Stakeholder Perceptions Audit Department of Health. Research Study Conducted for The Department of Health

Transcription

1 Stakeholder Perceptions Audit Department of Health Research Study Conducted for The Department of Health February 2005

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3 Contents Introduction 1 Interpretation of the Data 3 Publication of the Data 4 Executive Summary 5 Appendices Stakeholder survey marked-up questionnaire Charts of findings Internal survey marked-up questionnaire

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5 Introduction This report presents the findings of a stakeholder perceptions audit conducted by the MORI Social Research Institute for the Department of Health. The aim of the research is to provide an overall impression of perceptions of the Department and its performance in managing relationships with stakeholders. In addition, the research seeks to identify barriers to effective partnership working and to make recommendations for the future. Specifically, the research examines: 1. How stakeholders perceive the Department as an organisation; 2. The extent to which stakeholders feel they understand the Department s main objectives and how their roles fit into this; 3. The extent to which stakeholders feel positively or negatively about the Department, and how they speak about it to their colleagues and to the media; 4. Whether the Department is giving stakeholders the right support to enable them to deliver effectively; 5. The extent to which the Department has the right people and skills set in place to deliver its programmes; 6. How effective it is as a governmental organisation, and how it compares to other government departments; and 7. Whether stakeholders feel they are consulted effectively on policy issues.

6 Methodology The perceptions audit includes qualitative and quantitative research with Department of Health stakeholders and an internal questionnaire completed by Department of Health staff. Details on the methodologies used and a description of the stakeholders surveyed are given below. The Stakeholders Typically, the stakeholders of any organisation are those who have a vested interest in the actions and policies of that organisation. The Department has a wide variety of stakeholders from across the public, private and voluntary sectors. A database of key stakeholder contacts was provided to MORI by the Department. Stakeholders interviewed were senior representatives of their organisation (i.e. at Chief Executive or service director level) and were categorised into the following groups: Other Government Departments (OGDs); Local Government; Voluntary and Community Sector; Arm s Length Bodies (ALBs); Professional Bodies; The National Health Service; and The Commercial Sector. The research seeks to bring out the similarities and differences in views among these stakeholder groups, and to identify specific areas of strength and weakness in their relationships with the Department. Part 1 In-Depth interviews 50 qualitative in-depth interviews lasting between 30 and 60 minutes were conducted with key stakeholders. Stakeholders received an advance letter from Sir Nigel Crisp giving details of the research and inviting them to take part. A discussion guide for the interviews was designed by MORI in consultation with the Department of Health. Interviews were conducted by senior MORI executives face-to-face and by telephone between 30 th November 2004 and 25 th January Part 2 Telephone survey A quantitative survey of 300 structured telephone interviews was conducted, with each interview lasting around 15 minutes. Interviews were conducted by MORI s trained telephone interviewing team between 13 th December 2004 and 14 th January 2005.

7 The questionnaire was designed by MORI in consultation with the Department of Health, drawing on previous stakeholder research conducted by MORI to allow some results to be used comparatively. Stakeholders interviewed were at the same senior level within their organisations as those who took part in the qualitative part of the research, and were also sent an advance letter from Sir Nigel Crisp. No stakeholders were interviewed for both the qualitative and the quantitative parts of the research. Part 3 Internal survey The final part of the research consisted of a postal self-completion survey sent by MORI to Department of Health staff. The aim of this part of the survey was to ask staff to guess or approximate what they thought stakeholders responses would be to key questions from the telephone survey questionnaire. Staff were also asked to give an ideal response percentage for each question, i.e. the percentage with which they would feel comfortable. In total, 43 surveys were returned to MORI by DH staff. Interpretation of the Data Qualitative research Qualitative research involves an interactive process between the moderators carrying out the research and those being researched. It provides a way of probing the underlying attitudes of participants, and obtaining an understanding of the issues of importance. The real value of qualitative research is that it allows insights into the attitudes, and the reasons for these attitudes that could not be probed in as much depth with a structured questionnaire. However, it must be remembered when interpreting these results that they are not based on quantitative data. Where findings are given from the qualitative part of the research, the data are based on a small sample of different types of stakeholders and should therefore be seen as indicative. Throughout the report we record perceptions and not facts. Participants may hold views that are based on incorrect information and these perceptions are reported here. Quantitative research It should be remembered at all times that a sample and not the entire population of external stakeholders has been interviewed in the telephone survey. Where percentages do not sum to 100, this may be due to computer rounding, the exclusion of don t know categories, or multiple answers. Multiple responses mean that respondents can give more than one answer to a question, therefore results will total more than 100 percent.

