Understanding Usage Patterns of West Yorkshire Urgent Care Services

1. West Yorkshire Urgent Care Research PRESENTATION Commissioned by: NHS DIRECT Prepared by: January 2010 Swift Research Ref: 09/177a&b Swift Research Limited.Concept House Sandbeck Way Wetherby West Yorkshire LS22 7DN Telephone: +44 (0)1937 543600 Fax: +44 (0)1937 543610 Email: info@swift-research.co.uk www.swift-research.co.uk inner:visions, inner:sense, small:talk, web:sense, fem:talk and body:talk are brands of Swift Research Limited Registered in England No. 3151774 VAT No. 418 0062 85

2. TODAY’S PRESENTATION • INTRODUCTION • BACKGROUND • OBJECTIVES • METHODOLOGY • SAMPLE PROFILE • MAIN FINDINGS • CATEGORISATION OF HEALTH PROBLEMS • AWARENESS & USAGE OF NHS SERVICES • AWARENESS & USAGE OF WYUC • ATTITUDES TOWARDS WYUC • WYUC MARKETING MATERIALS • LIKELIHOOD OF USING WYUC IN THE FUTURE • NHS ‘CHOOSE WELL’ CAMPAIGN • AREAS FOR CONSIDERATION

3. INTRODUCTION

4. BACKGROUND • West Yorkshire Urgent Care (WYUC) - 0345 605 99 99 (a 24 hour telephone number for people with urgent care needs in West Yorkshire) was launched on the 1st April 2009. • Patients can be assessed and an appointment made for face-to-face treatment via the one call. The WYUC line currently handles in the region of 30k-40k calls per month and covers the 5 Primary Care Trust (PCTs) areas of Bradford & Airedale, Leeds, Kirklees, Calderdale and Wakefield. • It is currently being used by more females than males with younger residents most likely to make contact (aged 16-44 years). We understand that the highest users of emergency care are vulnerable families (social classes C2/D), white middle class families (social classes B/C1) and middle class Asians/multiculturals (social classes B/C1/C2/D/E). • After a few initial ‘teething troubles’ the service is now fully up and running and NHS Direct (who took over the call handling from LCD since it was launched) are ready to undertake further promotion of the service. Some marketing has already been delivered and localresearch amongst patients and residents identified the need for more information about urgent care services and out of hour’s access/facilities.

5. OBJECTIVES • Research is now required to assess the key messages and communication routes to: • - Increase awareness of the service • - Encourage usage • - Ensure the correct usage of the service • At this time research is also required to: • - Assess awareness of the service and of alternatives available • - Assess any shift in usage patterns due to the new service • - Understand perceptions of ‘urgent’, as opposed to ‘emergency’ and ‘general’ • - Understand the drivers behind usage of a range of NHS services, including 999, A&E, • GP Surgery, NHS Direct as well as the new WY Urgent Care number • - Establish which routes are used on which occasions and gain an understanding of how • this behaviour can be changed • Findings from the research will be used to offer guidance for raising awareness and • understanding of the WYUC service and will provide a benchmark from which to evaluate • awareness levels in the future.

6. METHODOLOGY QUANTITATIVE QUALITATIVE 2-STAGE APPROACH • ASSESS IN DETAIL: • Current attitudes regarding ‘emergency’, ‘urgent’, and ‘general’ • Motivations behind using NHS services • Attitudes towards the WYUC service and current marketing materials • QUANTIFY: • Awareness and usage of NHS services • Awareness and usage of WYUC • Attitudes towards WYUC • METHOD: • 600 interviews completed using face-to-face interviewing, end Nov/early Dec 2009 • Sample evenly split by PCT area and quotas applied to gender, age and social class to ensure a representative sample • Good spread of interviews to achieve a mix of those living in urban/rural areas • Respondents shown WYUC promotional materials – leaflet and posters • METHOD: • 5 focus group discussions – one per PCT area, October 2009 • Each group contained 8-11 respondents and lasted 90 minutes • Good mix of local population. One group with each of the following: • Vulnerable families, white middle class, Asian/multicultural, young people, older people

