of satisfaction with core NHS services have improved from thoserecorded in the Spring 2004 survey (see chart below). Notably, satisfaction with GPs, inpatientand NHS Direct services have increased. Satisfaction with A&E services has dropped slightly,

but it remains higher than any scores prior to Spring 2004.

Source: MORI

-10

0

10

20

30

4050

60

70

80

2000 2001 Spring2002

Winter2002

Spring2003

Winter2003

Spring2004

Winter2004

Public Satisfaction with the Running of Local NHSServices

Net satisfied

GP

In-patientsOut-patients

NHS Walk-in Clinics

NHS Direct

A&E

Among users, there have been some large jumps in satisfaction. Net satisfaction with GPs andwith outpatient services have both increased 5% (to 76% and 57% satisfied respectively), and netsatisfaction with inpatient services have increased 4% to 68%. The largest increase in satisfactionby far, however, is user satisfaction with Walk-in clinics, where net user satisfaction has increasedfrom 61% to 80% (the chart above shows general public satisfaction rather than usersatisfaction).

As is usually the case, the views of users are also more generally positive than those for the

public as a whole (see chart overleaf and Table 4 in Appendices):


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Source: MORI

76%74%68%

38%

57%

44%

18%10%

64%

28%

80%

25%

Net satisfaction: Users vs. General Public

GPs

Inpatients

Outpatients

A&E

Q From your own experience or what you have heard, to what extent areyou satisfied or dissatisfied with the following NHS services?

NHSDirect

Users All respondents

Walk-In

Clinics

Base: All respondents (994)

The biggest discrepancies between users and the general public here are for NHS Direct andWalk-in Clinics. This chart goes a long way towards showing just how much satisfactionincreases with mere exposure to the service. GPs are, as with previous waves of this research,

viewed almost equally by recent users and by the general public, and remain one of the mosttrusted groups of professionals in Britain according to MORIs research.


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5. Service satisfaction - last visit

5a. Last visit to NHS hospital

Patients ratings of their last visit to an NHS hospital (see Table 5 in Appendices) are generallyin line with the findings of Spring 2004 with the exception of inpatients. Inpatient satisfaction

with their last visit to an NHS hospital has risen 10 percentage points from Spring 2004. Inaddition, dissatisfaction has dropped 7%, yielding a net increase of +17%.

Satisfaction among outpatient and A&E users has remained very similar to six months ago, withoutpatient net satisfaction increasing 2% to 74%, and net satisfaction with A&E servicesremaining constant at 47%.

Source: MORI

0%

10%

20%

30%40%

50%

60%

70%

80%

90%

100%

Spring

2002

Winter

2002

Spring

2003

Winter

2003

Spring

2004

Winter

2004

Net satisfied

Out-patients

A&E

GP

In-patients

NHS Overall

Patient NET Satisfaction with Last Visit

to an NHS Hospital/GP

5b. Last visit to GPAmong those who have recently visited their GP, satisfaction remains fairly constant, at 87% -one percentage point lower than in Spring 2004 while fewer than one in ten feel dissatisfied(8% - see Table 8 in Appendices).


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6. Ratings of hospital service specifics

6a. Satisfaction

Respondents who have been an inpatient in an NHS hospital over the last year were presentedwith a list of different aspects of the care and treatment they received, and were asked to rate theextent to which they are satisfied or dissatisfied with each (see Table 6 in Appendices).

The overall findings are generally positive, with slight increases or little movement in mostmeasures. The data indicate high levels of satisfaction among patients with two-thirds or moresaying that they are satisfied with the friendliness of staff (92%), quality of care (88%), admissionarrangements (85%), the length of time staff spent with them (80%), the explanations staff gavethem (78%), discharge arrangements (78%), level of information about decisions (76%), follow-up care (76%), and facilities for patients (73%) and the overall appearance/cleanliness ofhospitals (69%). The amount of time waiting at the hospital for treatment falls just below thetwo-thirds mark, at 64%, which is consistent with the previous wave.

Ratings are also high on the measures of choice, with 68% satisfied with the amount of choiceabout the type of treatment received, and 59% satisfied with the amount of choice about whenand where they were treated.