8 Throughout the volume an asterisk (*) denotes any value of less than half a per cent. In the computer tables (under separate cover) and report text, reference is made to net figures. This represents the balance of opinion on attitudinal questions, and provides a particularly useful means of comparing the results for a number of variables. In the case of a net satisfaction figure, this represents the percentage satisfied on a particular issue or service, less the percentage dissatisfied. For example, if a service is recorded 40% satisfied and 25% dissatisfied, the net satisfaction figure is +15 points (40% - 25%). Publication of the Data As with all our studies, these findings are subject to our standard Terms and Conditions of Contract. Any press release or publication of the findings of this survey requires the advance approval of MORI. Such approval is only refused on the grounds of inaccuracy or misinterpretation of the research findings.

9 Executive Summary The term stakeholder covers a range of organisations in relation to the Department of Health. We would therefore expect to see a wide range of opinions and experiences related to the department, and certain characteristics particular to identifiable stakeholder groups. This is generally the case, with stakeholders from the NHS far likelier than those from Arm s Length Bodies or Local Government to be advocates of the Department. Indeed, those who know the department well; here stakeholders from the NHS or other Government departments; are in general less likely to be critical of it. Those from Voluntary and Community sectors and Local Government stakeholders are likeliest to identify communication and consultation as problematic areas and thus potential areas for improvement in the future. A positive and telling finding in itself is the high level of accuracy with which the Department s internal staff is able to predict the responses of its stakeholders. This is the case in almost all areas of inquiry, but particularly when considering overall impressions of the department. Strengths The Department is seen as having a difficult and high profile remit that it is delivering on effectively. There is a large degree of support and understanding among stakeholders for what the Department is trying to achieve and a recognition that it is doing a good job. Over half of stakeholders feel that DH currently has the right policies in place for the health and social care system compared with one in five who do not. The Department is seen as particularly effective on delivering improved access to services, with three quarters of stakeholders saying it has been effective in this regard. A further key perceived strength of DH is that it benefits from a supportive relationship with the centre of government, and our interviews with the centre confirm this. Overall, around three in five stakeholders feel that DH enjoys good support from the centre. DH staff are seen to be performing well at an individual level in terms of their technical knowledge, approachability and willingness to help stakeholders. There is particular praise for those at the top level of the Department for pursuing a difficult but effective change agenda. Stakeholders are also positive about recent moves away from a more central command style of leadership and towards greater local autonomy, particularly in the NHS. Overall, around half of stakeholders feel the Department is a good organisation to do business with compared with a quarter who do not.

10 Weaknesses The perceived size of the Department and the view that it is an organisation in constant change make it difficult to work with for some stakeholders. Many do not feel that the current structure is clear, and even stakeholders who have worked with DH for many years do not understand how individuals and units link up to the wider whole. Related to this is the perception that units within DH often work in silos and have relatively poor internal communications. This can lead to mixed messages coming from different parts of the Department, sometimes exacerbated by a perception that some units carry more weight than others. Around half of stakeholders say they find the Department remote and impersonal compared with two in five who disagree with this. There are also issues around whether stakeholder partners feel trusted by DH and a perceived need for a more open working culture. Three quarters of stakeholders see more openness as an important change to make in future stakeholder relationships. While some improvements have been made in how the Department consults with stakeholders, many still feel that consultation often occurs too late to be meaningful or is not acted upon. The type of consultation is also important; informal feedback is currently seen as the most effective way of consulting with the Department, suggesting a lack of trust that more formal feedback and consultation mechanisms are meaningful exercises. The Department has some work to do on advocacy: more stakeholders would be critical of the organisation than would speak highly of it to others. Relations with Arm s Length Bodies are clearly strained following the recent review of ALBs. Local Government stakeholders are most likely to feel that there is too little meaningful consultation with them, or that social care is not high enough on the Department s agenda. Suggestions for the way forward The research suggests a need for a range of changes in the way the Department works with stakeholders including: Providing stakeholders with more information about how the Department works internally, including an organisational chart Ensuring that consultation occurs early and that formal structures for feedback are seen to be meaningful Developing account management for key stakeholders, including rebuilding relationships with ALBs and developing closer relationships with Local Government and Voluntary sector stakeholders Improving internal communications and agreeing a corporate line to give a more coherent message to stakeholders

11 Learning from other effective models of partnership working elsewhere in Whitehall, and implementing them when working with other government departments MORI/J23911 Ben Page Simon Atkinson David Peckham Julia Clark Annie Taylor

