Qualitative evaluation of stakeholders perceptions' Initial interviews

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Qualitative evaluation of stakeholders
perceptions.Initial interviews

• Mark Strong
• Clinical Lecturer in Public Health
• ScHARR

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Aim

• Determine the views of key stakeholders to
• inform the development of BS
• evaluate its success

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Design and setting

• Qualitative evaluation
• Interview based
• Fifteen key stakeholders
• Views sought before BS (Oct 06 to Jan 07)
• Re interview 18 months post

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Analysis

• Framework analysis
• Identifies themes
• Maps the range of the data
• Finds associations
• Seeks explanations
• Develops news ideas

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Interviewees

• Patient representative
• Local counsellor
• Chief executives PCT, RFT, CRT, RMBC
• Directors Social services, Public Health
• PCT Professional Executive Dr
• Clinicians physio, GP, respiratory Dr, PH Dr
• Senior managers BS, smoking cessation

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Results
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(No Transcript)
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Themes

• Perceptions of COPD
• Doctors
• Patients
• Opportunities arising from BS project
• to improve quality of life
• to right wrongs
• to raise profile of Rotherham
• Threats
• competition between PCT and FT
• risks to funding post 09/10
• The Smoke Free debate

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Perceptions of COPD
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Perceptions

• Well I think its fair to say that COPD has been
  a Cinderella Service. (PH Dr)
• COPD has largely been ignored until fairly
  recently as a disease, as a problem. (PEC Dr)

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Why Cinderella service?

• Because largely its a disease of smokers its
  often seen as self inflicted, therefore they sit
  quietly in a corner feeling guilty (DPH)
• your first picture of lung disease is somebody
  coughing and spitting (Pt Rep)
• its unfashionable (PEC Dr)

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Doctors perceptions

• cos they are going to be so immobile they are
  going to have to be pushed out and wheeled out.
• the place will be No Smoking so I suppose they
  will have to charge their wheelchair up and go
  out onto the street

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Patients view

• He the doctor gave this talk and It was all
  about the mortality rates, so he'd got people
  crying I know its fatal and I'm going to die
  but I didn't want everybody in the world to
  know. (Pt Rep)

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I don't know what they told the artist you've
got all these little people with Zimmer frames
walking about (laughing) all white haired you
know! Pt rep
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Opportunities

• Righting an injustice
• Improving quality of life
• For Rotherham

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Righting an injustice

• COPD occupies a kind of a particular place in
  the sort of socio-political health kind of
  discourse doesn't it? (PCT CE)
• Its in industrial areas, its this north south
  divide and I think there's certainly an inverse
  care law its higher in places like Rotherham,
  therefore its not as politically important.
  (PEC Dr)

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Righting an injustice

• state of the art service with a fabulous
  building, big investment mm for Rotherham. I
  think that goes someway towards readdressing what
  I believe to have been an in-balance. (PCT CE)
• Rotherham has had a pretty tough time really,
  for a long time, but particularly over the past
  twenty years or so mm. I think investing in
  communities is really important. (PCT CE )

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Opportunities to improve QOL

• I think its going to be enormous the quality
  of life of the patients and the carers is going
  to be improved, improved immeasurably compared to
  what we are doing at the minute (GP)

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Opportunities to improve QOL

• I think it will be shown that if you get
  somebody with moderate COPD and you do all the
  right things to them and they stop smoking and
  they do exercise and they know which inhalers to
  take then you can improve the rest of their
  quality and quantity of life (PEC Dr)

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Opportunities to improve QOL

• people are nice to them, they see those nice
  physios and you know everyone loves physios I
  can see that patient satisfaction will be high
  (PEC Dr)
• its really nice, its like a five star hotel
  (BS manager)
• even if they don't improve, they might well
  enjoy it (PEC Dr)

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Opportunity for Rotherham

• it will be a kind of national resource that we
  have, held up as a centre of excellence (DSS)
• Rotherhams not had good press, its had bad
  press really from a lot of things like Teenage
  Pregnancy, you know, passing chips through
  railings. (BS manager)

