Version 1 NHS Providers: member perceptions research · 1 © Ipsos MORI Version 1 | Internal Use...

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Version 1 | Internal Use © Ipsos MORI

Version 1

NHS Providers: member perceptions

research

September 2015 21/09/15

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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

http://www.foundationtrustnetwork.org/home

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Introduction

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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.

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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

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Perceptions of NHS Providers

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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

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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.

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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

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Working relationships

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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.

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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

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Views on being a member of

NHS Providers

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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

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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

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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

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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

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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.

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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?

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Voice and impact

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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

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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

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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

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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!


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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

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• 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

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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…

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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

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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

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Positioning in the sector

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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

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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

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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

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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.

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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

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Future directions

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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.

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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

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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

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APPENDIX

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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

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[email protected]

[email protected]

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