What do we really expect of our doctors?

Do the public wonder what their doctor gets up to outside of work? Do they care if their doctor has a financial stake in the treatment options in their area or if it is OK for a doctor to let their personal beliefs guide the care they offer? And how would people feel if their doctor is involved in crime?

We were commissioned to explore what the public expects of doctors in the most recent review of the Good Medical Practice, the core guidance for all doctors, setting out the values and principles for good practice.

The General Medical Council consulted the general public and we added to this by speaking to people from ‘seldom heard’ groups - from members of the Gypsy and traveller community, to refugees, to retirees. We found that the public has realistic expectations of doctors. Like other professionals, in working hours they are expected to provide the best possible service, and while there were some issues that could undermine patient trust, the general public were under no illusion that doctors are, or should be, a morally superior species.

Doctors were expected to leave their personal beliefs ‘at the door’, and it was felt that their privacy should be respected. It was acknowledged, however, that some personal beliefs could impact on care. Abortion was a difficult one - some felt that doctors who opposed it should have the right to refer cases to colleagues, while others we spoke to said that it was simply part of a doctor’s role and that they should be able to set their personal beliefs aside.

The public were not particularly perturbed by the idea of doctors having a financial conflict of interest, for example a stake in a local care home. Provided this interest was declared and patient care wasn't affected, the public did not think it mattered. However, criminal behaviour was considered significant, whether or not it impacted on patient care, because it could undermine patients’ trust in doctors.

What emerged from our research is that the public were only truly concerned by two things: delivering good quality care and trust. So there are expectations of doctors, but the greatest expectations are of how they conduct themselves in working hours - they are expected to be good communicators, listen and be trustworthy. As long as their life outside of work doesn't affect their ability to provide a high standard of care – and they’re not involved in crime – the public do not expect doctors to live a life of great virtue. Pretty reasonable expectations I’m sure you’d agree.

What do we really expect of our doctors?

We need to talk about dying

This is a guestblog from Joe Levenson, Director of Communications, Dying Matters Coalition, www.dyingmatters.org

Every minute in the UK someone dies. It's the one sure fact of life and yet it's an issue the majority of us avoid. While attitudes are starting to change, new evidence suggests that death remains the final taboo.

British Social Attitudes' latest findings, published this week to coincide with Dying Matters Awareness Week, show a mismatch in what we say we feel comfortable doing and what we actually do.

While the majority of us say we’re comfortable talking about dying, the reality is that most people are still shunning important conversations and practical actions to manage their end of life care and final affairs. Despite encouraging signs that older people are increasingly likely to be make their wishes know, from comparison with earlier studies.

Just over one in three people have a will and less than a third say they have registered as an organ donor.  Following the Liverpool Care Pathway and the Francis Inquiry at Stafford Hospital, there is increased anxiety over how we care for the dying. Today's findings reveal just one in twenty people has an advance care plan, setting out how they would want to be cared for if they couldn’t make decisions themselves and whether they would want to be resuscitated. Even among older age groups, only a minority of people have made their wishes known in this way.

The research also reveals a disparity between where people want to die and current trends in terms of place of death. The findings show that just 7% of us say we would prefer to die in hospital and two-thirds (67%) would prefer to die at home.Yet latest NHS figures show that more than half of us die in hospital

At Dying Matters – which has over 30,000 members including charities, care homes, hospices, funeral directors, doctors and legal and financial organisations - we know that there are simple things we can all do to help ourselves and support our loved ones. You don’t have to be ill or dying to make plans for your future, which is why we are calling on people across the country to take practical steps by writing a will, recording their funeral wishes, planning their future care and support, considering registering as an organ donor and telling loved ones their wishes.

We need to talk about dying

Sight loss at seven: so much more than not being able to see

What do most seven year olds do? They go to school, socialise, play sport and generally get on with the happy business of growing up. But it’s not always the same for children with sight loss, as our recent study with RLSB and RNIB shows. We compared the circumstances of seven year olds with and without sight impairment. We found that having sight impairment means much more than not being able to see.

