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Research Report

Urgent and Emergency Care - Research Among Residents

Prepared for: Barking and Dagenham, Havering and Redbridge Clinical Commissioning Groups


Prepared for: Barking and Dagenham, Havering and Redbridge Clinical

Commissioning Groups

Prepared by: Steve Handley, Research Director

Date: March 2016

Produced by BMG Research

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Table of Contents

1 Introduction .................................................................................................................... 4

1.1 Context ................................................................................................................... 4

1.2 Methodology ........................................................................................................... 4

1.3 Weighting the data .................................................................................................. 4

1.4 Interpreting the data ................................................................................................ 5

2 Key findings ................................................................................................................... 6

2.1 Service awareness .................................................................................................. 6

2.2 Service usage ......................................................................................................... 6

2.3 Advice and signposting ........................................................................................... 7

2.4 Interest in personalised IT solution .......................................................................... 7

2.5 Views on over-use of Accident and Emergency ...................................................... 8

3 Service awareness and usage ....................................................................................... 9

3.1 Service awareness .................................................................................................. 9

3.2 Service use ........................................................................................................... 15

4 Accident and Emergency Visitors ................................................................................. 17

4.1 Visitor profile ......................................................................................................... 17

5 Urgent Care Centre Visitors ......................................................................................... 22

6 Walk In Centre Visitors ................................................................................................. 23

7 GP Hub Visitors ........................................................................................................... 25

8 Interest in personalised IT solution ............................................................................... 26

9 Anticipated response to care and advice scenarios ...................................................... 29

9.1 Non urgent scenario .............................................................................................. 29

9.2 Urgent scenario .................................................................................................... 30

9.3 Emergency scenario ............................................................................................. 32

10 Suggested reasons for over-use of Accident and Emergency Departments ............. 33

11 Sample profile .......................................................................................................... 35

11.1 Barking and Dagenham ........................................................................................ 35

11.2 Havering ............................................................................................................... 37

11.3 Redbridge ............................................................................................................. 39

12 Appendix: Statement of Terms ................................................................................. 41


2

Table of Figures

Figure 1: Have you heard of the following services where you can get help with treatment, or

advice for urgent and emergency care? (All responses) ...................................................... 10

Figure 2: Awareness of location of Nearest NHS walk in Centres/Urgent Care Centres (All

responses) .......................................................................................................................... 14

Figure 3: Profile of A&E visitors (All visitors in last 6 months -respondent or household

members) ............................................................................................................................ 17

Figure 4: Thinking about your last visit to A&E did you seek any advice on the best place to

go for care and treatment before you went? (All visitors to A&E in the last 6 months) ......... 18

Figure 5: And again thinking about your last A&E visit, had you...? (All A&E visitors in the last

6 months) ............................................................................................................................ 20

Figure 6: Please now think about your last visit to A&E. What was your main reason for

going to A&E? (All A&E visitors) .......................................................................................... 21

Figure 7: Thinking about your last visit to An Urgent Care Centre did you seek any advice on

the best place to go for care and treatment before you went? (All visitors in the last 6

months) ............................................................................................................................... 22

Figure 8: Profile of Walk in Centre visitors (All visitors in last 6 months respondent or

household members) .......................................................................................................... 23

Figure 9: Thinking about your last visit to Walk In Centre did you seek any advice on the

best place to go for care and treatment before you went? (All visitors in the last 6 months) 24

Figure 10: Thinking about your last visit to a GP Hub did you seek any advice on the best

place to go for care and treatment before you went? (All visitors in the last 6 months) ........ 25

Figure 11: Potential users of IT solution (All responses) ...................................................... 26

Figure 12: What do you think would be the main advantages of such site/app? (All those

who think they would use it) ................................................................................................ 27

Figure 13: Can you explain why you would be unlikely to use such a website or mobile

phone app? (All those who think they would not use it) ....................................................... 28

Figure 14: Suggested response to non-urgent scenario – David’s cough (All responses) ... 29

Figure 15: Suggested response to urgent scenario – Rosie’s cough (All responses) .......... 30

Figure 16: Suggested response to urgent scenario – Sarah’s accident (All responses) ....... 32

Introduction

3

Table of Tables

Table 1: Area analysis ........................................................................................................... 5

Table 2: Service awareness by borough (All responses) ..................................................... 11

Table 3: Service awareness among particular resident groups (All responses) ................... 12

Table 4: Awareness of sources of treatment and advice for urgent and emergency care by

A&E use in the last 6 months (All responses) ...................................................................... 13

Table 5: Use of services for urgent and emergency care in the last 6 months – respondent or

household member (All responses) ..................................................................................... 15

Table 6: Use of services for urgent and emergency care in the last 6 months – by borough

(All responses) .................................................................................................................... 16

Table 7: Use of prior advice among A&E visitors by age (All visitors to A&E in the last 6

months) ............................................................................................................................... 19

Table 8: Suggested response to urgent scenario (Rosie’s breathlessness) by age (All

responses) .......................................................................................................................... 31

Table 9: Suggested reasons why people tend to go to A&E when they have non-emergency

issues (All responses) ......................................................................................................... 34


4

1 Introduction

1.1 Context

In February 2016 BMG Research was commissioned by Barking and Dagenham,

Havering and Redbridge (BHR) Clinical Commissioning Groups to undertake a

residents’ survey using a telephone methodology.

This survey was designed to explore awareness among residents of the three

boroughs (1,000 per borough) of urgent and emergency care services and current

levels of service usage. The research was commissioned to provide evidence of how

residents currently negotiate through the complexity of urgent and emergency care

provision and to identify how non-emergency cases might be diverted away from A&E

departments given that these resources are currently over-used by individuals with

non-emergency conditions. Along with accompanying qualitative insight this

quantitative research will be used to support the process of urgent and emergency

care transformation.

1.2 Methodology

The results in this report are based on a survey of 3,002 telephone interviews

conducted from a sample of Ashfield residents between 2nd & 21st March 2016. 1001

interviews were completed with Barking and Dagenham and Havering residents and

1000 were completed among Redbridge residents. Interviewing targets were set in

such a way that the data collected per borough is representative in its own right. Per

borough, interviewing targets were set by ward to ensure geographical coverage and

by age and gender. Ethnicity was also monitored per borough. Targets were set with

reference to the 2011 census data available per borough.

Interviews were conducted using a mix on randomly generated numbers for the three

boroughs, supplemented by telephone numbers attributable to these locations, e.g.

mobile numbers known to be held in residents of these boroughs. The inclusion of the

latter helps to ensure that younger residents and those without landlines are not

unnecessarily excluded from the research.

