a conversation about wellbeing

A Conversation about WellbeingA Conversation about Wellbeing

A Conversation About

Wellbeing

Insights from the Public and the Health and Care Workforce from across the North East and North Cumbria Integrated Care System area

INSIGHTS

Version: 1.4 Date: 05/03/2020

Author: TONIC Status: Draft


INTRODUCTION

2


The BriefThe ICS wants to:• Change the way people:

• Perceive the role of the health and care system

• Use the health and care system

• Put prevention at the core• Develop a clear and effective ICS

narrative

By generating insights from:• The public• The health & care workforce

To inform ways that the ICS can:• Influence & change people’s attitudes and behaviour

on looking after themselves better• Further develop wellbeing and other comms /

campaigns in the context of a changing and evolving health and care system:• Supporting what matters to the person• Focussing on wellness, not illness

• Further enable self-care within the health and care environment/system

• Further influence health and care staff to be ‘health advocates’ by example – e.g. through their own self-care

3


Engagement Numbers

ONLINE SURVEY 2021 879

DEPTH INTERVIEWS 30 -

FOCUS GROUPS 220 -

POP-UPS 39 57

TOTAL 3,256 2,320 936

Public Staff

4


Who took part? Engagement DemographicsOnline Survey Demographics

• It is important to note that this engagement exercise was not designed to generate a representative sample as recruitment was through a self-selectingbasis

• Given the 2,021 responses received for an estimated total population for the NENC ICS region of 2,887,280, this gives a 95% confidence level at a confidence interval of 2% in the findings at headline level

• We achieved a sample of 0.05% of the total population aged 16 – 85 across all areas, with the exception of Allerdale (0.04%), Copeland (0.04%), Eden (0.02%) – all within the North Cumbria ICP area – and North Yorkshire (0.01%).

• The areas which were slightly under represented in our overall sample in relation to their percentage of the total NENC ICS Region population were: Allerdale; Durham; Eden; North Yorkshire; Redcar & Cleveland; Sunderland

• Males were under represented and, as a result, women were over represented in the sample

• 16-24s and over 65s were slightly under represented in the sample by 4 – 5 percentage points, whilst the 35-54 age group was slightly over represented. In addition, 16% did not give their age

• White/White British ethnic group were slightly under represented, whilst all other ethnic groups were represented in the sample

• All employment status groups were well represented in the sample

• Those with no qualifications and those with GCSE or equivalent qualifications were both under represented

For details, see Annex 9

All Other Activities

• All other activities (namely, the pop-ups, workforce online survey and focus groups) were self selecting samples

• Focus Groups: The 17 focus groups were organised by a number of different Healthwatch organisations, identifying key “seldom heard” cohorts who might not engage with the online survey and interviews. Initiations went to people engaging with a variety of local services and community organisations

• Pop-ups: These involved asking members of the public and the health and care workforce to engage in short discussions, participating or not was the decision of individuals our researchers asked when they were near our display stands

• Depth Interviews: Participants put themselves forward after taking a flyer promoting engagement at the pop-up events5


Methodology Overview• Literature Summary: Identifying what is already known and highlighting gaps in

knowledge • Research Tool Development: Informed by literature, steering group and ICS

Prevention Board consultation. Promotional materials were distributed through existing communications channels to public and staff• Fieldwork: • Online Surveys – with staff and public• Depth Interviews – with members of the public• Focus Groups – with seldom heard/hard to reach groups• Pop-ups – with staff and the public

• Analysis: Data cleansing, qualitative and quantitative data analysis

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MethodologyDepth Interviews: Public

We recruited 30 members of the public to participate in qualitative structured telephone interviews.

They were recruited through adverts placed on social media.

Participants were give a £20 voucher to thank them for their time.

The interviews were captured by the researcher in note form and a Thematic Analysis was performed on this data to identify the key themes emerging from these discussions.

PublicDepth Interviews

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Focus Groups: Public

Focus groups with the public were run by a number of local Healthwatch organisations.

A total of 247 people were engaged across 17 focus groups, which included people from a range of BAME groups, people with mental health problems, drug and alcohol service users, refugees and asylum seekers, young people, older people, those with long term conditions, people with learning disabilities, and carers.

Their views were recorded by each Healthwatch and have been summarised in this report.

Methodology: Pop-Ups

We attended 8 “pop-up” sessions that were arranged to correspond with existing visits of the ICS Roadshow.

We engaged with 96 people in total, consisting of 39 members of the public and 57 members of the health and care workforce.

Participants were engaged in a combination of activities, including informal discussion, written questionnaires and posters to stick post-it notes on, all in relation to some of the key research questions.

Key themes were captured from these activities and are summarised in this report.

The “pop-ups” were also used to recruit people to complete the online survey and individual depth interviews.

Analysis: Qual & Quant Data

All qualitative responses, including in surveys, pop-ups, focus groups and depth interviews, were written up, read, coded and themes identified from this using Thematic Analysis.

All quantitative data was analysed in Excel to allow access to anonymised raw data to the project commissioners.

Headline findings and statistically significant differences in sub-analysis by certain demographic groups have been highlighted.

In this report, where percentages do not sum to 100, this is due to computer rounding, the exclusion of “don’t know” categories, or multiple answers.


Pop-Up Events

Healthwatch Date Community group Venue No. attended

Cumbria 31/10/2019 Unity - Drug & Alcohol users (women) Women Out West, Whitehaven 6

Cumbria 13/11/2019 Millom Prostate Cancer Support Group Millom Rugby Club 12

Cumbria 04/11/2019 Mind Ya Marras Top of the Shops café, Mirehouse, Whitehaven 10

Gateshead 09/10/2019 Refugees and asylum seekers (Peace of Mind) 35

Gateshead 04/11/2019 Inspired Support (LD/Autism) Gateshead Stadium 7

Gateshead 06/10/2019 Young People Gateshead College 30

Hartlepool 13/11/2019 People over 50 St Josephs Court residential Home, Hartlepool 15

Hartlepool 09/11/2019 Diabetes support group Hartlepool Central Library 18

Hartlepool 07/11/2019 Men with mental health needs Rift House Community Building 14

Middlesbrough 04/11/2019 Adults with Learning Disabilities Myplace 10

Middlesbrough 14/11/2019 Adults with Learning Disabilities Myplace 10

Middlesbrough 18/11/2019 BAME Nur Fitness, Middlesbrough 12

Newcastle 29/10/2019 Better Days - People with LD Better Days 15

Newcastle 29/10/2019 Roma Group Riverside CHP 9

South Tyneside 10/10/2019 Apna Ghar Apna Ghar 14

South Tyneside 05/11/2019 Carers South Tyneside Carers' Centre 15

South Tyneside 06/11/2019 Your Voice Counts Unit 12, Interchange Centre 15

TOTAL 247

PublicFocus Group

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Date Time LocationNumber engaged

Tuesday 8 October 10am – 4pm

Freeman Hospital, Newcastle upon Tyne 22

Wednesday 9 October 10am – 4pm

Queen Elizabeth (QE) Hospital, Gateshead 18

Thursday 10 October 11am – 3pm Alnwick Medical Group 14

Tuesday 15 October

10am –12pm Blyth Marketplace 6

Tuesday 15 October 2pm – 5pm Clarendon, South Tyneside 10

Wednesday 23 October 10am – 4pm The Galleries, Washington 8

Tuesday 29 October 2pm – 4pm University Hospital of North Tees 6

Thursday 31 October 9am-11am

Wigton Hospital 12

Focus Groups


INSIGHTFINDINGS

This section sets out the answers to the research questions asked

across all strands of the engagement:

1. Online Survey - Public

2. Depth Interviews - Public

3. Focus Groups - Public

4. Online Survey - Workforce

5. Pop-ups – Workforce & Public

These strands have been collated and set out in this section

grouped together by themes

INSIGHTS


Headline Findings: Public• Less than ½ (46%) say their wellbeing is good and over ¼ (26%) feel it will deteriorate in 5 years. People

most strongly associate the term ”wellbeing” with physical health (72%), feeling happy (58%), and being fit and mobile (29%)

• The images most strongly associated with wellbeing were of family groups (42%) and a couple (19%)• Most (62%) are confident finding out info on their health and feel like an expert in their own health (59%)• The extent to which people feel that health & care (H&C) services support them with what matters to

them splits out roughly into thirds between Yes, Partially and No – with most (62%) feeling listened to by H&C services. Most (71%) expressed positive sentiments about how they felt after using an H&C service – feeling satisfied (27%), reassured & confident (21%)

• Only 21% think that current H&C services are affordable in future• ¾ (77%) have someone to talk to about their wellbeing – people most want to talk to Doctor (64%),

Friend (62%), Family (62%), Nurse (48%) or Counsellor (40%). In the qualitative feedback, 72% said they preferred to talk to family members or their partner/spouse

• 1/3 (36%) feel comfortable giving wellbeing and health advice to friends and family• 40% rate themselves as good at solving problems in their life and ½ (49%) feel they are “ok” at this – 2/3

(65%) usually solve problems in their lives themselves without any help and over ½ (56%) talk it through with a partner or family member. Over 1/3 (38%) find it easy to make healthy lifestyle changes and ½ (48%) say they can make these changes with some help

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Headline Findings: Public• Most (72%) feel that addressing a health problem should be a partnership of health services and the

individual working together and most (60%) feel they are most responsible for their own wellbeing• The main barriers to being in better health are Stress/anxiety related (20%), having an LTC (18%) and

lifestyle related (15%) including poor diet, smoking, alcohol etc.• People felt that H&C services could help them with self care through greater availability and

accessibility of services (18%), listening more and being more caring (13%) and being more holistic to address root causes (10%)

• 29% of people felt they did not belong to any “community” or “group”. However, the most common communities people felt they belonged to were a local community or social group (28%), sport/exercise related (20%) and groups of friends (19%) or family (10%) and interest groups (12%)

• Most people have an appetite to have partnership decision making when they have a health problem (PS18)

• Most people solve problems by themselves, with many talking it through with friends and family or going online (PS19)

• 90% feel good/ok at dealing with problems in their lives (PS20)• “Wellbeing” means being healthy (72%), happy & content (58%), fit, active & mobile (29%), and having

a healthy mind and emotional health (19%), as well as being stress free and calm (18%)• The largest barriers to being in the best possible health were stress and poor mental health (20%),

illness & LTCs (18%), lifestyle factors (15%) and work/caring responsibilities (12%)• 37% feel “completely” or “mostly” supported by H&C services with what matters to them, 50% feel

partially supported – having criticism and praise for services, while 12% do not feel at all supported

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Headline Findings: Workforce• Most (68%) feel that their role allows them to at least partially support people to live a healthy lifestyle

or change their behaviour, while 1 in 3 (32%) feel their role does not allow them to do this or that this is not relevant to their role. More than 4 out of 10 (44%) of Practitioners and Team Leaders said they they either did not help people live a healthy lifestyle or that it was not applicable to their jobs

• Nearly 4 out of 10 (39%) say that giving people advice on how to look after themselves better is an important part of their role, with a further ¼ (24%) saying it is a small part of their role – however, over 1/3 (37%) say it is not part of their role. Practitioners and Team Leaders were most likely (44%) to say that advice giving was not part of their role

• Just under ½ (45%) of the health & care workforce feel they only partially tackle root causes of ill health in their role and 1/3 (32%) don’t feel they do this at all. Practitioners and team leaders (34%) were slightly more likely to say they did not get to tackle root causes of ill health in their role

• The majority (78%) feel at least partially able in their job to support individuals with what matters to them. Practitioners and Team Leaders were most likely (25%) to say they were not able to support people with what matters to them or that it was not applicable to their role

• ½ (56%) feel they get to tackle the root causes of ill health in their role, but this is made up of 45% who feel they partially get to do this and only 6% who feel they fully get to do this – 1/3 (32%) feel they do not get to to do this at all and 17% feel it is not relevant to their job. Those working in North Cumbria ICP (56%) and frontline practitioners and Team Leaders (54%) were most likely to say they were not tackling root causes of ill health in their role or that it was not relevant to their role

• 2/3 (67%) say they either fully (22%) or partially (45%) promote education about health and wellbeing within their role – however, 18% say they do not get to do this at all and 15% say it is not applicable to their role

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Headline Findings: Workforce• Over half (58%) feel empowered in their role to give messages to help people look after themselves,

however ¼ (25%) do not feel able to do this and 17% are unsure. Those working in North Cumbria ICP (32%) and frontline practitioners/Team Leaders (30%) were the most likely to say they were not empowered in their role to help people look after themselves better

• 85% disagree with the statement “self care means no care” with only 5% agreeing with it and a further 11% being unsure

• The majority of respondents had not heard of MECC (54%), AOH (77%) and Social Prescribing (51%) -however the majority of those who had heard of these programmes found them to be at least partially effective

• Over ½ (54%) neither agree nor disagree with the statement “Digital healthcare will give you more time to care, promoting deeper interaction with people” and the clear majority (82%) feel ready and willing to navigate a data-rich healthcare environment, while only 13% say they are not ready to do this

• Nearly half (47%) feel that programmes at work support their wellbeing to some extent, while around ¼ (27%) are unsure and ¼ (26%) feel they do not help much or at all

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1. “Wellness not illness” -Our Understanding of WellbeingIncluding Talking about wellbeing, Wellbeing at work, What it means, Which images represent wellbeing, and Promoting “wellness” rather than treating “illness”

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A Conversation about WellbeingA Conversation about Wellbeing WELLBEING: What does wellbeing mean to you?

