The People s Priorities

Transcription

1 Patient and Client Council The People s Priorities People s views on future priorities for Health and Social Care in Northern Ireland November 2014 Your voice in health and social care

2 Table of Contents Foreword... 4 Summary... 5 Introduction... 5 The people... 5 Key findings... 5 Conclusion... 7 Next steps Introduction Background Aims and objectives Our Approach Data collection Questionnaire Focus groups and street consultation Analysis Reporting The People Profile of questionnaire respondents Focus group participants Street consultations Overview of Findings Questionnaire Questionnaire respondents experience of using health and social care services in the last 12 months Questionnaire respondent s priorities for health and social care Focus groups and street consultations Focus groups Street consultations The People s Top 10 Priorities Priority 1: Frontline health and social care staff...23 The People s Priorities People s views on future priorities for Health and Social Care in Northern Ireland 1

3 5.1.1 More frontline staff across all health and social care services More hospital staff (particularly nursing staff) Better pay and conditions to relieve pressure on staff Priority 2: Reduce waiting times Reduce waiting times for hospital care and treatment Reduce waiting times for all health and social care services Other issues around waiting times Priority 3: Quality of care Quality of hospital care Quality of care across all health and social care services Person-centred care Diagnostic care Priority 4: Care of older people Care of older people (general) Domiciliary care for older people Residential and nursing home care for older people Priority 5: A&E services Improve delivery of A&E services A&E waiting times Access to A&E services Priority 6: Funding, management and cost-effectiveness Investment in services that need it - no more cutbacks Improve health service management More cost-effective Stop medical tourism Priority 7: GP services Priority 8: Access to a full range of health and social care services locally Priority 9: Cancer services Priority 10: Health and social care for children and young people Other priorities...42 Appendix 1 - Data collection tools Questionnaire...48 Pro forma for street consultations...49 Appendix 2 - List of venues for street consultations Comparison with previous years Conclusion Next steps...46 References The People s Priorities People s views on future priorities for Health and Social Care in Northern Ireland The People s Priorities People s views on future priorities for Health and Social Care in Northern Ireland 3

4 Foreword Previous People s Priorities reports show the strong views people have around how their health and social care services are provided. With thousands of people using the service annually, it is important to understand what people s priorities are for the service. Considering people s views and involving them in the planning, development and decisions on how health and social care services are provided is recognised as essential for providing high quality, person-centred care. This report describes the priorities of people from across Northern Ireland for a high quality Health and Social Care service. Front line staff, waiting times and quality of care are the top three priorities people have for their service, with care of older people, A&E services and considerations around how the service is funded also important issues for people. It is particularly important to take account of people s views at a time when demand is rising and funding for public services is overstretched. I would like to thank everyone who took the time to talk to us. We will take every opportunity to make sure that the voices in this report are heard by those making decisions on the future of service delivery. Summary Introduction All of us use health and social care services at some point in our lives. It is therefore important that people feel that these services are developed and delivered for them, based on their needs. Listening to the views of patients and service users has been shown to contribute to more responsive services for those that use them. Involving people in health and social care services can also lead to greater accountability, increased transparency and openness within services, improved patient safety and more democratic decision making. From the outset, the Patient and Client Council (PCC) has been active in identifying the priorities people have for health and social care. This year s People s Priorities project is timely as health and social care in Northern Ireland is undergoing changes as a result of the 2011 review of health and social care Transforming Your Care and financial constraints are impacting on how services are being provided. The aim of this study was to provide people with an opportunity to have their say on health and social care issues which affect them, and to establish people s priorities for health and social care. It is hoped that the views of the people we talked to will help inform the planning and delivery of future health and social care services. The people Maeve Hully Chief Executive A total of 3,156 people contributed their views and opinions on health and social care in Northern Ireland to this year s People s Priorities project. People took part in the project in a number of ways: 1,252 members of the public completed a questionnaire which asked respondents to identify their priorities for health and social care. Questionnaires were distributed at public events using quotas with the aim of returning a sample representative of the Northern Ireland population by age and gender; 435 members of the PCC Membership Scheme completed a questionnaire; 87 people took part in focus groups where they could discuss their priorities for and experiences of health and social care in more detail; 1,382 people voiced their priorities in a short, one-to-one street consultation with a member of PCC staff at public events across Northern Ireland. Key findings 68.8% of general population questionnaire respondents and 75.9% of PCC Membership Scheme questionnaire respondents said they had used a health and social care service in the last 12 months. The majority of general population respondents (67.5%) rated the health and social care services they used as good (38.4%) or very good (29.1%), while 9.6% rated services poor (6.2%) or very poor (3.4%). PCC Membership Scheme questionnaire respondents rated the services they had used similarly to the general population sample. 63.3% of members rated services as good (34.4%) or very good (28.9%), while 11.4% rated services as poor (8.7%) or very poor (2.7%). The key question put to everyone who took part in The People s Priorities 2014 project was; If you were the health minister, what would be your top priority for health and social care? 4 The People s Priorities People s views on future priorities for Health and Social Care in Northern Ireland The People s Priorities People s views on future priorities for Health and Social Care in Northern Ireland 5