1.3 Weighting the data

The extent to which results can be generalised from a sample depends on how well

the sample represents the population from which it is drawn. As for all surveys of this

type, although a random sample of telephone numbers was selected, the achieved

sample was not perfect.

Under these circumstances, inferences about the views of the population can be

improved by calculating weights for any under or over-sampling of particular groups.

Weights are assigned by comparing the sample proportions for particular groups with

known population characteristics from other sources for the same groups. Each

observation is then multiplied by its weight to ensure that the weighted sample will

conform to the known population characteristics.

Introduction

5

To ensure that data set is representative the data has been weighted by ward, age,

gender and ethnicity at a borough level. A final weight has then been applied based on

the relative population size (18+) of each borough to ensure that the data set is

representative of the overall survey area.

1.4 Interpreting the data

On an observed statistic of 50%, a sample size of 3,002 is subject to a maximum

standard error of +/-1.8% at the 95% level of confidence. This means that if all

residents in BHR had responded to the survey, we are 95% confident that a figure of

50% in this report would actually have been between 51.8% and 48.2%.

At a borough level the data has a maximum standard error of +/-3.1% at the 95% level

of confidence. This is still highly robust.

Results have been presented rounded to 0 decimal places – this may mean that some

totals exceed 100%. This also has implications regarding how summary percentages

appear. For example, if 25.4% of residents state they are very satisfied and 30.3% of

residents are fairly satisfied, these figures are rounded down to 25% and 30%

respectively. However, the sum of these two responses is 55.7%, which is rounded up

to 56%, whereas the individual rounded responses suggest this total should be 55%.

This explains any instances of where summary text does not match a graph or table it

is referring to.

Given the sample size and the number of wards within the sample it is not appropriate

to view the data at ward level. For analysis purposes wards in immediate proximity to

hospitals/A&E departments have been grouped together as shown by Table 1.

Table 1: Area analysis

Wards closest to hospitals /A&E

Chadwell Heath, Whalebone, Seven Kings, Chadwell, Aldborough, Newbury, Brooklands, Romford Town, Hylands, Eastbrook

Wards further from hospitals /A&E

All other wards

Further analysis by Locality (further ward groupings) within each borough is also

planned later within this data analysis process.


6

2 Key findings

Analysis of the 3,002 surveys identifies the following key findings.

2.1 Service awareness

Only half (51%) of residents overall are aware of NHS Choices as a source of

advice about urgent and emergency care. Even among those who state that they

have internet access, this proportion only rises to 55%. On this basis it appears

that there is potential to increase awareness of this signposting resource.

While awareness of Walk In Centres is high at 94% awareness of Urgent Care

Centres at 37% is 59-percentage points lower than the awareness of A&E

departments (96%) despite these two resources being co-located.

Any focus on raising awareness of GP Hubs and GP Out of Hour’s services

should focus on Barking and Dagenham and Redbridge. Havering residents are

more likely to be aware of Out of Hours GP services (81%) than residents of both

Barking and Dagenham (77%) and Redbridge (76%). Havering residents are also

more likely to be aware of GP Hubs (51%).

A&E users in the last 6 months do not have significantly lower awareness of other

urgent and emergency care services than non-users. Indeed, where significant

variations do exist, these show that A&E visitors have a higher awareness of

some of the other providers of urgent and emergency care than non-users. On

this basis, it would appear that it is not simply the case of ignorance of other

services driving A&E attendance. The reality is likely to be a more complex mix of

awareness and understanding of what each service can offer and when these

services can be accessed.

2.2 Service usage

In the last 6 months A&E is the third most commonly used source of urgent and

emergency care after GPs and chemists. Residents are most likely to have used

their Doctor/GP in the last six months (72%), followed by a chemist/pharmacy

(69%). Accident and Emergency was the third most commonly used by

respondents or their households at 31%. Within this, 18% of A&E users within the

last 6 months only went on one occasion, the highest proportion across all of the

listed services. The proportion who visited A&E in the last 6 months is 8 times

larger than the proportion that went to an Urgent Care Centre (4%).

The proportion of those who state that either they, a household member, or

someone they care for has been to A&E in the last 6 months is significantly

higher among the 18-34 age group (38%) and among those aged 35 to 54

(33%). Parents with children aged 0-5 (41%), those with a long term illness or

disability (35%) and those with caring responsibilities (41%) are all significantly

Key findings

7

more likely to have visited A&E than those who do not have these

roles/conditions.

2.3 Advice and signposting

Where NHS advice/signposting is sought for heath issues the advice received is

followed in the majority of cases. Among those who visited A&E in the last 6

months and sought prior advice either from an NHS information source such as

111 or NHS Choices or from a healthcare professional 87% said that the advice

they received was to go to A&E. Similar proportions are seen among Urgent Care

Centre visitors (91% of those who sought NHS advice were advised to go here),

those who went to a Walk In Centre (87%) and those who went to a GP Hub

(86%).

When considering scenarios where advice and treatment would be required there

is evidence of younger residents being more likely to seek information prior to

treatment. For example, in a scenario where someone with ongoing health issues

is experiencing breathlessness more than twice as many 18-34 year olds (37%)

would suggest phoning NHS 111 than those aged 65 and over (16%). This

younger age group are also most likely to suggest searching for advice online

(4%). Among older residents (aged 65+) the most common suggestion is calling a

GP.

Furthermore, among A&E visitors in the last 6 months, analysis by age shows

that those aged 18-34 and 35-54 are most likely to have sought advice from an

NHS information source prior to their attendance at A&E (26% and 24%

respectively).

2.4 Interest in personalised IT solution

Looking to the future residents were asked to state whether they would be

interested in a personalised IT solution to help them access healthcare locally.

All were asked:

If the local NHS had a website or app which held all your health information,

where you could get advice, chat with a doctor or nurse if necessary or book

yourself into appointments with your GP or a clinic, do you think you would you

use it?

A clear majority of 79% express an interest in such a solution, suggesting they

would use it, while 21% said they would not use it. Breaking these responses

down further shows that among those with access to the internet 84% would be

interested in such a website or app compared to 47% of those who do not have

internet access.


8

2.5 Views on over-use of Accident and Emergency

When asked why they think that people tend to go to A&E when they have non-

emergency issues the key themes that emerge are:

o Awareness of the alternatives;

o Resource/capacity issues with other services;

o Speed/convenience;

o Reassurance/trust issues;

o Personal circumstances or characteristics;

o Uncertainty;

o Habit; and,

o Referrals.