12 Stakeholder survey marked-up questionnaire

13 DEPARTMENT OF HEALTH Stakeholder Audit Quantitative Telephone Questionnaire Topline Findings 21/01/05 Interviews conducted among 300 stakeholders When results do not add up to 100%, this may be due to computer rounding or multiple response An asterisk (*) denoted a finding of less than 0.5% but greater than zero Base: 300 respondents Fieldwork was conducted from 13 December January 2005 OVERVIEW Q1. On a scale of 1-5, how well, if at all do you feel you know the Department of Health? % Very well 24 A fair amount 49 Just a little bit 25 Have heard of it but know 1 nothing about it Never heard of it 0 Don t know * Q2. I would you like to tell me how favourably or unfavourably you regard the Department of Health, bearing in mind we are interested in your overall impressions. Is that very or fairly? % Very favourable 5 Mainly favourable 47 Neither nor 34 Mainly unfavourable 12 Very unfavourable 1 No opinion 1 Q3. How well would you say that you understand the Department of Health s objectives and priorities? % Very well 23 Fairly well 56 Not very well 18 Not at all well 3 No opinion/don t know 0 Q4. And do you feel you know enough about what the Department of Health is doing (regarding their priorities and objectives)? % I know a lot 18 I know a fair amount 55 I know a little 23

14 I know very little 4 No opinion/don t know 0 Q5. Which of these phrases best describes the way you would speak of the Department of Health to other people in general? % I would speak highly of the 3 Department of Health without being asked I would speak highly of the 16 Department of Health if I were asked I would be neutral towards the 51 Department of Health I would be critical of the 23 Department of Health if I were asked I would be critical of the 5 Department of Health without being asked Don t know/no opinion 2 Q6. And which of these phrases best describes the way you would speak of the Department of Health to the media? % I would speak highly of the 4 Department of Health without being asked I would speak highly of the 33 Department of Health if I were asked I would be neutral towards the 48 Department of Health I would be critical of the 7 Department of Health if I were asked I would be critical of the * Department of Health without being asked Don t know/ No opinion 7

15 IMAGE I am now going to read out a number of statements about the Department of Health and I woul like you to tell me to what extent do you agree or disagree with each? Is that strongly or tend t agree/disagree? Q7. The Department of Health is too remote and impersonal Q8. The Department of Health understands the needs and interests of my own organisation Q9. The Department of Health involves its stakeholders in the development of policies and strategies Q10. The Department of Health helps my organisation achieve its objectives Q11. The Department of Health is supported by the centre of government (e.g. the Treasury, Cabinet Office, No 10 Downing Street) Q12. The Department of Health has the right policies for the health and social care system POLICY AREAS Strongly agree Tend to agree Neither agree nor dis-agree Tend to disagree Strongly disagree % % % % % % No opinion Q13- Q16. And how effective, if at all, would you say the Department of Health is in achieving the follow policy objectives? Is that very or fairly effective? Very effective Fairly effective Not very effective Not at all effective Don t know % % % % % Q13. Improve the health of the population Q14. Improve health outcomes for people with long-term conditions Q15. Improve access to services Q16. Improve the patient and user experience

16 Q For each of these policy objectives I would like you to tell me how important you think it is for the Department of Health to achieve these: Is that very or fairly important? Not very impor Not at all impor Esse ntial Very impor tant Fairly impor tant tant tant Don t know % % % % % % Q17. Improve the health of the population Q18. Improve health outcomes for * 1 people with long-term conditions Q19. Improve access to services Q20. Improve the patient and user experience CONTACT Q21. How often do you personally have contact with staff at the Department of Health? % At least once a week 43 At least once a fortnight 10 At least once a month 23 At least once every three or four 10 months At least once every six months 5 At least once a year 3 Less than once a year 5 Don t know * Q22. And which groups within the Department of Health do you have contact with? % Standards and Quality group (Sir 28 Liam Donaldson) Delivery group (John Bacon) 37 Strategy and business 33 development group (Hugh Taylor) Other 16 None of these 14 Don t know 5 Q23. To what extent do you agree or disagree that the Department of Health is a good organisation to do business with? Is that strongly agree/disagree? % Strongly agree 5 Tend to agree 40 Neither agree nor disagree 26 Tend to disagree 20 Strongly disagree 6 Don t know/no opinion 3