Stress Free & Calm Family, Home & Love Healthy Diet Socially ConnectedUnder 1 in 5 (18%), linked wellbeing with

being stress free, feeling calm, being

relaxed, being at peace and having good

sleep

Wellbeing meant being loved, being part of a family, feeling valued and

being at home in a positive

environment for 15%

Eating a healthy diet, with good food, fruit and vegetables, leading to being a

healthy weight was equated with

wellbeing by around 1 in 10 people

(9%)

For some (6%), wellbeing was associated with being socially connected, with

friends, having someone to talk to and

being involved in society/community

Being Healthy Happy & Content Fit, Active & Mobile Healthy Mind & Emotional HealthBeing healthy physically and feeling

well were associated with wellbeing

by nearly ¾ (72%) of people

Over ½ (58%) associated wellbeing

with being happy, feeling content,

being positive, having resilience and

feeling fulfilled in life

Under 1/3 (29%) linked wellbeing with

being physically fit, taking regular

exercise (including walking), having

energy and being mobile

For nearly 1 in 5 (19%), wellbeing meant

having a healthy mind, and having good

mental and emotional health

72%

18%

58% 29% 19%

15% 9% 6%

PublicOnline Survey

A Conversation about WellbeingA Conversation about Wellbeing What does "wellbeing" mean to you?

Good Self-Care Work - Life Balance Free of Stress & Anxiety Coping & FunctioningFor more than 1 in 10 (13%) good self-care was a key ingredient in

wellbeing

For more than 1 in 10 (12%) a good work-life balance was vital to wellbeing,

along with where people felt they had a

comfortable and safe environment at

home and work

For 10%, wellbeing meant being in a ‘good place’, where they were free

of stress and anxiety

A number (6%) suggested that coping with life and

functioning well contributed

to an individual’s wellbeing

Good Mental & Emotional Health Good Physical Health Happy & Fulfilled Generally HealthyNearly ½ (48%) cited positive mental and

emotional health in their definition of

wellbeing

More than 4 in 10 (43%) said that

positive physical health was a key

element of wellbeing

3 in 10 (30%) put forward that wellbeing

meant being happy, content, well supported,

feeling positive about themselves, with a

sense of purpose, freedom and the ability to

do what they want

For ¼ (26%) being generally in

good health and feeling well was

part of what wellbeing meant to

them

48%

13%

43% 30% 26%

12% 10% 6%

WorkforceOnline Survey


Which image looks most like "wellbeing" to you?Overall ResultsThe images most strongly associated with wellbeing were of family groups (42%) and a couple (19%)

Images with moderate association with wellbeing were of fruit and vegetables (11%), jogging (9%) and yoga (7%)

The images least associated with wellbeing were of young women playing netball (2%) and older men playing football (3%)

Analysis by Demographic GroupsFamily Groups, Couple & Community GroupWomen (66%) and those with no LTCs (69%) and those aged 65+ (70%) most strongly associated family images with wellbeingYoga, Jogging & Team SportPeople from non-white ethnicities (26%), under 25s (25%) and men (23%) associated sport and fitness imagery more strongly with wellbeingFruit & VegOver 65s most were the group to most strongly associate wellbeing with images of fruit and vegetables (12%)GP / DoctorOverall, only 4% said that the image of a doctor represented wellbeing to themHowever, under 35s (7%) and those with 1 or more LTC (6%) more strongly associated the image of the doctor with wellbeing

Public

3%

4%

14%

28%

3%

11%

9%

2%

19%

7%

0% 5% 10% 15% 20% 25% 30%

Community Group (Mixed)

Doctor (Female)

Family Group (Asian)

Family Group (White)

Football (Older Males)

Fruit and Veg

Jogging shoes (Neutral)

Netball (Young Females)

Older Couple (Black)

Yoga Cartoon (Mixed)

28% 19% 14%

2% 3%

11% 9% 7%

Online Survey

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How do you rate your current wellbeing?Overall ResultsThe majority (81%) feel their current wellbeing is good or “ok”

• 46% rate their wellbeing as very good (12%) or good (34%)

• Over 1/3 (35%) say their wellbeing is “ok”

• 18% say their wellbeing is not good (13%) or bad (5%)

Analysis by Demographic Groups

Good wellbeing

Those who have no LTCs (64%) and people who are non-white (61%) have the highest levels of good wellbeing

Men (51%) are more likely than women (44%) to say they have good wellbeing

”Ok” wellbeing

North Cumbria ICP residents were the most likely to say their wellbeing was “ok” (46%)

Poor wellbeingPeople with 1 or more LTC were most likely to say their current wellbeing was not good or bad (26%) as were those who were not in employment (26%)

Public

0% 20% 40% 60% 80% 100%

Overall

Female

Male

No LTC

1 or more LTC

Under 35

35-64

65+

White

Non-White

Employed

Not Employed

Central ICP

North ICP

North Cumbria ICP

South ICP

A-Level+

< A-level

Good / Very good Ok / Not sure Not good / Bad

12%

34% 35%

1%

13%

5%

0%

5%

10%

15%

20%

25%

30%

35%

40%

Very good Good Ok Not sure Not good Bad

Online Survey

18


Compared to now, what do you think your health and wellbeing will be like in 5 years?Overall ResultsMost people (74%) think their health and wellbeing will improve or stay the same in 5 years time• Over 1/3 (36%) felt their wellbeing would be

better in 5 years – most feeling it would be “a bit better”

• Over 1/3 (38%) felt their wellbeing would be the same in 5 years as it is now

• Over ¼ (26%) felt their wellbeing would be worse in 5 years – most feeling it would be “a bit worse”

Analysis by Demographic GroupsWellbeing Optimists

Those aged under 35 were more likely to feel their health and wellbeing would improve in 5 years time (60%) and only 9% felt it would deteriorate over this periodPeople from non-white ethnicities were the most likely to feel their wellbeing would improve in 5 years (61%), with only 17% feeling it would get worse

The employed (43%) or qualified at A-Level or higher (42%) were more likely to feel their wellbeing would improve

Wellbeing Pessimists

Those aged 65+ were the most likely to feel their health and wellbeing would deteriorate in 5 years time (58%) and only 8% felt it would improve over this period

People who were not employed (42%) were more likely to feel this would get worse

Those with 1 or more Long Term Condition (34%) were more likely to say their health and wellbeing would decline in 5 years

0% 20% 40% 60% 80% 100%

Overall

Female

Male

No LTC

1 or more LTC

Under 35

35-64

65+

White

Non-White

Employed

Not Employed

Central ICP

North ICP

North Cumbria ICP

South ICP

A-Level+

< A-level

A bit better / Much better The same

A bit worse / much worse

13%

23%

38%

20%

6%

0%

5%

10%

15%

20%

25%

30%

35%

40%

Much better A bit better The same A bit worse Much worse

PublicOnline Survey

19


Do you have someone you can talk to about your wellbeing?Overall Results¾ (77%) said they have someone they can talk to about their wellbeing

• 17% said they did not have anyone to talk to about their wellbeing


Someone to talk to about wellbeing

Over 65s were the most likely (83%) to say they have someone to talk to about their wellbeing, followed by those with no LTC (81%)

No one to talk to about wellbeingThose most likely to say they did not have anyone to talk to about their wellbeing were those with 1 or more LTC (20%) and those from North Cumbria ICP (20%)

Public

77%

6%

17%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Yes Not sure No

0% 20% 40% 60% 80% 100%

Overall

Female

Male

No LTC

1 or more LTC

Under 35

35-64

65+

White

Non-White

Employed

Not Employed

Central ICP

North ICP

North Cumbria ICP

South ICP

A-Level+

< A-level

Yes Not sure No

Online Survey

20


Who would you feel comfortable talking to about your wellbeing?Overall ResultsPeople felt most comfortable talking about their wellbeing to a doctor (64%), family member (62%) or friend (64%)Many also felt comfortable talking to a nurse (48%) counsellor or therapist (40%)Just over 1 in 5 (22%) felt comfortable talking to a pharmacist about wellbeingNot many people felt comfortable talking about wellbeing to:• Someone who ran a local shop (2%)• Community leaders (3%)• Hairdressers (5%)• Religious leaders (6%)• Volunteers (8%)• Someone who ran a community

organisation (10%)

Analysis by Demographic GroupsFriends & FamilyWomen were most likely to talk to friends (68%) and family members (64%), followed by people with no LTCs (Friend 67%, Family member 66%)Doctors, Nurses & PharmacistsThose aged 65+ were most likely to talk to doctors (85%), nurses (67%) & pharmacists (44%) , followed by those who were not employed (Doctor 70%, Nurse 53%, Pharmacist 29%)CounsellorsWomen (45%) and those qualified at A-level or above (45%) were most likely to feel comfortable talking to a counsellorLocal shop owners, Religious and Community LeadersPeople from non-white ethnic background were most likely to feel comfortable talking to a religious leader (15%), community leader (5%) and someone who runs a local shop (6%) – although the numbers were still relatively small

Public

5%

62%

62%

64%

48%

22%

10%

8%

6%

12%

40%

3%

2%

0% 20% 40% 60% 80%

Hairdresser

Friend

Family member

Doctor

Nurse

Pharmacist

Someone from a communityorganisation

Volunteer

Religious leader

Someone from a charity

Counsellor / therapist

Community leader

Someone who runs a localshop

Online Survey

21


TALKING ABOUT WELLBEING

QUAL: Who do you talk to about your wellbeing?