7. SAMPLE PROFILE – FOCUS GROUPS * Note – Resps = Respondents

8. SAMPLE PROFILE –FACE-TO-FACE- Age & Gender % OF WEST YORKSHIRE POPULATION AGED 18-74 % BASE = 600 (TOTAL SAMPLE)

9. SAMPLE PROFILE –FACE-TO-FACE- Working Status & Social Class % BASE = 600 (TOTAL SAMPLE)

10. SAMPLE PROFILE – FACE-TO-FACE- Household Composition 7% of respondents consider themselves to be a carer for someone • AGES OF CHILDREN • (Base = 193 - Those with children): • Under 12 mths 12% • 1-2 yrs 26% • 3-4 yrs 20% • 5-6 yrs 22% • 7-10 yrs 31% • 11-13 yrs 24% • 14-16 yrs 27% % BASE = 600 (TOTAL SAMPLE)

11. SAMPLE PROFILE –FACE-TO-FACE- Ethnicity % OF WEST YORKSHIRE POPULATION 89% White 9% Asian 1% Mixed 1% Black 3% ‘Other’ % BASE = 600 (TOTAL SAMPLE)

12. SAMPLE PROFILE –FACE-TO-FACE- Urban/Rural Residence 45% live in a small town or it’s suburbs 22% live in a city, large town or it’s suburbs % BASE = 600 (TOTAL SAMPLE)

13. MAIN FINDINGS MAIN FINDINGS

14. CATEGORISATION OF HEALTH PROBLEMS

15. HOW SERIOUS IS IT? • When deciding seriousness, several factors considered: - • Duration of symptoms • Who is ill (more serious If child/someone elderly) • Amount of pain • Any pre-existing medical conditions • Typical questions asked included: - “How bad do you feel?” “How crippling is the pain?” “Depends how long it lasts.” Source: Focus groups

16. 4 KEY CATEGORIES IDENTIFIED BASED ON SERIOUSNESS & TREATMENT REQUIRED … NOTE – WITH NO PROMPTING, ‘URGENT’ ASSOCIATED WITH EMERGENCY AND LIFE THREATENING SITUATIONS … EMERGENCY LIFE THREATENING MOST SERIOUS 999 / A&E 1 URGENT A&E WALK-IN CENTRE MINOR INJURIES SERIOUS CAUSE FOR CONCERN 2 WALK-IN CENTRE GP NHS DIRECT ADVISORY NEEDS ATTENTION 3 GP NHS DIRECT PHARMACIST SELF CARE MINOR GENERAL 4 LEAST SERIOUS Source: Focus groups

17. WHEN ASKED TO DISTINGUISH BETWEEN CERTAIN CATEGORIES, THERE IS A DIFFERENCE WHEN DESCRIBING THE SERIOUSNESS OF A SITUATION … “You need help NOW.” “Someone might die from it.” • LIFE THREATENING • NEEDS IMMEDIATE ATTENTION • MAJOR / SEVERE EMERGENCY • STILL SERIOUS • CAUSE FOR CONCERN • NEEDS A FAST RESPONSE, • BUT NOT IMMEDIATE URGENT “Perhaps you can get yourself there.” • COMMON, EVERYDAY • OCCURS REGULARLY • MAY NEED ADVICE/2ND OPINION GENERAL “Wait to see if it gets worse.” Source: Focus groups

18. GENERAL CONCERN GENERAL CONCERN EMERGENCY/ LIFE THREATENING EMERGENCY/ LIFE THREATENING URGENT URGENT WHEN CATEGORISING SERIOUSNESS, HEAD PROBLEMS AND INGESTION ARE THE MOST SERIOUS. IT IS EVIDENT PROBLEMS ARE CONSIDERED MORE SERIOUS WHEN THEY AFFECT A CHILD OR SOMEONE ELDERLY … ADULTS GENERALLY • - High temperature • Flu like symptoms • Ankle/wrist sprain • Burn – size £2 coin, • blistered skin - Ingestion – prescribed medications - Head injury – knock to head & unconscious - Crippling headache – unable to bear light • Flu like symptoms - High temperature - Crippling headache – unable to bear light - Head injury – knock to head & unconscious - Ankle/wrist sprain - Ingestion – prescribed medications - Burn – size £2 coin, blistered skin CHILD/ELDERLY BASE = 600 (TOTAL SAMPLE) Source: Face-to-face