5 Frontline health and social care staff was the priority most frequently identified by both general population and PCC Membership Scheme questionnaire respondents. There were some differences in the order of priorities identified by the two sets of questionnaire respondents however. For instance, the second priority most commonly mentioned by general population respondents was waiting times, whereas for PCC Membership Scheme respondents it was care of older people, (see Table i.1) Table i.1: Top 10 priorities identified by general population questionnaire respondents and Membership Scheme questionnaire respondents 1 Top 10 priorities: general population (n=1080) Frontline health and social care staff (17.1%) Top 10 priorities: Membership Scheme (n=385) Frontline health and social care staff (22.3%) 2 Waiting times (13.9%) Care of older people (18.2%) 3 Quality of care (13.5%) Quality of care (13.2%) 4 Care of older people (12.1%) Waiting times (11.9%) 5 A&E services (10.6%) A&E services (9.6%) 6 Funding, management, and costeffectiveness (10.2%) 7 GP services (7.0%) Funding, management, and costeffectiveness (9.4%) Access to a full range of health and social care services locally (6.2%) 8 Access to a full range of health and social care services locally (6.8%) GP services (5.2%) 9 Cancer services (4.4%) Mental health services (3.4%) 10 Health and social care services for children and young people (4.0%) Health promotion / public health (3.1%) The overall top ten priority order presented below is based on findings from the general population sample, as these findings are most reflective of people from across Northern Ireland. However, similar themes and issues were noted across all fieldwork exercises and among each of the groups of people that we talked to. Priority 1: Frontline health and social care staff This was the most frequently identified priority among all questionnaire respondents, both general population and PCC membership scheme respondents. It was also a key issue in focus groups and street consultations. People were concerned about staffing levels across all services, but particularly hospital services. The key message was for more investment in frontline staff, to ensure safer delivery of services, less waiting time and better quality of care. Priority 2: Waiting times People expressed concern about the time patients and service users have to wait before getting access to treatment and care. Long waits for hospital appointments after being referred by a GP were of particular concern. The main issue for people was that the health and well-being of some patients could be put at risk because they have to wait so long to access services. Priority 3: Quality of care The importance of good care was a key priority across questionnaires, focus groups and street consultations. People identified a range of concerns around quality of care, such as nursing care, patient safety, hospital cleanliness, treatment, diagnosis, staff training and communication. The impact of staffing levels and waiting times on quality of care was an issue for many participants. Priority 4: Care of older people Many people thought that older people in society should be considered a priority when it comes to health and social care. Their priority would be to create a health service that people can have confidence in as they grow older and that helps older people to live as full and independent lives as possible. This includes improved domiciliary care and residential care provision. Priority 5: A&E services The three key issues for people who prioritised A&E services were; waiting times when attending an A&E department, access to A&E units at local hospitals, and the overall delivery and management of A&E services. Many people were concerned that existing A&E services do not have the resources to cope with demand. Priority 6: Funding, management and cost-effectiveness The key issues for people within this priority were to ensure that there is investment in those services most in need of funds and that services are managed efficiently and delivered in the most cost-effective way. Priority 7: GP services Access to GP services was the main issue for those who made this their top priority, particularly waiting time for an appointment, the appointment booking system, and opening hours. Some people suggested that GPs should spend more time with patients and that GP surgeries should offer a fuller range of services to relieve pressure on hospital and A&E departments. Priority 8: Access to a full range of health and social care services locally The key issue for most people who prioritised access to services more generally was to ensure that there was good access to local services across Northern Ireland. Priority 9: Cancer services People who identified cancer services as a top priority were concerned about diagnosis, treatment and care of cancer, as well as access to cancer treatments, screening, aftercare, counselling, and working with cancer charities and voluntary organisations. Priority 10: Health and social care services for children and young people People noted concerns about young people s health care such as child cardiac services, hospital care, disability services, and childhood obesity, as well as social care services for children and young people. Conclusion The priorities that people have for health and social care are informed in a number of ways: personal experience, the experiences of someone we know, what we have read, or what we have heard from friends, neighbours or reports in the media. This was evident throughout this project as some people gave detailed, at times emotional, explanations for their priorities based on personal experiences, while others took a more detached approach, basing their responses on the wider issues affecting health and social care such as staffing levels, waiting times and access. Despite these different approaches there is consistency in the overall priorities for health and social care 6 The People s Priorities People s views on future priorities for Health and Social Care in Northern Ireland The People s Priorities People s views on future priorities for Health and Social Care in Northern Ireland 7

6 chosen by the people who contributed to this project. People want accessible services which provide timely and quality care, delivered by well-trained and supportive staff who are employed in sufficient numbers. It is evident across the top priorities that quality of care is of utmost importance to people. Support for vulnerable groups, such as older people, and an increased emphasis on cancer services continue to be important to people. Issues around the cost and management of services in a challenging financial environment were raised more often this year than in previous reports. Next steps The Patient and Client Council will review in detail all the priorities, issues, and concerns that people talked to us about in this study and will seek to reflect these in its 2015/16 work plan. Previous People s Priorities reports have been influential documents, used by commissioners and providers of services to shape their planning and commissioning priorities. The Patient and Client Council will work to ensure that this continues to be the case for this year s People s Priorities report. 1.0 Introduction 1.1 Background All of us use health and social care services at some point in our lives. It is therefore important that people feel that these services are developed and delivered for them, based on their needs. Listening to the views of patients and service users has been shown to contribute to more responsive services for those that use them. There can be other benefits to involving people in health and social care services including greater accountability, increased transparency and openness within services, improved patient safety, and more democratic decision making. 1,2,3,4,5 In Northern Ireland, the importance of consulting with the public on Health and Social Care is reflected in the Health and Social Care (Reform) Act (NI) 2009 which placed a statutory duty of public involvement and consultation on all health and social care organisations and gave the Patient and Client Council (PCC) a key role in promoting consultation and involvement with patients, clients and the public. From the outset, the PCC has been active in identifying the priorities people have for health and social care. In 2009, the PCC carried out a consultation exercise with members of the public to inform the Department of Health, Social Services, and Public Safety (DHSSPS) Priorities for Action 2010/11. The report on public engagement on Priorities for Action included the recommendation that the process of engaging with the public in the setting of priorities should be further developed by the PCC in 2010 and beyond. 6 Since then a series of dedicated People s Priorities projects to gather the views of the public on their health and social care priorities have been undertaken. People have contributed to these projects in a variety of ways, such as surveys, street consultations, focus group discussions and interviews. Previous People s Priorities projects have consistently raised particular themes in relation to priorities for health and social care. These can be summarised as, the importance of quality of care, access to services, support for vulnerable groups, staffing levels, good communication and increased emphasis on specific services such as cancer services. 7,8,9,10 It is particularly important to take account of people s views at a time when health and social care in Northern Ireland is undergoing changes. In December 2011, the DHSSPS published a review of Health and Social Care in Northern Ireland, Transforming your care, which outlined recommendations for the future provision of services in Northern Ireland and provided a plan for their implementation. 11 Prior to this study, the most recent PCC People s Priorities project focused specifically on the proposals made in Transforming Your Care. People s Priorities for Transforming Your Care (2012) reviews the priorities, views, and experiences expressed to the PCC by patients, service users, and members of the public over three years and considers these views within the context of the changes proposed in Transforming Your Care. The report concluded that people do want to see changes in the way that services are delivered in Northern Ireland and that they agree with the underlying principles of Transforming Your Care, such as placing the individual at the centre of any model of care and providing the right care, in the right place, at the right time. 9 Monitoring people s priorities for health and social care continues to be important as the changes 8 The People s Priorities People s views on future priorities for Health and Social Care in Northern Ireland The People s Priorities People s views on future priorities for Health and Social Care in Northern Ireland 9

7 proposed in Transforming Your Care are being implemented and at a time when financial constraints are impacting on how services are being provided. This project is therefore timely and it is hoped that the views of the people we talked to will help inform the planning and delivery of future health and social care services. 2.0 Our Approach 2.1 Data collection 1.2 Aims and objectives Our approach to this year s People s Priorities study was to use both quantitative and qualitative The aim of this study was to provide people with an opportunity to have their say on health and methods to gather people s views and opinions on health and social care (see Figure 2.1). social care issues which affect them, and to establish people s priorities for health and social care. Figure 2.1: What we did The specific objectives of this project were as follows; Questionnaire - general population Establish people s recent experience of using health and social care services and their Questionnaires were distributed at public venues using quotas with the aim of returning a sample satisfaction with using these services; representative of the general population by gender To identify the particular priorities that different groups of people have for their health and and age social care services; To explore the motivations people have when giving their views on what health and social care priorities should be; To compare the priorities identified by people in this study with the findings of previous People s Priorities projects in 2010 and 2011, to see if these priorities have changed; and Ensure that the findings of this project influence the commissioning of future services, based on what people say they need from their Health and Social Care service. Quantitative Qualitative Questionnaire - Membership Scheme Questionnaires were distributed to members via the {PCC Membership Scheme Focus groups Focus groups were conducted so that participants could discuss their priorities for and experiences of health and social care services in more detail Street consultations Short, one-to-one consultations with members of the public were carried out by PPI officers at public events {across Northern Ireland Questionnaire A questionnaire was developed, the focus of which, similar to previous People s Priorities studies, was an open-ended question asking the respondent to state their top priority for health and social care. The questionnaire was distributed to two groups; the general public and the PCC Membership Scheme. In order to target the general population, PCC Personal and Public Involvement (PPI) officers undertook fieldwork across Northern Ireland, via face to face interviews to guide people through questionnaire completion. The fieldwork team was provided with quotas representative of the Northern Ireland population by age and gender based on NISRA mid-year estimates, in order to achieve a sample reflective of the views of the Northern Ireland population as a whole. 10 The People s Priorities People s views on future priorities for Health and Social Care in Northern Ireland The People s Priorities People s views on future priorities for Health and Social Care in Northern Ireland 11

