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Analysis of questionnaire on resources available for health service investigation to service community physicians
Public Health
(1988), 102, 34% 353
Analysis of Q u e s t i o n n a i r e on Resources Available for Health Service Investigation to Service C o m m u n i t y Physicians Harold Schnieden* and Michele Grimes
Stockport Health Authority, District Offices, Haze/Grove, Stockport SK7 5AB
In 1987 a questionnaire was sent to district medical officers or their equivalents in Great Britain. The purpose of the questionnaire was to obtain information on resources available for health service investigation. Analysis of the data showed that specific revenue funding at district level was not available to most service community physicians. Introduction
Districts seeking to determine the health needs of the local population require resources such as manpower, time and finance. The restructuring following the Griffiths report (1983) l may have made it more difficult for District Medical Officers to undertake essential health services investigations because of lack of resources for this purpose. This study was designed to obtain information on resources available to service c o m m u n i t y physicians for health service investigation. Methods
A draft questionnaire was discussed with a m a n a g e m e n t consultant and community physician and a district medical officer. An amended version was then produced. In order to try and get a high response rate the questionnaire was kept deliberately short. It was sent to all Heads of N H S Departments o f C o m m u n i t y Medicine in the United K i n g d o m ( D M O or equivalent in England and Wales, C A M O in Scotland and Northern Ireland). University Heads o f D e p a r t m e n t and Regional Medical Officers were excluded from the circulation. A copy o f the questionnaire plus some results is shown in Table I. The study was conducted in 1987. Results
218 questionnaires were sent out. After one reminder, 199 replies were received--a response rate of 91.3%. It was not possible to identify whether 8 questionnaires returned applied to Scotland and Northern Ireland or England and Wales. O f those that could be identified 180 replies were received from persons working in England and Wales. The analysis o f the results from persons working in England and Wales is shown in Table I. Referring to Question 1, whilst the majority of 'heads of d e p a r t m e n t ' had control of the revenue staff budget for consultant c o m m u n i t y physician (approximately 80%) and secretarial staff (approximately 67%), relatively few managed the revenue staff budget for
* To whom correspondence should be sent. © The Society of Community Medicine, 1988
H. Schnieden and M. Grimes
350
1 = YEs 2 = NO TO :
DMOs
(please
OR
PERSONS
encircle
is there a University
Of.
IN C H A R G E
all correct
Medical
School
D E P A R T m e N T S 5 = N O REPLY
MEDICINE
where appropriate) i
A
b) ~rea
9
(if applicable)
staff budget
for
I
C "D E F O
Community Physiclans (consultants) Community Physicians (training) C~inical Medical Officers Paramedicals (if so specify) Secretarial Staff Administrative Assistants 'Information Officer' Social Scientists Health Economists Others
Operational
0btainin ~ o f c ~ i ~ l
Q3.
(eg: computing
04
3
2
-'TO "I12t
H
74
I J K L
_ 8 _ 56
iXa
1
2
91
I 26
~6
3
etc)
ite~
equipment,
word processors)
Is there a mechanism by which you bid for capital equipment a ~ u a l l y (if SO pl . . . . . pecify) T ~ ~--~ ~
or
2
Do you receive a standard
or
3
Do you have to make a special
capltal
allow~ce
which is reviewed
annually
case per item '
Other ways of obtaining
capital
items
Is the main method of obtaining resources items via virement arising from unfilled
Yes
~.~
:
4
IUl
1
4
4
8 3
Budget:
COSTS of health service related special investigations Stationery Computing activities Costs of provision of teaching services: - ko medical staff (postgrads,registrars - to nurses - medical students - others (eg: paramedical)
b) c) d)
3
-Tr-
Have y o u a revenue budget for:
a)
2
Manased:
Have you control of revenue a) b) c) d) e) f) ~) h} i) j)
4 = NOT APPLICABLE
within your
a) District
Resources
Q2.