Work Colleagues

Health & CareService

Friends

Family / PartnerThe clear majority of people (79%) told us that

they talk to their spouse or partner or a

member of their family about their wellbeing

6% said they talk to a GP, nurse,

doctor, or someone from social

care about their wellbeing

4% spoke about wellbeing with people at work –

either their colleagues or line managers

1/3 (32%) talk to friends about

their wellbeing

79%

6%32%

4%

Only 3% said they did not have anyone to talk with about their wellbeing

Online SurveyPublic


How comfortable would you feel offering health advice to your friends and family?Overall ResultsOver 1/3 (36%) would feel comfortable offering health advice to their friends and family• ½ (51%) would feel somewhat

comfortable doing this• Only 15% would feel they would not

want to offer advice to friends and family


InfluencersThose most strongly inclined to feel comfortable in an advice giving role were people form non-white ethnic backgrounds (45%), those qualified at A-level or above (41%) and women (39%)

Potential InfluencersOver half of the following groups felt somewhat comfortable giving advice: those qualified below A-Level (56%), people from South ICP (56%), those from North Cumbria ICP (55%) and those not employed (54%)

Non-Advice GiversThe over 65s were most likely to not feel comfortable offering health advice (23%), followed by those who were not employed (20%) and men (19%)

Public

0% 20% 40% 60% 80% 100%

Overall

Female

Male

No LTC

1 or more LTC

Under 35

35-64

65+

White

Non-White

Employed

Not Employed

Central ICP

North ICP

North Cumbria ICP

South ICP

A-Level+

< A-level

Comfortable Somewhat comfortable Uncomfortable

36%

51%

14%

0%

10%

20%

30%

40%

50%

60%

Comfortable Somewhat comfortable Uncomfortable

Online Survey

23


To what extent does your role promote health and wellbeing?Overall Results

Only 1 in 5 say they fully (22%) promote health and wellbeing within their role, and 33% either say they do not do this at all (18%) or say it is not applicable to their role (15%)

45% say they partially promote health andwellbeing in their role


PromotersThose working in Central ICP (26%) and senior manager, commissioners and administrators (24%) were more likely to say they fully promoted health and wellbeing

Partial PromotersThose working in North (50%) and South (48%) ICPs were most likely to say they partially promoted health and wellbeing

Not Promoting

People working in North Cumbria ICP were most likely (42%) to say they were either not promoting health and wellbeing within their role or that it was not relevant to them

Workforce

22%

45%

18%15%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Fully Partial ly Not at all N/A

0% 20% 40% 60% 80% 100%

Overall

North ICP

Central ICP

South ICP

North Cumbria ICP

NHS

Local Authority

3rd & Private Sector

Practitioner & Team Leader

Senior Manager + Admin +commissioner


Online Survey

24


How does your work impact on your wellbeing?Overall Results

Opinions on how work impacted on wellbeing were fairly evenly split between positive (40%), neither positive nor negative (25%), and negative (35%)


Work has positive impactThose working in North Cumbria ICP were most likely (47%) and for the NHS (42%) to say work impacted positively on their wellbeing

Impact of work is neither positive nor negativeThose working in South ICP (28%) and Practitioners/Team Leaders (28%) were more likely to say the impact of work is neither negative nor positive on their wellbeing

Work has negative Those working in Central (41%) and South (40%) ICPs and those in Local Authorities (39%) were more likely to say that work impacted on their wellbeing negatively

Workforce

11%

29%25%

28%

7%

0%

5%

10%

15%

20%

25%

30%

35%

Very positively Positively Neitherpositively nor

negatively

Negatively Verynegatively

0% 20% 40% 60% 80% 100%

Overall

North ICP

Central ICP

South ICP

North Cumbria ICP

NHS

Local Authority




Positively

Neither positively nor negatively

Negatively

Online Survey

25


Assistance & Training1/3 (32%) said their wellbeing was

looked after at work through

assistance programmes, training

and workshops, and the provision

of relevant information and

signposting to support services Nothing¼ (25) said there was nothing

specific (e.g. programmes) that their

employer did to look after their

wellbeing

Counselling & Flexible Working

Under ¼ (23%) felt their employer supported

their wellbeing through the provision of

occupational health and counselling services, and

by allowing flexible working practices

Management Support15% told us their wellbeing was looked

after by their line managers in 1 to 1

support and through the line management

process

IncentivesMore than 1 in 10 (13%) said the use of

incentives and other activities promoting good

health by their employer helped to look after

their wellbeing

32% 25% 23% 15% 13% 4%

Need More Time to Benefit from What is on Offer

4% suggested that provisions were made

by their employer to promote their

wellbeing, but they needed more time in

their role to be able to access and benefit

from these

Workforce

WELLBEING AT WORK

What does your employer do to look after your wellbeing?

Online Survey


How effective do you think these programmes are at supporting your wellbeing?Overall Results

Nearly half (47%) feel programmes at work support their wellbeing to some extent, while around ¼ (27%) are unsure and ¼ (26%) feel they do not help much or at all


Wellbeing is supported at workThose working in North Cumbria (56%) and North (54%) ICPs were most likely to say that programmes in their workplace were at least partially effective at supporting their wellbeing

Wellbeing is not supported at workThose working in Central (30%) and South (29%) ICPs, and Commissioners/Senior Managers (29%) were most likely to say that programmes in their workplace were not effective at supporting their wellbeing

Workforce

19%

28%27%

14%12%

0%

5%

10%

15%

20%

25%

30%

Very A bit unsure Not much Not at all

0% 20% 40% 60% 80% 100%

Overall

North ICP

Central ICP

South ICP

North Cumbria ICP

NHS

Local Authority




Effective Not sure Not effective

Online Survey

27


WELLBEING AT WORK

What more could your employer do to support wellbeing?

Flexibility

9% wanted more flexible working practices, such as

flexible working hours, and working from home,

No change needed

13% felt no change was needed or that they could not

think of anything, suggesting “they are doing the best

they can given the circumstances”

Benefits & Easy Access Programmes

13% asked for a range of benefits, such as private

healthcare and incentives (e.g. promote healthy eating).

Some said support programmes should be easy to access

and well promoted “Don’t use up our lunchtimes!”

Improved Management Response

15% felt better management was needed in the form

of supervision, good communication, and taking

discussions seriously and acting on them. Some spoke

of the need for anonymous feedback channels

More Resources & Improved Work Environment

22% felt that their wellbeing would be supported by

having more time to do their job, facilitated by

increased staffing and resources. Some asked for a

better working environment and greater job stability

Valued, Supported & Listened to

27% felt there should be more support, so people felt

valued & listened to – e.g. through team building

13%

9%

15%13%

27% 22%

Help to Manage Stress & Sickness Better

12% wanted a reduced workload and expectation management,

including help to deal with stress and prevent bullying. Some wanted

recognition of their efforts, and to not being penalised for sick days

12%

Not Sure8% did not know what could be done to improve wellbeing at work

8%



2. Putting Prevention at the core of the approach + Helping people look after themselves betterCommunicating about people’s health and wellbeing: Inform wellbeing and other comms/campaigns in the context of a changing and evolving health and care system that supports what matters to the person – focussing on wellness, not illnessEffectively addressing the root cause of illness Including programmes such as AOH, MECC, SP, Digital etc.Engaging the public to help deliver messagesFurther enable self-care within the health and care environment/system + Influence and change peoples’ attitudes and behaviour in relation to looking after themselves

29


Do you feel like an expert on your own health?Overall ResultsMost people (60%) feel like an expert in their own health, but many do not (40%)

• 15% “very much” feel like experts on their own health, with a further 45% feeling “a bit” like an expert

• 34% do “not really” feel like an expert in their own health with a further 6% saying they are “definitely not” an expert in this


Experts

Those most likely to feel like experts in their own health were people from non-white ethnicities (67%), over 65s (65%), and people qualified at A-level or above (65%)

Non-Experts

Under 35s (49%), men (46%) and those with below A-level qualifications (45%) were more likely to say they were not experts in their own health

Public

15%

45%

1%

34%

6%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Yes, very muchso

Yes, a bit Not sure Not really Definitely not0% 20% 40% 60% 80% 100%

Overall

Female

Male

No LTC

1 or more LTC

Under 35

35-64

65+

White

Non-White

Employed

Not Employed

Central ICP

North ICP

North Cumbria ICP

South ICP

A-Level+

< A-level

Yes Not sure No

Online Survey

30


How confident do you feel finding out information about your health for yourself?Overall ResultsMost feel confident (62%) or “ok” (28%) finding out information about their health for themselves• 26% felt very confident and 36% felt

confident finding out health information

• 28% felt ok about finding out health info

• 9% were not confident and only 2% would not find out their own health information


Health Info Finders

Those with no LTCs (68%), those qualified at A-Level or above (68%), those who are employed (65%), aged 65+ (65%) and women (64%) were most likely to feel confident finding out their own health information OK at funding out health info

Under 35s (33%), men (31%), those from non-white ethnicities (31%) and those with below A-level qualifications (31%) were more likely to feel “ok” about finding out health info for themselvesNot finding out health infoUnder 35s (13%), those who were not employed (13%) and those with 1 or more LTC (13%) were least likely to find out their own health information

Public

26%

36%

28%

9%

2%

0%

5%

10%

15%

20%

25%

30%

35%

40%

Very confident Quite confident OK Not confident I would not dothis

0% 20% 40% 60% 80% 100%

Overall

Female

Male

No LTC

1 or more LTC

Under 35

35-64

65+

White

Non-White

Employed

Not Employed

Central ICP

North ICP

North Cumbria ICP

South ICP

A-Level+

< A-level

Very confident / Quite confident

OK

Nof confident / I would not do this

Online Survey

31


How would you rate your ability to make changes to live a more healthy lifestyle? Overall ResultsNearly ½ (48%) feel they can make changes to live a more health lifestyle with some help in place• Over 1/3 (38%) find it easy to make

healthy lifestyle changes• 14% find it hard to make healthy

lifestyle changes


Easy to change

Over 65s (51%) and people with no LTCs (47%) were most likely to say they found it easy to make healthy lifestyle changes

Can make changes with helpUnder 35s (52%) and those from Central ICP (50%) were the most likely to say that they could make healthy lifestyle changes with some help

Hard to changeThose with 1 or more LTC (19%), those not employed (18%) and those qualified below A-Level (17%) were most likely to say they found it hard to make healthy lifestyle changes

Public

38%

48%

14%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

I find it easy to makehealthy l ifestyle changes

I can make changes withsome help

I find it hard to makelifestyle changes

0% 20% 40% 60% 80% 100%

Overall

Female

Male

No LTC

1 or more LTC

Under 35

35-64

65+

White

Non-White

Employed

Not Employed

Central ICP

North ICP

North Cumbria ICP

South ICP

A-Level+

< A-level

I find it easy to make healthy l ifestyle changes

I can make changes with some help

I find it hard to make lifesty le changes

Online Survey

32


How would you rate your ability to deal with problems in your life?Overall Results½ (49%) feel they are ok at dealing with problems in their lives, with 40% feeling they are good or very good at thisOnly 10% rated themselves as being not very good or bad at dealing with problems in their lives


Problem solvers

Those with no LTCs (48%) and over 65s (48%) were most likely to rate their ability to deal with problems as very good or good

”Ok” at problem solvingUnder 35s (54%) were most likely to say they were ok at dealing with problems in their lives

Struggle with problemsPeople with 1 or more LTC (15%), under 35s (14%), and those who are not employed (14%) were most likely to rate themselves as not very good or bad at dealing with problems

Public

40%

49%

10%

0%

10%

20%

30%

40%

50%

60%

Very good / Good OK Not very good / Bad

0% 20% 40% 60% 80% 100%

Overall

Female

Male

No LTC

1 or more LTC

Under 35

35-64

65+

White

Non-White

Employed

Not Employed

Central ICP

North ICP

North Cumbria ICP

South ICP

A-Level+

< A-level

Very good / Good OK Not very good / Bad

Online Survey

33


How do you usually solve problems?Overall Results2/3 (65%) usually solve problems themselves, with over ½ (56%) talking it through with a partner or family member and nearly ½ (48%) going online or speaking to friends (46%)

• Over 1/3 (38%) would get advice from an expert

• Only 9% would use an App to help solve a problem

• 5% would “sleep on it for a few days” before trying to solve a problem


Solve it yourselfOver 65s (69%) and those not employed (69%) were most likely to solve problems for themselves. Those from non-white ethnicities (54%) and under 35s (60%) were least likely to solve problems by themselves

Speak to family or friendsWomen were the most likely to speak with family/partner (61%) or friends (52%), whilst men were the least likely to do so (46% family/partner, 33% friends)

Go OnlinePeople from non-white ethnicities (56%) and people qualified at A-level or above (55%) were most likely to go online to help solve a problem

Use an AppPeople from non-white ethnicities (22%), under 35s (13%) were the groups most likely to use an App to solve problems

Public

46%

38%

48%

9%

65%

56%

5%

0% 20% 40% 60% 80%

Speaking to friends

Getting advice from anexpert

Going online

Using an App

Solve it yourself

Talk it through with yourpartner or a family member

Sleep on i t for a few days

Online Survey

34


How do you usually solve health concerns?• Almost every interviewee responded to this by initially saying “It depends on what it is or how major it is”. • The majority said they would try to treat the problem themselves with self-care or by self-medicating, often this

would involve “googling” symptoms to check severity or commonality. When individuals said they would use the internet for information, they typically choose to use the national NHS website as “it usually comes up first” and was felt to be “probably the most reliable source”.

