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CHAPTER EIGHT. PUBLIC INVOLVEMENT IN THE DESIGN AND DELIVERY OF SERVICES AND THE RESPONSIVENESS OF THE NHS

Perceptions of the level of Public involvement

8.1 'Patient Focus and Public Involvement', published in 2001, outlined the need for a culture change in the way the NHS in Scotland interacts with the people it serves and the way that services are delivered, stating that "it is no longer good enough to simply do things to people; a modern healthcare service must do things with the people it serves". To achieve this, it was recognised that individuals, groups and communities needed to be informed, engaged and consulted on improving the quality of care, in influencing priorities and planning services. Various public involvement initiatives have been put into place including the appointment of Designated Directors for Public Involvement at NHS Board level and the implementation of the learning gained from 'Designed to Involve', an Executive-funded project to support the development of public involvement in Primary Care and to extend training and support for public involvement across the NHS. As part of the Performance Assessment Framework (PAF) process of 2002/03, NHS Boards, including the Special Health Boards, were asked to submit Sustainable Frameworks for Public Involvement and plans for how these would be met, the impact of which was assessed in the PAF process.

8.2 The changes brought about by modernisation will mean that many staff have to build upon existing and develop new relationships with the people and communities that they serve, and in order to do this successfully, they will need training in communication skills and a patient focussed approach. As discussed in 'Patient Focus and Public Involvement', and more recently in 'Partnership for Care', previous attempts to make the NHS more 'patient friendly' may have failed because patients felt excluded or patronised, and NHS organisations will therefore need to respect the views and needs of patients. Specifically, it has become clear that it will be necessary for the NHS to provide a range of opportunities and methods for the public to provide feedback on local health services, be flexible and sensitive when responding to specific needs, and have mechanisms in place for taking account of, and responding to, comments, compliments, complaints and concerns.

Perceptions of public influence at the moment

8.3 In terms of public involvement, the results show that there is a wide gap between the level of influence that members of the public think they have over the way in which the NHS is run at present, and how much they feel they should ideally have over the health service.

8.4 In common with the survey carried out in 2000, the results show that most people felt that the public have very little (33%) or no influence at all (40%) over the way that the NHS is run. In 2000, 57% said that the public had little or no influence and this has risen to 73% in the current survey. The Health Board framework for public involvement may have a positive effect on these figures in time.

Table 8.1: How much influence do you feel members of the public have at the moment over the way that the NHS is run?

Base: all = 2600

The desire for public influence

8.6 As in 2000, the majority of people questioned (86%) felt that the public should have at least some influence over the way that the NHS is run. This feeling was particularly strong amongst women aged 16-34, with nearly four in ten (39%) saying that they felt the public should have a great deal of influence over the way that it is run - see Table 8.2. These findings show the importance of opportunities for public involvement.

Table 8.2: How much influence do you think members of the public should have over the way that the NHS is run?

Base: all = 2600

Responsiveness of the NHS - experience in the past 12 months

8.7 A third (32%) of all people questioned who had used the NHS in the past twelve months reported that they had wanted to pass on a comment, either positive (14%) or negative (18%). Those most likely to report that they had wanted to give negative feedback were the younger and middle-aged respondents, particularly women. Young men (16-24) and older men and women (65+) were the most likely to have no desire to give feedback - see Table 8.3.

Table 8.3: Did you want to pass on any comments, whether positive or negative, about the service you received?

Base: all who have used an NHS service in the last 12 months = 1937

8.8 In common with the results reported in 2000, people who described their health as "bad" (23%) were more likely to have wanted to give negative feedback or complain than those who described themselves as being in "very good" health (14%). Similarly, people who suffered from a limiting disability (22%) were more likely to want to give negative feedback than both those with non-limiting disabilities (19%) and those with no disability at all (16%). NHS users who self-reported as having either "very good" or "good" health were most likely to say that they did not want to raise any comment at all.

Negative feedback

8.9 Of those who expressed a desire to raise negative feedback, 40% reported that they made a complaint - this is about 7% of all NHS users over the last year. Reflecting the profiles of those who wanted to make a complaint, those who did so were more likely to have a limiting disability (49%) than a non-limiting (38%) or no disability (35%), and also more likely to be in bad health (55%) as opposed to very good health (35%).

8.10 The majority (80%) of negative feedback was given verbally to a member of staff. Just over one in ten said that they had sent a letter, and a small minority (4%) voiced their concerns by means of a patient questionnaire.