Within these comments there are two responses that are particularly prevalent.

The first is that individuals cannot get an appointment with a GP or other care

services (33%). This includes comments on GP appointments taking too long to

get, GP practice hours and GPs being overworked. The second major suggestion

is that the public don't know of other services or are not well informed (31%). The

dominance of these two comments suggests that future strategies will need to

assess both capacity issues in care provision and information

provision/signposting in relation to urgent and emergency care. The other

comments suggest that awareness raising will need to develop trust in the

alternatives in terms of both the quality of care and its availability.

Service awareness and usage

9

3 Service awareness and usage

3.1 Service awareness

Before residents were asked any questions on the subject matter all were provided

with definitions of urgent and emergency care. These definitions were:

Emergency care is provided in a medical emergency when life or long term

health is at risk, such as serious injuries or blood loss, chest pains, choking or

blacking out.

Urgent care is defined as care needed the same day. This could include cuts,

minor injuries, and mild fever or wound infections.

The purpose of providing these definitions was to ensure that residents answered

within the same broad level of understanding throughout the subsequent questions. In

this context residents were first of all asked whether they had heard of fourteen

possible sources of treatment or advice for urgent and emergency care. The list of

services was randomised in the survey to avoid order basis in the responses given.

While near universal awareness is evident for services such as 999, (97%) A&E

(96%) and GPs (96%) providing advice and treatment in the urgent and emergency

context, levels of awareness of other services vary considerable. While this may have

been expected there are notable findings from within these responses.

Firstly, only half (51%) of residents overall are aware of NHS Choices as a source of

advice about urgent and emergency care. Even among those who state that they have

internet access, this proportion only rises to 55%. On this basis it appears that there is

potential to increase awareness of this signposting resource.

Secondly, the awareness of Walk in Centres is high at 94%. This awareness is nearly

twice as high as that for appointment based, but same day service of GP Hubs (49%).

Thirdly awareness of Urgent Care Centres at 37% is 59-percentage points lower than

the awareness of A&E departments (96%) despite these resources being co-located.


10

Figure 1: Have you heard of the following services where you can get help with treatment, or advice for urgent and emergency care? (All responses)

Unweighted sample base: 3,002

49%

66%

14%

6%

4%

22%

64%

51%

6%

63%

4%

3%

76%

39%

51%

34%

86%

94%

96%

78%

36%

49%

94%

37%

96%

97%

24%

61%

NHS Choices website

Non-NHS health advice websites

NHS 111 telephone helpline

Chemist/Pharmacy

Doctor/ GP

Out of Hours GP Services

Mental Health Direct telephone helpline

GP Hubs where you can get same day appointments in the evening or at weekends with local doctors

Walk in Centre

Urgent Care Centres (UCCs)

Accident and Emergency (A&E)

999 (London Ambulance Service)

Community Treatment Team

Emergency dentists

No Yes


11

Breaking the responses down spatially shows some significant variations in awareness

by borough. Levels of awareness that are significantly different to at least one other

borough are denoted by bold figures in Table 2. Among these variations the most

notable are:

Havering residents are significantly less likely to be aware of the NHS Choices

website (47%). This may reflect the fact that this borough has an older population

relative to Barking and Dagenham and Redbridge.

Havering residents are more likely to be aware of Out of Hours GP services

(81%) than residents of both Barking and Dagenham (77%) and Redbridge

(76%). Havering residents are also more likely to be aware of GP hubs (51%).

Redbridge residents are significantly less likely to be aware of the Community

Treatment Team as a provider of urgent/emergency care (21%).

Table 2: Service awareness by borough (All responses)

Total

Barking and Dagenham Havering Redbridge

NHS Choices website 51% 52% 47% 54%

Non-NHS health advice websites 34% 32% 35% 34%

NHS 111 telephone helpline 86% 85% 88% 84%

Chemist/Pharmacy 94% 93% 96% 94%

Doctor/ GP 96% 96% 96% 97%

Out of Hours GP Services 78% 77% 81% 76%


36% 39% 37% 33%


49% 47% 51% 49%

Walk in Centre 94% 96% 95% 91%

Urgent Care Centres (UCCs) 37% 39% 35% 37%

Accident and Emergency (A&E) 96% 95% 98% 95%

999 (London Ambulance Service) 97% 97% 98% 97%

Community Treatment Team 24% 26% 27% 21%

Emergency dentists 61% 61% 68% 56%

Unweighted sample base 3002 1001 1001 1000


12

Service awareness among the particular resident sub-groups this research sought to

focus on are shown in the table below, with significant variations highlighted. This

suggests that parents have significantly higher awareness of online sources of

advice/signposting than non-parents. This is likely to be interrelated with variations in

online access/use by age. Parents are also more likely to be aware out Out of Hours

GP services and GP Hubs. Analysis among those who state that they have caring

responsibilities (unpaid, for a friend or family member, who cannot cope without their

support) shows these individuals are significantly more likely to be aware of the more

specialist services asked about, namely the Mental Health Direct helpline (44%) and

the Community Treatment Team (33%).

Table 3: Service awareness among particular resident groups (All responses)

PARENT

LONG TERM HEALTH PROBLEM/DISABILITY CARER

Yes No Yes No Yes No

NHS Choices website 57% 47% 44% 52% 52% 51%


36% 32% 27% 35% 32% 34%

NHS 111 telephone helpline 87% 85% 89% 85% 91% 85%

Chemist/Pharmacy 94% 95% 95% 94% 94% 95%

Doctor/ GP 97% 96% 96% 96% 97% 96%

Out of Hours GP Services 81% 76% 74% 79% 80% 78%


34% 37% 38% 35% 44% 35%


53% 47% 47% 50% 54% 49%

Walk in Centre 94% 93% 92% 94% 93% 94%

Urgent Care Centres (UCCs) 38% 36% 36% 37% 39% 37%


96% 97% 97% 96% 96% 96%


97% 98% 99% 97% 97% 97%

Community Treatment Team 24% 25% 33% 23% 33% 23%

Emergency dentists 62% 61% 54% 63% 63% 61%

Unweighted sample base 1194 1791 585 2408 389 2601


13

Further analysis shows that A&E users in the last 6 months do not have significantly

lower awareness of other urgent and emergency care services than non-users. This is

demonstrated by the table below. Indeed, where significant variations do exist, these

show that A&E visitors have a higher awareness of some other providers of urgent and

emergency care than non-users. On this basis, it would appear that it is not simply the

case of ignorance of other services driving A&E attendance. The reality is likely to be a

more complex mix of awareness and understanding of what each service can offer

plus when and how these services can be accessed.