17 Q24. Why do you say that? % They are very helpful/supportive 13 Got better with 10 communication/good individual contact Working together on 10 objectives/to achieve objectives Poor communication 8 Their structure is confusing 6 Prepared/willing to listen 5 Too slow/slow to respond 4 Good deal of knowledge/local 4 knowledge Good calibre of staff 4 Difficult due to government 4 policies Lack of consistency 4 Lack of understanding 3 Professional/Have become more 3 professional Lack of support 3 Too remote/centralised 3 More contribution to policy 2 decisions/greater involvement in policy Too bureaucratic 2 They have a clear set of objectives 2 Too many changes/restructuring 1 Fail to involve shareholders 1 Other 9 Don t know * None/Nothing/No comment 1 CUSTOMER FOCUS Q25. Thinking generally about other government departments that you deal with, how do you think the Department of Health compares overall in terms of its dealing with your organisation? Is the Department of Health % Much better 8 A little better 19 About the same 35 A little worse 13 A lot worse 2 Don t know/no opinion 22

18 Q26. Can you give any examples of good practice from other government departments that you would like the Department of Health to follow? Improve communication/consultation/ contact Better/clear structure of the department % 15 Be more responsive 3 3 Involve stakeholders/engagement of stakeholders before policy is announced More joined up thinking 2 More openness/transparency 2 Improve dealings with businesses 2 Regular meetings 1 Reduce bureaucracy/paperwork 1 Improve their website 1 More timely decisions 1 Be more concerned for the 1 customers wants and needs They are all the same 1 Need better PR/media coverage 1 Other 8 Don t know 5 None/Nothing 33 6 COMMUNICATION Now I would like to ask you about how the Department of Health communicates with your organisation? Q27. Which of the following do you use to find out about what the Department of Health is doing? % National newspapers, radio 70 and television Specialist publications 73 the Department of Health s own 72 publications the Department of Health website 85 Meetings organised by the 78 Department Informal discussions with 76 Department staff None of these 1

19 Q28.- Q33. And how useful do you find? Very useful Fairly useful Not very useful Not at all useful Don t know % % % % % * Q28. National newspapers, radio and television Q29. Specialist publications * * Q30. the Department of Health s own publications Q31. the Department of Health website Q32. Meetings organised by the Department Q33. Informal discussions with Department staff Q34. Which of the following ways do you use to feed back into the Department of Health policy making? % Working groups and 75 consultative forums Q35.- Q38. Formal written consultations 75 Informal discussions with 76 Department staff Lobbying ministers and 39 Parliamentarians None of these 8 And how effective do you find feeding back through? Q35. Working groups and consultative forums Very effective Fairly effective Not very effective Not at all effective Don t know % % % % % * 4 Q36. Formal written consultations Q37. Informal discussions with * 4 Department staff Q38. Lobbying ministers and Parliamentarians Q39. To what extent do you agree or disagree that the Department of Health listens and responds to what you say? % Strongly agree 3 Tend to agree 36 Neither agree nor disagree 29

20 IMPROVING RELATIONSHIPS Tend to disagree 23 Strongly disagree 4 Don t know/no opinion 5 Q40.- Q45. Finally, thinking about how the Department of Health might improve the way it works with you in the next few years, how important or unimportant do you think each of the following will be? Is that very or fairly important/unimportant? Very Fairly Not very Not at all No Essential important important important important opinion % % % % % % Q40. More openness * 2 Q41. Introducing new forms of consultation Q42. More explanation about decisions and developments Q43. Better access to individual staff within the Department of Health Q44. More briefing/liaison meetings with staff within the Department of Health Q45. Better understanding of the challenges you face * 1

21 Charts of findings

22 Objectives and priorities Q Do you feel you know enough about what the Department of Health is doing (regarding their priorities and objectives)? % Know a little/very little % Know a lot/fair amount All stakeholders ALB Commercial Local Gov NHS OGDs Professional bodies Voluntary Base: 300 DH stakeholders interviewed by telephone, 13 Dec Jan Advocacy - general Q Which of these phrases best describes the way you would speak of the Department of Health to other people in general? % Would speak % Would be critical highly All stakeholders ALB Commercial Local Gov NHS OGDs Professional bodies Voluntary Base: 300 DH stakeholders interviewed by telephone, 13 Dec Jan

23 Advocacy - media Q Which of these phrases best describes the way you would speak of the Department of Health to the media? % Would speak % Would be critical highly All stakeholders 7 37 ALB Commercial Local Gov NHS OGDs Professional bodies Voluntary Base: 300 DH stakeholders interviewed by telephone, 13 Dec Jan Remote and impersonal? Q To what extent do you agree or disagree that the Department of Health is too remote and impersonal? % Agree % Disagree All stakeholders ALB Commercial Local Gov NHS OGDs Professional bodies Voluntary Base: 300 DH stakeholders interviewed by telephone, 13 Dec Jan

