Editor's blog Monday 20 June 2011: NHS staff survey finds big concerns over NHS reform

 Almost half of NHS staff (49%) feel that the care the NHS delivers to patients will get worse over the next few years: in summer 2009, this level had been 33%.
 While two-fifths (42%) of staff thought that patients want health professionals to make decisions about their treatment, more than half of the public (55%) said this in a recent Ipsos MORI survey
 Just over half of GPs (56%) envisaged the changes to commissioning would have a negative impact on the GP-patient relationship.
 Six in ten NHS staff felt that GPs do not have the capacity to take on this role (of commissioning). GPs themselves felt strongly about this with seven in ten disagreeing that they had the capacity to take on this role.

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It's not exactly a 'hold the front page!' moment in the glorious annals of Things That Are Not Surprising, but newly-released, DH-commissioned polling finds that NHS staff are getting much less happy about the quality of present and future care.

The GfK NOP study covers the period 19/11/2010 – 28/1/2011, so it just straddles the publication of the Health And Social Care Bill (19th January).

The survey finds that "There has ... been a decline in the proportion of staff thinking that patient care in their local area had got better over the past 12 months (from 33% in Autumn 2008 to 23% in Winter 2010) and a corresponding increase in the proportion feeling that patient care had worsened over the same period (from 19% in Autumn 2008 to 28% in Winter 2010).

"In Winter 2010, almost half of staff (49%) expected the care the NHS delivers to patients to get worse over the next few years, compared with just a third (34%) in Summer 2009.

"Over time, GPs remained the most likely occupation to think that patient care had got worse recently, and would get worse in the next few years, though other staff views were catching up (with the exception of Hospital Doctors). In Winter 2010, members of the Community Workforce were the least positive about working in the NHS.".

Now, it is a truth universally acknowledged that morale in the NHS has always been at its lowest since 1948. And we should remember that extreme uncertainty such as the last year has provided unstintingly is never very likely to make people more optimistic.

Even with these caveats, these are bad numbers.

They don't get any better in the section on awareness of the changes, with the finding that "there were lower levels of awareness of initiatives to reduce central Government control over health (56%) and give local councils a greater role in shaping health services (30%)".

Choice confusion
Choice is to be a key driver of the new NHS, and so it is somewhat concerning to read that "staff were broadly supportive of the initiative to increase patient information and choice to help improve patient care but there is some evidence that they also felt that this could potentially be at the expense of operational efficiencies within the NHS:
 Seven in ten (72%) agreed that providing patients with more information would help to improve standards of clinical care, but half (50%) felt that this would also lead to an increased duplication of resources within the NHS.
 Three fifths (61%) felt the initiative to increase patient information and choice would have a positive impact on the quality of patient care, but a fifth (21%) felt that it would negatively impact on how effectively the NHS operates.

"On the whole, staff felt that patients would like decisions about treatment to be made for them or it should be a joint decision, but it is notable that staff think patients want more involvement than they actually do. While two fifths (42%) of staff thought that patients want health professionals to make decisions about their treatment, more than half of the public (55%) said this in a recent Ipsos MORI survey" (my underlining).

When it comes to "the likely impact of the initiative to increase patient information and choice on both the quality of patient care and NHS efficiencies ... GPs, Hospital Doctors and Practice Managers tended to be the least positive". Nurses do view this one more positively, which is something.

Commissioning confusion
Once again, it is not much of a surprise that the White Paper and Bill's sheer inarticulation of the proposed reforms, having caused the Bill to stop in its tracks, would indicate that this area is badly understood by NHS staff.

Even so, it is striking to read of "the new commissioning structures (that) less than a fifth (18%) strongly agreed that they understood their own role within the new structures and only 14% strongly agreed that they would be involved in the work to bring about the changes to commissioning.

"There was a high level of concern expressed about both the capacity and the skills of GPs to take on the commissioning role, not least amongst GPs themselves: just a fifth of GPs (21%) agreed that they had the capacity to take on the role (72% disagreed), and only a quarter agreed that they had the relevant skills (66% disagreed).

"Opinions were divided when thinking about whether the changes would encourage a closer working relationship between staff in primary and secondary care settings, similar proportions were seen to agree (42%) that it was unlikely to foster closer working relationships as to disagree (35%).

"Around a third of staff thought that the new commissioning structure would have a positive impact on the quality of patient care and how effectively the NHS operates, but similar proportions thought they would have a negative impact.

"Just over half of GPs (56%) and around two fifths of Practice Managers (44%) envisaged the changes to commissioning would have a negative impact on the GP-patient relationship.

"Six in ten NHS staff felt that GPs do not have the capacity to take on this role (of commissioning). GPs themselves felt strongly about this with seven in ten disagreeing that they had the capacity to take on this role".

As I say, some of the research leading to these findings will pre-date the publication of the actual Bill. Even considering this, these figures are striking.

The Q words - quality and QIPP
Deep breath, optimists: "there has been a decline in the proportion of staff agreeing that they are supported to provide high quality care for patients (falling from 68% in Spring 2010 to 53% in Winter 2010), with the decline mainly amongst Nurses and NHS Managers".

In the same vein, "staff did express concerns that cost reductions could be made without losing frontline services, particularly at the same time as delivering other reforms:
 Only 37% agreed that efficiency savings would be reinvested in frontline services; and
 Only 31% felt it would be possible to increase the quality of patient care while reducing costs.

"Just under half of staff were aware of the QIPP programme". Jesus. Although in the interests of balance, "a greater proportion of staff felt that the QIPP programme would have a positive impact on the quality of patient care (61%) than on how efficiently the NHS operates (54%)". Though when you look at it, making a dichotomy between quality and efficiency is an interesting perspective ...

The charts in the main report are unhelpfully inconsistent on whether the responses to this most recent survey are placed at the top or bottom of comparison graphics.

The future - quality of care glass will be half-empty
"There has been a significant decline of staff optimism regarding future patient care, a drop from 39% in Summer 2009 to 22% in Winter 2010 thinking that it would get better (Chart 5). Almost half of NHS staff (49%) feel that the care the NHS delivers to patients will get worse over the next few years".

Read that again.

In the 18 months since the last round of this survey, 17% less staff reported thinking care would get better over the next few years; 49% suggest it will get worse (up 10% from the previous 39%).