Table 4: Awareness of sources of treatment and advice for urgent and emergency care by A&E use in the last 6 months (All responses)

% aware A&E user in last 6 months

Yes No

NHS Choices website 52% 50%

Non-NHS health advice websites 34% 34%

NHS 111 telephone helpline 88% 85%

Chemist/Pharmacy 96% 94%

Doctor/ GP 96% 97%

Out of Hours GP Services 80% 77%

Mental Health Direct telephone helpline 37% 35%

GP Hubs where you can get same day

appointments in the evening or at weekends

with local doctors

50% 49%

Walk in Centre 95% 93%

Urgent Care Centres (UCCs) 40% 35%

Accident and Emergency (A&E) 100% 95%

999 (London Ambulance Service) 98% 97%

Community Treatment Team 25% 24%

Emergency dentists 62% 61%

Unweighted sample base 916 2086


14

Given that Walk in Centres and Urgent Care Centres are likely to be key resources in

attempts to reduce residents with non-emergency issues presenting at A&E, a further

follow question was asked in relation to these centres. Any individual who stated that

they are aware of these centres were asked if they knew the location of their nearest

centre. In response, 79% of those aware of Walk in Centres know the location of their

nearest one. This equates to 74% of the total sample. Among those who say they have

previously heard of Urgent Care Centres 57% know the location of their nearest one.

This equates to 21% of the full sample of 3,002 residents.

While there is no significant spatial variation in awareness of the location of Urgent

Care Centres, there are significant variations in awareness of the location of Walk in

Centres. Among Redbridge residents who have heard of Walk in Centres the 70% who

are subsequently knowledgeable about the location of their nearest one is significantly

lower than in the other two boroughs. It is also notable that those living in closest

proximity to hospitals are significantly less likely to know the location of their nearest

Walk in Centre (75%) than those further afield (80%), (based on those with prior

awareness of this care service).

Figure 2: Awareness of location of Nearest NHS walk in Centres/Urgent Care Centres (All responses)

Unweighted Bases in parentheses

79%

86%

83%

70%

75%

80%

Total (2819)

Barking and Dagenham (957)

Havering (950)

Redbridge (912)

Wards closest to hospitals /A&E (517)

Wards further from hospitals /A&E (2302)

Walk In Centre

57%

55%

61%

55%

61%

56%

Total (1110)


Havering (348)

Redbridge (371)

Wards closest to hospitals /A&E (211)

Wards further from hospitals /A&E (899)

Urgent Care Centre


15

3.2 Service use

Any residents who said they were aware of any of the above providers of treatment

and advice for urgent and emergency care were then asked how often they, a

household member, or someone they care for had used that service during the past 6

months. These results are shown on a full sample base below in order to illustrate the

total proportion of the population who have used each service in the last six months.

This illustrates that residents are most likely to have used their Doctor/GP in the last

six months (72%) followed by a chemist/pharmacy (69%). Accident and Emergency

was the third most commonly used by respondents or their households at 31%. Within

this, 18% of A&E users within the last 6 months only went on one occasion, the

highest proportion across all of the listed services. The proportion who visited A&E in

the last 6 months is 8 times larger than the proportion who went to a UCC (4%).

Table 5: Use of services for urgent and emergency care in the last 6 months – respondent or household member (All responses)

Not aware

Aware of but

not used

1 visit

2 visits

3 visits

4 visits

5 or more visits

Total user %

NHS Choices website 49% 33% 6% 5% 2% 1% 4% 18%


66% 24% 2% 3% 1% 1% 2% 10%

NHS 111 telephone helpline

14% 62% 13% 6% 3% 1% 2% 24%

Chemist/Pharmacy 6% 25% 10% 12% 10% 5% 32% 69%

Doctor/ GP 4% 25% 17% 16% 10% 7% 23% 72%

Out of Hours GP Services

22% 62% 9% 4% 2% 1% 1% 16%


64% 33% 2% 1% *% *% *% 3%

GP Hubs where you can get same day appointments in the evening or at weekends

51% 36% 6% 3% 2% 1% 1% 13%

Walk in Centre 6% 68% 15% 6% 3% 1% 1% 26%

Urgent Care Centres (UCCs)

63% 33% 3% 1% *% *% *% 4%


4% 66% 18% 7% 3% 1% 2% 31%


3% 85% 8% 2% 1% *% *% 12%

Community Treatment Team

76% 22% 1% *% *% *% 1% 3%

Emergency dentists 39% 56% 5% 1% *% *% 0% 6%


16

Breaking the responses down by Borough shows that:

The proportion of residents using A&E does not vary significantly on a borough

by borough basis. More detailed spatial analysis also shows no variation in A&E

attendance between residents who live in the wards neighbouring local hospitals

and those further afield, with 31% of each group stating they or a household

member have used A&E in the last 12 months.

Use of Out of Hours GP services is most commonly seen in Barking and

Dagenham (18%). This is significantly higher than in both other boroughs. GP

Hubs are most commonly used by Redbridge residents (15%).

The 21% of Redbridge residents who have used a Walk in Centre is significantly

lower than the 28% of Havering residents and the 31% recorded among Barking

and Dagenham residents.

Table 6: Use of services for urgent and emergency care in the last 6 months – by borough (All responses)

Total

Barking and

Dagenham Havering Redbridge

NHS Choices website 18% 19% 15% 18%

Non-NHS health advice websites 10% 9% 9% 11%

NHS 111 telephone helpline 24% 26% 24% 23%

Chemist/Pharmacy 69% 69% 68% 70%

Doctor/ GP 72% 73% 68% 74%

Out of Hours GP Services 16% 18% 15% 15%


3% 4% 4% 2%

GP Hubs where you can get same day appointments in the evening or at weekends

13% 13% 11% 15%

Walk in Centre 26% 31% 28% 21%

Urgent Care Centres (UCCs) 4% 5% 4% 4%

Accident and Emergency (A&E) 31% 32% 30% 31%

999 (London Ambulance Service) 12% 14% 12% 11%

Community Treatment Team 3% 2% 3% 2%

Emergency dentists 6% 7% 5% 6%

Unweighted sample base 3002 1001 1001 1000

Accident and Emergency Visitors

17

4 Accident and Emergency Visitors

Given that understanding the reasons for use of A&E when it may not be necessary is

a fundamental component of this research, any residents who said either themselves,

a household member, or someone they care for had been to A&E in the last six

months were asked some additional follow up questions. These questions sought to

examine how commonly residents seek advice before presenting at A&E and the

extent to which these visits are driven by one off problems or more long standing

issues.

