version 1 nhs providers: member perceptions research · 1 © ipsos mori version 1 | internal use...
TRANSCRIPT
1
Version 1 | Internal Use © Ipsos MORI
Version 1
NHS Providers: member perceptions
research
September 2015 21/09/15
2
Version 1 | Internal Use © Ipsos MORI
From 2014 to 2015...
Ever-increasing challenges
and pressures for the NHS
have created a stronger
demand (and appreciation)
for you and your work.
2015
2014
Last year, member perceptions of the
FTN (as was) were positive.
This year:
Higher satisfaction
More positive working
relationships
More valued
More trusted and respected
Stronger performance in an increasingly
tougher climate
3
Version 1 | Internal Use © Ipsos MORI
Introduction
4
Version 1 | Internal Use © Ipsos MORI
Aims of the research
• Explore members’ working relationship with NHS Providers and
perceptions of the support NHS Providers offer.
• Understand how members view NHS Providers as an organisation,
including the benefits and drawbacks of being a member and its position
in the health and care sector.
• Generate insight into how well members believe NHS Providers is
performing and how they would like the organisation to develop.
5
Version 1 | Internal Use © Ipsos MORI
Methodology
• 20 in-depth qualitative interviews
• Reflective of NHS Providers’ membership
−a mix of current and aspiring Foundation Trusts (FTs)
−Chairs and Chief Executives
−acute, ambulance, DGH, integrated, mental health and
specialist trusts
2
specialist
6 DGH
6
integrated
2 mental
health
2 large
acute
2
ambulance
6
Version 1 | Internal Use © Ipsos MORI
Perceptions of NHS Providers
6
7
Version 1 | Internal Use © Ipsos MORI
Members still perceive NHS Providers to be a representative and
vocal lobbyist
“It’s a body representing the
interests of NHS providers within
the wider health and social care
environment, and an effective
provider of support and influence.”
Non-FT, Large acute
8
Version 1 | Internal Use © Ipsos MORI
The heart of your role still remains the same, but there’s a belief that you
have grown in strength
A representative body, which ensures that the
voice of provider trusts and their specific
issues were heard and influenced policy
makers.
Helping trusts to share information, key
learnings, good practice and benchmarking
with one another.
Good networking opportunities for members.
"I know that points that I raise to them
will in turn be raised at the highest level
of government.” Non-FT, DGH
Advice and support in tough situations.
Compared with last year, there
appears to be an increased clarity of
purpose around the organisation. All
members used similar terminology
when describing your role.
9
Version 1 | Internal Use © Ipsos MORI
9
They represent the voice of NHS provider
organisations, the voice of the provider, influence
policy where it impacts on membership, lead in
particular areas of research and policy development,
and provide and share learnings across the system.
Performance in the past year has been good. I think
the transition from the FTN to NHS Providers has felt
very natural. I think NHS Providers have managed to
gain a profile in a year, it was a kind of continuation,
but the FTN is dead and NHS Providers seems to be
increasing its profile and becoming relevant.
Non-FT, Mental health
10
Version 1 | Internal Use © Ipsos MORI
Working relationships
10
11
Version 1 | Internal Use © Ipsos MORI
Positive working relationships with members
• Staff were praised as supportive and knowledgeable –
as they were last year.
• Members talk frequently about the personal contact and
relationships with various staff.
• These personal relationships have been maintained
despite taking on more work – this was a concern last
year.
"What I like about it is it's an informal
relationship... I certainly feel that I can email
Chris readily and get a quick response.”
FT, DGH
• General agreement that there is a two-way dialogue – some hesitated over this but
only because they hadn’t sought it out. They were confident that it would be there if
they needed it.
12
Version 1 | Internal Use © Ipsos MORI
12
Sometimes with some organisations of that
sort, you can feel that if you contact them, it
goes into a big black hole. And I never feel
that. I always get, even if it's a brief response,
that is really good.
FT, DGH
13
Version 1 | Internal Use © Ipsos MORI
Views on being a member of
NHS Providers
13
14
Version 1 | Internal Use © Ipsos MORI
Satisfaction with membership of NHS Providers
remained very high
Key benefits are the same as last year
• Being able to receive, learn from and
share information, ideas, case studies
and good practice with other trusts
• Intelligent support and strong
networks, making trusts feel part of a
‘bigger system’
• Using NHS Providers to support them
in difficult circumstances and raise
issues on their behalf
• Giving local providers a united, strong
voice in the national arena
More valued than last year.
Members feel like NHS Providers is a ‘lifeline’
(despite, or because of, increased pressures on
the NHS).
