Research Study Conducted for Department of Health - May 2008

The report reflects on the findings of a research project conducted by the Ipsos MORI Social Research Institute on behalf of the Department of Health in April 2008. The research consisted of 102 telephone interviews with users in the three areas which were running the pilot scheme of delivering community equipment and health aids.

All patients who were issued with a prescription for health equipment or aids in the three pilot areas – Cheshire, Manchester and Oldham – between October 2007 and April 2008 were invited to take part in the research. Consent forms were issued to patients in the three pilot areas along with their prescription. A total of 261 consent forms were returned to Ipsos MORI by 22nd April 2008 (179 from Cheshire, 50 from Manchester and 32 from Oldham).

All those who provided their consent, or consent for someone to take part on their behalf, were contacted to take part in the survey. Fieldwork was conducted using Computer Assisted Telephone Interviewing (CATI) at one of Ipsos MORI's dedicated UK telephone centres between 14th and 24th April 2008. A total of 102 responses were achieved, representing an unadjusted response rate of 39%.

It should be remembered that a sample and not the entire population of users took part in this survey. As a consequence, all results are subject to sampling tolerances, which means that not all differences are statistically significant. It should also be noted that due to the small overall sample size (102) no sub-group analysis could be undertaken.

The headline results of the survey are very positive. Users are satisfied with the overall service that they are receiving, as well as having high levels of satisfaction with each stage of the prescription process. The responsiveness of the staff, the speed of the service and the quality of the health equipment or aids are the most commonly mentioned factors for users' satisfaction with the pilot system. Satisfaction with the individual retailers shows similarly positive results with users broadly very satisfied with the service that they have received as well as the time
taken for their equipment or aids to be delivered.

The reputation of the pilot system and the individual retailers used is currently good. The high level of satisfaction, among users of the service, has clearly transferred into a positive reputation for both the system and retailers. Indeed, many users would speak highly of the service and retailers to others.

There is an appetite among users for the system to offer choice and flexibility. Most users feel that it is important for them to be offered a choice when it comes to the equipment or aid they will use, as well as a choice in the individual retailer that fulfils their prescription. While desire for choice is high, awareness of the choices which are available within the pilot system are limited.

Users Views

Users' overall impressions of the service for providing health equipment and aids are very positive. Few users express negative views towards the service or individual aspects of the service. The majority (92%) of users are satisfied with the pilot system, while around one in twenty (6%) are dissatisfied. For those who are satisfied, the helpfulness of the staff and the speed of service are the main reasons for their satisfaction, both being cited by just over two in five users (45% and 43% respectively). Other reasons for satisfaction include aspects relating to the equipment and aids themselves, the briefing and information that users have received during their assessment.

As previously mentioned, levels of dissatisfaction with the service were extremely low (6%). The reasons provided by users for their dissatisfaction include having to travel to pick-up the equipment or aid, the length of time they had to wait for the equipment or aid to be delivered and the fact that you are no longer able to take equipment directly home from hospital.

Quality of the service

Individual aspects of the process are highly rated, with all aspects providing a ‘good' service in the eyes of users. The majority of users rate the initial assessment process and the quality of the equipment or aid that they receive as good (97% and 94% very/fairly good respectively). A further nine in ten respondents also rate as very or fairly good the processing of the prescription (90%) and the service provided by the retailer (90%).

While all aspects of the process are rated positively by the majority of respondents, two have a slightly lower rating – the choice of the equipment and aids on offer, and the number of retailers available. These both relate to choice, an intended cornerstone of the new pilot system. The lower rating for these is in part explained by the relatively large number of users who answer “Don't know” on these aspects. This may be due to a lack of awareness by users of these features. Given the importance placed upon choice in the pilot model, these are key areas to focus on while the system develops.

The retailer and delivery

In addition to adding direct choice, introducing contact between the patient and private sector retailers is a further important change of the pilot scheme. As such, it is pleasing to see that users are also broadly very satisfied with all aspects of their contact with the retailers.