19. THOSE FROM A MULTI-CULTURAL BACKGROUND ARE MORE LIKELY TO VIEW SITUATIONS MORE SERIOUSLY, ESPECIALLY FOR PROBLEMS AFFECTING CHILDREN OR THE ELDERLY … BASE = n in brackets (TOTAL SAMPLE) Note: bases for ethnic sample is low Source: Face-to-face

20. AWARENESS & USAGE OF NHS SERVICES

21. FOR MOST, THE MAIN SOURCE OF AWARENESS OF NHS SERVICES IS BY VISITING NHS BUILDINGS (USUALLY GP SURGERY) AND SEEING POSTERS AND LEAFLETS. AWARENESS OF SERVICES DOES VARY … AWARENESS VARIES BY AREA % % BASE = 600 (TOTAL SAMPLE) Source: Face-to-face

22. GP/DOCTOR BY APPOINTMENT IS THE MOST WIDELY USED CARE OPTION. USAGE OF NHS WALK-IN CENTRE AND MINOR INJURIES VARIES BY AREA DEPENDING ON WHAT’S AVAILABLE … % % BASE = 600 (TOTAL SAMPLE) Q1c. Which if any have you EVER used? Q1d. And which, if any, have you used in the past 6 months?

23. OVERALL THERE IS GOOD UNDERSTANDING OF WHEN THE 3 MORE FAMILIAR SERVICES SHOULD BE USED … “It’s an instant experience that needs immediate care and first aid.” “My Grandma had pneumonia … it became serious … then had to call 999.” Source: Focus groups

24. OVERALL THERE IS GOOD UNDERSTANDING OF WHEN THE 3 MORE FAMILIAR SERVICES SHOULD BE USED … “It’s an instant experience that needs immediate care and first aid.” “My Grandma had pneumonia … it became serious … then had to call 999.” “I would call an ambulance if I physically couldn’t get to A&E.” Source: Focus groups

25. OVERALL THERE IS GOOD UNDERSTANDING OF WHEN THE 3 MORE FAMILIAR SERVICES SHOULD BE USED … “It’s an instant experience that needs immediate care and first aid.” “My Grandma had pneumonia … it became serious … then had to call 999.” “I would call an ambulance if I physically couldn’t get to A&E.” “Any medical concerns.” “Anything that doesn’t need a hospital appointment.” Source: Focus groups

26. FOR OTHER SERVICES, AWARENESS IS LOWER AND UNDERSTANDING OF WHAT THE SERVICE OFFERS IS MIXED … “In A&E you would be sat there waiting for hours .. she was in and out in no time.” Source: Focus groups

27. FOR OTHER SERVICES, AWARENESS IS LOWER AND UNDERSTANDING OF WHAT THE SERVICE OFFERS IS MIXED … “In A&E you would be sat there waiting for hours .. she was in and out in no time.” “Very generalised health conditions.” “I’d go there if I couldn’t get to see my own GP.” Source: Focus groups

28. FOR OTHER SERVICES, AWARENESS IS LOWER AND UNDERSTANDING OF WHAT THE SERVICE OFFERS IS MIXED … “In A&E you would be sat there waiting for hours .. she was in and out in no time.” “Very generalised health conditions.” “I’d go there if I couldn’t get to see my own GP.” “Try and get a diagnosis. Don’t want to go to casualty if not serious and waste time.” “Offer advice on what treatment is needed and where you need to go.” Source: Focus groups

29. FOR OTHER SERVICES, AWARENESS IS LOWER AND UNDERSTANDING OF WHAT THE SERVICE OFFERS IS MIXED … “In A&E you would be sat there waiting for hours .. she was in and out in no time.” “Very generalised health conditions.” “I’d go there if I couldn’t get to see my own GP.” “Try and get a diagnosis. Don’t want to go to casualty if not serious and waste time.” “Offer advice on what treatment is needed and where you need to go.” Source: Focus groups

