Clarify the quality message to get people behind seven day services

One issue sure to be on the lips of reinvigorated MPs back from their summer breaks is whether the fresh Conservative government can implement its longstanding plan to have an NHS that operates fully seven days a week.

While the health secretary and his fellow MPs have been enjoying their time off, the British Medical Association published their research with the general public showing that most believed the plans unaffordable.

The government, before its recess, announced it would forge ahead with its seven day services plans because “illness doesn’t respect working hours”. New research conducted by the health team at Ipsos MORI shows that neither side of the debate adequately captures the message from the public.

Barely registered

It’s true that the availability of NHS services is an issue for the public.

A quarter (25 per cent) of the public feel that some services being unavailable at the weekend is one of the biggest issues facing  the NHS today. This is a sizeable part of the adult population.

However, when we put this particular issue among a list of others facing the NHS, we found that it came below most concerns.

At the top were waiting times (44 per cent) and a lack of resources in the NHS (43 per cent).

What’s more, when we compared this to long term data from the Public Perceptions of the NHS and Social Care survey, where the same question is asked without presenting respondents with a list, concerns about the weekend have barely registered.

‘It means the issue isn’t keeping them awake at night’

So while a quarter are concerned about the lack of weekend services when the idea is put to them, it has rarely been mentioned when people are left to come up with their own concerns.

What does this tell us about public attitudes?

It doesn’t necessarily mean that people don’t really care about having seven day services, but it just means the issue isn’t keeping them awake at night.

Quality or quantity?

This is made all the more surprising when we see that at the bottom of the list of issues facing the NHS today is that “some services are worse on some days than others” (only 15 per cent mention it).

Given that the purpose of making services available on the weekend is precisely to ensure that the quality of outcome is the same every day, it seems odd that the public are more concerned about there being a lack of services at the weekend than they are about poorer quality services on the weekend.

‘It seems odd that the public are more concerned about the lack of services rather than the quality’

And it’s certainly not the case that the public are in support of differential services at the weekend. Nearly four in five (79 per cent) support the same standard of services at the weekend as during the week - over half (54 per cent) strongly agree with this. 

And this is to be expected – who would say no to having the same quality of services guaranteed over the course of the seven days?

Yet it is still the case that there is very low concern about poorer services being offered on some days more than others.

Convenience is king

So, why is there this dissonance – on the one hand, there is an overwhelming desire for weekend services to be of a high quality, but on the other, availability is seen as more important than quality?

Asking respondents why it was they thought that the government felt seven day services were needed helps illuminate this. The top two responses were not about guaranteeing quality at all.

Over a third of people said that the services were needed for convenient appointments (36 per cent), and a similar proportion said it was because there are not enough appointments (36 per cent).

Just over a quarter of people said it was to improve the quality of services (27 per cent). But overall, reasons of convenience trumped reasons of quality – 59 per cent thought services were needed for reasons relating to convenience, while only 43 per cent talked about quality.

Somewhere along the line, the message has been confused.

‘Somewhere along the line, the message has been confused’

While Jeremy Hunt and the BMA toss and turn over the impact of seven day services on the quality of outcomes, among the public quality has been conflated with convenience. And convenience is the answer to a problem that many of the public say they face regularly – long waiting times, and a lack of appointments.

This convenience may seem trivial to technocrats who are trying to fix the big picture problems, but when a grand solution is offered to the public, they assume that it solves the problems with which they are familiar.

Perhaps wrapping up seven day hospital services with seven day GP services has confused matters – the ability to get a convenient GP appointment is often talked about, and seven day services looks as though it’s designed to fix this.

Certainly the public want a continual level of quality throughout the week but it comes low down on a list of concerns about the NHS.

Not because they don’t care, but because the issue doesn’t resonate and we know from our other research that pride in the NHS can be blinding.

The message to both sides of this debate is that the public might be a lot more concerned and engaged in this policy if they understood that its primary objective is to save lives, and not just to make their own lives easier.

Anna Quigley is head of health research, and Harry Evans is research analyst, both at Ipsos MORI