8 The questionnaire was also distributed through the PCC Membership Scheme in order to find out what priorities our members have for health and social care. The questionnaire was distributed to PCC Membership Scheme members online and via hard copy postal return Focus groups and street consultation A number of focus groups facilitated by PCC staff were held across Northern Ireland. In the focus groups, participants had the opportunity to discuss their priorities for health and social care in more detail and to talk about the reasons behind their responses. The key questions put to focus group participants were similar to those used in the questionnaire and street consultations, namely to identify their priorities for health and social care. However in focus group discussions PCC staff were able to use additional prompting questions in order to understand the reasons behind the particular responses participants gave. Some focus groups were specifically targeted at people with specific issues or concerns, whose views might not always be reflected in traditional surveys, such as a disability group, a transgender group and an ethnic minority group. The main findings section includes discussion of the top ten priorities for health and social care identified by the people who contributed to this study and a summary of other priorities emerging from the people we talked to. The top ten priority order and associated statistics discussed in this section of the report are based on the findings from our general population questionnaire sample unless otherwise stated, in order to present findings most reflective of people from across Northern Ireland. As similar themes and issues were recorded across all fieldwork exercises, (questionnaires, focus groups and street consultations) quotations and discussions on issues and concerns that people raised are from the full range of data collection sources. A comparison of people priorities in 2014 with previous findings (people s priorities in 2010 and 2011) can be found in Section 6.0 (p45) and study conclusions can be found in Section 7.0 (p46) of this report. Percentages presented in this report may not add up to 100% due to rounding. In addition, at events across Northern Ireland staff asked members of the public about their priorities for health and social care in short, one-to-one street consultations. Staff talked to participants about their priorities and asked them to suggest one thing they would change to improve people s experience of health and social care services. A pro forma was used to record people s views during these conversations. All fieldwork took place between January and August Analysis Qualitative data was analysed thematically. The data returned from focus groups and street consultations was examined to identify the key issues and concerns voiced by participants. As some focus groups were targeted at people with specific issues or concerns, any issues and priorities specific to that group were noted in addition to the broader themes emerging from discussions. In addition to thematic analysis, data collection from street consultations was used to assist in the development of coding frames for quantitative (questionnaire) data analysis. Analysis of questionnaire data included frequency analysis of data to provide an overview of trends and cross tabulations were calculated to understand patterns and differences by groups about people s priorities for health and social care. Coding was used to organise responses to the central, open-ended survey question. 2.3 Reporting This report outlines the priorities for health and social care of more than 3,000 people who took part in this study across Northern Ireland. The People section of this report (Section 3, p13) outlines how many people were involved in each data collection exercise. The findings sections of this report (Section 4.0 Overview of Findings, p17, Section 5.0 The People s Top Priorities, p23) begins with an overview of key questionnaire findings, including whether or not respondents had used services in the past 12 months, how respondents rated the services they used, and the top priorities for health and social care identified by questionnaire respondents. A brief overview of the key themes emerging from focus group discussions and street consultations is also included. 12 The People s Priorities People s views on future priorities for Health and Social Care in Northern Ireland The People s Priorities People s views on future priorities for Health and Social Care in Northern Ireland 13

9 3.0 The People A total of 3,156 people contributed their views and opinions on health and social care in Northern Ireland to this year s People s Priorities project. People took part in the project in a number of ways: 1,252 people completed a questionnaire across Northern Ireland (based on total weighted cases); 435 members of the PCC Membership Scheme returned a questionnaire; 87 people discussed their priorities in a focus group; 1,382 people voiced their priorities in an on-street consultation. 3.1 Profile of questionnaire respondents 1,252 members of the public completed a questionnaire at venues across Northern Ireland. The fieldwork team were provided with quotas representative of the Northern Ireland population by age and gender based on NISRA mid-year estimates (2012). However, a weighting correction was applied as some of the questionnaires collected were outside of quota targets *. See Table 3.1 for a summary of achieved sample and weighted sample by NISRA mid-year population estimate. Table 3.2: Membership Scheme questionnaire sample Demographic Group Achieved Sample % n Gender Male Female Age Group TOTAL 100.0% 435 Demographic Group Table 3.1: General population questionnaire sample NISRA Mid-Year Achieved Sample Weighted Sample Estimates (2012) % n % n % n 3.2 Focus group participants A total of 87 people took part in a focus group. Table 3.3 provides details of the focus groups. Table 3.3: Focus groups Gender Male Female Age Group TOTAL 100.0% % % 1252 Type of group No. of participants Ethnic mother s group 6 Eating Disorders NI carers support group 6 Professional and retired women s group 10 Sure Start group 9 Cardio support group 11 Transgender group 6 Disability group 18 Further Education group 12 ME and Fibromyalgia support group 6 PCC Membership Scheme group 3 TOTAL 87 The questionnaire was also distributed via the PCC Membership Scheme. A total of 435 members returned a questionnaire (70 completed a questionnaire online, 365 were paper returns). As Table 3.2 shows, the majority of members who responded were female (76.3%, n=332) and almost half of respondents were aged over 65 (49.2%, n=214). * Some questionnaires collected during fieldwork fell outside of quota targets and a weighting correction was applied so that the achieved sample represented the general population by age and gender. The discrepancy between the quota targets and achieved sample was largely due to the lag in time between achievement of targets and figures being recorded prior to hard copy questionnaires being returned. In addition, Personal and Public Involvement officers were briefed not to exclude anyone who expressed an interest in taking part in our study. 14 The People s Priorities People s views on future priorities for Health and Social Care in Northern Ireland The People s Priorities People s views on future priorities for Health and Social Care in Northern Ireland 15