Trusted and respected - members are willing to
tell them when they’re struggling
15
Version 1 | Internal Use © Ipsos MORI
Providing a collective voice was seen as a key benefit
of membership
"The NHS haven't operated as a system
for about 4 years. I think it's getting worse
and NHS Providers give us an opportunity
at least for the provision system to think
as a system. It gives the provision system
a voice in trying to influence the need for
a wider system.” Non-FT, Mental health
• Easier for a body that brings together sector opinions and
concerns to raise these publically than individual trusts.
• Members appreciated NHS Providers taking forward these
concerns in a more powerful and sophisticated way without
drawing attention to their individual trusts.
"They are able to take those
arguments forward in a way that
individually, most of us individually,
would not be able to do.” Non-FT,
Ambulance
16
Version 1 | Internal Use © Ipsos MORI
Members were most aware of its media and policy services, and
its events
“Their briefings are things that they do
very well. I just find them helpful, they do
summaries of major documents which is
helpful to actually brief my board members
about issues. So they’re good, and I think
the quality of those has got much better.”
FT, Integrated
17
Version 1 | Internal Use © Ipsos MORI
Sharing NHS Providers’ services and outputs across teams
However,
members
acknowledge
that they could
do more to share
them.
Members say
that the
services and
outputs they
receive are
very good.
“They make me look good
to my board because they
keep me in the know. It’s
all about being able to
spread information for
me." Non-FT, DGH
Is there something NHS
Providers could be doing
to help members
disseminate their
learnings more widely?
So much so,
they share
them widely
18
Version 1 | Internal Use © Ipsos MORI
The local vs national debate is ongoing…
Generally thought that NHS Providers
ensures that local concerns are fed into
national discussions
HOWEVER...
Some called for more events outside
London.
Disengaged trusts thought they could
have regional representatives who
they could develop a relationship with.
There was a desire for a greater
opportunity to meet with Chris and
senior team in a smaller setting.
19
Version 1 | Internal Use © Ipsos MORI
NHS Providers was seen to provide value for money
"I don't know the fee actually! I
do know they are second to
none so whatever the fee is, I’m
sure it’s worth it.”
Non-FT, DGH
Satisfaction with the service
Leading to perceptions of a sound investment despite
not knowing the fee
Being part of a network is a ‘soft value’
Wouldn’t hesitate to renew.
People haven’t questioned the fee yet
When will members start to question this?
What will be the tipping point?
20
Version 1 | Internal Use © Ipsos MORI
Voice and impact
20
21
Version 1 | Internal Use © Ipsos MORI
NHS Providers was seen to have delivered for its members
when they needed support – even more so than last year
This is unusual – we would
normally expect members to
call for more visible
examples of impact
22
Version 1 | Internal Use © Ipsos MORI
Like last year, the main focus of NHS Providers was thought
to be NHS finances and sustainability
Consensus that finance was
the key topic to focus on –
yet has caused other long-
term issues to slip off the
agenda
Areas of work mentioned
23
Version 1 | Internal Use © Ipsos MORI
23
I think this is overriding most people's normal agenda at the
moment, which isn't the best way to run the organisation, but
everyone has to be quite focused on that. It's overload on everything
that everyone's doing unfortunately. They surfaced on the likely
provider sector deficit nationally about 9 months ago, well before
DH, Monitor, politicians were concerned about it . They've been
ahead of the game on the big issues and what they are and have
been flagging these up and getting people talking about them, so I
think that's been one of those areas where that's maybe not allowed
them to spend as much time as they might have done on models of
care and ways of working, and the need to transform the workforce,
which I think is fundamental for the future of the NHS. I think some
things have just slipped off the radar. Difficult long-term issues have
slipped off the agenda where short-term issues have come on.
FT, Large acute
24
Version 1 | Internal Use © Ipsos MORI
Members noted the efforts to embrace wider provider
issues
“Since NHS providers came into inception, we feel more involved now
than we did before, because we're not a FT.”
Non-FT, Mental health
• Wide acknowledgement of the efforts made to talk
about the whole of the provider sector.
• The name change was seen as sensible but also a
clever marketing exercise!
25
Version 1 | Internal Use © Ipsos MORI
Members recognise the increase in mental health work
over the past year
Members are aware of the increased focus on mental health in the past year and
have noticed the broader representation of mental health trusts and issues.
“They will include mental health issues in some of the work they
do around lobbying and other things. They actually did a really
good piece of work about mental health funding and highlighting
some of the gaps in that.”
FT, Mental health
26
Version 1 | Internal Use © Ipsos MORI
• Keen for this wider work to continue –
particularly in relation to mental health and
community.
• Not seen as experts in all aspects of
mental health, but for many members this
is not necessary.
However, members are still keen for more work on
mental health and community
“I’m not particularly concerned that they
don’t focus too heavily on mental health
trust or integrated issues. I’d be more
concerned if it was a membership body
specifically for mental health trusts.”