Ratings remain low on a number of other items especially car parking (21%), which hasdropped 7% since June 2004. Public transport remains low at 32%, and the quality of hospitalfood has increased to 47% (from 44%), although dissatisfaction has also increased. None ofthese figures represent a significant change from the spring.

The balance of opinion on each service attribute is broadly consistent among all patientsubgroups although it is noteworthy that recent A&E users are generally less satisfied thanother patient sub-groups. However, satisfaction among A&E users has increased on themeasures where it was especially low especially in terms of waiting (up to 52% from 43%),follow-up care (up to 58% from 55%), and admission and discharge arrangements (up to 68%and 70% respectively, each from 63%).


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6b. Importance

Respondents were also presented with the same list of service attributes and were asked to selectwhich two they would identify as being the most important (see Table 7 in Appendices).

There are two issues that clearly emerge as most important and have since this survey begun in2000: quality of care provided (45%) and explanations by staff about your illness and treatment(28%). Up until this wave, the third issue on this list has always been information about decisionsaffecting treatment (22% in Spring 2004). This wave however has seen a drastic increase in thenumber of respondents citing overall appearance and cleanliness of the hospital (up from 14% to21%), finding cleanliness as an overall more important issue than information about decisionsaffecting treatment which has dropped from 22% to 20%.

These findings reflect those of the MORI Monthly Health Monitor, which finds Poor standardsof cleanliness/superbugs/MRSA to be among the biggest problems facing the NHS (seechart below). The percentage of people citing this cleanliness response as important has been

rising over the past six months, and thus serves to reiterate the above message. Please seeappendices for these tables in greater detail.

Source: MORI

0

5

10

15

20

25

30

35

40

45

50

Jul-04 Aug-04 Sep-04 Oct-04 Nov-04 Dec-04

%

Lack of resources/investment

Base: c. 1,000 adults 18+, MORI Monthly Health Monitor

Q What do you see as the biggest problems facing the NHS?What else?

Biggest Problems facing the NHS top 5

Long waitinglists/times

Bureaucracy/ top heavy/poor management

Not enoughdoctors/nurses/understaffed

Poor standards ofcleanliness/superbugs/MRSA

These shifts towards concern about cleanliness are most likely attributable to the mediasincreasing focus on and coverage of issues like MRSA and hospital superbugs. Later in thisreport we come on to media sources as a factor when people are making decisions about their

views of the NHS.

Other issues that have changed since spring 2004 are waiting time, which has dropped slightly in

importance (down 3% to 15%) and car parking, which has increased slightly (up 2% to 8%).


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7. Information

7a. Local improvement indicator

The number of people saying that there is no need for improvement in the amount ofinformation about local health care services has been increasing steadily since Spring 2003, and iscurrently almost a quarter (24%). Another third (32%) feel that there is need for a littleimprovement, and 30% say that there needs to be a fair amount/a lot of improvement. Thisbalance of opinion is generally consistent across patient subgroups (see Table 11 in Appendices).

When looking at geographical area subgroups, however, a few differences emerge: respondentsin the North West of England are more likely to feel there is no need for improvement, whilethose in the West Midlands are more likely than average to feel there is a lot of need forimprovement.

Before delving into the types of information sources and their favourability, it is worthmentioning that MORI has also been conducting some research on the language used in

information passed on by the NHS to the general public. Focus group research has found thatpeople are primarily concerned with how NHS services affect them locally and personally andthat the use of technical jargon is off-putting (e.g. Strategic Health Authority, NHS Trust).

More specifically, people become quite distrustful of words and terms they do not understand,and argue that phrases such as whole time equivalent (regarding dentists) are designed toconfuse rather than clarify. Statistics are subject to suspicion as well, although it is accepted thatthey are unavoidable to a certain degree. Regardless, phrases such as 98% of people can seetheir GP in 48 hours are seen as exaggerated and not believable. The Department of Health hasshared these findings with 28 SHA communications teams to encourage them to use plainEnglish with local press and the public they serve.

The messages in the above research are provided in a neutral, research environment. In everydaylife of course, messages about the NHS are generally provided by other means.