30. HOW SERIOUS IS IT? • Acknowledged severity differs from person to person but severe usually means immediate attention (999/A&E) • Consultation with family & friends is widespread “When I twisted my ankle and had a black foot … I went to A&E, perhaps I could have gone to minor injuries, but I was unsure if it was broken.” WHEN DECIDING WHICH SERVICE TO USE, SEVERAL FACTORS ARE CONSIDERED … MAIN FACTORS OTHER FACTORS • WHO IS UNWELL • If self unwell, easier to decide – know how feeling • More cautious when diagnosis for someone else, especially children or elderly • Time of day/day of week • Familiarity with services • Location • Pain threshold • Duration of symptoms • Location of injury on body • Previous experience of similar problem • Existing health conditions “If it involves a child or an older person I would be more inclined to go straight to A&E. They are fragile.” Source: Focus groups

31. WITHIN THE FOCUS GROUPS A DETAILED DESCRIPTION WAS GIVEN FOR EACH SERVICE. RESPONDENTS WERE THEN GIVEN A LIST OF MEDICAL SCENARIOS AND WE ASKED WHICH CARE OPTION WOULD BE MOST APPROPRIATE. OVERALL, THERE APPEARS TO BE A GOOD UNDERSTANDING OF USAGE FOR THE MOST WELL KNOWN SERVICES, BUT THOSE NOT SO WELL KNOWN (MINIOR INJURIES & WALK-IN CENTRE) WERE LESS LIKELY TO BE CONSIDERED AS AN OPTION … Source: Focus groups

32. FOR THE MOST SERIOUS SCENARIO (HEAD INJURY) EMERGENCY TREATMENT (999/A&E) IS THE MOST LIKELY COURSE OF ACTION FOR BOTH ADULTS AND THE MORE VULNERABLE. FOR INGESTION, A VISIT TO A&E IS MOST LIKELY. A CRIPPLING HEADACHE WILL BE TREATED MORE SERIOUSLY (VISIT TO A&E) IF IT IS A CHILD/ SOMEONE ELDERLY, WHEREAS A GENERAL ADULT MAY SELF CARE OR VISIT THEIR GP … BASE = 600 (TOTAL SAMPLE) Source: Face-to-face

33. FOR LESS SERIOUS SCENARIOS, IF A GENERAL ADULT IS SUFFERING SELF CARE IS THE MOST LIKELY COURSE OF ACTION. IF IT IS A CHILD/SOMEONE ELDERLY WHO IS UNWELL, ADVICE/ TREATMENT IS MORE LIKELY TO BE SOUGHT, THIS IS LIKELY TO BE AN A&E VISIT FOR BURNS AND SPRAINS OR A VISIT TO THE GP FOR FLU AND HIGH TEMPERATURES … • VERY LOW ANTICIPATED USAGE OF WYUC: - • LACK OF AWARENESS/FAMILIARITY WITH SERVICE • CONFUSION OVER WHEN IT SHOULD BE USED Source: Face-to-face

34. THE ETHNIC SAMPLE ARE MORE LIKELY TO SEEK MEDICAL HELP AS OPPOSED TO SELF CARE OR CALLING NHS DIRECT, OR ARE LIKELY SEEK HELP OF A MORE URGENT NATURE (I.E. A&E AS OPPOSED TO SEEING THEIR GP). IS THIS BECAUSE THEY CLASSIFY PROBLEMS MORE SERIOUSLY OR THEIR LACK OF AWARENESS OF THE RANGE OF SERVICES AVAILABLE? BASE = n in brackets (TOTAL SAMPLE) Note: bases for ethnic sample is low YOUNGER PEOPLE ALSO MORE INCLINED TO SEEK MEDICAL HELP Source: Face-to-face

35. 48% of BME’s agree 66% 34% of BME’s agree 46% of BME’s agree THERE IS SOME UNCERTAINTY AND LACK OF UNDERSTANDING ABOUT THE RANGE OF NHS SERVICES AND WHERE TO OBTAIN THE MOST APPROPRIATE CARE. IT APPEARS A MUCH WIDER ISSUE FOR ETHNIC MINORITIES … % AGREE 61% 39% 38% 50% % % BASE = 600 (TOTAL SAMPLE) Source: Face-to-face

36. THE MAJORITY OF PEOPLE CLAIM THEY PREFER TO GO TO SEE THEIR GP FOR ALL THEIR HEALTH NEEDS AND WOULD ONLY GO TO A&E IF THE PROBLEM WAS URGENT. HOWEVER, THE ETHNIC SAMPLE ARE LESS LIKELY TO AGREE WITH THESE STATEMENTS INDICATING A MORE CASUAL APPROACH TO THE USAGE OF A&E … % AGREE 68% of BME’s agree 80% 77% of BME’s agree 93% % % BASE = 600 (TOTAL SAMPLE) Source: Face-to-face