4.1 Visitor profile

Using the responses to the previous question on service use it is possible to identify

which resident groups are more likely to have visited A&E in the last 6 months. It must

however be recognised that this analysis takes into account the characteristics of the

individual completing the survey, and that these individuals could have said that

another member of their household or someone they care for attended A&E in this

period.

Figure 3: Profile of A&E visitors (All visitors in last 6 months -respondent or household members)

Unweighted sample bases in parentheses

31%

32%

30%

31%

38%

33%

21%

21%

30%

32%

41%

35%

35%

34%

27%

35%

29%

41%

29%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45%

Total (3002)


Havering (1001)

Redbridge (1000)

18 to 34 (866)

35 to 54 (1151)

55 to 64 (406)

65+ (579)

Male (1326)

Female (1676)

Parent -child 0 to 5 yrs (608)

Parent -child 6 to 10 years (521)



Non-parent (1791)

Long term illness/disability (585)

No log term illness /disability (2408)

Carer (389)

Non carer (2601)


18

With this caveat in mind it is still notable that significant variations in those who say

they or a member of their household had been to A&E in the last 6 months. As shown

by the figure above the proportion using this service is significantly higher among the

18-34 age group (38%) and among those aged 35 to 54 (33%). Parents with children

aged 0-5 (41%), those with a long term illness or disability (35%) and those with caring

responsibilities (41%) are all significantly more likely to have visited A&E than those

who do not have these roles/conditions.

Among those who indicate either themselves, a household member or someone they

care for have been to A&E in the last 6 months, two in five (39%) did not seek any

prior advice before attending, with a further 19% being taken to A&E directly by

ambulance. A further two in five however did seek some form of prior advice either via

a NHS information source such as 111 or NHS Choices (23%) or via a healthcare

professional (22%). Please note that more than one response was possible at this

question.

Figure 4: Thinking about your last visit to A&E did you seek any advice on the best place to go for care and treatment before you went? (All visitors to A&E in the last 6 months)

Unweighted sample base: 916

23%

22%

7%

39%

19%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45%

Yes - from an NHS information source such as 111/ NHS choices

Yes - from a healthcare professional such as a doctor, chemist

Yes - from a non-NHS source e.g. other website/friends family

No - I did not seek advice

I was taken to A&E by ambulance


19

Breaking down these responses by age shows that those aged 18-34 and 35 to 54 are

most likely to have sought advice from an NHS information source prior to their

attendance at A&E (26% and 24% respectively). Those aged 65 and over were least

likely to have sought advice prior to going to A&E due to this group being most likely to

having gone to A&E by ambulance (46%).

Table 7: Use of prior advice among A&E visitors by age (All visitors to A&E in the last 6 months)

Total 18 to 34 35 to 54 55 to 64 65+


23% 26% 24% 16% 12%


22% 22% 21% 17% 23%


7% 10% 5% 3% 7%

No - I did not seek advice 39% 39% 43% 41% 26%

I was taken to A&E by ambulance

19% 11% 15% 30% 46%

Unweighted Bases 916 330 381 85 120

Among those who said that they sought advice on the best place to go from an NHS

information source or a healthcare professional, 87% said that this advice was to go to

Accident & Emergency. On this basis it is possible to infer that 13% went to A&E

despite the advice suggesting an alternative course of action.


20

Among those who indicated that their visit to A&E was because of a new/one off

problem the extent to which advice was sought beforehand is not notably different to

the level seen in Figure 4 for the total sample of A&E visitors. This is a reflection of the

fact that 74% of A&E visitors in the last 6 months; i.e. a majority of this cohort; said that

their visit was in response to a new /one off problem. This is shown by the figure

below.

Figure 5: And again thinking about your last A&E visit, had you...? (All A&E visitors in the last 6 months)


The proportion of residents who stated that they had been treated somewhere else

with their problem before (23% of A&E visitors) does not vary by age or gender.

However, this proportion does rise to 32% among those with a long term illness or

disability compared to 21% among those who do not.

77%

63%

74%

26%

23%

37%

26%

74%

Been treated somewhere else with this problem before

Seen a GP with this problem before

Been to A&E with this problem before

This was a new/one off problem

No Yes


21

Probing the reasons for A&E attendance shows that 49% of recent users state that

they had an urgent condition or injury and/or that they were taken by ambulance. A

further 24% said that they were referred by someone. The remaining 28% gave

responses that suggest that going to A&E was perhaps not the most appropriate

course of action. One in eight (13%) said they went because it was the nearest/most

convenient place, 8% said nowhere else was known to be open and 7% said that they

did not know of any alternatives.

Figure 6: Please now think about your last visit to A&E. What was your main reason for going to A&E? (All A&E visitors)


24%

13%

8%

7%

49%

0% 10% 20% 30% 40% 50% 60%

Referred by someone

Nearest/most convenient place

Nowhere else known to be open

Didn't know of any alternatives

Urgent injury/condition / taken by ambulance


22

5 Urgent Care Centre Visitors

In total, 127 of the sample indicated that they had visited an Urgent Care Centre in the

last 6 months. This small sample size does not allow us to examine the profile of

visitors in the same way as is shown in the previous chapter for A&E visitors. However,

among users of this service it is evident that slight majority of 56% sought some prior

advice before going to the Urgent Care Centre, while 44% did not.

Figure 7: Thinking about your last visit to An Urgent Care Centre did you seek any advice on the best place to go for care and treatment before you went? (All visitors in the last 6 months)


Where advice was sought either from an NHS information source or from a healthcare

professional, 91% of visitors suggested that the advice they received was to go to an

Urgent Care Centre. The majority therefore followed the signposting/advice they were

given.

35%

25%

8%

44%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%





Walk In Centre Visitors

23

6 Walk In Centre Visitors

The fact that 786 residents in the sample have visited a Walk in Centre in the last 6

months allows some examination of the visitor profile for this service. As shown by the

figure below, as well as Walk in Centre use being more common in Barking and

Dagenham and Havering, (as already noted previously), this service is more

commonly used among those aged 18-34 (34%) and 35-54 (29%). Alongside this

parents are significantly more likely than non-parents to have used Walk in Centres,

but the other variations in the figure below are not statistically significant.