7b. Sources of information - Favourability

The most common sources of information from which members of the public say they hearabout the NHS are TV or radio (45%), leaflets or posters in GP surgeries or hospitals (43% - upfrom 34% in Spring 2004), national newspapers (39%) and friends or relatives who have usedNHS services (36%). The least common information sources are the Internet (9%) and leaflets

delivered to your door (13%).

Respondents were then asked to state whether they thought each source of information wasbroadly favourable or critical of the NHS. Unsurprisingly, those produced by the NHSthemselves are most likely to be seen as favourable (leaflets or posters in GP surgeries - 73%;and leaflets delivered to the door - 67%).

The chart overleaf shows that some of the most highly recalled sources of information on theNHS are perceived to be the most critical. National press is seen to be the most critical (64%),followed by local press (54%) and TV or radio (51%). However, while the critical scores of

national newspapers and TV/radio have decreased slightly since Spring 2004 (from 65% and


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55% respectively), local newspapers are perceived to have become more critical (up 5% from49%).

In previous waves of this survey, TV/radio has generally followed national newspapers as themost critical in this wave, local newspapers have now superseded TV/radio in their perceived

criticism of the NHS. Additionally, the favourability scores for all three of these informationsources has increased, most notably national newspapers, from 7% favourable in Spring 2004, to13% favourable now.

Source: MORI

Q Im now going to ask you about each source in turn for each, would you saythat what you have seen or heard was generally favourable or critical of theNHS?

73% 67%

45% 41% 39%23% 17% 13%

-39% -37% -32%

-7%

-54% -51%-64%

39%

-1%-2%

% Favourable

% Critical

Base: All respondents who have heard or read information from each source

Localpress

Leaflets(in GPs)

Internet

Friends

Nationalpress

Directmail

TV orradio

Medicalprofs

Friends(in NHS)

How favourable does the public think informationsources are?

People with friends or relatives who work in the NHS are only slightly more likely to see them asfavourable rather than critical (41% compared to 37%, a net difference of 4% favourable), whichis a 5% drop from the previous wave, where the difference between the two measures was (net)9% favourable. Medical professionals who work in the NHS, who generally tend to emerge as

the most likely group to bad-mouth the NHS, are no more likely to be seen as critical ratherthan favourable (39% critical and 45% favourable, an improvement from 38% and 40%respectively from Spring 2004).

The generally positive trends in patient experience and public perceptions found throughout thisreport are reflected in the way NHS staff are also becoming more positive (friends who work inthe NHS are 3% more positive and medical professionals 2% more positive). This is animportant hurdle to overcome because, as mentioned above, these groups have traditionally beenamong the most critical of the NHS.


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7c. Sources of information - Reliability

Respondents were also asked which information sources they believed to be the most reliable asa source of information about how well the NHS is performing. Leaflets in GP surgeries andfriends or relatives who have used NHS services are equally likely to be the most reliable

information sources (77%) with medical professionals who work in the NHS (75%) closebehind. This is followed by friends or relatives who work in the NHS, at 60% reliable.

This illustrates just how important internal NHS workers (medical professionals and other staff)are towards shaping public opinion about the NHS. While neither of these are seen as topsources of information (21% for friends or relatives who work in the NHS and 17% for NHSmedical professionals), they are seen as the most reliable sources of information. In comparison,the media is consistently seen as less reliable, with the national press the only source on the list tobe viewed as not very/not at all reliable (50%) by a greater percentage than who view it asvery/fairly reliable (36%). The media, however, is a top information source for information

about the NHS.

Source: MORI

-11% -9% -6% -4%

-35%-17%

-50%

-12%

77% 77% 75%60% 54%

46% 45%36%

28%

-38%

Perceived reliability of information sources

Q How reliable do you think that the following are as a source of informationabout how well the NHS is performing?

% Reliable

% Not very/at all reliable

Base: All respondents (994)

Localpress

Leaflets(in GPs)

InternetFriends

Nationalpress

Directmail

TV or

radio

Medicalprofs

Friends(in NHS)

It is clear that improved communications can play a role in improving public perceptions of theNHS but that branding and advocacy issues are of equal importance. The NHS is succeeding atcommunicating that real service improvements at local levels are reflective of improvements inthe system across the country but continued messages aimed at linking up local and nationalservices, as well as looking towards media sources and NHS staff themselves, are just as critical.