Non-FT, Integrated
27
Version 1 | Internal Use © Ipsos MORI
Last year’s concerns about a balance between critiquing and
working with the system seem to have been assuaged
Being a critical friend / solving
problems
Criticising the health system /
being provocative when necessary
Last year…
• Members frequently noted that the organisation had to
balance the desire of its members for it to be candid and
support their views, with maintaining an open and
productive dialogue with government and regulators.
• Members thought that the FTN’s (as was) commentary
could be stronger, but could understand why it was not.
• One participant thought it was too concerned about its
relationships with politicians.
• A few wanted the FTN (as was) to be challenging the CQC
and Monitor more robustly.
Members are now comfortable with the balance
struck between voice and influence. These concerns
were not mentioned this year. Members mentioned
other tensions instead…
28
Version 1 | Internal Use © Ipsos MORI
Instead, some members highlighted a tension about
trying to be “all things to all people”
Want to represent the views of all
members equally
Can lead to relatively muted and conservative
positions on current issues
“It's a strength and a weakness that they represent all providers.
It's a strength because of the numbers; there are issues where
the interests of different sorts of providers will diverge, and
that's a tension they have to manage.”
Non-FT, Large acute
29
Version 1 | Internal Use © Ipsos MORI
29
One of Chris Hopson's and staff's real problems is that they're
dealing with all FTs, so acute, major, mental health, community
trusts, and the issues that they're facing, despite what Chris tries
to pretend at times, is fundamentally different. And so it's very
difficult in these large settings, to get really meaningful dialogues
going on about particular problems facing for e.g. large acute
hospitals. So I feel one thing they could also do is to try and
focus a bit on the particular issues facing particular types of
hospitals, so have sessions running for that, rather to
accommodate sessions for everybody, when it's manifestly
obvious that the problems I'm facing are totally different from that
facing a small community trust.
FT, Large acute
30
Version 1 | Internal Use © Ipsos MORI
Positioning in the sector
30
31
Version 1 | Internal Use © Ipsos MORI
NHS Confederation was the main comparative body for
participants
• Most participants were past or current members of
• Members have noticed the efforts to coordinate actions more and have seen consensus between the two.
• Members value being part of both organisations, acknowledging certain aspects the Confederation are working on
which differ to NHS Providers. They also appreciate the quality of both organisations and how they complement one
another, often bringing slightly different perspectives to issues. The similarity of the two organisations is not a problem
day to day, but members acknowledged the potential for confusion.
• Despite this, NHS Providers generally viewed more positively.
“In the last 3-4 years they've started working in harmony more and I
would encourage them to do so more in the future.” FT, DGH
“I’m a member of the Confed as well. I think it’s probably a token,
actually the quality of both those organisations, most of us are
prepared to be members of both of them if you see what I mean
because you could say there’s an overlap between the two and in
some ways it’s hard to particularly distinguish the different roles.”
FT, Mental health
“I’ve seen the fact that they’ve had a
more complementary relationship
with each other, they’re not really
competing in the same space and
they seem to, they do a lot of joint
work together which I think can only
be in our best interest, to some
extent. Sometimes those individuals
give you a slightly different
perspective.” FT, Integrated
32
Version 1 | Internal Use © Ipsos MORI
Other bodies mentioned but members of these didn’t think they
were comparable with NHS Providers
• Other bodies were mentioned but members of these didn’t think they were
comparable with NHS Providers.
• The advantages of being a member of AACE
were acknowledged.
• Special interest group which focus on
specialist providers.
• One member stated that they used them
more for specific lobbying than NHS
Providers who focus on a broad range of
providers with different interests.
“We use the Shelford Group to represent
specific interests and particular issues,
such as research and specialist tariffs,
where those interests are of special
interest to us and may not be one for a
DGH hospital or mental health
community trust, for example.”
Non FT, large acute
“I don't see duplication between the bodies but
I’ve been aware of different views, so on
occasions AACE have taken a different view on
national policy than NHS Providers which I don't
think is unhealthy.” Non-FT, Ambulance
33
Version 1 | Internal Use © Ipsos MORI
33
You could say there’s an overlap between the two and in
some ways it’s hard to particularly distinguish the different
roles. In some ways it is, I don’t particularly perceive a
distinction between them but I think there is a value in
having two organisations that are doing complementary
work and add to that the weight of that mental health voice.
I think it’s good that Chris and Rob (Webster) are making a
point of working together and collaborating and I think it
would be unfortunate, as might have been the case when
the FTN first started, to see a bit of divergence and
difference because the provider movement in the NHS
needs a united voice. I think there’s a more visible attempt
to join things up and be seen working together.