Figure 8: Profile of Walk in Centre visitors (All visitors in last 6 months respondent or household members)


26%

31% 28%

21%

34% 29%

17% 13%

27% 25%

34% 32%

34% 35%

21%

23% 27%

29% 26%

0% 5% 10% 15% 20% 25% 30% 35% 40%

Total (3002)

Barking and Dagenham (1001) Havering (1001)

Redbridge (1000)

18 to 34 (866) 35 to 54 (1151)

55 to 64 (406) 65+ (579)

Male (1326) Female (1676)

Parent - child 0 to 5 yrs (608) Parent - child 6 to 10 years (521)

Parent - child 11 to 15 years (419) Parent - child 16 to 18 years (258)

Non parent (1791)

Long term illness/ disability (585) No- long term illness/ disability (2408)

Carer (389) Non- Carer (2601)


24

More than six in ten (64%) visitors to Walk in Centres did not seek prior advice before

presenting. Among those who sought advice from an NHS source 87% state that the

advice they were given was to go to a Walk in Centre.

Figure 9: Thinking about your last visit to Walk In Centre did you seek any advice on the best place to go for care and treatment before you went? (All visitors in the last 6 months)


15%

19%

10%

64%

0% 10% 20% 30% 40% 50% 60% 70%





GP Hub Visitors

25

7 GP Hub Visitors

Among the 394 residents who visited a GP Hub in the last 6 months a majority of 67%

did not seek advice on the best place to go beforehand. Among the 33% who did, one

in five (20%) said they sought advice from a healthcare professional. Again more than

one response was possible at this question.

Figure 10: Thinking about your last visit to a GP Hub did you seek any advice on the best place to go for care and treatment before you went? (All visitors in the last 6 months)


In 86% of cases those who sought NHS advice (either from an information source or a

professional) said that the advice they received was to go to a GP Hub, again

illustrating that advice is being followed in the majority of instances.

11%

20%

5%

67%

0% 10% 20% 30% 40% 50% 60% 70% 80%






26

8 Interest in personalised IT solution

Looking to the future residents were asked to state whether they would be interested in

a personalised IT solution to help them access healthcare locally. All were asked:

If the local NHS had a website or app which held all your health information, where you

could get advice, chat with a doctor or nurse if necessary or book yourself into

appointments with your GP or a clinic, do you think you would you use it?

A clear majority of 79% express an interest in such a solution, suggesting they would

use it, while 21% said they would not use it. Breaking these responses down further

shows that among those with access to the internet 84% would be interested in such a

website or app, compared to 47% of those who do not have internet access. In terms

of demographics residents aged 18-34 most commonly say that they would use such

as solution (91%). Although this proportion drops to 54% among those aged 65 and

over, it should be noted that this still represents a majority of this age group.

Figure 11: Potential users of IT solution (All responses)


79%

80%

75%

82%

91%

85%

70%

54%

81%

78%

84%

47%

86%

75%

66%

82%

74%

80%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Total (3002)


Havering (1001)

Redbridge (1000)

18 to 34 (866)

35 to 54 (1151)

55 to 64 (406)

65+ (579)

Male (1326)

Female (1676)

Internet access (2576)

No internet access (426)

Parent (1194)

Non-parent (1791)

Long term illness/disability (585)

No long term illness/disability (2408)

Carer (389)

Non-carer (2601)

Interest in personalised IT solution

27

Among those who would use a personalised website or app the most commonly

identified advantages of this are advice being available all the time/outside of working

hours (31%), access not being location specific (29%) and the site/app being a single

source of information (18%). Other advantages commonly mentioned include

personalisation (12%) and speed (12%). This question was asked in an unprompted

way with the responses given grouped into themes after the completion of data

collection. The full range of themes identified is shown in the figure below. Many of the

themes listed are related to speed/time saving and convenience.

Figure 12: What do you think would be the main advantages of such site/app? (All those who think they would use it)

Unweighted sample base: 2,348 * denotes less than 0.5%

31%

29%

18%

12%

12%

9%

9%

5%

4%

4%

3%

3%

3%

2%

2%

2%

2%

1%

1%

1%

1%

1%

1%

*%

*%

4%

4%

0% 5% 10% 15% 20% 25% 30% 35%

Available all the time/ outside of working hours

Can be accessed anywhere

Single source of information

Personalised/responses based on my health records

Speed (all mentions)

Ease of use/convenience/user-friendly

Provides me with instant advice/guidance/information

Direct access to a GP/healthcare professional

Would be able to book an appointment

Quicker response/faster communication (incl. fewer queues )

Less waste of time (for both medical and personal time)

Flexible appointment times (incl. being seen faster)

Would stop people using A&E/shorter waiting times

For peace of mind/reassurance

Directs me to the correct place

Able to stay in own home/don't have to visit the GP

It would stop people using the GP

Saves money

Greater efficiency/better organised

No need to go through receptionists/less queuing

Ability to access my medical records

Get treated/diagnosed faster

Saves on NHS resources

It's an alternative option

Offers a choice of services

Other

Don't know


28

A question was also asked to identify what barriers or concerns might exist among

those who would not use this possible IT solution. Among this cohort the most

commonly cited issues are the preference to speak to someone in person (33%), a

lack of confidence with technology (24%) and/or a lack of access to the internet and

the required technology (22%). A further 16% of this group express concern about the

security of personal data and health records.

Figure 13: Can you explain why you would be unlikely to use such a website or mobile phone app? (All those who think they would not use it)


33%

24%

22%

16%

6%

3%

3%

3%

1%

1%

1%

1%

1%

1%

1%

1%

1%

1%

1%

1%

1%

5%

2%

0% 5% 10% 15% 20% 25% 30% 35%

Would prefer to speak to someone in person

Do not feel confident with technology/ would not know how to use

Do not have internet access/computer/ smartphone

Concern about security of personal data/ health records

Use existing online GP booking systems

It would take too long (incl. Calling them would be quicker and easier)

Prefer to access GP/easier to access GP(unspecified)

Don't see the point/there's no need to go online

Data charges/cost to access

Don't want/like to use the internet or computers

Don't access healthcare/ only access when needed

Lack of information (incl. inaccurate information and advice)

Could lead to misdiagnosis

Cannot be diagnosed/examined over the phone or online

Old age

Reliability of technology (incl. Breakdowns)

Disability/health problems

Receive services from elsewhere

Poor quality service

Staff lack knowledge/experience

Lack of knowledge about the app

Other

Don't know

Anticipated response to care and advice scenarios

29

9 Anticipated response to care and advice scenarios

In the next section of the survey residents were asked to consider which options for

care and advice are most appropriate for specified health issues. Three scenarios

were read to residents (in a random order) and for each one residents were asked to

state what the first course of action should be. Although residents taking part in the

survey were advised that there were no right or wrong answers, the objective of these

questions was to determine what proportions might suggest using services that are

inappropriate for the severity of the issue described.