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Appendices


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Summary of Survey Results

1. Summary tables1

Table 1 Use of NHS services

Q7: Which of the following health services, if any, have you personallyused in the last year or so?

QJ: Which of the following services have members of your family usedwithin the last year or so?

Base: All (994) Self(Q7 & QG)

Family/friends

(QJ)

% %

Visited a NHS GP 77 78

Attended a NHS hospital as an outpatient 40 40

Visited an accident and emergency department 24 28

Been an inpatient at a NHS hospital 18 20

NHS Direct 18 15

Walk In Clinics 14 11

Had medical treatment as a private patient NA 9

Have private health insurance 19 NA

Source: MORI

1 Please refer to the marked-up questionnaire in the appendices for full details on all of thequestions employed on the present survey, as well as trend data.


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Table 2 Perceptions of the National Health Service

All In-patient

GP Out-patient

A&E

Base: All and users (994)% (186)% (767)% (406)% (221)%

Overall satisfaction (Q1)

Satisfied 62 68 62 63 65

Dissatisfied 20 19 20 21 21

The Government has the rightpolicies for the NHS (Q2a)

Agree 32 33 31 32 31

Disagree 39 37 41 39 39

The NHS service is providing a goodservice nationally (Q2b)

Agree 51 58 50 51 48

Disagree 29 26 30 28 33

My local NHS is providing me with agood service (Q2c)

Agree 67 72 67 71 70

Disagree 16 18 17 16 19

Attitudes towards NHS (Q31)

NHS is crucial to British society 78 83 79 78 74

Cant maintain NHS in current form 20 15 20 19 24

Source: MORI


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Table 3: National versus local health services versus Government policies

Q2: To what extent, if at all, do you agree or disagree with the following statements?

a. The government has the right policies for the NHS

b. The NHS is providing a good service nationally

c. My local NHS is providing me with a good service

Governmentpolicies

Good servicenationally

Good servicelocally

Base: All respondents (994) % % %

Strongly agree 4 8 21

Tend to agree 28 43 46

Neither/nor 24 17 14

Tend to disagree 26 22 11Strongly disagree 13 7 5

Dont know 6 3 3

Agree 32 51 67

Disagree 39 29 16

Net agree -7 +22 51

Source: MORI


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Table 4 Service satisfaction: overall

Q6: From your own experience, or from what you have heard, to whatextent are you satisfied or dissatisfied with the NHS?

Satisfied Dissatisfied Netsatisfied

Base: All (994) and users of inpatient(186), GP (767), outpatient (406) andA&E (221) service

% % +

Inpatient services

All 48 10 +38

Users 78 10 +68

GP services

All 82 8 +74

Users 84 8 +76

Outpatient services

All 57 13 +44

Outpatient users 71 14 +57

A&E services

All 35 25 +10

A& E users 51 33 +18

Source: MORI

Table 5 Service satisfaction - last hospital visit

Q25: Which one of these was the most recent hospital visit you have made as apatient?

Q26: Now thinking about the last time you visited an NHS hospital, overall, howsatisfied or dissatisfied were you with this last visit as a patient?

Most recent hospital visit as patient

All Inpatient Outpatient A&E

Base: All users (511)%

(80)%

(321)%

(102)%

Satisfaction with last visit (Q25)

Satisfied 81 92 85 70

Dissatisfied 13 8 11 23

Net satisfied +68 +84 +74 +47

Source: MORI


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Table 6 Satisfaction with hospital service specifics

Q8-23: Thinking now about the last time you were treated/attended hospital, to whatextent you are satisfied or dissatisfied with each of the following aspects of the NHS?