10 3.3 Street consultations A total of 1,382 people took part in a short street consultation with a member of PCC staff. Table 3.4 gives a breakdown of participants by gender and age. Table 3.4: Street consultation participants Demographic Group Participants % n Gender Male Female No gender given Age Group No age given TOTAL 100.0% Overview of Findings 4.1 Questionnaire Questionnaire respondents experience of using health and social care services in the last 12 months 68.8% (n=858) of general population questionnaire respondents said they had used a health and social care service in the last 12 months. As Figure 4.1 shows, women were more likely to have used health and social care services in the last 12 months in comparison with men; 78.2% (n=503) of women said they had used a service compared with 58.7% (n=355) of men. Those aged over 65 years were most likely to have used a health and social care service in the last 12 months in comparison with other age groups. No 31.2% Figure 4.1: Have you used health and social care services in the last 12 months? Yes 68.8% % who used health and social care services in the last 12 months by demographic group Male 58.7% Female 78.2% Over % 60.7% 63.9% 73.1% 76.3% 80.5% Base: 1,248 general population (weighted) Percentage of respondents (%) The majority of respondents (67.5%, n=579) rated the health and social care services they used as good (38.4%, n=329) or very good (29.1%, n=250). 9.6% (n=82) of respondents rated services poor (6.2%, n=53) or very poor (3.4%, n=29). The remaining 22.9% (n=196) of people described services as average. See Figure 4.2 overleaf. 16 The People s Priorities People s views on future priorities for Health and Social Care in Northern Ireland The People s Priorities People s views on future priorities for Health and Social Care in Northern Ireland 17

11 Figure 4.2: How would you rate the health and social care services you have received in the last 12 months? General population respondents Figure 4.4: How would you rate the health and social care services you have received in the last 12 months? Membership Scheme respondents Percentage of respondents (%) % 6.2% 22.9% 38.4% 29.1% Very Poor Poor Average Good Very Good Base: 858 general population (weighted, those who have used HSC services in previous 12 months) Percentgage of respondents (%) % 28.9% 25.3% 8.7% 2.7% Very Poor Poor Average Good Very Good There was little difference between how male and female respondents rated health and social care services, however there was some variation by age group. Respondents aged over 65 years were most satisfied with the services they used, while, year olds and year olds, were least satisfied with services. For example, as Figure 4.3 shows, 79.8% (n=150) people aged over 65 years rated services as good or very good, compared with 56.9% (n=91) of year olds and 60.5% (n=83) of year olds. Figure 4.3: Percentage of respondents who rated services good or very good by demographic group Male Female 67.6% 67.5% Base: 332 Membership Scheme respondents (those who have used health and social care services in the past 12 months) Questionnaire respondent s priorities for health and social care The key question put to everyone who took part in The People s Priorities 2014 project was: If you were the health minister, what would be your top priority for health and social care? Over % 68.2% 60.5% 56.9% 69.5% 79.8% Percentage of respondents (%) Base: 858 general population (weighted, those who have used HSC services in previous 12 months) The majority of PCC Membership Scheme questionnaire respondents (75.9%, n=330) had also used a health and social care service in the last 12 months. Members rated the services they had used similarly to the general population sample. As Figure 4.4 shows, 63.3% of members rated services as good (34.4%, n=114) or very good (28.9%, n=96) and 11.4% rated services as poor (8.7%, n=29) or very poor (2.7%, n=9). A quarter of members (25.3%, n=84) rated the services they used as average. Figure 4.5 shows the full list of priorities identified by questionnaire respondents. 18 The People s Priorities People s views on future priorities for Health and Social Care in Northern Ireland The People s Priorities People s views on future priorities for Health and Social Care in Northern Ireland 19

12 Figure 4.5: If you were the health minister, what would be your top priority for health and social care in Northern Ireland? Frontline health and social care staffhealth Support Promotion / Other* Waiting for carers timespublic health Disability services 17.1% Mental health services 13.9% 11.9% Health and social care 22.3% services for children and young people Cancer services Membership Scheme 6.5 Quality of care % % General population % Care of older people 18.2% A&E services Funding, management and cost-effectiveness GP services Access to a full range of health and social care services locally Cancer services Health and social care services for children and young people Mental health services Disability services Health Promotion / public health Support for carers Other* 4.4% 2.9% 4.0% 2.6% 3.7% 3.4% 1.6% 2.9% 1.3% 3.1% 1.0% 2.6% 7.0% 5.2% 6.8% 6.2% 4.4% 6.5% 10.6% 9.6% 10.2% 9.4% Percentage of respondents (%) General population Base = 1080 (weighted) Acce rang soci loca Membership Scheme Base = 385 (Multiple response, percentages based on total responses) * Other includes community services, emergency services, to lift the ban of blood donation by gay men, to prioritise the treatment and care of a specific condition (other than cancer), end of life care, new technology, organ donation, occupational therapy, physiotherapy, and dental care. As can be seen in Figure 4.5, the top priority most frequently identified by both the general population and membership scheme respondents was frontline health and social care staff. However, there were some differences in the top 10 priorities identified by general population respondents in comparison with PCC membership scheme respondents. For instance, the second priority most commonly mentioned by general population respondents was waiting times, whereas for PCC membership scheme respondents it was care of older people. See Table 4.1 overleaf. Table 4.1: Top 10 priorities identified by general population questionnaire respondents and membership scheme questionnaire respondents 1 Top 10 priorities: general population (n=1080) Frontline health and social care staff (17.1%) Top 10 priorities: Membership Scheme (n=385) Frontline health and social care staff (22.3%) 2 Waiting times (13.9%) Care of older people (18.2%) 3 Quality of care (13.5%) Quality of care (13.2%) 4 Care of older people (12.1%) Waiting times (11.9%) 5 A&E services (10.6%) A&E services (9.6%) 6 Funding, management, and costeffectiveness (10.2%) 7 GP services (7.0%) Funding, management, and costeffectiveness (9.4%) Access to a full range of health and social care services locally (6.2%) 8 Access to a full range of health and social care services locally (6.8%) GP services (5.2%) 9 Cancer services (4.4%) Mental health services (3.4%) 10 Health and social care services for children and young people (4.0%) 4.2 Focus groups and street consultations Health promotion / public health (3.1%) The following section provides a brief overview of the main themes that emerged from focus group discussions and street consultations with members of the public Focus groups In general, the key themes of the focus groups were similar to the top priorities identified by questionnaire respondents. Focus group participants were clearly concerned about staffing levels across health and social care services, particularly the perceived impact of staff shortages on waiting times and quality of care. Many participants shared experiences of lengthy waits to access services or poor experiences of treatment or care which they often felt was down to lack of staff. The importance of GP services, as the only or most frequently used service for many participants, was also apparent in focus group discussions. The different approaches that people take when asked to define their priorities for health and social care were very much evident within focus groups discussions. Some people explained or justified their choice of priority by describing a personal experience, particularly when prioritising areas such as quality of hospital care, mental health services, A&E or primary care services. Other participants took a more detached approach as they spoke about more wide-ranging issues affecting health and social care services as a whole, such as funding, investment, organisation and decision-making, waiting times or staff concerns. While the broader issues discussed by participants were similar across all groups, some focus groups were targeted at groups with particular interests or concerns, or support groups for particular illnesses or conditions. In addition to discussing their wider priorities, these groups talked about more specific health and social care issues that affected them. For example, members of a support 20 The People s Priorities People s views on future priorities for Health and Social Care in Northern Ireland The People s Priorities People s views on future priorities for Health and Social Care in Northern Ireland 21