• If self-help was unsuccessful a few said they would go to a pharmacist for advice on simple issues, but most said they would book a GP appointment or attend a walk-in centre if the issue was more serious. If it was an emergency, people would call 999 or go to A&E. However, a small number said they do anything they can to avoid having to go to their GP.

• Use of the internet was quite a polarising topic, people either seemed happy to search based on symptoms or were against it because “horrendous things come up”. Some people implied the internet was a tool more commonly used to research and educate themselves following a diagnosis from a medical professional, rather than using it initially to solve health concerns.

• Almost all said they would be “mostly comfortable” to discuss their health issues or concerns with family and friends, a few specified they would have to be close family or very close friends, but in general people appeared to be happy to go to them for advice, with a couple stating that they might ask family or friends about whether they should go to the GP or would “ask around to see if anyone has experience of similar issues”. Those who were not so keen to discuss with family and friends said it was because they prefer to keep health issues to themselves and “don’t want to burden them”. One person said they would “be spiritual and pray”.

• No-one reported use of health Apps, other than 2 people saying they use Apps to monitor their fitness or track the number of steps they take in a day.


35

A Conversation about WellbeingA Conversation about WellbeingIMPROVING SELF CARE

How health and care professionals can help you look after yourself better

Nothing1 in 5 (20%) said there was

nothing that H&C services needed

to do to help them look after

themselves better

Improved Accessibility & AvailabilityNearly 1 in 5 (18%) felt that services could help them with self care

through more/longer appointments allowing them to talk about

more than one issue or in more depth about one issue. They

wanted to see shorter waiting times, enabling quicker support

through a more flexible service offer using non-NHS settings as the

first point of contact – including being seen at home

Listening & Caring

More than 1 in 10 (13%) wanted services to

listen more and be more supportive,

demonstrating caring by being non-judgemental,

reassuring and honest – treating them as an

individual

Be Holistic: Address Root Causes1 in 10 (10%) felt that self care would be helped

by services being more holistic, addressing the

root cause and ensuring effective treatment.

They wanted services to promote healthy eating

and other preventative solutions, offer more

testing, and provide fitness, exercise and physio

opportunities

Online & Phone Access1 in 10 (10%) felt self care could be supported by online and phone

services which improved access. They wanted to see personalised

plans, aftercare and expertise provided through these channels.

They felt this could lead to quicker and better referrals (inc. self

referrals) and a greater choice of services available

Public

20% 18% 13% 10% 10% 9%

Explain More & Give Better Info

9% though self care could be enhanced if

H&C services provided more information

and advice which was explained better.

They also felt that services needed to be

more assertive and proactive – “do what

they say they will” – and to take control of

the condition

Online Survey

A Conversation about WellbeingA Conversation about Wellbeing BARRIERS: What stops you from being in the best health possible now?

Not Enough Time Life & Family Issues Nothing Pain & Limited MobilityOver 1 in 10 (11%) said a key barrier to

being in the best health was that they did

not have enough time to do things to

improve their health, such as exercise and

healthy eating

For 9%, family issues, bereavement social isolation and loneliness, their

living situation, past choices (inc., for

some, “bad luck”) were barriers to

being in good health

For 1 in 10 (9%) there were no barriers to them being in the best health

possible

8% said that pain or limited mobility (including being post–op or housebound)

were the main barriers to being in the best

health

Stress & Poor Mental Health Illness & Long Term Conditions Lifestyle Factors Work & Caring Responsibilities1 in 5 (20%) said that poor mental health

(including depression and PTSD), stress

and anxiety prevented them from being in

the best health

Nearly 1 in 5 (18%) told us that an

existing illness or chronic long term

condition stopped them from being in

the best health possible

A key barrier for 15% of respondents were related to their lifestyle –particularly drinking too much, smoking, being overweight, not

enough exercise and too little sleep

Over 1 in 10 (12%) said that their existing

work or caring responsibilities were a

barrier to being in the best health

20%

11%

18% 15% 12%

9% 9% 8%

PublicOnline Survey


SELF CARE• In general, both the workforce and the public, when asked questions related to self care

and prevention, found it hard to focus on changes individuals could make for themselves, and turned the conversation to the NHS itself – in terms of perceived problems with the NHS and suggestions for improvements that could be made.

• With regard to whether NHS staff felt comfortable and empowered to address people's poor health habits and problems, some did and some did not. Most felt that they could do this if they had to and that it would not be a problem; but some also said that there could be a 'backlash effect', that doing this may push their patients away, and that they had seen that before. Some stressed how important it was to build trust and a relationship before broaching such subjects, given the sensitive nature of the issues. We observed that there may have been more freedom to be direct with individuals about the need to change their behaviour at higher staff grades, such as surgeons operating on people and giving more direct advice afterwards, rather than nurses and carers dealing one-to-one and trying to foster an ongoing relationship.

• Some spoke of the importance of easily accessible activities such as sport’s facilities and council leisure centres, and ensuring that these were affordable to all. Some spoke about the need to ensure widespread promotion of information: for example, that doctors can 'prescribe' gym memberships and slimming programs and other things through social prescribing.

Pop-Ups

Public Workforce

38


BARRIERS TO SELF CARE: What stops you being able to look after yourself as well as you would like?

Just under half said they did not think there were normally any barriers preventing them from being able to look after themselves as well as they would like. Of barriers suggested by other participants, lack of time and work commitments were the most common, followed bydifficulty accessing services, family commitments, rural location and existing mental or physical health issues.

NumberNot normally any barriers 14Lack of time 7Work commitmentsMaking it difficult to access services or do exercise around shifts

7

Difficult to access services 5Children / busy family life 5Rural location – lack of transport 5Mental healthCan make it difficult to get out of the house

4

Physical healthPreventing individuals from exercising

4

Live alone 3FinancesIn particular, preventing access to dentistry

3

Having to go to GP for minor medicationLack of education about healthStigma surrounding talking about healthThe weather

1


39


How much do you agree or disagree with the statement “self care means no care”?Overall Results

The clear majority (85%) disagree with the statement “self care means no care” with only 5% agreeing with it and a further 11% being unsure


Self care means no careNo significant findings

Self care does not mean no care

No significant findings

Workforce

2% 3%

11%

41%44%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Strongly agree Agree Neither agreenor disagree

Disagree Stronglydisagree

0% 20% 40% 60% 80% 100%

Overall

North ICP

Central ICP

South ICP

North Cumbria ICP

NHS

Local Authority




Strongly agree and Agree

Neither agree nor disagree

Strongly disagree and disagree

Online Survey

40

A Conversation about WellbeingA Conversation about WellbeingSELF CARE

What do you understand by the term ‘self care’?

Being ProactiveNearly 2/3 (63%) felt that self

care meant looking after yourself

by being proactive about your

health (emotional and physical)

Making Healthy Lifestyle Choices / ChangesOver ¼ (26%) identified self care with making healthy lifestyle

choice and making positive changes to lifestyle and behaviours

Look After Your Mental Health

Nearly ¼ (23%) equated self care with looking

after your mental and emotional health

Positive Physical HealthOver 1 in 5 (22%) linked self care to achieving or

maintaining positive physical health

People Need Support to Self CareSome (7%) said that support was needed to be able to

self care effectively - such as educational and support

input from community, family, friends, the workplace or

the NHS

63% 26% 23% 22% 7% 1%

Manage LTCs or Reduce Ill Health

Only 1% mentioned self care in the

context of reducing ill health or managing

long term conditions



Have you ever asked anyone you know to do something to improve their health?Most said they have, or would be happy to, ask someone they know to do something to improve their health. Only one individual said that they did not feel it was their place to do this. When asked about their experiences of doing this, encouraging others to take up exercise was a common theme. Several interviewees said a particularly easy way to go about this would be if something had worked for them, to then recommend it to a friend or family member. A few people felt it can be a sensitive subject, so it would depend on who the person was and the circumstances; but regardless, said it would always be a topic that must be approached with care. Some people expressed concerns about coming across as hypocritical. Several interviewees identified that change is most likely when the person themselves are motivated to make the change, saying it “needs to come from them”, and implying that their role is more about being supportive and encouraging, or being someone who gives them the final push to make the change.

NumberYes 24Would be happy to do so, but haven’t needed to so far 5No, not my place 1


42


To what extent do you feel you get to tackle the root causes of ill health?Overall Results

½ (56%) feel they get to tackle the root causes of ill health in their role, but this is made up of 45% who feel they partially get to do this and only 6% who feel they fully get to do this – 1/3 (32%) feel they do not get to to do this at all and 17% feel it is not relevant to their job


Tackling Root CausesThose working in North (7%) and South (7%) ICPs are slightly more likely to say they fully tackle root causes of ill health in their role

Partially Tackling Root CausesThose working in Central (52%), North (50%) and South (50%) ICPs are more likely to say they partially tackle root causes of ill health in their role

Not Tackling Root Causes

Those working in North Cumbria ICP (56%) and frontline practitioners and Team Leaders (54%) were most likely to say they were not tackling root causes of ill health in their role or that it was not relevant to their role

Workforce

6%

45%

32%

17%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%


0% 20% 40% 60% 80% 100%

Overall

North ICP

Central ICP

South ICP

North Cumbria ICP

NHS

Local Authority





Online Survey

43


To what extent does your role support people to live a healthy lifestyle or change behaviour?Overall ResultsMost (68%) feel that their role allows them to at least partially support people to live a healthy lifestyle or change their behaviour, while 1 in 3 (32%) feel their role does not allow them to do this or that this is not relevant to their role

• ¼ (27%) feel their role fully supports people to live a healthy lifestyle

• 41% feel their role partially supports this

• 18% feel their role does not do this

• 14% feel this is not relevant to their role


Fully helping people live healthy livesThose working in Central and North ICPs were most likely to say they fully helped people to live a healthy lifestyle or change behaviour (31% and 29% respectively). Those working in North Cumbria (18%) were least likely to say they this. Senior managers, administrators and commissioners (29%) were more likely to say this than frontline practitioner an team leaders (22%)

Partially helping people live healthy livesPeople working in North Cumbria ICP (51%) were most likely to say they partially help people live health lifestyles

Not helping people live healthy livesMore than 4 out of 10 (44%) of Practitioners and Team Leaders said they they either did not help people live a healthy lifestyle or that it was not applicable to their jobs

Workforce

27%

41%

18%

14%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%


0% 20% 40% 60% 80% 100%

%

North ICP

Central ICP

South ICP

North Cumbria ICP

NHS

Local Authority





Online Survey

44


How much of your role involves giving people advice on how to look after themselves better?Overall Results

Nearly 4 out of 10 (39%) say that giving people advice on how to look after themselves better is an important part of their role, with a further ¼ (24%) saying it is a small part of their role – however, over 1/3 (37%) say it is not part of their role


Advice giversThose working in Central (50%) and North ICP (46%) were most likely to say that advice giving is an important part of their role

Occasional advice giversThose working in South ICP (29%) were most likely to say that advice giving was a small part of their role

Advice giving not part of rolePractitioners and Team Leaders were most likely (44%) to say that advice giving was not part of their role

Workforce

39%

24%

37%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

It's an important part ofmy role

It's a small part of my role It's not part of my role

0% 20% 40% 60% 80% 100%

%

North ICP

Central ICP

South ICP

North Cumbria ICP

NHS

Local Authority




It's an important part of my role

It's a small part of my role

It's not part of my role

Online Survey

45


Do you feel empowered to give messages to help people look after themselves better?Overall Results

Over half (58%) feel empowered in their role to give messages to help people look after themselves, however ¼ (25%) do not feel able to do this and 17% are unsure


Empowered Those working in North (66%) and Central (62%) ICPs, those working in the NHS (60%) and senior managers/commissioners (60%) were most likely to feel empowered to give messages to help people look after themselves better

Not Empowered

Those working in North Cumbria ICP (32%) and frontline practitioners & Team Leaders (30%) were the most likely to say they were not empowered in their role to help people look after themselves better

Workforce

58%

17%

25%

0%

10%

20%

30%

40%

50%

60%

70%

Yes Not sure No

0% 20% 40% 60% 80% 100%

Overall

North ICP

Central ICP

South ICP

North Cumbria ICP

NHS

Local Authority




Yes Not sure No

Online Survey

46

A Conversation about WellbeingA Conversation about Wellbeing EMPOWERED: Do you feel empowered to give prevention messages in your role?