Base: All (527) and inpatient (186), outpatient(406), and A&E (221) service users Very/fairlysatisfied Fairly/verydissatisfied Net satisfied

% % +

The friendliness of staff in the hospital

All 91 4 +87

Inpatient users 92 4 +88


A&E users 88 4 +84

The quality of care provided

All 87 7 +80



A&E users 84 9 +75

The length of time staff spent with you

All 80 11 +69



A&E users 75 14 +61

The explanations that staff gave you aboutyour illness and its treatment

All 79 13 +66



A&E users 78 14 +64

How well informed you felt about decisions

made about your treatmentAll 76 14 +62



A&E users 74 17 +57


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Overall appearance and cleanliness of thehospital

All 68 22 +46


Outpatient users 70 20 +50A&E users 65 26 +39

Admission arrangements

All 75 10 +65


A&E users 68 11 +57

Discharge arrangements

All 74 10 +64

Inpatient users 78 15 +63A&E users 70 9 +61

Follow-up care

All 65 11 +54



A&E users 58 14 +44

Facilities for patients (such as shops,hairdressers, telephones, books and TV)

All 64 10 +54



A&E users 64 13 +51

Amount of choice you were given about thetype of treatment you received

All 62 12 +50


Outpatient users 60 13 +47A&E users 53 16 +37

Amount of time waiting at the hospital foran appointment/treatment

All 59 31 +28



A&E users 52 38 +14


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Hospital food


Amount of choice you had aboutwhen/where you were treated

All 57 17 +40Inpatient users 59 17 +42


A&E users 54 18 +36

Public transport to/from the hospital

All 33 18 +15



A&E users 28 19 +9Car parking

All 23 60 -37

Inpatient users 21 66 -45

Outpatient users 22 60 -38

A&E users 23 63 -40

Source: MORI


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Table 7 Importance of hospital service specifics

Q24: Which TWO things from this list are the most important to how you feel aboutthe quality of service you would expect when you are in/attend hospital [as a patient]?

Base: all (994) and all inpatient (186), outpatient (406) andA&E (221) users

All Inpatientusers

Outpatientusers

A&Eusers

% % % %

The quality of care provided 45 41 48 47

The explanations that staff gave you about yourillness and its treatment

28 27 31 28

How well informed you felt about decisions madeabout your treatment

20 23 22 22

The friendliness of staff in the hospital 17 28 16 15

Amount of time waiting at the hospital for anappointment/treatment

15 12 13 15

Overall appearance and cleanliness of the hospital 21 24 21 25

Amount of choice you were given about the type oftreatment you received

12 8 9 6

Follow-up care 7 8 9 10

The length of time staff spent with you 8 10 8 9

Amount of choice you had about when/where youwere treated

7 3 5 4

Car parking 8 8 8 9

Hospital food 4 6 4 5

Admission arrangements 2 0 2 2

Public transport to/from the hospital 3 2 1 2

Discharge arrangements 1 2 2 1

Facilities for patients (such as shops, hairdressers,telephones, books and TV)

1 2 2 1

Source: MORI


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Table 8 Service satisfaction: last visit to GP

Q30: Now thinking about the last time you visited your local doctor or GP, overall,how satisfied or dissatisfied were you with this last visit as a patient?

Base: all (994) and all users (767) Very/fairlysatisfied

Fairly/verydissatisfied

Netsatisfied

% % +

All 86 8 +78

GP users 87 8 +79

Source: MORI

Table 9 Satisfaction with GP service specifics

Q28: Thinking now about the treatment you received when you last visited a GPsurgery, to what extent were you satisfied or dissatisfied with each of the followingaspects of the surgery?

Base: all (1,031) and all users (767) Very/fairlysatisfied

Fairly/verydissatisfied

Net satisfied

% % +

Overall appearance and cleanliness of thesurgery

All 90 3 +87

GP users 92 3 +89

The quality of care provided

All 84 7 +77

GP users 86 7 +79

The friendliness of staff

All 88 4 +84

GP users 89 4 +85

The explanations that staff gave you aboutyour illness and its treatments

All 80 8 +72

GP users 82 9 +73

The length of time staff spent with you

All 81 8 +73

GP users 83 8 +75


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Facilities for patients and children

All 71 7 +64

GP users 73 7 +66

The time it took to get an appointmentAll 72 20 +52

GP users 73 19 +54

The amount of choice you had about thedate and time of your appointment

All 64 23 +41

GP users 65 24 +41

Car parking

All 49 28 +21

GP users 50 29 +21

Public transport to/from the surgery

All 32 11 +21

GP users 31 11 +20

The availability of out-of-hours care

All 23 21 +2

GP users 23 22 +1

The availability of home visits

All 23 15 +8

GP users 23 16 +7

Source: MORI


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Table 10 Importance of GP service specifics

Q29: Which TWO things from this list are the most important to how you feel aboutthe quality of services you would expect when you visit a GP surgery?