O F CO~O~JNITY
responses
No
Partly
(if so please
for capital posts in the
In Past
No R e p l y
specify)
and recurrent manpower budget
Not Applicable
H e a l t h Authority ................................................. * = 2 replies to ~ e s % i o n
TableI
England&Wales-analysisofl80Repliestoquestionniare
4
Resources for Health Service Investigation
351
'information officer', social scientist or health economist (approximately 20%, 7% and 4% respectively). The replies to Question 2 indicated that most (74%) community physicians had no formal budget for health service investigation, only 26% replied in the affirmative. In addition only 27% of community physicians control the budget for computational activities. Referring to Question 3, the majority of heads of department had to make out a special case to obtain an item of equipment; very few (less than 10%) indicated they received a standard capital allowance which was reviewed annually but the majority could bid annually for items of capital equipment. Referring to Question 4, virement arising from unfilled posts appeared to be one m e t h o d - - a p p r o x i m a t e l y one third of heads o f department stated they used i t - - b y which health service investigations were funded. Question 4 provoked a number o f additional comments from heads of department, a few are shown in Appendix I. Reference to these show that in order to get monies for'health service investigation 'heads of departments' of community medicine have tried a number of different mechanisms including subterfuge and stealth. Scotland and Northern Ireland
11 replies could be definitely identified as arising from respondents in Scotland and Northern Ireland, i.e. a response rate of at least 58%. The response rate may have been higher as some respondents failed to identify their area or district. Unidentified district or area
8 respondents failed to give their Health Authority. The pattern of their replies appeared to be similar to the other groups. 6 out of 8 did not have a revenue budget for health service related investigation. A higher proportion o f this small number used virement as a means of funding health service investigation. Discussion
If health service investigation is a priority in the health service then it needs proper funding for infra-structure support. The survey just completed shows that if community physicians are to take a lead in this direction the budgetary arrangements to provide sustained work in this field arc lacking. In spite o f this some community physicians retain an interest and try by various means to get funds for such work. A minority are very successful, c.g. see Appendix I item 28, others not so, see Appendix I item 35. If the overall standards of health service investigation arc to be raised then one of the factors that should be taken into account is adequate finance at district level for this area of N H S work, and also adequate finance at district level for training of young entrants in community medicine in health service investigation techniques.
352
H. Schnieden and M. Grimes
Appendix I: Some comments--D.M.O.'s questionnaire (England and Wales) Q. Is there a mechanism by which you bidjor capital equipment annually? ( I f so please specify) I. Yes--recently established through Unit Management Group. 2. Computer equipment is bid for from computer allocation via Computer Working Party (this includes word processors). 3. Unplanned underspends towards the end of a year from current budgets. 4. Use revenue underspendings--virement to capital on one off basis. 5. Y e s - - b u t only as part o f H.Q.--general office support. 6. Through a Capital Allocations Group. 7. There is a Computer Committee, which sifts and decides on bids. 8. Yes: All capital equipment is bid for in Annual Planning Programme. 9. Through Short Term Plan. 10. Bid goes to District Management Board. 11. Against programmed expenditure District Headquarters. Q. Do you receive a standard capital allowance which is reviewed annually? 12. Yes, currently non-staff allocation to use at my discretion, could be computer or other requirements. 13. Very small annual sum o f less than £250.00. Q. Do you have to make a special case per item? 14. 15. 16. 17.
Informal liaison with Treasurers. Yes - through Capital Allocations Group. Yes, if over £5,000. To Computer Steering Group.
Q. Other ways o f obtaining capital items (if so please specify) 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28.
Joint financing, Devious stealth. Research and Charitable Organisation Grants. Discussion with Unit General Manager. Behind the scenes negotiation. Donations from Industry. I can and do use research grants given to individual consultants e.g. gastroenterology and haematology. By subterfuge. Friends o f the Hospital, Round Table, Trust Funds. Trust funds. I always include hardware and software in project grants o f which we seem to get about £50,000 p.a. over last 5 years.
Resources Jor Health Service Investigation
353
Q. Is the main method of obtaining resources for capital and recurrent items via virement arising from unfilled posts in the manpower budget? 29. N o - - h a v e to ask D G M if I wish to do anything; if he agrees I can get it; if not too bad. Not allowed to spend budget from unfilled posts. 30. Has been in p a s t - - n o t currently. 31. So far this is my only source of funds for special investigations and projects. 32. Probably will be from now on. 33. Y e s - - b u t the sums involved are so small that my £200 per annum book allowance is a luxury! 34. Funds arising from vacancies are no longer available to me. They were available prior to 1985. 35. I have no defined budget these days! 36. N o resources for anything. We are currently 'in the red' as a district. Previously answer to question would have been 'no'. 37. A very useful supplementary method. 38. Everything is at present in a state of flux following new District structure arrangements. Acknowledgement The authors wish to thank Dr C. Birt and Dr Frada Eskin for their interest and advice. Reference 1. The Griffiths Report (1983). NHS Management Inquiry, DHSS.