37. DUE TO A LACK OF AWARENESS AND UNDERSTANDING OF THE FULL RANGE OF CARE OPTIONS AVAILABLE, IT IS UNSURPRISING TO SEE A&E BEING USED INAPPROPRIATELY, ESPECIALLY WHEN THE REGULAR GP IS UNAVAILABLE. OVERALL, 44% OF THE SAMPLE ADMITTED THEY HAD USED A&E AS THEY FELT IT WAS THE ONLY OPTION AVAILABLE … Only 34% of BME’s claimed they had used A&E as the only option available – which could be seen to support their more casual attitude towards using A&E “If I wanted to see a GP, and was desperate to see someone and couldn’t I would go to A&E.” % BASE = n in brackets (TOTAL SAMPLE) Source: Face-to-face

38. MORE LIKELY AT WEEKENDS A&E IS LIKELY TO BE USED AS ‘THE ONLY OPTION AVAILABLE’ ON ALL DAYS OF THE WEEK AND AT ALL TIMES, ALTHOUGH LATE EVENING (BETWEEN 8PM AND 3AM) IS MORE LIKELY TO BE MENTIONED FOR A WEEKEND … % BASE = 264 (Those having used A&E as only option available) Source: Face-to-face

39. IT WAS SUGGESTED GREATER AWARENESS OF ALL OPTIONS AVAILABLE WOULD LEAD TO A MORE INFORMED DECISION ABOUT THE MOST APPROPRIATE SERVICE TO USE … • Even amongst those aware, not all are fully aware of what service is there for • Acknowledged that different people view situations with varying levels of seriousness • Suggested a summary of services should be provided to all households detailing the services available AND the types of problems most appropriate for each • Several distribution methods mentioned: - • Business card to keep in wallet / stick on fridge • List in Yellow Pages / local phone book • Give information to children to bring home from school • A SINGLE PHONE number to call where you can be directed to the most • appropriate service was also suggested Source: Focus groups

40. AWARENESS & USAGE OF WYUC

41. AWARENESS OF WYUC WAS ASSESSED IN 3 WAYS … • Spontaneously – NO prompting at all, respondents simply asked which care options they could think of when they may need medical help or advice • Prompted – read the NAME only • Prompted – read a DESCRIPTION of the service, as below: “Launched in April 2009, there is now one local number to call if you live in West Yorkshire to get the right NHS services when you need them urgently. Urgent Care is for when you have minor accidents or unexpected health problems and need help within the next few hours. Your calls will be dealt with in a timely manner by our health professionals who will get the right treatment for you. Lines are open 24-hours a day, including bank holidays.”

42. SPONTANEOUS AWARENESS OF WYUC WAS ONLY EVIDENT IN TWO AREAS AND WAS HIGHEST IN CALDERDALE. ON PROMPTING WITH THE NAME ONLY (I.E. NO DESCRIPTION OF THE SERVICE) THERE IS AWARENESS IN ALL AREAS, AGAIN IT IS HIGHEST IN CALDERDALE. OVERALL AWARENESS IS LOWEST IN LEEDS … NO AWARENESS IN FOCUS GROUPS BASE = n in brackets (TOTAL SAMPLE) Source: Face-to-face

43. AWARENESS LEVELS ARE HIGHER AMONGST FEMALES, THOSE AGED 55+ YEARS, THE LOWER SOCIAL CLASSES (C2DE) AND THOSE WHO ARE WHITE … BASE = n in brackets (TOTAL SAMPLE) Source: Face-to-face

44. OVERALL, 3% OF THE SAMPLE (17 RESPONDENTS) HAVE HAD CONTACT WITH WYUC – 5 PEOPLE CALLED THEM DIRECTLY, 13 WERE AUTOMATICALLY TRANSFERRED WHEN CALLING THEIR GP OUT OF HOURS … 52 people had called GP Surgery out of hours - 25% (13 people) transferred directly to WYUC BASE = n in brackets (TOTAL SAMPLE) Source: Face-to-face