Base: all (994) and all users (767) All GP users

% %

The quality of care provided 49 49

The time it takes to get an appointment 36 36

The explanations that staff gave you about your illness and itstreatments

38 41

The amount of choice you had about the date and time of yourappointment

13 14

The length of time staff spent with you 13 13

The friendliness of staff 14 12

The availability of out-of-hours care 8 8

The availability of home visits 7 6

Overall appearance and cleanliness of the surgery 10 11

Car parking 4 4

Facilities for patients and children 4 3

Public transport to/from the surgery 1 1

Source: MORI


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Table 11 Local improvement indicators

Q3: Based on what you know or have heard about the NHS can you tell mewhether 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?

Base: all (994) and all users of inpatient (186), GP(767), outpatient (406) and A&E (221) services

A lot A lot/fairamount

A lot/fairamount/

little

No need

% % % %

Time spent waiting for an ambulance aftera 999 call

All 6 12 33 20

Inpatient users 8 13 31 30

A&E users 8 13 37 26

Quality of medical treatment in hospitals

All 6 18 59 33


Outpatient users 5 18 61 36

A&E users 4 19 64 34

Quality of nursing care in hospitals

All 6 16 51 40



A&E users 5 20 55 44

Quality of medical treatment by GPs

All 8 20 57 40

GP users 7 19 58 41

General condition of hospital buildings

All 16 35 70 25



A&E users 16 43 72 27

Cancelled operations

All 14 32 51 4



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Hospital waiting lists for non-emergencyoperations

All 27 55 75 6


Waiting time before getting appointmentswith hospital consultants

All 29 56 78 8


Length of time to get an appointment witha GP

All 18 34 62 37

GP users 16 32 59 40

Time spent waiting in A&E departmentsAll 35 56 77 7

A&E users 41 62 83 13

Information about local health services

All 11 30 62 24


GP users 11 29 63 24


A&E users 11 32 65 24Services for treating cancer

All 9 19 40 15

Services for treating heart disease

All 7 17 41 14

Ease of registering with an NHS dentist

All 49 63 75 11

Amount of choice people have about whichGP they can register with

All 15 30 53 24

GP users 14 29 53 29

Source: MORI


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Table 12 Sources of Information

Q32: Thinking about the different ways in which you hear or seeinformation about the NHS, have you heard or read anything recently from

any of these sources?

All

Base: All respondents (994) %

TV or radio 45

Leaflets or posters in GP surgeries or hospitals 43

National newspapers 39

Friends or relatives who have used NHS services 36

Local newspapers 30

Friends or relatives who work in the NHS 21

Medical professionals who work in the NHS 17

Leaflets delivered to your door 13

The Internet 9

None of these 12

Dont know 1

Source: MORI


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Table 13 Messages conveyed about the NHS

Q33: Would you say that the information that you have seen or heard from each sourcewas generally favourable or critical of the NHS?

Base: All respondents who have read or heard information from eachsource (see figures below)

Favourable Neutral Critical

Leaflets or posters in GP surgeries or hospitals (431) 73 22 2

Friends or relatives who work in the NHS (205) 41 17 37

Friends or relatives who have used NHS services (341) 39 23 32

Medical professionals who work in the NHS (165) 45 11 39

National newspapers (383) 13 19 64

Local newspapers (296) 23 21 54

TV or radio (444) 17 27 51

Leaflets delivered to your door (130) 67 23 1

The Internet (87) 39 46 7

Source: MORI

Table 14 Perceived reliability of information about the NHS

Q34: And how reliable do you think that the following [sources of information] are as

a source of information about how well the NHS is performing?