(1988), 102, 34% 353
Analysis of Q u e s t i o n n a i r e on Resources Available for Health Service Investigation to Service C o m m u n i t y Physicians Harold Schnieden* and Michele Grimes
Stockport Health Authority, District Offices, Haze/Grove, Stockport SK7 5AB
In 1987 a questionnaire was sent to district medical officers or their equivalents in Great Britain. The purpose of the questionnaire was to obtain information on resources available for health service investigation. Analysis of the data showed that specific revenue funding at district level was not available to most service community physicians. Introduction
Districts seeking to determine the health needs of the local population require resources such as manpower, time and finance. The restructuring following the Griffiths report (1983) l may have made it more difficult for District Medical Officers to undertake essential health services investigations because of lack of resources for this purpose. This study was designed to obtain information on resources available to service c o m m u n i t y physicians for health service investigation. Methods
A draft questionnaire was discussed with a m a n a g e m e n t consultant and community physician and a district medical officer. An amended version was then produced. In order to try and get a high response rate the questionnaire was kept deliberately short. It was sent to all Heads of N H S Departments o f C o m m u n i t y Medicine in the United K i n g d o m ( D M O or equivalent in England and Wales, C A M O in Scotland and Northern Ireland). University Heads o f D e p a r t m e n t and Regional Medical Officers were excluded from the circulation. A copy o f the questionnaire plus some results is shown in Table I. The study was conducted in 1987. Results
218 questionnaires were sent out. After one reminder, 199 replies were received--a response rate of 91.3%. It was not possible to identify whether 8 questionnaires returned applied to Scotland and Northern Ireland or England and Wales. O f those that could be identified 180 replies were received from persons working in England and Wales. The analysis o f the results from persons working in England and Wales is shown in Table I. Referring to Question 1, whilst the majority of 'heads of d e p a r t m e n t ' had control of the revenue staff budget for consultant c o m m u n i t y physician (approximately 80%) and secretarial staff (approximately 67%), relatively few managed the revenue staff budget for
* To whom correspondence should be sent. © The Society of Community Medicine, 1988
H. Schnieden and M. Grimes
350
1 = YEs 2 = NO TO :
DMOs
(please
OR
PERSONS
encircle
is there a University
Of.
IN C H A R G E
all correct
Medical
School
D E P A R T m e N T S 5 = N O REPLY
MEDICINE
where appropriate) i
A
b) ~rea
9
(if applicable)
staff budget
for
I
C "D E F O
Community Physiclans (consultants) Community Physicians (training) C~inical Medical Officers Paramedicals (if so specify) Secretarial Staff Administrative Assistants 'Information Officer' Social Scientists Health Economists Others
Operational
0btainin ~ o f c ~ i ~ l
Q3.
(eg: computing
04
3
2
-'TO "I12t
H
74
I J K L
_ 8 _ 56
iXa
1
2
91
I 26
~6
3
etc)
ite~
equipment,
word processors)
Is there a mechanism by which you bid for capital equipment a ~ u a l l y (if SO pl . . . . . pecify) T ~ ~--~ ~
or
2
Do you receive a standard
or
3
Do you have to make a special
capltal
allow~ce
which is reviewed
annually
case per item '
Other ways of obtaining
capital
items
Is the main method of obtaining resources items via virement arising from unfilled
Yes
~.~
:
4
IUl
1
4
4
8 3
Budget:
COSTS of health service related special investigations Stationery Computing activities Costs of provision of teaching services: - ko medical staff (postgrads,registrars - to nurses - medical students - others (eg: paramedical)
b) c) d)
3
-Tr-
Have y o u a revenue budget for:
a)
2
Manased:
Have you control of revenue a) b) c) d) e) f) ~) h} i) j)
4 = NOT APPLICABLE
within your
a) District
Resources
Q2.
