Public Insight Research

Introduction and context

Last year, the Charity published an analysis by Deloitte of the performance of the health and care system in Lambeth and Southwark. This work analysed existing data against four stages of care: prevention, diagnosis, cure and on-going management. These stages were chosen as a reasonable proxy for the outcomes that are important to patients. The analysis showed that on this perspective the performance of the current health and care system is not as favourable as might be expected in some respects and may not fully meet patient needs. The analysis focussed on outcomes that patients benefited from, rather than looking at patient experience and attitudes.

Charity Trustees identified that they wanted to understand patient experience and attitudes towards the health and care system, to sit alongside the Deloitte research. In particular, they were interested to hear about the local population’s health needs and what affected those needs.

The Deloitte analysis showed that one area where the system does not always perform well is in providing timely and accurate diagnosis. The Charity therefore convened representatives of some key local partners to discuss the challenges around timely and accurate diagnosis and ways of tackling the problem. Some of the challenges relate to misdiagnosis or incorrect referrals, whilst other challenges are around patients presenting late with particular symptoms. Participants at the meeting agreed that before being able to tackle the diagnosis challenge, they first wanted to understand the local population better. They suggested undertaking research with the local population to understand the cultural norms or beliefs and motivations which affect what an individual values in relation to their health and wellbeing. They also wanted to understand the implications of those cultural norms or beliefs for an individual’s general health status and whether or how the individual accesses the healthcare system to seek a diagnosis for a perceived health problem.

As a result, the Charity commissioned the Social Kinetic to undertake this research. The research was an opportunity to test previous assumptions and gain a better understanding of public perceptions about their own health and care and their expectations of how services and support in Lambeth and Southwark should meet their needs. The Charity believes that understanding the true needs of patients and citizens in Lambeth and Southwark can help it set appropriate priorities for its work and may also inform the strategies of commissioners.

The research had three different stages:

· The first stage consisted of a literature review and meetings with stakeholders to refine the focus of the research and identify key questions to be tackled.

· The second stage consisted of vox pops with a small number of people in Lambeth and Southwark, to get a high level understanding of their priorities and aspirations and also to understand how they think about their health.

· The third stage involved a small number of in-depth interviews with a range of people of different ages and different economic backgrounds in Lambeth and Southwark. These interviews explored people’s history, narrative and goals, whilst considering the impact of their health on those things.

Research findings

Care should be taken in generalising the findings of the research beyond the sample of those involved in the research. Nevertheless, the findings raise some important points that have interested the Charity and which deserve further consideration and exploration. In particular, these are:

· that people are largely aware of how to stay healthy but do not prioritise their health;

· that key life events can lead some people to focus on their health, whilst others no longer prioritise their health;

· that mental health is seen as a core part of being healthy; and

· the interaction between health and self-betterment.

The research unveiled that participants rarely prioritised their own health. The majority of those interviewed showed some awareness of how to stay healthy (for example smoking cessation or weight loss). Most participants only prioritised their health (or doing things to stay healthy) when their health affected their life or things they considered important. In addition, many saw focussing on their health as a luxury or as something aspirational, rather than something which was achievable or possible, because they had too many other demands on their time or money.

The research gives real insight into what ‘good health’ meant to participants. Participants described ‘good health’ as being about the absence of ill health or sickness, rather than a more positive framework. Individuals commented that they were responsible for looking after their own health, but many were not taking actions to improve their health even when they recognised that they needed to, raising concerns about their future health.

Participants mentioned certain life stages which could lead to them (or led to them) reconsidering how they approached their health. This included the birth of a child or illness of their parents, or reaching a particular age. Alternatively, several participants mentioned other potentially adverse life experiences (such as unemployment or divorce), which could lead to a more negative approach to their health.

The impact of mental health on most participants was extremely apparent. It was striking that psychological and mental challenges featured strongly in the participant interviews (even if they were not specifically identified as such). In addition, those psychological and mental challenges were closely connected with the participant’s physical health or ill-health. This research shows evidence of unmet need in relation to mental health and also the impact of that unmet need on individuals, which is of concern for the health and care system.

January 2015