13 group for people with Fibromyalgia and ME were particularly concerned about diagnosis and the lack of specialist level care for these conditions in Northern Ireland; a group of carers for people with eating disorders saw mental health services as a key priority, particularly specialist services for the people that they care for; and a transgender group talked about the detrimental impact of long waiting times between first seeking advice and support from the GP and being referred for specialist care and support. The views, opinions, and personal experiences of focus group participants are reflected in the quotations used throughout the main findings section of this report Street consultations The response from 1,382 people who took part in street consultations supported questionnaire findings. The most frequently voiced priorities were to employ more frontline staff across all services, to reduce waiting times for health and social care services, to improve the quality of care given to patients and services users, particularly inpatient hospital care and to provide better care for older people. A&E services and GP services were also high on participants list of priorities. Typical issues or concerns that people talked about in relation to these services included better access, less waiting time, and better organisation and use of resources for both services. Other priorities frequently identified in street consultations were access to local services, mental health services, cancer treatment and care, health and social care services for children and young people, and health promotion and education on preventing illness. Once participants had given their top priority for health and social care, they were asked if they could identify one thing they would change to improve health and social care in Northern Ireland. Access to GP services and waiting times across health and social care services were the most frequently mentioned areas in which participants would like to see change. Participants suggested that better access to the GP, who was often people s first point of contact with services, and a more responsive health and social care system that provided quicker access to treatment and care, would greatly improve people s experience of health and social care. As with the focus groups, the different approaches participants took to answering these questions was noticeable during street consultations. Some people gave detailed, and at times emotional, responses which were clearly drawn from personal experience. Other participants based their response on their perceptions of health and social care services, sometimes as a result of the experiences of someone they knew, something they had read, or media reports. These responses were usually less personal and more likely to relate to issues such as funding, management, staffing levels, or a wider service issue within, for instance Accident and Emergency or GP services. However, despite these different approaches in considering priorities, there was consistency in findings across each data collection exercise. The views expressed by street consultation participants are reflected in the quotations used throughout the main findings section of this report. 5.0 The People s Top 10 Priorities The top 10 priorities for health and social care identified by questionnaire respondents were: Priority 1: Priority 2: Priority 3: Priority 4: Priority 5: Priority 6: Priority 7: Priority 8: Priority 9: Priority 10: Frontline health and social care staff Waiting times Quality of care Care of older people A&E services Funding, management, and cost-effectiveness GP services Access to a full range of health and social care services locally Cancer services Health and social care for children and young people 5.1 Priority 1: Frontline health and social care staff Questionnaire respondents noted that their top priority was frontline health and social care staff (17.1% of general population respondents [n=185] and 22.3% of membership scheme respondents [n=86]). Frontline health and social care staff was the most frequent priority identified by both males and females and by each of the different age groups. There were several key themes within this priority: More frontline staff across all health and social care services More hospital staff (particularly nurses) Better pay and conditions to relieve pressure on frontline staff Figure 5.1: Key issues within the Frontline health and social care staff priority Better pay More hosp More frontline staff across all health and social care services More 9.7 frontline staff 31.9across 58.4 all health and social care services More hospital staff Better pay and conditions to relieve pressure on staff 9.7% 7.0% 20.9% 31.9% 58.4% 72.1% General population Base = 185 (weighted) Membership Scheme Base = Percentage of respondents (%) Based on an achieved sample (weighted) of the Northern Ireland general adult population, n=1, The People s Priorities People s views on future priorities for Health and Social Care in Northern Ireland The People s Priorities People s views on future priorities for Health and Social Care in Northern Ireland 23

14 5.1.1 More frontline staff across all health and social care services People were clearly concerned about staffing levels across all health and social care services and facilities. As Figure 5.1 shows, more than half of respondents in the general population (58.4%) and nearly three quarters of membership scheme respondents (72.1%) who identified health and social care staff as their top priority were not specific about which services needed more staff poor staffing levels were perceived to be a problem across health and social care. Comments provided within questionnaires and across focus group discussions and street consultations included concerns about needing more frontline staff, medical staff, and doctors and nurses across all services. Some people added that an increase in the number of staff should improve the quality of care patients received and reduce long waiting times for services. Increase staffing levels to enable better care to patients and reduce waiting times. Female questionnaire respondent, years old More frontline staff in hospitals and community (e.g. nurses, physios etc.) otherwise Transforming Your Care will not work. Female questionnaire respondent, years old I would definitely improve the number of staff, particularly nursing staff, but medical staff certainly. So more frontline staff. Can I add another thing? Paid more. Female focus group participant, age not given For many of those who prioritised health and social care staffing levels, the key issue was to see more resources and funding going into frontline staffing and less spending on managerial and administrative staff. Reduce top heavy management and invest more money in frontline and community care staff. Female questionnaire respondent, years old More hospital staff (particularly nursing staff) More frontline staff in all departments less managers and backroom!! Male questionnaire respondent, years old Almost a third of general population respondents (31.9%, [20.9% of membership scheme respondents]) specified more hospital staff, mainly nursing staff, as their concern within the health and social care staff priority. People were concerned that hospitals do not have enough nursing and medical staff to cope with demands on the service, particularly inpatient wards and Accident and Emergency units. Making sure there are enough nurses and doctors in hospitals for each shift. No more 11 hours on a trolley. Male questionnaire respondent, 65 years old or over Employ more nursing and midwifery staff more staff to cope with the demands of hospital care. Female questionnaire respondent, years old Some people were concerned that understaffed hospital wards could lead to poorer quality of hospital care for patients. Three focus group participants talked in detail about recent hospital experiences when they felt that a lack of staff on the hospital ward impacted on the care and attention they, or their family member, received. I found when my husband was in hospital, in the evening, staff had no time to do anything other than write up their notes. Then at 8pm there was handover between staff, then at 9pm, they come out on the ward and it could ve been 10.30pm- 11pm before you got taken to the toilet or medication. I think that handover business is just added pressure because of the lack of staff. I found it very frustrating and told my husband, if he needed anything to ask before 7pm, otherwise you wouldn t get it before 11pm! Female focus group participant, 65 years old or over I had an experience three years ago in [hospital] after my head injury. The place was just crazy. The nurses were just under a lot of pressure Even in physio it was one person straight in after the next and I never felt I was getting the support I needed. Male focus group participant, years old Maternity services need some money spent on them. There is no point in having the community midwife tell you about all these great things when the reality is that wards are understaffed and you can t avail of them when you get there. Or in my case, you don t get there because they send you home It s not a safe healthcare system we have when they send you home to give birth on your kitchen floor because they don t have enough staff on the labour ward to look after you. Female focus group participant, years old 24 The People s Priorities People s views on future priorities for Health and Social Care in Northern Ireland The People s Priorities People s views on future priorities for Health and Social Care in Northern Ireland 25