Training & Support Needed Supporting Colleagues Lack of Time & Opportunity Public have Low Self Care CapacitySome (8%) felt they could do this if they

received the right training, support, tools

and communication materials needed to

build confidence and deliver this in their

role

A number (8%) raised that they supported colleagues in their

workplace with wellbeing – seeing

this as an important part of their role

Some (7%) said the barriers preventing them giving prevention messages in

their role were not having the time,

capacity or opportunity to do this

5% felt the public has low self care capacity and were not open to this kind of

prevention advice – seeing it as “a hard

sell”. Some said this could be tackled by

involving patients in developing messages

All Part of the Job Not My Job Confident & Experienced Advice & Info OnlyNearly 4 in 10 (39%) saw it as part of their role to give prevention messages or can factor it into interventions.

Some said they commission this through providers. People emphasised the importance of this and said

evidence backs this up. Some saw it as an organisational or personal commitment (e.g. being a role model) and

said the public expects this

1 in 5 (21%) said that giving prevention messages was not part of their role, with some adding that they did not feel

confident to provide this

1 in 5 (19%) said they felt confident, skilled, experienced and supported to

provide prevention messages. This was helped by having good relationships

with their clients

18% responded that they gave brief advice and information only and did not

provide more intensive interventions within their role (due to time constraints

or lack of training)

39%

8%

21% 19% 18%

8% 7% 5%


A Conversation about WellbeingA Conversation about Wellbeing ENABLERS: What could encourage you & colleagues to give prevention advice?

Support & Recognition Incentives & Targets Nothing Not SureMore than 1 in 10 (13%) wanted to see

greater support to deliver prevention advice

from their workplace (e.g. organisation

and/or manager) and recognition of this as a

key part of their role

More than 1 in 10 (12%) said that prevention advice giving would be

enabled through the use of incentives and targets, including flexible working

hours, longer breaks, shorter shifts, increased wages

Some (12%) said that nothing would further enable prevention advice giving

as they should already be doing this as

part of their role or acknowledging that

they can only do so much to help

1 in 10 (10%) said they were not sure what would enable

them to give more prevention

advice

More Time & Staff Greater Promotion Training & Joined-up Messages User-Friendly ResourcesAround 1 in 5 (19%) said they felt that

having more time allowed in their role with

each patient would enable them to give

more prevention advice

Under 1 in 5 (18%) felt that greater promotion of the need to give prevention

advice would enable them, along with accessible information about signposting

to relevant services

Some (16%) thought that more training and knowledge focused on clear and consistent joined-up messages would enable them to give more prevention

advice

A number (14%) asked for easily

accessible, user-friendly resources

that they could give to people

19%

13%

18% 16% 14%

12% 12% 10%



PREVENTION• Most people appeared to have an understanding of what wellbeing means to them. This was

generally described in terms of physical, mental, emotional, and spiritual health.• The main issue raised in relation to prevention was how important being part of a community and

having someone to talk to is. “This allows people to get things off their chest.” Both groups emphasised how important it was, in every part of people’s contact with health services, for them to be really listened to. Some spoke of creating better links between hospitals, GPs, social services, and community services such as food banks and churches, etc.

• Nearly all participants, when asked what more could be done to lead to reduced demand on health and care services service, suggested that there should be more services. For example, more community outreach programs; more nurses; more doctors; more appointment times; more places where people could go; more programs, such as for exercise and obesity; more help for the homeless and the vulnerable, etc.

• Some suggested increasing prevention awareness and dissemination of information, through leaflets, advertisements, etc. Though a number mentioned how much is already available, in terms of both opportunities and programs to spread awareness of prevention opportunities.

• It was also suggested that more could be done to address the root causes of ill-health, rather than merely treating the symptoms, through education of the young and increased mental health and addiction services, especially with regard to problems caused by excessive use of alcohol, smoking and drugs.

Pop-Ups

Public Workforce

49


How effective do you find Making Every Contact Count (MECC) in your work?Overall Results

More than half (54%) had not heard of MECC, however the majority of those who had heard of it found it to be very or partially effective• 16% thought MECC was very effective

• 25% said MECC was partially effective

• 5% say MECC is not effective


Very or partially effectiveThose working in North Cumbria (44%) and Central (42%) ICPs, NHS staff (42%) and Commissioners/Senior Managers (42%) were most likely to say MECC is at least partially effective

Not effectiveThose working in South ICP (7%) were more likely to say MECC is not effective

Not heard of itPractitioners/Team Leaders (58%), Local Authorities (56%) and those working in North ICP (56%) were most likely to say they had not heard of MECC

Workforce

16%

25%

5%

54%

0%

10%

20%

30%

40%

50%

60%

Very effective Partial ly effective Not effective I don't know whatit is

0% 20% 40% 60% 80% 100%

Overall

North ICP

Central ICP

South ICP

North Cumbria ICP

NHS

Local Authority




Very effective Partial ly effective

Not effective I don't know what it is

Online Survey

50


How effective do you find All Our Health (AOH) in your work? Overall Results

More than ¾ (77%) had not heard of All Our Health (AOH), however most of those who had heard of it found it to be very or partially effective• 6% thought AOH was very effective

• 19% said AOH was partially effective

• 4% say AOH is not effective


Very or partially effectiveThose working in North ICP (20%) were most likely to say AOH is at least partially effective

Not effectiveThose working in South ICP (7%) were more likely to say AOH was not effective

Not heard of itLocal Authorities (79%), Practitioners/Team Leaders (78%), and those working in the private or 3rd sector (78%) were most likely to say they had not heard of AOH

Workforce

6%13%

4%

77%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%


0% 20% 40% 60% 80% 100%

Overall

North ICP

Central ICP

South ICP

North Cumbria ICP

NHS

Local Authority






Online Survey

51


How effective do you find Social Prescribing in your work?Overall Results

More than half (51%) had not heard of Social Prescribing, however the majority of those who had heard of it found it to be very or partially effective• 15% thought Social Prescribing was very

effective• 25% said Social Prescribing was partially

effective• 8% say Social Prescribing is not effective


Very or partially effectiveThose working in North Cumbria (47%) were most likely to say Social Prescribing was at least partially effective

Not effectiveThose working in North Cumbria (11%), South (10%) and Central (10%) ICPs were m0re likely to say Social Prescribing was not effective

Not heard of itThose working in South ICP (58%), and senior managers/commissioners (55%) were most likely to say they had not heard of Social Prescribing

Workforce

15%

25%

8%

51%

0%

10%

20%

30%

40%

50%

60%


0% 20% 40% 60% 80% 100%

Overall

North ICP

Central ICP

South ICP

North Cumbria ICP

NHS

Local Authority






Online Survey

52

A Conversation about WellbeingA Conversation about WellbeingPREVENTION PROGRAMMES

What could make these programmes (MECC, AOH, Social Prescribing) more effective?

Training & ImplementationNearly 1 in 3 (31%) felt that wider

knowledge of the content of these

programmes would make them more

effective, through more training and better

implementation

Raising Awareness & Greater PromotionNearly 3 in 10 (29%) suggested that greater awareness was needed

through increased promotion of the programmes. They also felt

this would be enhanced through easier referral mechanisms/easier

access

Never Heard Of Them

Nearly 1 in 5 (18%) explained that they were

unaware of these programmes or that they were

not part of their role / We can only help so much

Not Sure14% said they were not sure of what would

make these programmes more effective

Time & ResourcesMore than 1 in 10 (13%) said that more dedicated

time in people’s jobs and more resources available

to aid implementation would allow the programmes

to be more effective

31% 29% 18% 14% 13% 11%

A More Joined-Up Approach

1 in 10 (11%) wanted to see a more joined-

up working and better communication and

support from leaders and organisations in

order to enable these programmes to be

more effective in prevention activity

Workforce

Only 2% mentioned being a positive role model and setting a good example

Online Survey


"Digital healthcare will give you more time to care, promoting deeper interaction with people"?Overall Results

Over ½ (54%) neither agree nor disagree with the statement “Digital healthcare will give you more time to care, promoting deeper interaction with people”• 22% agree with the statement

• 25% disagree with the statement


Digital ReadyThose who work in South ICP (25%) more strongly agreed with the statement

Digital Sceptics

Those who work in North Cumbria (58%) and South (56%) ICPs, for the NHS (56%) and Commissioners/Senior Managers (56%) were most likely to say they neither agreed nor disagreed with the statement “Digital healthcare will give you more time to care, promoting deeper interaction with people”

Not Digital ReadyCommissioners/Senior Managers (28%) were most likely to say they disagreed with the statement

Workforce

4%

18%

54%

17%

7%

0%

10%

20%

30%

40%

50%

60%

Strongly agree Agree Neither agreenor disagree

Disagree Stronglydisagree

0% 20% 40% 60% 80% 100%

Overall

North ICP

Central ICP

South ICP

North Cumbria ICP

NHS

Local Authority




Strongly Agree / Agree

Neither agree nor disagree

Strongly disagree / Disagree

Online Survey

54


Staff will need to navigate a data-rich healthcare environment. Do you feel ready & willing to do this?Overall Results

The clear majority (82%) feel ready and willing to navigate a data-rich healthcare environment, while only 13% say they are not ready to do this


Digital ReadyThose working in South (87%) and North Cumbria (84%) ICPs are most likely to say they are ready and wiling to navigate a data-rich healthcare environment

Digital ScepticsSenior managers/Commissioners (17%) were most likely to say they were not ready and willing to navigate a data-rich healthcare environment

Workforce

48%

34%

5%

11%

2%

0%

10%

20%

30%

40%

50%

60%

Yes, very muchso

Yes, a bit Not sure Not really Definitely not 0% 20% 40% 60% 80% 100%

Overall

North ICP

Central ICP

South ICP

North Cumbria ICP

NHS

Local Authority




Yes Not sure No

Online Survey

55


DIGITAL SKILLS

Tell us about using digital skills in your work

Reduces QualityTime with People

Better I.T. Needed

Digital Ready

Training & Support

More than half (55%) said they needed more information,

training and support to maximise the potential of digital

healthcare opportunities. Some added that this should

address key issues such as barriers for older people and

identify ways to get buy-in from patients

¼ (24%) felt that there needed to be

better IT systems in place, with more

devices available. They also said there

needed to be greater consistency across

teams, better information sharing systems

and a need to build confidence in these

systems in the wider workforce

1 in 10 felt that more reliance on digital reduces

or is replacing quality time spent with patients.

Some added that time constraints limited their

ability to make best use of digital opportunities

¼ (25%) stated that they were already

competent with technology, using this in their

roles and felt positive about it driving

improvements

55%

24%25%

10%

1% were not sure


A Conversation about WellbeingA Conversation about Wellbeing What can you do to reduce future demands on NHS?