24 Understanding needs and interests Q To what extent do you agree or disagree that the Department of Health understands the needs and interests of my organisation? All stakeholders ALB % Disagree % Agree Commercial Local Gov NHS OGDs Professional bodies Voluntary Base: 300 DH stakeholders interviewed by telephone, 13 Dec Jan Involving stakeholders Q All stakeholders ALB To what extent do you agree or disagree that the Department of Health involves its stakeholders in the development of policies and strategies? % Disagree % Agree Commercial Local Gov NHS OGDs Professional bodies Voluntary Base: 300 DH stakeholders interviewed by telephone, 13 Dec Jan

25 Achieving objectives Q All stakeholders ALB Commercial To what extent do you agree or disagree that the Department of Health helps my organisation achieve its objectives? % Disagree % Agree Local Gov NHS OGDs Professional bodies Voluntary Base: 300 DH stakeholders interviewed by telephone, 13 Dec Jan Supported by government Q To what extent do you agree or disagree that the Department of Health is supported by the centre of government? % Disagree % Agree All stakeholders ALB Commercial Local Gov NHS OGDs Professional bodies Voluntary Base: 300 DH stakeholders interviewed by telephone, 13 Dec Jan

26 Has the right policies Q All stakeholders ALB To what extent do you agree or disagree that the department of health has the right policies for the health and social care system? % Disagree % Agree Commercial Local Gov NHS OGDs Professional bodies Voluntary Base: 300 DH stakeholders interviewed by telephone, 13 Dec Jan Good to do business with? Q To what extent do you agree or disagree that the Department of Health is a good organisation to do business with? % Disagree % Agree All stakeholders ALB Commercial Local Gov NHS OGDs Professional bodies Voluntary Base: 300 DH stakeholders interviewed by telephone, 13 Dec Jan

27 Listening and responding Q To what extent do you agree or disagree that the Department of Health listens and responds to what you say? All stakeholders ALB Commercial % Disagree % Agree Local Gov NHS OGDs Professional bodies Voluntary Base: 300 DH stakeholders interviewed by telephone, 13 Dec Jan Improving relationships - openness Q Thinking about how the Department of Health might improve the way it works with you in the next few years, how important do you think more openness will be? % Not important % Essential/important All stakeholders 5 93 ALB Commercial Local Gov NHS OGDs Professional bodies Voluntary Base: 300 DH stakeholders interviewed by telephone, 13 Dec Jan

28 Improving relationships understanding challenges Q Thinking about how the Department of Health might improve the way it works with you in the next few years, how important do you think better understanding of the challenges you face will be? % Not important % Essential/important All stakeholders 2 97 ALB Commercial Local Gov NHS OGDs Professional bodies Voluntary Base: 300 DH stakeholders interviewed by telephone, 13 Dec Jan

29 Internal survey marked-up questionnaire

30 STAKEHOLDER SURVEY GUESSTIMATE QUESTIONNAIRE TOPLINE FINDINGS - 42 Department of Health staff completed this short questionnaire - They completed this task between December 2004 and January The actual column represents comparative findings from the stakeholders questionnaire, among 300 stakeholders Instructions to respondents were as below: In the Predicted column please write in the % of stakeholders you think will give each answer. In the Target column please write in what you think should be the target % of stakeholders giving each response i.e. what you would be comfortable with. Predicted % Target (i.e. what you would be comfortable with) % Q1. What % of stakeholders say they would speak highly of the Department of Health? Q2. What % say they would be critical of the Department of Health? Actual % To other people: 19 To the media: 37 To other people: 28 To the media: 7 Q3. What % say the Department of Health is too remote and impersonal? Q4. What % say the Department of Health has the right policies in place for the health and social care system? Q5. What % say that the Department of Health is supported by the centre of government (e.g. the Treasury, Cabinet Office, No 10 Downing Street)

31 Q6. What % say the Department of Health involves its stakeholders in the development of policies and strategies? Q7. What % say they understand the Department of Health s objectives and priorities well? Q8. What % agree that the Department of Health is a good organisation to do business with? Q9. What % agree that the Department of Health listens and responds to what they say? Q10. What do stakeholders think are the most important ways of improving the way the Department works with them over the next few years? PLEASE TICK TWO BOXES Predicted Actual (Ranked by frequency) (numbers represent order of importance) Better Departmental understanding of the challenges stakeholders face 1 1 More openness 2 2 More explanation about decisions and developments 3 3 More briefing/liaison meetings with staff within the Department of Health 4 5 Introducing new forms of consultation 5 6 Better access to individual staff within the Department of Health 6 4