45. THOSE WITH CHILDREN IN THE HOUSEHOLD ARE THE MOST LIKELY TO HAVE HAD CONTACT WITH WYUC … BASE = n in brackets (TOTAL SAMPLE) Source: Face-to-face

46. IN THE FOCUS GROUPS THE NAME ‘WEST YORKSHIRE URGENT CARE’ CAUSED CONFUSION OVER WHAT THE SERVICE SHOULD BE USED FOR, DUE TO WORD ‘URGENT’ AND SIMILARITIES WITH NHS DIRECT … “The name makes you think a serious, A&E type situation.” • The word ‘URGENT’ suggests a service: - • To be used for SERIOUS health conditions • Used in similar way to 999/A&E “Urgent means urgent – it means 999.” “You either need urgent care or you don’t, there’s no in between. You would just go to hospital or call 999.” “Word ‘urgent’ puts me off – would I be wasting their time?” • After being read service description,there was CONFUSION what WYUC should be used for: - • Perceived to be similar to NHS Direct, combined with word ‘urgent’: • - NHS Direct offers advice, not immediate care, word ‘urgent implies immediate • care required “It’s similar to NHS Direct, but I would ring NHS Direct for advice not action, if I had an emergency I wouldn’t ring NHS Direct.” • Some thought WYUC would replace NHS Direct, others thought it might replace 999 “Is it in place of 999?” “Same service as NHS Direct.” Source: Focus groups

47. THERE WAS ALSO SOME CONFUSION IN THE FACE-TO-FACE SAMPLE REGARDING THE SERIOUSNESS OF PROBLEMS DEALT WITH BY WYUC … THERE WAS POLARISATION TOWARDS THE STATEMENT ‘I WOULD CALL WYUC IN AN EMERGENCY WHEN IMMEDIATE CARE IS REQUIRED’: - 45% AGREE - 42% DISAGREE % BASE = 600 (TOTAL SAMPLE) Source: Face-to-face

48. 41% ETHNIC SAMPLE RESPONSES MUCH HIGHER FOR ETHNIC MINORITY SAMPLE, FOR THEM, WYUC MORE LIEKLY TO REPLACE THESE SERVICES 25% ETHNIC SAMPLE AND IT IS PERCEIVED WYUC WILL BE USED PRIMARILY IN PLACE OF CALLING GP OUT OF HOURS AND NHS DIRECT … 71% AGREED THAT THEY ARE MOST LIKELY TO CALL WYUC OUTSIDE NORMAL GP HOURS “For general queries late at night for reassurance.” % BASE = 600 (TOTAL SAMPLE) Source: Face-to-face

49. WYUC WOULD BE MAINLY CALLED IN RELATION TO SICK CHILDREN, TIMES WHEN HELP/ADVICE IS REQUIRED QUICKLY AND FOR MINOR PROBLEMS. HOWEVER, 22% AGREED THEY WERE CONFUSED ABOUT WHEN THEY SHOULD CALL, PARTICULARLY THOSE IN THE ETHNIC SAMPLE … 63% AGREED THAT THEY ARE MORE LIKELY TO CALL WYUC IN RELATION TO A SICK CHILD/ELDERLY PERSON OVERALL, 22% AGREED THAT THEY ARE CONFUSED ABOUT THE TYPE OF MEDICAL CONCERNS THEY WOULD CALL WYUC ABOUT. ETHNIC MINORITIES APPEAR MORE CONFUSED (37% AGREED) • AMONGST THE 17 PEOPLE WHO SPOKE WITH WYUC, THE MAIN REASONS FOR CALLING WERE: • SICK CHILD (7 people) • SEVERE PAIN (3 people) • FLU (2 people) • FEELING VERY UNWELL (2 people) % BASE = 600 (TOTAL SAMPLE) Source: Face-to-face

50. RESPONDENTS WERE ENCOURAGED TO GIVE SPECIFIC PROBLEMS THAT THEY MAY CALL WYUC ABOUT. THE MAJORITY WERE ABLE TO SUGGEST SOMETHING, RANGING FROM MORE MINOR AILMENTS SUCH AS FEVERS, COLDS AND FLU THROUGH TO THE MORE SERIOUS SUCH AS CHEST PAINS AND HEAD INJURIES … % BASE = 600 (TOTAL SAMPLE) Source: Face-to-face