Joined-Up & Efficient Processes Acknowledge the Limits Personalised Prevention Not Sure1 in 10 (10%) suggested that improved

processes which were more efficient and

consistent, coupled with joined-up working

and a more holistic approach would lead to

reductions in future NHS demand

Some (9%) felt that the NHS and they in their role can only help so much and that they were already doing everything they

could. Some added that they could be firmer with patients, even introducing

penalties for some service use

A number (7%) put forward that prevention and early intervention

should be ramped up and be

personalised, leading to more

individualised plans and support

6% said they were not sure what could be done to reduce

future NHS demand

Educate The Public in Prevention Self Care by Public Self Care by Staff Increased InvestmentNearly 4 in 10 (38%) said future NHS demand could be

reduced by more public education in prevention through

greater promotion, raising awareness of preventative

measures, better signposting to prevention services and

easy access to preventative information

Nearly 1 in 5 (18%) suggested encouraging and empowering greater self care with patients and the wider public. Some felt this could be done

in part by being a role model

A number (14%) thought NHS demand could be reduced by promoting self-

care among staff and providing better

support for staff

More than 1 in 10 (12%) recommended that more

investment and resources in the NHS were needed to help reduce

future demand

38%

11%

18% 14% 12%

9% 7% 6%



3. “What Matters To You?”, not “What is the Matter with You?”: Telling the story of the ICS”Changing the way people perceive the role of the health and care system and how they use itThe Role of Health & Care Services and User ExperiencesFurther influence health and care staff to be ‘health advocates’ by example –e.g. through their own self-care“Telling the story of the ICS” – Informing the development of a clear ICS Narrative

58


ACCESS TO SERVICES• Almost all participants were happy with their local NHS facilities, staff and the range of

care provided. There were very few instances of negative feedback, and a large amount of positive feedback and support, among both public and workforce.

• Many said that it is too hard to get a GP or doctor’s appointment; but some said that it was easy for them.

• A number said they did not know which service to use and when to use it. This was both among the workforce and the public.

• The workforce told us about some inefficiencies in the system were different departments were not linked up well enough and that patients were needlessly and repeatedly referred to the wrong places, meaning, for example, that individuals might be seen three or four times when one appointment would have sufficed. Similarly, people were going to A&E and calling 999 when they should have been using their GPs, calling 111, or using pharmacies to deal with their presenting issue.

• Members of the workforce felt that people should take greater responsibility for their own health rather than relying on health services to do this for them. Some wondered whether it was right that people drinking above recommended limits and smokers should continue to be treated since they were damaging their own bodies.

Pop-Ups

Public Workforce

59


Do you usually feel listened to by health and care services you have used?Overall ResultsMost (62%) usually feel listened to by health and care services

• However, nearly 1 in 5 (19%) do not usually feel listened to by H&C services


Feeling listened to

Those aged 65+ (73%) were most likely to feel listened to by health and care services2/3 (66%) of men, people with no LTC, and people from non-white ethnic groups

Not feeling listened toUnder 35s were most likely (24%) to say they were not listened to by health and care servicesPeople with 1 or more LTC (22%) and qualified below A-level (22%) were also more likely to not feel listened to

Public

62%

18% 19%

0%

10%

20%

30%

40%

50%

60%

70%

Yes Not sure No

0% 20% 40% 60% 80% 100% 120%

Overall

Female

Male

No LTC

1 or more LTC

Under 35

35-64

65+

White

Non-White

Employed

Not Employed

Central ICP

North ICP

North Cumbria ICP

South ICP

A-Level+

< A-level

Yes Not sure No

Online Survey

60

A Conversation about WellbeingA Conversation about Wellbeing SERVICE USE: How do you usually feel after you have visited a H&C service?

Feeling Better & Hopeful Frustrated & Disappointed Feel The Same Rushed1 in 10 (10%) feel better and that their

condition has improved, leading them

to be hopeful for the future

1 in 10 (10%) say they usually feel

frustrated and disappointed after they

have used H&C services – leaving them

feeling irritated, annoyed and dissatisfied,

like the problem is not solved

Just under 1 in 10 (9%) feel the same or indifferent, stating that it

depends on the situation or

outcome of the use of services

6% feel rushed due to the NHS being understaffed, saying that the service

suffers as a result, leading to long waiting

lists making it hard to get appointments

Satisfied & OK Reassured & Put at Ease Happy & Positive Depressed & DeflatedOver ¼ (27%) feel satisfied or ”ok” with the

support that has been provided – feeling

content or fine after having used a service

1 in 5 (21%) feel reassured after they have visited a service, saying they have been put at ease or relieved,

made to feel more confident, informed and listened to

Nearly 1 in 5 (18%) feel happy and positive after using H&C services,

feeling glad, relaxed, healthy and

grateful for the NHS

More than 1 in 10 (13%) feel depressed or “deflated” after having used a service,

saying that it usually causes them more stress, worry and anxiety, leaving them

feeling down

27%

10%

21% 18% 13%

10% 9% 6%

PublicOnline Survey


Tell us about the last time you used a health or care service and things went well – what happened?All participants could think of positive personal experiences they had had with health or care services. Interviewees were keen to go into detail and explain the processes they had been through. The most common positive experiences were with GPs, perhaps due to GPs being the most commonly accessed service. Hospital staff and physiotherapists were also praised by several interviewees; although, in some cases physiotherapists had been accessed privately. In general, despite acknowledging the struggles faced by the system, participants appeared to hold very positive opinions of the NHS, one participant stated: “Overall, I want to commend the NHS, they are doing a wonderful job”.

No.Quotes

GP 11 “They listened”“New young doctor was very caring – now will always try to get appointments with her… she is wonderful”“GP was good and took time to explain possible treatments”“GP is fantastic, kind and friendly”“Listened actively”“Stayed late to accommodate my working hours”“Couldn’t fault them at all”“Really helpful at giving advice”“Very supportive”“Really good service”

Hospital staff 6 “Care at hospital was very good”“Amazing”

Physiotherapist 6 “Was flabbergasted that I got an appointment within about 2-weeks – so much quicker than I expected”“Thought the system of making a self-referral and then being notified to make appointment was good”“Really helped”“A good thing was that they have sent me videos of exercises which is great as I always struggled with the pictures”“Got referral and appointment really quickly”

111 4 “They were able to put all principles into everyday language so we felt really reassured that they knew what was going on and we understood everything”“Very helpful”

Paramedics 2 “Very reassuring”

A&E 2 “Staff were amazing”“Always been quite positive experiences”

Private podiatrist 1 “Really good experience”

Wheelchair services

1“Excellent service, professional and quick”

Pharmacy 1 “Really convenient”

Dentist 1 “Absolutely wonderful”


62


Tell us about the last time you used a health or care service and things did not go well – what happened?With the exception of two participants, all interviewees could think of a negative personal experience that they had had with health or care services. As with positive experiences, GPs were most commonly discussed in answer to this question – again, perhaps due to GPs being the most commonly accessed service among this sample. Mental health services, in particular their long wait times, was the second most common negative experience. One male participant discussed how disappointing it is that despite large promotional campaigns to encourage talking about mental health, especially targeted at males, services cannot meet the demand following this. He explained that considering how much courage it takes to come forward when struggling with mental health, it is simply not satisfactory to then have to wait over a year for help when someone does reach out.The majority of negative experiences came down to lack of capacity, long wait times, services being understaffed and services not being able to meet demand. Quite a few participants explained that their negative experiences had resulted in them looking for private healthcare alternatives where possible. One participant even said: “The difference In care between private and NHS is incredible – if everyone could be dealt with like you are when you go private it would be a wonderful world, it would make a tremendous difference ”.

Service No. Quotes

GP 20 “It was a situation where I had never felt that unwell in my life and GP didn’t really respond when I told them that”“GP’s care was unsatisfactory – they need to show more empathy”“GP couldn’t relate to what I was going through”“Postcode lottery”“Contacting GP was difficult”“Could not get an appointment”“Staff are overworked”“There are loop holes people misuse”“Didn’t seem interested”“Dismissed and told nothing was wrong… ended up with a collapsed lung, which has happened multiple times since and resulted in surgery… still suffer a lot… doctor was oblivious”“Tricky to get GP appointments”“Phoning GP is a nightmare”“Poor – haven’t ever come out feeling any better”“Strained”“Implied it was all in my head… need to be more understanding”

Mental Health 7 “12 months to get an appointment with MH team”“Didn’t feel safe”“Didn’t fulfil the duty of care”“Mental health provision is appalling”“Psychiatrists just diagnose everyone with borderline personality disorder”“They didn’t have the right attitude to suit what I needed”“Still waiting for an appointment”“Shouldn’t sell a service and then not have the resources to supply it”

Hospital 4 “In the end I looked into and went for private consultation”“Long wait times are common”“Felt a bit overlooked”“Staff were run off their feet”“Understaffed”

No negative experience 3 “No bad experiences”“No personal bad experiences”

Physiotherapist 2 “This was disappointing”Midwifery 1 “Didn’t feel supported”Paramedics 1 “Their attitude wasn’t good”


63


Experience of using your local GPKey themes:It was generally felt to be hard to contact and access GP practices through appointments or phone calls. People spoke of being kept on hold for a long time when phoning reception, some spoke of having “to ring dead on 8am and it’s ‘hit and miss’ whether you will then get through”. When they did get through, receptionists were often described as being “unhelpful and sometimes even rude”People spoke of long wait times for GP appointments – it was described as “pot luck” when discussing how long the wait times were, which was spoken of as “frustrating”. Some said they often thought “why bother?” and would wait in hope that symptoms would go away rather than trying to get a GP appointment – Some they said that this sometimes had negative outcomes on their health. Some spoke of there being “Less wait time if you’re not fussy about who you will see and don’t have to go to work or on the school run so you are available at any hour.”Those in rural areas appeared to get GP appointments more quickly, this was thought to be due to having less demand. GP practices in cities and large towns were described as bigger and seemed to be described as the most difficult to get appointments in.GP appointments were said to “typically overrun, which can be problematic when you try to fit them in your lunch break or around work schedules.” Some felt that GPs were taking on too many patients for the size of their practice and that there should be some restrictions or limits in place for how many patients each practice is allowed to have registered. This was linked with a need for more GPs in their area to help meet demand.The few that had used online booking systems described these as good and that they had made access somewhat easier. There was some concern that this could be leaving the older population behind by excluding them. However, a few participants highlighted that in a decades time, almost all people will be competent with technology, “so in the future this should work better for most.” Participants were very positive about systems where you can book a phone call from a GP to have a brief discussion – although this seemed to have been discontinued in some locations

Other issues raised by some respondents:• Missed appointments (DNAs) were thought to be a problem by some,

with people suggesting there was a need for more education of the public about the impact of this. Some said they found text reminders for appointments very useful, but that they were not delivered consistently.

• Some practices seem to offer evening appointments but there was a lack of consistency and knowledge about when these were available - “It’s hit and miss when evenings or Saturdays are offered.”

• Some suggested that there needed to be more organisation by the GP practice to ensure more consistent care if you could not see the same doctor

• Some said that GPs should stop prescribing medication that is available over the counter.

• Some spoke of it being difficult for students when they are home for holidays as they felt there was a lot of paperwork to re-register each time.

• Despite a number of issues raised by participants, there was an overall feeling that “GPs are doing their best.”