The disadvantages are seen in the classroom. Parents of sight impaired children were more likely to report that their child had difficulty with reading, writing and maths, and their children were more likely to say they didn’t like reading or writing. Teachers agreed - they were more likely to report that sight impaired children’s reading, writing and maths was below average. Relatively small problems early on can escalate with time; we’ve done other studies that show that levels of attainment are lower for the partially sighted and that blind adults find it harder to come by a job.

And when it comes to playtime and socialising in school, children with sight impairment were three times more likely than other children to have been bullied. Again, parents, teachers and children were in agreement on this. That said, the great majority of children – both those with and without sight impairments – are not bullied and do feel safe at school.

Having opportunities to make and sustain friendships is important for children. Equally important is having the opportunity to be able to spend positive time alone. Children with sight impairment appear to be disadvantaged on both counts. It’s clear that sight loss often has an impact on young children’s social development. So it’s not surprising that children with sight impairment were more likely to feel unhappy, to feel worried, and to have emotional, concentration or behavioural difficulties.

Alongside these emotional difficulties, there are health implications that can come with a sight disability. These children were less active than their sighted peers, less likely to exercise regularly or be in a sports club outside of school. This lack of physical activity is bound to take it's toll in the long run.

Many also had disadvantaged home lives. Children with sight impairment were more likely to have unemployed or financially struggling parents. This wasn’t just a  feeling disadvantage; they were also more likely to be below the median income level. Disadvantage could be a cause or a consequence of sight impairment. Having a disabled child could affect parental employment prospects, while disadvantage may be aligned with poorer access to eye tests and poorer general health.

Sadly, all these differences are even more marked for children who have an additional disability. We compared those with only sight impairment to children with both sight impairment and another disability. For each of the areas, children with sight impairment and an additional impairment were the worst off.

From socio-economic disadvantage at home, to trouble with literacy and numeracy at school and difficulty developing socially, the already significant obstacles faced by children with sight impairment are compounded by other factors, if not another disability or impairment. Although progress has been made in improving the chances of sight impaired children, as Tom Pey, Chief Executive of RLSB comments, "this report demonstrates that we still haven't got it totally right."

Sight loss at seven: so much more than not being able to see

Are 'healthy' foods marketed at children really that healthy?

Research published this week shows that some foods being marketed to children are less healthy than those marketed to the general population and asks whether more guidelines are needed to regulate food promotion to children.

With the rise in childhood obesity, attention has focused on the advertising of ‘unhealthy’ products high in fat, sugar and salt such as confectionary and soft drinks. However this study compared foods that could be deemed ‘healthy’, namely yoghurts, cereal bars and ready meals and found that a significant number of products marketed towards children were higher in fat, saturated fat and sugar.

The study was carried out at the University of Hertfordshire where I was part of the research team. Nutritional data was collected on products from major UK supermarkets and categorised as children’s or non-children’s products based on the characteristic, promotional nature or information on the product packaging. Fat, sugar and salt content was compared per 100g and per recommended portion size.

What this research highlights is that parents need to be made more aware that ‘healthier’ foods marketed for children are not always the healthiest option. For example, a children’s cereal bar may have less saturated fat than a chocolate bar, but it may have more saturated fat than an adults’ cereal bar. Results from Years 1 and 2 combined of the National Diet and Nutrition Survey (NDNS) show that children’s average consumption of sugar and chocolate confectionery has fallen in the last 15 years and that fewer children are consuming these types of foods perhaps reflecting a move by parents and older children to purchase alternatives such as cereal bars.

The use of cartoon characters and labelling products ‘for lunchboxes’ has a strong influence on children’s consumption and what parents’ buy for them, particularly through ‘pester power’ (requesting particular items whilst shopping) and so manufacturers and retailers have a responsibility to deliver healthful child-orientated foods. At the very least, recognisable characters should be utilised more to promote foods like fruit and vegetables so that children use their ‘pester power’ for their own good.

Are 'healthy' foods marketed at children really that healthy?

What light can research shed on the multiculturalism debate?