9.1 Non urgent scenario

The non-urgent scenario described to residents was as follows:

David works long hours and has to take time off work to get an appointment with his

GP. He has had a persistent cough for several weeks. His wife persuades him to get

some help. What should he do?

The range of responses to this scenario are shown by the figure below. Over half

(54%) of residents suggest that David should call his GP, with a further 13%

suggesting seeking advice online (3%) or by phone (9%). A quarter (26%) would

suggest a visit to an NHS Centre they can walk into without an appointment, while 4%

would suggest a visit to A&E. While this last percentage is small, it does demonstrate

that even for non-urgent issues some residents have a tendency to default to A&E as

their first port of call.

Figure 14: Suggested response to non-urgent scenario – David’s cough (All responses)


9%

3%

54%

26%

4%

2%

1%

*%

Phone NHS 111

Search for advice online

Call his GP

Go to an NHS centre you can walk into without an appointment

Go to an accident emergency department

Go see a chemist/pharmacist

Use out of hours GP service/GP Hubs

Something else


30

The proportion who would suggest that David goes to A&E about his cough peaks at

6% among those aged 65 and over, a proportion that is significantly higher than in any

other age group. It is also notable that those living closest to hospitals more commonly

suggest going to A&E than those who live further from hospitals (5% cf. 3%), with this

difference again statistically significant.

Any resident who suggested that seeking advice and care from A&E first would be

appropriate were asked why this is the case. In this non-urgent scenario 32% of those

who suggested A&E said this was most appropriate for this health problem, while 25%

said that they did not know enough about the other services., Among the other

responses given, 5% said it takes too long to get a GP appointment and 4% said A&E

was appropriate to make sure that he is seen. The remaining 32% gave other reasons.

9.2 Urgent scenario

The second scenario in the survey was an urgent one:

Rosie has a number of health issues and sees her GP regularly. Today she has been

feeling breathless and is worried. What should she do?

In response to this scenario the most common suggestions are calling a GP (33%),

closely followed by phoning NHS 111 (27%). The third most common suggestion is

that Rosie goes to A&E. The 17% who suggest this is 3-percentage points higher than

the proportion who suggest she goes to a walk in centre (14%), which is the more

appropriate choice in this situation. This perhaps illustrates ambiguity between urgent

and emergency issues.

Figure 15: Suggested response to urgent scenario – Rosie’s cough (All responses)


27%

3%

33%

14%

17%

5%

1%

Phone NHS 111


Call her GP



Ring 999/call an ambulance

Something else

Anticipated response to care and advice scenarios

31

While such ambiguity is understandable, it is interesting to note the variation by age

regarding seeking advice and information. More than twice as many 18-34 year olds

(37%) would suggest phoning NHS 111 than those aged 65 and over (16%). This

younger age group are also most likely to suggest searching for advice online (4%).

Among older residents (aged 65+) the most common suggestion is calling a GP. The

44% of this age group who suggest this action is significantly higher than the 23% of

those aged 18-34 who advocate this response. Despite these variations, the proportion

who suggest that Rosie go to A&E is consistent in each age group at between 16%

and 18%.

Table 8: Suggested response to urgent scenario (Rosie’s breathlessness) by age (All responses)

Total 18 to 34 35 to 54 55 to 64 65+

Phone NHS 111 27% 37% 27% 21% 16%

Search for advice online 3% 4% 2% 1% 1%

Call her GP 33% 23% 33% 39% 44%


14% 15% 13% 16% 14%

Go to an accident emergency department.

17% 16% 18% 16% 18%

Ring 999/call an ambulance 5% 4% 5% 6% 6%

Something else 1% 2% 2% 1% 1%

Unweighted Bases 3002 866 1151 406 579

Among those who would suggest A&E was appropriate for Rosie (181 respondents)

the perception that this is most appropriate for this health issue (57%) clearly exceeds

the lack of awareness of other sources of care (15%).


32

9.3 Emergency scenario

The third scenario for consideration was as follows:

Sarah is cycling to work when she is involved in an accident. She is briefly

unconscious but feels well enough to make her way to continue her journey. On

arrival, she feels dizzy and decides she needs to get herself checked out. What should

she do?

In response to this 54% suggest that A&E would be most appropriate for Sarah, with a

further 17% suggesting visiting a walk in centre. This suggests that generally residents

would act appropriately to an emergency scenario although 15% suggest that Sarah

should get advice via NHS 111 initially. Echoing previous results the proportion who

suggest using the NHS 111 resource is significantly higher among those aged 18 to 34

(20%).

Figure 16: Suggested response to urgent scenario – Sarah’s accident (All responses)


15%

1%

5%

17%

54%

8%

1%

Phone NHS 111


Call her GP



Ring 999/call an ambulance

Something else

Suggested reasons for over-use of Accident and Emergency Departments

33

10 Suggested reasons for over-use of Accident and Emergency

Departments

In order to complete the survey all residents were asked directly about the issue of

NHS Accident and Emergency Departments commonly treating people whose injuries

or illnesses could be treated just as well elsewhere. All were asked why they think that

people tend to go to A&E when they have non-emergency issues. This question was

asked in an open and unstructured manner allowing individuals to give their views in

their own words. Having reviewed the comments given by the 3,002 survey

participants, key themes emerge. These are:

Awareness of the alternatives;

Resource /capacity issues with other services;

Speed/convenience;

Reassurance/ trust issues;

Personal circumstances or characteristics ;

Uncertainty;

Habit; and

Referrals.

The range of comments types within these over-arching themes are shown in the table

overleaf. Within these comments there are two responses that are particularly

prevalent. The first is that individuals cannot get an appointment with a GP or other

care services (33%). This includes comments on GP appointments taking too long to

get, GP practice hours and GPs being overworked. The second major suggestion is

that the public don't know of other services or are not well informed (31%). The

dominance of these two comments suggests that future strategies will need to assess

both capacity issues in care provision and information provision/signposting in relation

to urgent and emergency care. The other comments suggest that awareness raising

will need to develop trust in the alternatives in terms of both the quality of care and its

availability.