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Threats
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Threats perversity of PBR

• when this was originally muted we had no such
  things such as Payment by Results or the Tariff
  and therefore, it wasn't so financially
  dependent on reducing admissions, but now I think
  it very much is dependent on reducing
  admissions (FT CE)
• we are desperate that patients don't go to A and
  E or be admitted and they are desperate that they
  do go to A and E and get admitted, well that's
  just nonsense from a clinical point of view isn't
  it? (PEC Dr)

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Threats perversity of PBR

• it is seen as threatening to the acute sector
  because if you prevent a lot of admissions then
  the specialists we have here will not get as many
  patients (FT CE)
• if you are the admitting Clinician and you're
  fully appreciative of the fact that your
  Directorate is losing money and you want to admit
  people, you admit them (PEC Dr)

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Will it reduce admissions?

• YES
• if we can identify people with COPD, assess
  their needs and provide a primary care community
  driven mm provision of services to meet those
  needs fewer people will need to go into
  hospital (PCT CE)
• NO
• Is it going to reduce admissions? I suspect
  probably not. (Respiratory Dr)

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Threats future funding

• I think it is going to be quite a difficult
  decision for the prospective Boards in two years
  time because the evaluation really is going to
  have to say fairly speculative gains that will
  occur if the programme is kept for longer than
  two years (PH Dr)
• how much do you spend for keeping the patients
  happy? (PEC Dr)

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The Smoke Free Debate
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Smoke Free debateThe case For - equity

• the worry is that if you are going to get
  certain people who wont go because they cant
  have a fag, then it's a shame for themLet them
  have a fag and ignore it (PEC Dr)

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Smoke Free debateThe case For - addiction

• I think that it is probably unrealistic to
  expect people who have smoked for the last forty
  fifty years to suddenly stop so we need some
  facility for that, but in the meantime it is
  about working with them and their families to try
  and help them cut down and hopefully stop
  smoking. (DSS)

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Smoke Free debateThe case For - pragmatism

• I honestly think we have got to have a smoking
  area for them because I hate to see at the
  District General Hospital people in their flimsy
  nighties out in the snow with a drip coming down
  in their arms so they can have a smoke.
  (Counsellor)

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Smoke Free debateCase Against changing society

• I think it should be totally non smoking and
  that's changing society isn't it? There no
  smoking in pubs and no smoking in public spaces,
  I cant see that being a problem but it might be
  but I think they should make it no smoking.
  (Respiratory Dr)

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Smoke Free debateCase Against - benefits to
society

• I think that the mm benefits to us all of moving
  to Smoke Free environments in my view the
  benefits far, far outweigh the challenge
  difficulty that that may present to a small
  number of people (PCT CE)

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Smoke Free debateCase Against - consistency

• my surgery is smoke free, the hospital is smoke
  free, the PCT is smoke free so Breathing Space
  should be smoke free (GP)

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Smoke Free debateCase Against - contradiction

• a contradiction in terms to have this build and
  it was all about this and then provide a smoking
  facility in it (CRT CE)

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Smoke Free debateCase Against - legislation

• we will have little choice legislation is
  coming in, weve got the new PCT Policy youve
  existing Health and Safety Legislation. (Smoking
  cessation manager)

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Smoke Free debateConsultation?

• I hope that people have been, the potential
  clients, have been consulted and it hasnt just
  been a decision taken in an office Im quite
  glad that its not my decision. (RMBC CE)
• you can consult but you dont have to go along
  with whatever the findings of that consultation
  are. If you think something is right and you can
  justify why you are doing it (Smoking cessation
  manager)

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Finally
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A challenge to succeed

• it's a fight for people in Rotherham to make
  sure it works, not to get anybody coming in and
  saying I don't really think this is going to
  work get them away. You know we don't want
  people like that, we want people who can see that
  vision, and not just see it now, but see it in
  two years. (Pt rep)

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Questions?

• Contact details
• m.strong_at_nhs.net