15 5.1.3 Better pay and conditions to relieve pressure on staff A few respondents (9.7% of general population respondents, 7.0% of membership scheme respondents, based on those who indicated frontline health and social care staff as their top priority) suggested that existing frontline staff do not get rewarded adequately and should be offered better pay and conditions to relieve the pressure they are currently working under. And there is this thing now that the nurses do a 12 hour shift and if you were driving a lorry you are only allowed to do 8 hours; how is a nurse supposed to be fit to do 12 hours? Male focus group participant, 65 years old or over 5.2 Priority 2: Reduce waiting times The second most common priority identified by questionnaire respondents was to reduce waiting times for health and social care. 13.9% of general population respondents (n=150) and 11.9% of membership scheme respondents (n=46) indicated that waiting times would be their top priority. The key issues for people around waiting times were: Reduce waiting times for hospital care and treatment Reduce waiting times for all health and social care services Other* Figure 5.2: Key issues within the Reduce waiting times priority Reduce wa Reduce waiting times for hospital care and treatment Reduce 8.7 waiting times 32.6 for hospital 58.7 care and treatment Reduce waiting times for all health and social care services Other* Improving the facilities and terms and conditions for staff and support for staff. Male questionnaire respondent, 65 years old or over 7.3% 8.7% Increase nurses on the ground in all nursing departments to manage workload and reduce stress levels amongst staff. 38.0% 32.6% Female street consultation participant, years old 54.7% 58.7% Percentage of respondents (%) General population Base = 150 (weighted) Membership Scheme Base = Reduce waiting times for hospital care and treatment Just over half of both general population respondents (54.7%) and membership scheme respondents (58.7%) who identified reduction in waiting times as their top priority were referring to waiting times for hospital care and treatment. Many people questioned the amount of time patients had to wait between being referred by their GP to receiving a hospital appointment. Some respondents however simply stated that waiting lists more generally would be at the top of their list of priorities. I m waiting over a year for a rheumatology appointment for my son, first it was six months then I rang and they told me it would be another few months and now they are telling me it might take another six months. Surely that can t be right, to have to wait that long? Female focus group participant, years old Waiting times wait so long for hospital appointments your condition ends up getting worse and costing the health service more in the end. Male street consultation participant, years old Reduce waiting times for appointments to hospital you could have something serious but by the time you get there you could be dead. Male questionnaire respondent, years old A few people were concerned that a patient who could afford to pay for a private consultation could see a specialist within 24 hours, while patients using Health and Social Care services waited months for the same appointment. One focus group participant discussed his experiences of paying privately to reduce the waiting time to see a consultant, in what he referred to as a two-tiered system. My GP said that it was going to be probably a year before I was seen by a consultant and then a year and a half after that before I got the operation so I contacted a [private] clinic and it cost me 180 but I was taken the same day that I phoned. I thought, you know, a year down to the same day. 2 years [wait] you could say down to 6 months because you paid to see the consultant. It s not right. Male focus group participant, years Reduce waiting times for all health and social care services Many people (38.0% general population respondents, 32.6% membership scheme respondents, based on all those who indicated that waiting times was their top priority) felt that long waiting times were an issue across all health and social care services, not just hospital services. Their concerns were similar to those respondents who singled out waiting times for hospital care; that people s health and wellbeing could be put at risk because they have to wait so long to access services. * Other includes: waiting time for surgery specifically, time spent waiting when attending an appointment, and waiting time for access to services in the community. 26 The People s Priorities People s views on future priorities for Health and Social Care in Northern Ireland The People s Priorities People s views on future priorities for Health and Social Care in Northern Ireland 27

16 Improving ALL NHS services, especially long waiting lists and waiting times in A&E departments. Female questionnaire respondent, membership scheme member, years old A few people in discussions suggested that more honest and accurate information about the length of time people should expect to wait for appointments or access to services would be helpful in managing concerns and frustrations around waiting times. There needs to be honesty when dealing with patients and waiting times. Female focus group participant, years old Other issues around waiting times Accurate information on waiting times, published online so you know to expect a date in say 3 months. [I was] told 6 months, 2 years later still waiting. Female street consultation participant, years old Within the waiting lists priority, a small number of people identified other specific issues around waiting times (7.3% of general population respondents, 8.7% of membership scheme respondents, based on all those who indicated that waiting times was their top priority). For example, a few people were clear that their top priority would be waiting lists or waiting time for surgery, rather than hospital appointments more generally. The length of time patients spend in the waiting area when attending an appointment and long waits to access services in the community were also mentioned by respondents. These issues were also discussed in street consultations. Reduce the waiting times for operations. Better management of the waiting lists, to make sure those most in need are prioritised. Female street consultation participant, years old Keep up with the times delays at appointments. Female questionnaire respondent, years old Shorter waiting times for all services. Female questionnaire respondent, 65 years old or over Quicker turnover times to access services in the community (referrals). Female questionnaire respondent, years old A participant in a focus group for transgendered people and their families spoke of specific issues with waiting times that can affect transgendered people seeking help and advice from health and social care services. The issues this participant raised however, reflects the experiences of many people who talked about lengthy waiting times for referrals from GP services to hospital or community services. In relation to transgendered issues the big complaint we are hearing is the length of time they have to wait for an appointment. A year is the minimum wait for an appointment. Then when you get your appointment in the relevant place you have to wait a further 6 months for your next one. People who decide to come out as transgendered to their GP, it is a last resort. They are not in the position to wait a year and a half before anyone speaks to them about their issues. Focus group participant, transgender group 5.3 Priority 3: Quality of care 13.5% (n=146) of general population respondents and 13.2% (n=51) of membership scheme respondents said that improving quality of care would be their top priority. People had many different concerns around quality of care, but the key issues they identified were: Quality of hospital care Quality of care across all health and social care services Person-centred care Diagnostic care Figure 5.3: Key issues within the Quality of care priority agnostic Person-cenQuality of cquality of hospital care Quality of hospital care Quality of care across all health and social care services Person-centred care Diagnostic care 6.8% 13.7% 17.6% 15.7% 31.4% 33.6% 35.3% 45.9% Percentage of respondents (%) General population Base = 146 (weighted) Membership Scheme Base = 51 There were some notable variations in the types of respondents who prioritised quality of care by demographic group. For example, women were more likely to say that quality of care would be their top priority than men, (15.9% of female respondents in comparison with 11.0% of male respondents). Respondents from the youngest age group, year olds, were more likely to prioritise quality of care than older respondents; 23.5% of year olds identified quality of care as their top priority compared to 10.2% of year olds, 13.0% of year olds, 11.8% of year olds, 12.2% of year olds and 12.5% of 65 year olds or over Quality of hospital care Specific issues with quality of hospital care was singled out by 45.9% of general population respondents and 31.4% of membership scheme respondents who indicated quality of care as their top priority, (see Figure 5.3). People noted a range of concerns with hospital care, from the standard of nursing care and hospital cleanliness, to poor treatment and lack of efficiency on hospital wards. Cleaner hospitals and more caring nurses. Female questionnaire respondent, years old They haven t got time anymore (in hospital), just shove you out as quickly as you can. Female focus group participant, years old Some people felt that the quality of nursing care in hospital could be improved with more hands on practical care from nursing staff. 28 The People s Priorities People s views on future priorities for Health and Social Care in Northern Ireland The People s Priorities People s views on future priorities for Health and Social Care in Northern Ireland 29

