DO THE PUBLIC GET WHAT THE PUBLIC WANTS IN NORTHERN IRELAND HEALTH AND SOCIAL CARE?

Editor,

Healthcare systems in Northern Ireland have undergone some degree of transformation over the last decade. Within the hospital sector, some services have relocated from smaller “local hospitals” to larger units. However, reorganisation of services has proven difficult, with evidence based proposals ignored and service alterations overturned by Government or judicial review, often as a consequence of “Save our hospital” campaigns by local community groups and political representatives. It is nonetheless unclear if these voices are representative of the population.

The recently published Donaldson Report recommends a major service reconfiguration to provide the Northern Ireland population with optimal secondary healthcare.[1] The subsequently appointed Northern Ireland Health and Social Care (HSC) Review Panel aims to determine the needs of the Northern Ireland population and describe a configuration of health and social care to best serve these.

Over recent years, increasing emphasis has been placed on empowering patients by offering more choice on treatment location and methods, similar to other consumer choices[2]. In this context, do patients employ a similar decision making process when contemplating healthcare decisions to that employed when purchasing other consumer commodities? We compared Northern Ireland public attitudes to healthcare with that of traditional consumer goods.

Methods

Questionnaires to assess public attitudes were distributed over a two-week period (18th-31st July 2014) in two locations-Belfast and Newcastle, County Down. Participants living within the Greater Belfast area were considered to be urban dwellers, all others were considered rural dwellers. Data were analysed using SPSS (Version 21.0 Armonk, NY).

Results

One hundred questionnaires were completed. The participants rated accessibility of healthcare as more important than accessibility for traditional consumer products (Table 1). Participants would travel further for healthcare treatments than a variety of consumer products. Notably, participants would travel further for high quality products including healthcare treatments than for products of average quality (Table 2).

Table 1

The importance of accessibility to healthcare and consumer items

	Importance of accessibility*
Sick children	4.63
Cancer treatment	4.63
Accident and Emergency	4.39
Cardiac surgery	4.16
Outpatient clinic	4.09
Bread	4.09
Everyday essentials e.g. shampoo	4.04
Large household appliances	2.78
Clothes for a special occasion	2.55
Television	2.51

Accessibility was measured on a Likert scale from 1-5 with 5 being highest importance

Table 2

Acceptable travel time for healthcare and consumer items of varying quality.

	Average quality “Item”Travel time*	High quality “Item”Travel time*
Cardiac surgery	3.29	3.60
Clothes for a special occasion	3.05	3.20
Cancer treatment	2.98	3.56
Large household appliance	2.72	3.05
Television	2.67	2.96
Outpatient clinic	2.45	2.99
Accident and Emergency	2.38	2.96
Sick children	2.21	3.19
GP	1.92	2.59
Bread	1.16	1.48

Travel time was assessed using a Likert scale from 1-4 corresponding to the travel times below

Discussion

Consumers have similar attitudes to healthcare as they do to other consumer commodities. Consumers are willing to travel further for what they perceive to be specialised products or large one off purchases such as a fridge or television. Similarly, consumers are willing to travel further for traditionally perceived specialised treatments such as cardiac surgery, in comparison with GP or outpatient attendance. The public do want community based services such as their general practitioner to be nearby, similarly to frequently purchased consumer items such as bread. However, consumers are willing to travel on average more than one hour for secondary healthcare such as cancer treatment, particularly when the healthcare provided is of high quality. No longer should pressure be applied to maintain all local healthcare services at the expense of providing regional services of high quality. We encourage the HSC review panel to focus on the provision of high quality health and social care regardless of vocal opposition and suggest that implementation of a quality focussed system would meet the approval of the Northern Ireland population.

10-15 minutes

215-30 minutes

330-60 minutes

4more than 60 minutes