Mirroring the results of the service overall, nine in ten users are satisfied (90%) with the service that they receive from their chosen retailer, while a similar proportion (89%) are also satisfied with the length of time it took for the health equipment or aids to be delivered.

Two in five (40%) users collected their equipment or aid from the retailer straight away, while a further one in five (21%) received their equipment within two days. Just under a quarter of users (23%) waited over a week for their equipment to be delivered. As seen previously, the speed of the service was the second most popular reason for satisfaction with the service. As such, reducing the time that some users are
waiting for their prescription to be delivered is likely to improve satisfaction levels.

When users were asked how likely they would be to be an advocate of their chosen retailer, the results are similarly positive. Approaching three-quarters (73%) of respondents are happy to do so, while only three per cent would be actively critical. This indicates the high regard in which the private sector retailers are held, appearing to lend patient support for their inclusion into the delivery model.

Choice and “Topping Up”

One of the key aims of the pilot system was to place service users at the centre of the service by providing “state supported users with a choice that they have not previously enjoyed”. Since October 2007, users in the pilot areas are able to choose between a range of accredited retailers to source their prescription from, as well as also having the option to “top up” their prescription to better suit their lifestyle or preference.

Users' views on choice

There is a strong desire among users for a choice of retailers and a choice of equipment and aids available to them. Nine out of ten (89%) feel that it is either very or fairly important that they are offered a choice of equipment, while over three-quarters (78%) feel that it is important to be offered a choice of retailers from which to source their equipment or aid.

These results indicate that, if rolled out across the entire system, the addition of choice into the delivery of health equipment and aids is likely to be welcomed by the vast majority of users.

“Topping up”

As mentioned, since October 2007 service users in the three pilot areas have been able to “top up” their prescription. “Topping up” involves paying a supplement over and above the basic prescription which allows the choice of an aid or item of equipment that is different from that available under the standard prescription. As with other aspects of choice, support among users for the ability to “top up” their prescription is high. Nine out of ten (90%) users feel that it is either very or fairly important that they are given the opportunity to do this.

Perhaps surprisingly, despite the high apparent level of importance placed upon this by users, under half (44%) were actually aware that they were able to “top up” their prescription. Further, under one in ten (7%) actually did “top up” their prescription and only one in five (19%) bought additional items that were not included in their prescription from the retailer.

The most popular health equipment or aids that are prescribed are bathing aids (46%), personal care/living aids (45%), mobility aids (40%) and toileting aids (40%).

The sources of advice used to find out about where to go for the initial assessment is varied. The most popular source of information is the local
Council, which was used by just under a half (48%). A further quarter (25%) get their information from the hospital, while over one in ten gain their information from friends or relatives (14%) or their GP (13%).

It is clear that the system of providing health equipment and aids has been successful in providing a service that users are not only satisfied with, but one that they hold in high regard.

While the current situation provides a strong base, the results do highlight a number of key areas to focus on in order to ensure that the benefits of the pilot system are realised by all users:

The pilot system has increased the amount of choice that users are offered when redeeming their health equipment or aid. While users clearly feel that having a choice is important, it appears that far fewer were actually aware of the full extent of the options available to them or indeed actually fully made use of these options where available (whether this be “topping up” or having a choice of retailer). One of the key aims of the pilot system was to offer users with previously limited choice, such as those on state support, a far wider range of options. As such, the research indicates that there is still some way to go in informing users of the full range of options available to them in the pilot system. Given the importance users place on being offered a choice, effort should be focused towards making sure that all users are aware of the options available. In order to reach all users, providing this information with the prescription would be the most suitable point of dissemination.

The research shows that one of most popular reasons for users' satisfaction with the pilot service is that the service they received was quick and prompt. As speed is a key factor for patient satisfaction making the process as short as possible is likely to help maintain the high levels of satisfaction that are currently displayed. One element where there may be potential to improve the speed of the service that users receive is in the time that users have to wait before their equipment or aid is delivered. While for the majority of users this was less than one week, a significant minority of users are currently waiting over a week for their equipment or aid. Given the nature of the goods, having to wait for such a time period may well have a significant impact.