17 To ensure more real care from nurses. Female questionnaire respondent, years old I was personally in hospital recently myself and I asked a nurse to help me to the toilet, she said, I don t do toilets, I m doing a degree. So I said to her, well it s not in caring dear. Female focus group participant, age not given One focus group participant talked about a personal experience of hospital care when she felt that the most basic and essential care, such as assistance with eating, was lacking. When I was in [hospital] they called me by the wrong name from when I went in until I went out My husband kept telling them you ve got the wrong name up there, that s not her name, her name is and they never changed it. And the care in [hospital] was just ridiculous. You would have thought with someone with complete memory loss they would at least help you. They just set my breakfast down in front of me and didn t say anything, even if they had told me here is your breakfast, but I didn t know what food was. They just left it, walked off, then they would come back in a couple of hours and see that I hadn t ate it. A nurse would look at the other and say she hasn t ate it, then look at me and say why didn t you eat that? You know Female focus group participant, years old A few focus group participants suggested that hospital wards were not as efficient or organised as they were in the past, which had implications for quality of care, hygiene and cleanliness. In past years we had a ward sister, the domestics etc. were all under the ward sister - our hospitals were clean then. Female focus group participant, 65 years old or over Years ago when I was nursing, it was the Ward Sister who was in charge hygiene had to be 100%, especially regarding your patients. I just think all those things have gone. Female focus group participant, 65 years old or over One focus group participant shared a very personal experience of hospital care in which she was critical of the level of care received by her family member and other patients on a hospital ward which she felt was under staffed and under pressure. My son went into hospital with broken ribs a few years ago and there was no bed for him, so they put him in the old people s ward. I have never seen such a lack of help for the patients. There wasn t enough staff. There was a wee man in the bed beside my son, he tried to climb out of his bed to go to the toilet, the nurse said I haven t time. When I found out my son wasn t getting help with eating his food I stayed 24/7, but wasn t always possible living down here. At first I wasn t allowed to stay, was told to leave at meal times. The man in the next bed said to me, I can t stand the way your son gets his meals brought to him and taken away and doesn t get a chance to eat it. That was awful for me to hear, so that s when I decided to stay all the time to ensure he was fed. My son died on that ward he didn t receive adequate care, none of the patients got the care. Female focus group participant, 65 years old or over Quality of care across all health and social care services Some respondents (33.6% of general population respondents, 35.3% of membership scheme respondents) just wanted to see an improvement in quality of care across all health and social care services. Patient safety, standards and staff training were some of the issues that people frequently raised. Ensure all health and social care staff have proper training to ensure they can meet the needs of all their clients. Female street consultation participant, years old Quality of provision; quality of assurance; quality of life for all. Male questionnaire respondent, years old High quality services provided by competent and caring health care professionals and delivered in the appropriate facility and within the accepted timeframe. Female questionnaire respondent, membership scheme member, years Person-centred care For some respondents (13.7% general population respondents, 17.6% membership scheme respondents, based on all those who indicated that quality of care was their top priority), quality of care meant prioritising care that was centred on the specific needs of each patient and delivered by staff who listen to and communicate effectively with patients, clients and carers. 30 The People s Priorities People s views on future priorities for Health and Social Care in Northern Ireland The People s Priorities People s views on future priorities for Health and Social Care in Northern Ireland 31

18 All staff to see the patients and not the paper work. Male questionnaire respondent, years old Reliable, honest, caring, helpers at the best place for you you need the best care, in the best place, by the best people, whether that is hospital, home, or care home to be listened to, to live by the saying, no decisions about me without me being involved. Female questionnaire respondent, membership scheme member, 65 years old or over There were some differences in the types of respondents who prioritised care of older people by demographic group. Women were more likely to identify care of older people as a top priority than men; 15.1% of female respondents, compared to 9.0% of male respondents. Respondents aged 65 years or over, were more likely to prioritise care of older people than younger age groups; 21.7% of over 65s compared with 9.3% of year olds, 9.5% of year olds, 4.3% of year olds, 12.5% of year olds, and 14% of year olds Care of older people (general) Diagnostic care A few people (6.8% general population respondents, 15.7% membership scheme respondents, based on all those who indicated that quality of care was their top priority) felt that improving diagnostic care should be a priority, particularly an improvement in early diagnosis to prevent the development of more serious conditions. The majority of respondents (79.4% of general population respondents, 71.4% of membership scheme respondents) who indicated care of older people as their top priority felt that, in general, older people in society should be considered a priority when it came to health and social care. People said their top priority would be to create a health service that people can rely on and have confidence in as they grow older; a service which helps older people to live as full and independent lives as possible. More emphasis on tests and early diagnosis to prevent more serious illness that requires more expensive intervention or means it is too late to do anything. Female questionnaire respondent, membership scheme member, years old 5.4 Priority 4: Care of older people It s really hard to think about one area only to prioritise but I would think in general it could be spent on preventative treatment and this would be getting early diagnosis so in the long run the treatment plan is shorter with better results for the patient. Female focus group participant, years old To ensure the elderly have confidence that they will receive the best care and remain as independent as possible. Female questionnaire respondent, membership scheme member,16-24 years old Better services for older people. Male questionnaire respondent, 65 years old or over Better care for older people in the community and in hospital. Female street consultation participant, years old A few participants in focus groups voiced their concern that there had not been adequate investment in services for older people, despite the ageing population. Care of older people was a top priority for 12.1% (n=131) of general population respondents. Care of older people was the second most common priority amongst membership scheme respondents after health and social care staff; (18.2%, n=70). People identified a number of key areas within care of older people: Care of older people (general) Domiciliary care for older people Residential and nursing home care for older people Figure 5.4: Key issues within the Care of older people priority Care of older people (general) Domiciliary care for older people Residential and nursing home care for older people 13.0% 12.9% 7.6% 15.7% 79.4% 71.4% Percentage of respondents (%) General population Base = 131 (weighted) Membership Scheme Base = 70 Because of the recession there is little money about and I can see the area that is going to suffer is care of the older people. I don t think we have invested enough in long term care of the elderly. I mean domiciliary care - they get 13 minutes in the morning and that s crazy. I don t know what the answer is. Female focus group participant, no age given Domiciliary care for older people Some questionnaire respondents felt that the priority in relation to care of older people should be on care provided for people in their own homes; similar proportions of general population respondents (13.0%) and membership scheme respondents (12.9%) who noted that care of older people should be a top priority specifically indicated particular issues in relation to domiciliary care. People continue to be concerned about the standard of domiciliary or home care currently provided to older people, particularly the limited amount of time care workers are allocated with each older person in their care. 32 The People s Priorities People s views on future priorities for Health and Social Care in Northern Ireland The People s Priorities People s views on future priorities for Health and Social Care in Northern Ireland 33