Base: all respondents (1,031) Very/fairly reliable Not very/not at allreliable

% %

Leaflets or posters in GP surgeries or hospitals 77 11

Friends or relatives who work in the NHS 60 4

Friends or relatives who have used NHS services 77 9

Medical professionals who work in the NHS 75 6

National newspapers 36 50

Local newspapers 46 38

TV or radio 54 35

Leaflets delivered to your door 45 17

The Internet 28 12

Source: MORI


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Guide to Statistical Reliability

The sample tolerances that apply to the percentage results in this report are given

in the table below. This table shows the possible variation that might beanticipated because a sample, rather than the entire population, was interviewed.As indicated, sampling tolerances vary with the size of the sample and the size ofthe percentage results.

Approximate sampling tolerances applicableto percentages at or near these levels

10% or90%

30% or70% 50%

Size of sample on which

Survey result is based

100 interviews 6 9 10200 interviews 4 6 7300 interviews 3 5 6400 interviews 3 5 5500 interviews 3 4 4600 interviews 2 4 4700 interviews 2 3 4800 interviews 2 3 4

900 interviews 2 3 3994 interviews (Winter 2004 survey) 2 3 31000 interviews (Spring 2003 survey) 2 3 31,002 interviews (Winter 2002 survey) 2 3 31,021 interviews (Winter 2001 survey) 2 3 31,031 interviews (Spring 2004 survey) 2 3 31,039 interviews (Winter 2003 survey) 2 3 31,041 interviews (Spring 2002 survey) 2 3 31,046 interviews (Spring 2000 survey) 2 3 3

Source: MORI

For example, on a question where 50% of the people in a sample of 994 respondwith a particular answer, the chances are 95 in 100 that this result would not varyby more than 3 percentage points, plus or minus, from a complete coverage ofthe entire population using the same procedures.


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Tolerances are also involved in the comparison of results from different parts ofthe sample. A difference, in other words, must be of at least a certain size to beconsidered statistically significant. The following table is a guide to the samplingtolerances applicable to comparisons.

Differences required for significance at or nearthese percentages

10% or90%

30% or70% 50%

Size of sample on which

Survey result is based

100 and 100 8 13 14100 and 200 7 11 12100 and 300 7 10 11100 and 400 7 10 11100 and 500 7 10 11200 and 200 7 10 11200 and 300 5 8 9200 and 400 5 8 9200 and 500 5 8 8300 and 300 5 7 8300 and 400 5 7 8300 and 500 4 7 7

400 and 400 4 6 7400 and 500 4 6 7500 and 500 4 6 6994 and 1,031 (Winter 2004 and Spring 2004 survey) 3 4 4

Source: MORI


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Guide to Social Classification

The table below contains a brief list of social class definitions as used by the

Institute of Practitioners in Advertising. These groups are standard on all surveyscarried out by Market & Opinion Research International (MORI) Limited.

Social Grades

Social Class Occupation of Chief Income EarnerA Upper Middle Class Higher managerial, administrative or professional

B Middle Class Intermediate managerial, administrative orprofessional

C1 Lower Middle Class Supervisor or clerical and junior managerial,

administrative or professional

C2 Skilled Working Class Skilled manual workers

D Working Class Semi and unskilled manual workers

E Those at the lowestlevels of subsistence

State pensioners, etc, with no other earnings

Source: MORI


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Sample Profile

Unweighted Weighted

N % n %Total 994 100 994 100

Gender

Male 435 44 483 49

Female 557 56 509 51

Age

16-24 94 9 134 13

25-34 136 14 197 2035-54 354 36 344 34

55-64 170 18 132 14

65+ 240 24 187 19

Social Class

AB 244 25 242 25

C1 241 24 244 25

C2 210 21 215 22

DE 298 30 293 30

Work Status

Full-time 361 36 426 43

Not full-time 633 64 568 57

Ethnicity

White 882 89 877 88

Black 58 6 49 5

Asian 44 4 55 5Mixed 3 * 5 *

Source: MORI


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Marked-up Questionnaire

Documents

NHS: zadovoljstvo korisnika