O F CO~O~JNITY
responses
No
Partly
(if so please
for capital posts in the
In Past
No R e p l y
specify)
and recurrent manpower budget
Not Applicable
H e a l t h Authority ................................................. * = 2 replies to ~ e s % i o n
TableI
England&Wales-analysisofl80Repliestoquestionniare
4
Resources for Health Service Investigation
351
'information officer', social scientist or health economist (approximately 20%, 7% and 4% respectively). The replies to Question 2 indicated that most (74%) community physicians had no formal budget for health service investigation, only 26% replied in the affirmative. In addition only 27% of community physicians control the budget for computational activities. Referring to Question 3, the majority of heads of department had to make out a special case to obtain an item of equipment; very few (less than 10%) indicated they received a standard capital allowance which was reviewed annually but the majority could bid annually for items of capital equipment. Referring to Question 4, virement arising from unfilled posts appeared to be one m e t h o d - - a p p r o x i m a t e l y one third of heads o f department stated they used i t - - b y which health service investigations were funded. Question 4 provoked a number o f additional comments from heads of department, a few are shown in Appendix I. Reference to these show that in order to get monies for'health service investigation 'heads of departments' of community medicine have tried a number of different mechanisms including subterfuge and stealth. Scotland and Northern Ireland
11 replies could be definitely identified as arising from respondents in Scotland and Northern Ireland, i.e. a response rate of at least 58%. The response rate may have been higher as some respondents failed to identify their area or district. Unidentified district or area
8 respondents failed to give their Health Authority. The pattern of their replies appeared to be similar to the other groups. 6 out of 8 did not have a revenue budget for health service related investigation. A higher proportion o f this small number used virement as a means of funding health service investigation. Discussion
If health service investigation is a priority in the health service then it needs proper funding for infra-structure support. The survey just completed shows that if community physicians are to take a lead in this direction the budgetary arrangements to provide sustained work in this field arc lacking. In spite o f this some community physicians retain an interest and try by various means to get funds for such work. A minority are very successful, c.g. see Appendix I item 28, others not so, see Appendix I item 35. If the overall standards of health service investigation arc to be raised then one of the factors that should be taken into account is adequate finance at district level for this area of N H S work, and also adequate finance at district level for training of young entrants in community medicine in health service investigation techniques.
352
H. Schnieden and M. Grimes
Appendix I: Some comments--D.M.O.'s questionnaire (England and Wales) Q. Is there a mechanism by which you bidjor capital equipment annually? ( I f so please specify) I. Yes--recently established through Unit Management Group. 2. Computer equipment is bid for from computer allocation via Computer Working Party (this includes word processors). 3. Unplanned underspends towards the end of a year from current budgets. 4. Use revenue underspendings--virement to capital on one off basis. 5. Y e s - - b u t only as part o f H.Q.--general office support. 6. Through a Capital Allocations Group. 7. There is a Computer Committee, which sifts and decides on bids. 8. Yes: All capital equipment is bid for in Annual Planning Programme. 9. Through Short Term Plan. 10. Bid goes to District Management Board. 11. Against programmed expenditure District Headquarters. Q. Do you receive a standard capital allowance which is reviewed annually? 12. Yes, currently non-staff allocation to use at my discretion, could be computer or other requirements. 13. Very small annual sum o f less than £250.00. Q. Do you have to make a special case per item? 14. 15. 16. 17.
Informal liaison with Treasurers. Yes - through Capital Allocations Group. Yes, if over £5,000. To Computer Steering Group.
Q. Other ways o f obtaining capital items (if so please specify) 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28.
Joint financing, Devious stealth. Research and Charitable Organisation Grants. Discussion with Unit General Manager. Behind the scenes negotiation. Donations from Industry. I can and do use research grants given to individual consultants e.g. gastroenterology and haematology. By subterfuge. Friends o f the Hospital, Round Table, Trust Funds. Trust funds. I always include hardware and software in project grants o f which we seem to get about £50,000 p.a. over last 5 years.
Resources Jor Health Service Investigation
353
Q. Is the main method of obtaining resources for capital and recurrent items via virement arising from unfilled posts in the manpower budget? 29. N o - - h a v e to ask D G M if I wish to do anything; if he agrees I can get it; if not too bad. Not allowed to spend budget from unfilled posts. 30. Has been in p a s t - - n o t currently. 31. So far this is my only source of funds for special investigations and projects. 32. Probably will be from now on. 33. Y e s - - b u t the sums involved are so small that my £200 per annum book allowance is a luxury! 34. Funds arising from vacancies are no longer available to me. They were available prior to 1985. 35. I have no defined budget these days! 36. N o resources for anything. We are currently 'in the red' as a district. Previously answer to question would have been 'no'. 37. A very useful supplementary method. 38. Everything is at present in a state of flux following new District structure arrangements. Acknowledgement The authors wish to thank Dr C. Birt and Dr Frada Eskin for their interest and advice. Reference 1. The Griffiths Report (1983). NHS Management Inquiry, DHSS.