34

Table 9: Suggested reasons why people tend to go to A&E when they have non-emergency issues (All responses)

Awareness of alternatives

Awareness: They don't know of other services/not well informed (incl. services are new)

31%

Resource /capacity issues with other services

Can't get an appointment with the GP or other services (incl. take too long/are closed/overworked)

33%

A&E have more resources/facilities 1%

Can’t get help from the chemist/pharmacist *%

Speed/convenience Speed: To get treatment/advice as quickly as possible 18%

They know they will be seen/get treatment (incl. open 24/7) 7%

Ease/convenience 7%

It’s the nearest place to them/ease of access 3%

Personal circumstances or characteristics

They are stupid/lazy (incl. other negative characteristics of the public)

6%

They are not registered with a GP 3%

They are foreign 1%

Due to the age of the patient (i.e., child, elderly person) 1%

They are drunk/homeless 1% They are ill/had an accident/injury *%

Reassurance/ trust issues

They panic/get scared/are worried 12%

Think they get better care/reassurance then at the GP/walk-in centre/NHS 111

6%

Think it's the best place to get help 2%

A&E are more professional *%

They want to see a doctor 2%

They feel safe/have faith in/trust A&E (incl. peace of mind) 3%

NHS 111 doesn’t work/is no good/a waste of time 1%

Habit It's the first option that comes to mind/habit/common practice/everyone knows it (incl. historical) 9%

Uncertainty Varying definition of emergency/they are not certain of their illness/injury (incl. misunderstanding of what A&E is for)

11%

Referrals They have been referred/advised to go 2%

*Denotes less than 0.5%

Sample profile

35

11 Sample profile

The tables below show the sample profile per borough prior to the application of

weights.

11.1 Barking and Dagenham

Ward Count %

Abbey 53 5%

Alibon 44 4%

Becontree 68 7%

Chadwell Heath 66 7%

Eastbrook 67 7%

Eastbury 61 6%

Gascoigne 58 6%

Goresbrook 64 6%

Heath 63 6%

Longbridge 68 7%

Mayesbrook 60 6%

Parsloes 50 5%

River 61 6%

Thames 41 4%

Valence 59 6%

Village 57 6%

Whalebone 61 6%


36

Age Count %

18 to 24 85 9%

25 to 34 250 25%

35 to 44 301 30%

45 to 54 96 10%

55 to 59 57 6%

60 to 64 52 5%

65 to 74 81 8%

75+ 79 8%

Gender Count %

Male 439 44%

Female 562 56%

Ethnicity Count %

English/Welsh/Scottish/Northern Irish/British 513 51%

Irish 8 1%

Other White 91 9%

White and Black Caribbean 11 1%

White and Black African 4 0%

White and Asian 1 0%

Other Mixed 11 1%

Indian 51 5%

Pakistani 48 5%

Bangladeshi 39 4%

Chinese 3 0%

Other Asian 14 1%

African 139 14%

Caribbean 25 3%

Other Black 9 1%

Arab 2 0%

Any other ethnic group 22 2%

Prefer not to say 10 1%

Sample profile

37

11.2 Havering

Ward Count %

Brooklands 57 6%

Cranham 64 6%

Elm Park 62 6%

Emerson Park 58 6%

Gooshays 43 4%

Hacton 60 6%

Harold Wood 53 5%

Havering Park 48 5%

Heaton 43 4%

Hylands 58 6%

Mawneys 65 7%

Pettits 63 6%

Rainham and Wennington 46 5%

Romford Town 50 5%

South Hornchurch 55 6%

Squirrel's Heath 61 6%

St Andrew's 56 6%

Upminster 59 6%


38

Age Count %

18 to 24 68 7%

25 to 34 154 15%

35 to 44 217 22%

45 to 54 154 15%

55 to 59 81 8%

60 to 64 79 8%

65 to 74 134 13%

75+ 114 11%

Gender Count %

Male 435 44%

Female 566 57%

Ethnicity Count %


Irish 9 1%

Other White 39 4%




Other Mixed 7 1%

Indian 32 3%

Pakistani 10 1%

Bangladeshi 8 1%

Chinese 4 0%

Other Asian 6 1%

African 20 2%

Caribbean 10 1%

Other Black 1 0%

Arab 0 0%



Sample profile

39

11.3 Redbridge

Ward Count %

Aldborough 60 6%

Barkingside 48 5%

Bridge 43 4%

Chadwell 51 5%

Church End 39 4%

Clayhall 49 5%

Clementswood 44 4%

Cranbrook 51 5%

Fairlop 49 5%

Fullwell 49 5%

Goodmayes 45 5%

Hainault 47 5%

Loxford 57 6%

Mayfield 46 5%

Monkhams 41 4%

Newbury 44 4%

Roding 45 5%

Seven Kings 54 5%

Snaresbrook 37 4%

Wanstead 51 5%


40

Age Count %

18 to 24 98 10%

25 to 34 211 21%

35 to 44 272 27%

45 to 54 111 11%

55 to 59 79 8%

60 to 64 58 6%

65 to 74 81 8%

75+ 90 9%

Gender Count %

Male 452 45%

Female 548 55%

Ethnicity Count %


Irish 17 2%

Other White 74 7%




Other Mixed 16 2%

Indian 184 18%

Pakistani 99 10%

Bangladeshi 45 5%

Chinese 10 1%

Other Asian 39 4%

African 40 4%

Caribbean 30 3%

Other Black 5 1%

Arab 4 0%



Appendix: Statement of Terms

41

12 Appendix: Statement of Terms

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requirements (ISO 9001:2008) and the International Standard for Market, opinion and social

research service requirements (ISO 20252:2012) and The International Standard for

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The interpretation of the results as reported in this document pertain to the research problem

and are supported by the empirical findings of this research project and, where applicable,

by other data. These interpretations and recommendations are based on empirical findings

and are distinguishable from personal views and opinions.

BMG will not be publish any part of these results without the written and informed consent of

the client.

Ethical practice

BMG promotes ethical practice in research: We conduct our work responsibly and in light of

the legal and moral codes of society.

We have a responsibility to maintain high scientific standards in the methods employed in

the collection and dissemination of data, in the impartial assessment and dissemination of

findings and in the maintenance of standards commensurate with professional integrity.

We recognise we have a duty of care to all those undertaking and participating in research

and strive to protect subjects from undue harm arising as a consequence of their

participation in research. This requires that subjects’ participation should be as fully informed

as possible and no group should be disadvantaged by routinely being excluded from

consideration. All adequate steps shall be taken by both agency and client to ensure that the

identity of each respondent participating in the research is protected.

With more than 25 years’ experience, BMG Research has established a strong reputation for delivering high quality research and consultancy.

BMG serves both the public and the private sector, providing market and customer insight which is vital in the development of plans, the support of campaigns and the evaluation of performance.

Innovation and development is very much at the heart of our business, and considerable attention is paid to the utilisation of the most up to date technologies and information systems to ensure that market and customer intelligence is widely shared.

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