8.11 The large majority of the negative feedback was given informally (84%) with only 16% saying that they had made a formal complaint. This figure represents 1% of the NHS users interviewed (or only 22 people out of 2600 interviewed on the survey).

8.12 Those who gave their feedback informally were asked how satisfied or dissatisfied they were with the way that their complaint was handled. Some 34% of people reported that they were very or fairly satisfied, 20% said that they were neither satisfied nor dissatisfied, and 44% were dissatisfied. The latter figure included around one in five (19%) who reported being very dissatisfied with the way that their complaint was handled.

8.13 A similar picture emerges when investigating satisfaction into the final outcome of the complaint. Just under three in ten (29%) were satisfied with the final outcome, a quarter (24%) were neither satisfied nor dissatisfied, but many (40%) were dissatisfied, including 17% who were very dissatisfied with the final outcome.

8.14 Small base sizes do not allow a thorough investigation of people's reasons for dissatisfaction, but explanations included such issues as:

• nothing being done,
• receiving the wrong or unhelpful advice,
• not enough importance being placed on the problem,
• rudeness from staff,
• and the time it took to resolve the issue.

8.15 In view of the very small number of NHS users who made a formal complaint, actual figures, rather than percentages, are reported. Fourteen of the 22 respondents who made a formal complaint were not satisfied with the way that their formal complaint was handled and 12 of these were very dissatisfied. Five of the 14 people who were dissatisfied said this was because nothing seemed to be done about the complaint, or they were still waiting to hear about it. Four people said that they had only been sent a letter and that their questions had not been answered adequately. A further three people said that they felt that their complaint had not been properly investigated. Sixteen of the 22 people who had made a formal complaint said that they felt it had been handled unfairly. Eleven of the 22 people who made a formal complaint were dissatisfied with the outcome (including nine who were very dissatisfied) and nine were satisfied (with seven being very satisfied).

8.16 All of those who had expressed a desire to make a negative comment or complaint, were asked what the issue concerned. Many reasons were given, but the most common, mentioned by nearly four in ten (38%), was about waiting times. This finding reflected the lower levels of satisfaction reported by people who had to wait longer to access NHS services - see Chapter 5. All other reasons were mentioned by fewer than 10% of this group including such concerns as inadequate or unsuitable treatment or a wrong diagnosis (9%), difficulty getting an appointment (9%), lack of staff (8%) and being rushed (6%).

8.17 Those people who wanted to make a negative comment or complaint but did not do so gave the following reasons:

• didn't think it would make any difference/didn't see the point in complaining (25%)
• didn't want to make a fuss (16%)
• didn't get round to it (14%)
• did not know who to give feedback to (11%)
• no mechanism/way of giving feedback (10%).

Positive feedback

8.18 Three quarters (72%) of those who wanted to make a positive comment did so, almost 10% of all NHS users in the sample. Small base sizes do not allow for meaningful analysis in terms of identifying demographic differences.

8.19 Most people who gave positive feedback did this by simply saying thank you (78%). Smaller numbers of respondents reported that they completed a Patient Satisfaction questionnaire (11%), or sent a letter or card (10%), and a minority said that they sent flowers or gave the staff chocolates.

8.20 Those who wanted to give positive feedback but did not do so (81) said this was because:

• they didn't get around to it (17)
• they weren't aware of the procedures for giving positive feedback (16)
• they didn't think that it would make any difference/didn't see the point (8)
• they didn't know who to comment or give praise to (8)
• they didn't want to make a fuss (5).

8.21 When asked what the positive feedback or praise was about, many different reasons were given as follows:

• they were satisfied with everything/did a good job/gave efficient service (34%)
• they had received good treatment/were well cared for (17%)
• they wanted to pass on a thank you for the service they received (12%)
• the information they received was well explained and clear (11%)
• the staff were nice and work hard under pressure (11%)
• they were happy about the speed of the service, or the appointments (10%).

Summary

8.22 There remains a considerable gap between the level of influence people think they should have over how the NHS is run compared with the influence they feel they have at present - this gap has widened since the 2000 survey.

8.23 The number of people making a formal complaint was very small, though a somewhat larger group had made negative comments informally, often about waiting times. Some people did not know how to go about making a complaint, suggesting a need to improve this aspect of responsiveness within the NHS in Scotland. However, a greater proportion of people made a positive comment than passed on negative observations.

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