64


To what extent do you feel able in your job to support individuals with what matters to them?Overall Results

The majority (78%) feel at least partially able in their job to support individuals with what matters to them

• ¼ (25%) feel they can fully support people with what matters to them

• Over ½ (54%) feel they can partially support people with what matters to them

• 8% feel they cannot do this at all in their job

• 13% say this was not applicable to their job


Full supportersNHS staff (26%) and those in North ICP (25%) were the most likely to say they fully support people with what matters to them

Partial supportersThose working in South (66%) and North Cumbria ICP (65%) areas were most likely top say they can partially support people with what matters to them

Not able to supportPractitioners and Team Leaders were most likely (25%) to say they were not able to support people with what matters to them or that it was not applicable to their role

Workforce

24%

54%

8%13%

0%

10%

20%

30%

40%

50%

60%


0% 20% 40% 60% 80% 100%

%

North ICP

Central ICP

South ICP

North Cumbria ICP

NHS

Local Authority





Online Survey

65


To what extent do health and care services support you with what matters to you?Overall ResultsMost people (69%) feel health and care services support them, at least partially, with what matters to them, only 11% felt they were supported completely and 12% felt they were not supported at at all• Over 1/3 (37%) felt supported “completely” or

“mostly”• 1/3 (32%) felt supported partially • Just under 1/3 (31%) felt they were not

supported much or not at all supported


Those who feel supportedPeople aged 65+ were most likely to feel supported (52%) by health and care services, followed by men (42%) and those who were not employed (41%)

Those who don’t feel supportedThose most likely to feel they were not supported by health and care services were those from Central and North Cumbria ICPs (33%), those qualified below A-level (33%), those aged 35-64 (32%) and those with no LTCs (32%)

Public

11%

27%

32%

19%

12%

0%

5%

10%

15%

20%

25%

30%

35%

Completely Mostly Partial ly Not much Not at all

0% 20% 40% 60% 80% 100%

Overall

Female

Male

No LTC

1 or more LTC

Under 35

35-64

65+

White

Non-White

Employed

Not Employed

Central ICP

North ICP

North Cumbria ICP

South ICP

A-Level+

< A-level

Completely / Mostly Partial ly Not much / Not at all

Online Survey

66


SERVICES SUPPORT WHAT MATTERS TO YOU

To what extent do health and care services support you with what matters to you?

Not At All

PartiallyMostly

Completely

11% feel completely supported by H&C services, due to the

good support and help they receive. They feel services are

always there, accessible, with good staff providing useful

information and advice through effective communication and

regular check ups. They trust the NHS completely.

½ of all respondents felt either partially or

not very supported by H&C services with

what matters to them. Criticism focused

on difficulties in getting appointments,

services being overstretched & lacking

resources, staff/the system not listening

to them, not feeling cared for by services,

lack of follow up, and criticisms about a

lack of mental health provision

Over 1 in 10 (12%) felt that H&C services did not

support them at all with what matters to them.

This was due to difficulty getting appointments,

long waiting times, austerity cuts, feeling services

don’t care, feeling fobbed off, bad referrals, not

feeling listened to and incompetent services.

Over ¼ (26%) experience good support & help

which leaves them feeling mostly supported by

H&C services. This is due to good staff who are

there when needed, giving good care (inc.

medication) through accessible appointments,

regular check-ups & onward referrals

11%

50%26%

12%

37% feel “completely” or “mostly” supported with what matters to them by H&C services

Online SurveyPublic


Will current levels of health and care services in your area still be affordable in the future?Overall Results44% are not sure whether the current level of health and care provision in their area will be affordable in future and 34% feel that they will not be• Only 1 in 5 (21%) feel that current services

are affordable in future


Positive about sustainable services

People from non-white ethnicities (34%), those aged under 35 (28%) and people from the South ICP (28%) were most likely to be positive about the sustainability of current service levels into the future

Negative about sustainable services

The under 35s, however, were also most likely to say that current service levels were not sustainable into the future (38%)

At a similar level were people from the Central ICP (38%), North Cumbria ICP (36%), people who are employed (36%) and people with 1 or more LTC (36%)

Public

21%

44%

34%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Yes Not sure No

0% 20% 40% 60% 80% 100% 120%

Overall

Female

Male

No LTC

1 or more LTC

Under 35

35-64

65+

White

Non-White

Employed

Not Employed

Central ICP

North ICP

North Cumbria ICP

South ICP

A-Level+

< A-level

Yes Not sure No

Online Survey

68


Do you think people who work in health & care services should be role models for healthy living?Overall Results2/3 (65%) feel that the people who work in health and care services should be role models for healthy living• 18% were unsure about this• 16% felt that the H&C workforce should

not be health living role models


Role Models

People from non-white ethnicities (74%) and from the North Cumbria ICP (73%) were most likely to feel that H&C workforce should be healthy living role models

Not Role Models

People qualified below A-level (19%) and under 35s (19%) were more likely to say the H&C workforce should not be healthy living role models

Public

65%

18%16%

0%

10%

20%

30%

40%

50%

60%

70%

Yes Not sure No

0% 20% 40% 60% 80% 100% 120%

Overall

Female

Male

No LTC

1 or more LTC

Under 35

35-64

65+

White

Non-White

Employed

Not Employed

Central ICP

North ICP

North Cumbria ICP

South ICP

A-Level+

< A-level

Yes Not sure No

Online Survey

69


Who should be most responsible for your health and wellbeing?Overall ResultsMost people (60%) feel they are most responsible for their heath and wellbeing• Over 1/3 (38%) think that

responsibility for your health and wellbeing was a balance between the individual and health & care services

• Only 2% stated that this should be the responsibility of H&C services


Responsible for my own wellbeingThose with no LTCs (65%) and those qualified at A-level or above (63%) were most likely to say they were the most responsible for their health and wellbeing

A balanceOver 65s (46%) and those not employed (43%) were most likely to say that responsibility for health and wellbeing was a balance between the individual and H&C services

H&C responsible for my wellbeingPeople from non-white ethnicities (6%) were the most likely group to say that their health and wellbeing was more the responsibility of H&C services

Public

60%

38%

2%

0%

10%

20%

30%

40%

50%

60%

70%

Me Balance between me &health/care services

Health & Care Services

0% 20% 40% 60% 80% 100%

Overall

Female

Male

No LTC

1 or more LTC

Under 35

35-64

65+

White

Non-White

Employed

Not Employed

Central ICP

North ICP

North Cumbria ICP

South ICP

A-Level+

< A-level

Me

Balance between me & health/care services

Health & Care Services

Online Survey

70


If you had a health problem, how involved would you expect to be when making decisions about what action to take?Overall ResultsMost people (72%) think it should be a balance of health services and the individual working together when making decisions about what action to take when they have a health problem• ¼ (25%) feel that they should make all

the decisions when they have a health problem

• Only 3% feel that health services should make all the decisions


Partnership decision making with HealthOver 65s (77%), those from North Cumbria ICP (76%) and those who are not employed (75%) were most likely to believe in partnership decision making when they have a health problem

I should make all the decisionsPeople living in Central ICP (30%), those from non-white ethnicities (29%), women (27%) and people with no LTCs (27%) were most likely to feel that they should make all the decisions

Health Service should make all the decisionsMen and under 35s were more likely (5%) to think that health services should make all the decisions

Public

3%

72%

25%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Health services shouldmake all decisions

Health services and meworking together

I should make alldecisions

0% 20% 40% 60% 80% 100%

Overall

Female

Male

No LTC

1 or more LTC

Under 35

35-64

65+

White

Non-White

Employed

Not Employed

Central ICP

North ICP

North Cumbria ICP

South ICP

A-Level+

< A-level

Health services should make all decisions

Health services and me working together

I should make all decisions

Online Survey

71


IMPROVING SELF CARE

How can health and care professionals help you to look after yourself better?

Over Reliance on GPs

The overall message was that too much

reliance on GPs leads to long wait times. To

improve this, it was felt that education

should be provided about the importance of

self-care and accessing help from non-clinical

settings – e.g. visiting a pharmacist for advice

before going to a GP.

Know When to Access GP

It was felt that people lack

knowledge of when it is

appropriate to access

emergency services or GPs,

which creates greater

demand for services which

are already under-resourced

to cope with this.

Promote Alternatives

“Health should not be about

absence of illness it should

be about being your best”.

Some suggested a need for

increased promotion about

what services and groups

already exist and how to

access these.

Raise Awareness

Leaflets in GP surgeries were seen

as “ok”, but often it is too late by

the time people see them there.

People need to access information

sooner. Some suggested

information in pharmacies and

community areas, along with

increased use of social media

Tailored Information

It was suggested there could be a pop-

up health survey developed to be

displayed on social media feeds. Using

an individual’s answers and location to

recommend relevant health initiatives -

e.g. exercise groups.


A Conversation about WellbeingA Conversation about Wellbeing COMMUNITY: Which groups or communities do you feel part of?

Interest Group Family Work Where I LiveOver 1 in 10 (12%) said they were part of

an interest group, based on a shared

interest in music, hobbies or other

interests

1 in 10 (10%) identified as being part of a family group, including nuclear

and wider family

8% felt part of a work-based group both with friends and wider

colleagues at their workplace – for

some, this was both at work and in a

social context

8% said they were part of a

community based on the area that

they live in

None Community Group Sport & Exercise FriendshipNearly 3 in 10 (29%) people said they did

not feel part of, or identify with any

community or social group

Nearly 3 in 10 (28%) felt part of a

community group, school, community

centre, meeting place, social club or

local pub

1 in 5 (20%) said they belonged to groups or communities based on

playing sport, taking exercise or going to exercise classes, being part of a

sports club or gym

1 in 5 (19%) identified with being

part of a friendship group

29%

12%

28% 20% 19%

10% 8% 8%

PublicOnline Survey


PROFILES

74


MEN & WOMEN

51% 44%

MEN

Found it easier to make healthy lifestyle changes (41% to 37%)

More likely to feel health & care services helped with what

matters to them (42% to 36%)

Felt more able to deal with problems (43% to 38%)

WOMEN

More confident in finding out health information (64% to 59%)

Felt more like an expert in their own care (61% to 53%)

More comfortable giving health advice to friends & family(39% to 28%)

Felt more responsible for their wellbeing (61% to 51%)

32% 38%

RATE THEIR CURRENT

HEALTH AS GOOD

RATE THEIR CURRENT

HEALTH AS GOOD

EXPECT THEIR

HEALTH TO BE BETTER IN

5 YEARS

EXPECT THEIR


5 YEARS

PublicOnline Survey


BY HIGHEST QUALIFICATIONPublicOnline Survey

42% 50%

29% 42%

RATE THEIR CURRENT

HEALTH AS GOOD

RATE THEIR CURRENT

HEALTH AS GOOD

EXPECT THEIR


5 YEARS

EXPECT THEIR


5 YEARS

GCSE & BELOW (inc. no qualifications)

Less likely to be confident looking up health information (56% to 68%)

More likely to feel that health & care services do not support them

with what matters to them (33% to 29%)

Less likely to feel listened to H&C services (60% to 65%)

Less likely to feel that they should be solely responsible for their

health and wellbeing (57% to 63%)

A-LEVEL & ABOVE

More likely to rate their ability to deal with problems (43% to 36%)

More likely to feel like an expert in their own health (65% to 52%)

More likely to have someone to talk to about wellbeing (79% to 74%)

More likely to feel comfortable offering health advice to friends

and family (41% to 29%)


BY EMPLOYMENT STATUSPublicOnline Survey

38% 50%

22% 43%

RATE THEIR CURRENT

HEALTH AS GOOD

RATE THEIR CURRENT

HEALTH AS GOOD

EXPECT THEIR


5 YEARS

EXPECT THEIR


5 YEARS

NOT EMPLOYED (inc. unemployed & retired)

More likely to want to talk to a doctor (70% to 60%) or nurse (53% to 46%)

Twice as likely to feel uncomfortable offering health advice to friends

or family (11% to 20%)

More likely to find it hard to make lifestyle changes (18% to 13%)

Less likely to feel that they should be solely responsible for their own

health and wellbeing (55% to 62%)

EMPLOYED (inc. part-time & fulltime)

More likely to have someone to talk to about wellbeing (79% to 73%)

More likely to want to talk to a family member (63% to 59%) or friend(65% to 56%)

More likely to be comfortable offering health advice to friends or

family (39% to 36%)

More likely to say they are good at dealing with problems (41% to 35%)


BY ETHNICITYPublicOnline Survey

46% 61%

35% 61%

RATE THEIR CURRENT

HEALTH AS GOOD

RATE THEIR CURRENT

HEALTH AS GOOD

EXPECT THEIR


5 YEARS

EXPECT THEIR


5 YEARS

WHITE / WHITE BRITISH ETHNIC GROUP

More confident finding out health information (63% to 58%)