19 Providing good quality care for older people in their own homes. Female questionnaire respondent, 65 years old or over Care agencies are moneymaking businesses 15 minutes care for a lonely, elderly person is not adequate. Female questionnaire respondent, 65 years old or over Cuts to care packages. Carers sometimes have as little as 10 minutes to spend with a person. Also people have to go to bed at 8 at night just because that is the time the carer comes at. Female questionnaire respondent, membership scheme member, years old Figure 5.5: Key issues within the A&E services priority Improve delivery of A&E services 59.1% 48.6% A&E waiting times 20.9% 24.4% Access to A&E services 20.0% 27.0% Percentage of respondents (%) General population Base = 115 (weighted) Membership Scheme Base = Residential and nursing home care for older people A few people (7.6% general population respondents, 15.7% membership scheme respondents, based on those who gave care of older people as their top priority) suggested that residential care for older people should be made a particular priority. Issues around residential and nursing home care included ensuring that adequate care home places are available, improving the quality of care in homes, and keeping HSC Trust residential homes open. Making sure there are enough nursing homes and care workers for the elderly. Female questionnaire respondent, 65 years old or over Make sure elderly people are looked after. Monitor care homes to ensure the elderly are getting adequate help and support. Female street consultation participant, 65 years old or over Men were more likely than women to identify A&E services as a top priority; 15% of male respondents prioritised A&E services compared to 6.5% of female respondents Improve delivery of A&E services As Figure 5.5 shows, the majority of general population respondents (59.1%) who chose A&E services as their top priority for health and social care felt there should be a general improvement in the way in which A&E services are delivered. Nearly half of membership scheme respondents (48.6%) who indicated A&E as a priority also noted that there should be general improvement to services. Respondents identified areas for improvement such as the organisation of A&E units, and more generally, quality of care, staff and resources. As with those participants who prioritised health and social care staffing levels and the quality of hospital care, many people were concerned that existing A&E services do not have the resources to cope with demand. Not to close nursing homes run by the Trust when they are first class compared to private nursing homes. Female questionnaire respondent, years old A&E is in total crisis! Male questionnaire respondent, years old Get A&E sorted, it s a disgrace how staff are expected to work in that environment. Male street consultation participant, years old 5.5 Priority 5: A&E services Accident and Emergency (A&E) services was the top priority for 10.6% (n=115) of general population respondents and 9.6% (n=37) of membership scheme respondents. The majority of respondents said they wanted to see an overall improvement in A&E services but some people prioritised specific issues such as waiting times and access. The three key issues were: Improve delivery of A&E services A&E waiting times Access to A&E services I was in A&E last year, it was a really cold day and this old man had been left in a wheelchair right beside the automatic doors, every time the doors opened it was freezing. My heart went out to him but the receptionists or nurses didn t bother with him and another patient went and got him a blanket and put it around him. I got one of the suggestion cards and filled it in stating this problem, then I had an occasion to return to A&E the following year and still nothing had changed. What is the point in asking for suggestions when they aren t going to take a blind bit of notice of them? Female focus group participant, years old 34 The People s Priorities People s views on future priorities for Health and Social Care in Northern Ireland The People s Priorities People s views on future priorities for Health and Social Care in Northern Ireland 35

20 5.5.2 A&E waiting times Just over a fifth of general population respondents (20.9%), (and nearly a quarter of membership scheme respondents [24.4%]) who prioritised A&E services were particularly concerned about lengthy waiting times for patients attending A&E departments. A&E waiting times and care. Male questionnaire respondent, 65 years old or over Access to A&E services Waiting time at the A&E is where I would put my money. If you need to be there in the first place then you don t need to be waiting around for hours to be seen. Yet we have the current closures of A&E s in Belfast that is having a knock on effect for the surrounding areas. They didn t solve any problem by doing that, they made the problem bigger. Female focus group participant, years old Of those noting A&E as a priority, a fifth of general population respondents (20.0%) and over a quarter of membership scheme respondents (27.0%) said that access to A&E services would be their top priority. The two most common issues voiced by people were the recent closure of some A&E departments and the lack of 24/7 A&E services in some hospitals. Better access to A&E departments, all areas, 24/7. Female questionnaire respondent, 65 years old or over There is an excellent A&E unit in Downpatrick and there isn t the staff to staff it. It s closed at the weekends It s crazy. It s a state of the art hospital, brand new. Male focus group participant, years old I think we need more transparency because they closed the A&E in Belfast City Hospital and told a pack of lies and said it was temporary but it was permanent and now you have this terrible situation at the A&E at the Royal and Dundonald people are lying on trollies, it s an absolute disgrace. Male focus group participant, years old 5.6 Priority 6: Funding, management and cost-effectiveness 10.2% (n=110) of general population questionnaire respondents and 9.4% (n=36) of membership scheme questionnaire respondents said that if they were the health minister, their priority would be funding and management; to ensure that there was investment in those services in most need of funds and that all services were managed efficiently. There were a number of key issues for people: Invest in services that need it no more cutbacks Improve health service management More cost-effective Stop medical tourism Figure 5.6: Key themes - Funding, management, and cost-effectiveness Invest in services that need it Improve health service management More cost-effective Stop medical tourism 2.7% 20.9% 16.7% 16.4% 31.8% 27.8% 30.9% 52.8% Percentage of respondents (%) General population Base = 110 (weighted) Membership Scheme Base = 36 Male respondents were more likely than female respondents to prioritise funding, management and cost-effectiveness, (14.5% of men in comparison with 6.1% of women) Investment in services that need it - no more cutbacks Of those who noted funding, management and cost-effectiveness priorities, just under a third of general population respondents (31.8%) and over a quarter of membership scheme respondents (27.8%) made specific comments on investment in services that need it. People felt that services that were struggling needed further investment, not further cutbacks. Money for services to be spent where it is urgently needed. Female questionnaire respondent, years old Put more money into the health service in general. I think that is part of the problem. Male focus group participant, 65 years old or over Some people were concerned that current changes to the way in which health services are delivered, under Transforming Your Care, would not benefit patients without proper investment in services from the beginning. With TYC [Transforming your Care] they are taking the money out of the hospitals but I don t see the benefit in the community care; that happened away back in the community care acts in the 1990s, where is the money that was transferred that time? Never saw the benefits of it. So I think TYC it s not going to work unless there is community care and more money put in I was at a meeting not that long ago in Omagh where one of the chief executives said, look our money is getting cut so we can t provide the services that you are all asking for, the money has been cut and she said something has to go. We haven t the money to pay for all those services. Male focus group participant, 65 years old or over Improve health service management Within the funding, management and cost effectiveness priority, almost a third of general population respondents (30.9%) and over half of membership scheme respondents (52.8%) thought that the focus should be on better management of services and an improved approach to service delivery. Some people suggested that health services were approaching a state of crisis due to poor management. 36 The People s Priorities People s views on future priorities for Health and Social Care in Northern Ireland The People s Priorities People s views on future priorities for Health and Social Care in Northern Ireland 37