FT, Mental health
34
Version 1 | Internal Use © Ipsos MORI
As in 2014…
Strong, vocal leadership –
independent of government and
willing to challenge policymakers.
Provides a single, focused and
coherent view, lobbying on behalf
of FTs (and aspiring FTs).
Has a detailed understanding of
the needs of the full spectrum of
providers.
Closer to government and aim
to provide a more balanced view
from across the sector.
Generalist – can represent and
lobby on behalf of a broader
audience, as members include
third sector and private sector
providers.
Incorporates commissioners –
can talk about system-wide
issues and bring people
together in a safe environment
for learning.
Both seek to
support
FTs/trusts, and
influence
Government and
the health
service
But compared with last year, there is now a
greater clarity amongst members around the
respective roles and strengths of each
organisation.
35
Version 1 | Internal Use © Ipsos MORI
35
I genuinely do feel that they [NHS Providers] ultimately
have the best interests of the provider at heart, and I can't
say that about the Confederation, or NHS England, or
anybody else for that matter. They're the one body I will
look to who will have empathy for the issues I'm facing and
are trying alongside myself and my colleagues to do
something about it. However uphill that challenge may be.
FT, Large acute
36
Version 1 | Internal Use © Ipsos MORI
Future directions
36
37
Version 1 | Internal Use © Ipsos MORI
Perceptions of NHS Providers’ strategy
• Members weren’t particularly familiar with the strategy but they had trust that NHS Providers is doing
what it needs to do.
• Lack of awareness was not an issue.
• Members do not see you as ‘strategic’, and do not need you to be.
“I always think of NHS Providers more as a kind of pit bull
terrier type; it’s kind of slightly more operational if that makes
sense as opposed to less strategic. So it gets in and dirty with
some of the issues … whereas I sort of see NHS Confederation
as being slightly more intellectual, slightly more strategic,
slightly more distant.” FT, Integrated
• However, members recognise that you have become more solutions focused over the last year and
are driving conversations about big issues such as the likely provider sector deficit, before other
organisations start thinking about them. For this reason, they perceive you to be proactive and
‘ahead of the game’ compared with other organisations.
38
Version 1 | Internal Use © Ipsos MORI
Priorities for the future
Continuing priorities:
• Maintaining strengths
• Encouraging conversations about the reality of increasing challenges
and pressures for the NHS, particularly about resources and quality
• Being more solutions focused and constructive
Newer areas this year:
• Support the development of new organisations formed as a result of
service integration
• Need to be constructive contributors to new models of care and adapt
to changing landscape. How does the FT model fit into this?
• Needs to be a debate about what is feasible in the long-term
“Should they be a
voice that is unable
to express the
unthinkable at
present rather than
just deal with
issues like the
current agenda?”
Non-FT, Ambulance
39
Version 1 | Internal Use © Ipsos MORI
39
They need to reflect the reality and be brave about the
level of difficulty there is in getting through this
financial crisis, and be realistic about what actually
can be done. There's enough politicians going round
and telling us 'you can do more with less and less.’ It
needs some people who are close to the issue to say
actually ‘that's not feasible to be going down that line
forever’. Someone somewhere needs to start the
debate off about fundamental reforms of payment
strategy, agenda for change. You can't ignore these
things. They're at the heart of the finance things.
FT, DGH
41
Version 1 | Internal Use © Ipsos MORI
List of participants
Main Organisation FT status Trust Type
Wirral University Teaching Hospital NHS Foundation Trust FT Large acute
Oxford University Hospitals NHS Trust Non-FT Large acute
Gloucestershire Hospitals NHS Foundation Trust FT DGH
Barnet, Enfield and Haringey Mental Health NHS Trust Non-FT Integrated
Avon and Wiltshire Mental Health Partnership NHS Trust Non-FT Mental Health
Kettering General Hospital NHS Foundation Trust FT DGH
Mid Yorkshire Hospitals NHS Trust Non-FT DGH
Northampton General Hospital NHS Trust Non-FT DGH
London Ambulance Service NHS Trust Non-FT Ambulance
Royal Surrey County Hospital NHS Foundation Trust FT DGH
Birmingham Children’s Hospital NHS Foundation Trust FT Specialist
Barnsley Hospital NHS Foundation Trust FT DGH
Tavistock and Portman NHS Foundation Trust FT Mental Health
Cumbria Partnership NHS Foundation Trust FT Integrated
East Midlands Ambulance Service NHS Trust Non-FT Ambulance
Dorset Healthcare University NHS Foundation Trust FT Integrated
Kent and Medway NHS and Social Care Partnership Trust Non-FT Integrated
Papworth Hospital NHS Foundation Trust FT Specialist
Leeds and York Partnership NHS Foundation Trust FT Integrated
Anonymous FT Integrated