More likely to have someone to talk to about their wellbeing (77% to 74%)

More likely to solve problems by speaking to friend (47% to 39%) or solve

it themselves (66% to 54%)

More likely to speak about their wellbeing with a friend (63% to 53%) or

family member (62% to 57%)

ALL OTHER ETHNIC GROUPS

More likely to feel like an expert in their own health (67% to 59%)

More likely to think H&C workforce should be role models (74% to 65%)

More likely to feel comfortable giving health advice to friends & family(45% to 35%)

More likely to feel good at solving problems (45% to 39%) and find it

easy to make lifestyle changes (43% to 38%)


BY LONG TERM CONDITIONS

34% 64%

LONG TERM CONDITION (1 or More)

Less likely to feel confident finding out health info (59% to 68%)

More likely to feel that H&C services support them with what matters

to them (38% to 35%)

Less likely to think current H&C services are sustainable (19% to 25%)

Less likely to have someone to talk to about their wellbeing (74% to 81%)

NO LONG TERM CONDITIONS

More likely to feel good at solving problems (48% to 34%)

More likely to feel solely responsible for their health (65% to 55%)

More likely to find it easy to make lifestyle changes (47% to 32%)

More likely to speak with friends to help solve problems (51% to 44%)

34% 39%

RATE THEIR CURRENT

HEALTH AS GOOD

RATE THEIR CURRENT

HEALTH AS GOOD

EXPECT THEIR


5 YEARS

EXPECT THEIR


5 YEARS

PublicOnline Survey


BY AGE GROUPUnder 35s

The least confident in finding out health information for

themselves (54%)

Most likely to feel comfortable talking to friends about their

wellbeing (64%)

Most likely to solve problems by talking to friends (50%) and

going online (49%) or using an App (13%)

Most likely to think health services should make all decisions (5%)

35-64 Year Olds

Most likely to say their current wellbeing is not good (19%)

Least likely to think that H&C services are sustainable (18%)

Most likely to feel comfortable giving health advice to friends or

family (39%)

Most likely to feel they are solely responsible for their health

and wellbeing (61%) and least likely to rely on services (1%)

PublicOnline Survey

65 & overs

Most likely to say their current wellbeing is good (49%)

Most likely to feel an expert in their own health (65%)

Most likely to feel that H&C services support them with what

matters to them (52%) and listen to them (73%)

Most likely to have someone to talk to about wellbeing (83%)

Most likely to want to talk to a doctor about their wellbeing

(85%)

TRENDS• Associating wellbeing with images of family rose with age (from 58% to 70%), whilst associations with sport (25% to 15%) and doctors (7% to 3%) fell with age• Thinking their future health would be better in 5 years time fell with age (from 60% in under 35s to 8% in 65+)• Feeling like an expert in their own health rose with age (50% to 65%)• Having someone to talk to about wellbeing rose with age (75% to 83%)• Being good at dealing with problems increased with age (32% to 48%), as did finding it easy to make healthy lifestyle changes (30% to 51%)


BY ICP AREA

NORTH CUMBRIA ICP

37% said their current wellbeing was good & 24% said their future wellbeing

would be better (lowest for both)

29% feel H&C service support them with what matters to them & 59% usually

feel listened to by services

74% have someone to talk to about wellbeing & 30% feel comfortable giving

health advice to friends and family (lowest for both)

38% feel good at solving problems & 37% find it easy to make lifestyle changes

NORTH ICP


would be better


feel listened to by services (highest for both)


health advice to friends and family


PublicOnline Survey

CENTRAL ICP


would be better






SOUTH ICP


would be better (highest for both)







Overarching ThemesKey themes identified across the data and what are they telling us

82


Overarching ThemesMore of Everything

Among both the public and workforce, many just ask for “more” resources, staff, funding, services, time etc. This includes turning questions on self care into lists of what is wrong with the system (e.g. complaints about services and ideas of what could be done with more resources) rather than ways to increase individual responsibility and capacity for self care. Some were concerned that promoting prevention might lead to increased demand for services which could not them meet the demand.

A Joined-Up ApproachBoth the public and the workforce spoke of the need for a more joined up approach with clear, visible, united system leadership across the ICS partnership to find efficiencies, free up staff time to spend more time with patients to encourage and enable self care, make better use of resources, improve the patient journey, co-ordinate attempts to put prevention at the core, and use of alternatives to GP and hospital.

83

Digital & Initiative ScepticsStaff are “agnostic” or unsighted about the benefits of digital healthcare and programmes such as All Our Health, MECC and Social Prescribing.

The Importance of FamilyThe public strongly associated family with wellbeing in both imagery and words, telling us how important having someone to talk to andbelonging to a community was for wellbeing.


Overarching ThemesSystems

• There is a lack of overall cohesion to the wellbeing and self care efforts across the ICS regions and partner agencies. Visible ICS leadership is needed to empower the workforce to prioritise prevention, carry wellbeing messages and enable self care

• The current variety of single message prevention campaigns and initiatives could be more effective and efficient if they were joined up under n overarching wellbeing banner that all members of the workforce understand and see delivery as being prioritised in their roles and given recognition by their managers

People

• The public and workforce are the greatest asset in promoting wellbeing, enabling self care at a much greater scale, role modelling healthy living and pushing prevention, but our insights show they are underused and under confident in seeing this as their “role”

• Our survey data shows some big differences in how certain groups feel, and highlight some key groups that would benefit from a targeted and tailored approach to improving their wellbeing and focussing activity to promote self care

• A genuine dialogue with the public and the workforce about wellbeing and self care could usefully be employed to ensure coherence to messaging and keep commissioners informed on what is needed

84

Place

• The differences in survey results for North Cumbria show that different approaches are needed in specific areas with both the workforce and the public

• People’s wellbeing is influenced by feeling part of their local community and some wanted wellbeing and prevention initiatives to accessible in their community


Areas for ActionPoints to consider taking action on in future

85


Recommendations2. Create the Conditions to Further Enable Self CareIdentify and utilise ways to better influence & change people’s attitudes and behaviour on looking after themselves betterEngage Influencers: Harness the willing and potential influencers who can promote messages to family and friends from across age, gender, ethnicity and community groups. This builds on how people solve problems in their lives and who they feel they can talk to about their wellbeing. Join the dots – bring those comfortable giving advice together with those who need help to access information and to feel “an expert” or better at dealing with problems. It is important to find ways to make it easier for U35s to find health information for themselves and feel confident in using it. One way could be through older people being wellbeing mentors for U35s. Challenge workforce misconceptions that the public are not ready to receive self care messages from them and ensure all staff know what to say, when and who to say it to. Commissioners, managers and administrators are a group who feel more empowered to give prevention & wellbeing messages and may be able to to mentor frontline staff.

Target Support: Ensure a targeted approach to prevention, concentrating resources on the groups most in need. Our insights found that some key groups need support to allow them to be able to effectively self care: Under 35s; Those who are not employed; People with one or more long term conditions; People with no qualifications or only Level 1 qualifications; and People who feel socially isolated.

86

1. Communicate Effectively & Widely about Wellbeing

Create and sustain an ongoing dialogue with both the workforce and the public about wellbeing, prevention and self-care. The need for this was evidenced by the fact that there are only 25 "likes" for the ICS Facebook page, 293 followers on Twitter, and low numbers signed up to ICS website updates, and by our experience that there was limited ability to get all partners to send out a co-ordinated message about engagement with the survey to the public and staff, as no clear mechanism appeared to exist to facilitate this. As a result, most public online responses came through our own paid Facebook adverts, depth interviews were recruited at the "pop-up" events and workforce engagement was limited. Use a strengths-based approach to empower individuals to feel more like experts who can make changes, and that support is available to help with this. This is a change from traditional “one way” campaigns.

Communications about wellbeing should be targeted to keydemographics identified in these insights, using their own language,ideas and chosen imagery to represent wellbeing to give it more of a tailored rather than generic appearance. This should centre on supporting what matters to the individual, with a focus on promoting wellness rather than responding to illness. This will include linking messages to people’s engagement within families and communities, encouraging talking about wellbeing amongst groups and not just with services, and linking a number of prevention agendas under a single wellbeing banner used across the ICS by all agencies, joining up and emphasising key messages about what actions the public and all ICS staff should be taking.


Recommendations

87

3. Shape the way people use the health & care system

Promote alternatives to the default health routes of using 999, A&E and the GP by promoting alternative routes to earlier intervention and prevention initiatives and wider community engagement, to tackle social isolation, for example through greater use of social prescribing.

Challenge the “it’s not part of my role / not enough time” group of the workforce to engage them more fully in advocating and promoting prevention and self care messages.

Facilitate Easy Access: It was suggested to encourage wider use of online booking, video consultations, and other easy access measures to get people to use the full range of prevention services and also be able to see their GP more quickly and easily.

4. Influence the way people see the health & care system

The public and the workforce felt that health & care staff should be healthy role models. This includes them giving outthe right self care messages confidently and by demonstrating this through their own self-care.

Use the majority views from this insight: Most people highlyvalue the NHS and care services but accept that current service levels are unsustainable and many felt it should be publicly acknowledged that the NHS cannot do everything for everyone. This gives a chance for an honest dialogue about what services can and can’t do and what should be the responsibility of individuals and communities. Most believe their wellbeing and health is their responsibility and want to be an active partner in decision making if they fall ill. This will require a potential change in workforce behaviour to enable people to play this “active partner” role.

People don’t yet see a joined up ICS system, with most interpreting the term “health and care system” to mean the NHS but not linking it to wider “care” provision. There is much work to be done in communicating to the public to make them aware of the broad range of entry points in this system and how it can work for them, and to staff to get them to consider themselves part of a system and to start to think and operate inthat way.


Recommendations

88

6. Develop a clear ICS narrative

Clear and visible leadership across the ICS system is needed, providing a single, united message and approach to empower staff to deliver prevention and self care to tackle root causes of illness rather than just “patch people up and send them home”. Staff asked for leaders to acknowledge this as an important part of their roles and allow them time to do this.

Make the most of existing programmes: One way to drive this forward could be increased awareness and wider take up of programmes that support the delivery of this, such as All Our Health, MECC and Social Prescribing.

5. Put Prevention at the Core

Enable & Empower the Entire Workforce: The health and care workforce is the greatest asset in making change to really push prevention. To enable the workforce to give more prevention and self care messaging, staff tell us more time, recognition and reward from their management and employing organisation, greater numbers of staff and an increase in dedicated resources are needed.

Staff say they need greater awareness of what to do and whento do it, along with the training and user friendly tools to enable them to do this, backed up by support and importance give to the agenda from management and system leaders. This should be written explicitly into people’s job descriptions and appraisals.

Frontline Practitioners and Team Leaders are a target group to ensure they feel fully empowered, trained, confident, supported and recognised in delivering prevention, self care and wellbeing messages and interventions.

Impact on this can be measured by seeing improvements insome of the key measures in this insight research, such as thosefeeling empowered to give prevention messages, seeing prevention as an important part of their role and tackling root causes of ill health.


ANNEXES

89


Annexes• Annex 1: Public Online Survey• Annex 2: Workforce Online Survey• Annex 3: Public Focus Group Schedule• Annex 4: Public Depth Interview Schedule• Annex 5: Pop-Ups Schedule• Annex 6: Public Online Survey Data Workbook• Annex 7: Workforce Online Survey Data Workbook• Annex 8: Literature Review• Annex 9: Public Online Survey Response Demographics• Annex 10: Public Depth Interviews Analysis• Annex 11: Focus Group Reports

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Report prepared byTONICMatthew ScottDr Maureen TaylorRory MillerKatie LundDaisy ElvinOzden Karaali

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Contact DetailsTONIC Consultants [email protected]

Freephone: 0800 188 40 34

Company Registration:06141892

http://www.tonic.org.uk/

http://www.tonic.org.uk/

http://tonic.org.uk

a conversation about wellbeing

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