A couple of days ago, I attended an event: ‘The Politics of Diversity and One Nation’ held by Demos about whether multiculturalism would sink or swim as a major integration policy in the years to come. It’s a big topic that has raged on in the media and in parliament, with much generalistion, anecdote and politicisation. So how can research help us move beyond polemic debates towards a more evidence-based and substantiated discussion?

Some of the discussion on Tuesday was about immigration: how the public feels about immigration, why they feel this way. And it seems that the facts are more nuanced than rhetoric leads us to think. The public has always favoured a reduction in the numbers of immigrants, even during times of little immigration to Britain, and in our most recent round British Social Attitudes (BSA) 75% of respondents supported an overall reduction in immigration. But immigration and multiculturalism are not synonymous with each other.

In fact, this opposition to immigration may bear little relation to public sentiment about existing multiculturalism. 51% of respondents in 2011 felt that the cultural impact of migration was neutral or positive and 48% perceived the economic impact of migration to be neutral or positive. The data also gives us a more nuanced picture about what types of immigration people oppose and under what conditions. Ultimately, qualifications are seen as more important than origins and professionals and good students are also perceived positively regardless of origin. It seems immigrants aren’t the only victims of generalisation, the British public is often overgeneralised, too.

But the debate about multiculturalism is about much more than immigration, it’s about national identity as well and for that we need to look at the actual experiences and opinions of minorities as well as the majority. Understanding Society suggests that a multicultural society is compatible with a united national identity. Indeed, those ethnic minority Brits who retain their minority self-classification are more strongly attached to a British identity than the white majority. Moreover, the white majority is more mixed than previously thought; many of those who identify as white come from mixed-ethnicity backgrounds. As Mark Easton, the BBC Home Affairs Editor put it, the figures ‘suggest our mixed race population may be twice the size of official figures - numbering up to two million people’.

So to some extent we are already living in a multicultural society. Multiethnic and diverse religious groups have a sense of Britishness and although the public are, on the whole, against more immigration, their attitudes to multiculturalism are complex. These studies alone do not tell the whole story, but the hard facts certainly add often overlooked detail to the debate. There is more to come: our Youth is Europe study is decoding the lives, experiences and opinions of young immigrants across Europe and this year’s British Social Attitudes asks questions about immigration. I look forward to seeing the findings of these studies and a more substantiated debate on a topic that is far more complex and nuanced than is often portrayed.

What light can research shed on the multiculturalism debate?

Will living standards decide the next election?

Yesterday I was one of four speakers addressing an audience at the Resolution Foundation on the issue of whether 7 May 2015 was going to be the “Living Standards Election”.

We were asked to respond to some new YouGov polling, presented by the always excellent Peter Kellner. YouGov’s research suggested, broadly, that the British public think they are worse off now they were in 2010 and that they expect to be even worse off in 2015. It also suggested that the public were pretty uncertain about whether any of the political parties would be able to do anything about it, at least in the short term.

I was invited, in the words of Newsnight’s Political Editor Allegra Stratton (also at the event), to tell the story of British living standards over time and, as is so often the case, I was able to turn to our British Social Attitudes (BSA) survey.

For almost 30 years BSA has asked people how well off they think they are, revealing that surprisingly few people see themselves as struggling even in the darkest economic times.

The percentage admitting to struggling is recession related, but has never risen beyond 29% in the last 30 years, a figure recorded in 1984 when unemployment hit 11.9%, its highest level since records began in 1971.

Even well into the current recession, we aren’t seeing levels back up to previous recessions – most recent figures have been hovering around 20%. (The figure has never fallen below 13%).

What might explain this puzzling finding?   

Our first hypothesis is that people believe there are lots of people worse off than themselves, and this tempers their assessment. If you ask people what shape society is (in terms of income distribution), they tend to think it is triangle shaped, with very few people at the top, and lots towards the bottom. But paradoxically, most people place themselves in the middle. So if many think others are worse off than themselves, this might explain why they are reluctant to describe themselves as struggling, even in tough times. Our second hypothesis is that while people’s living standards have fallen and they have noticed it, they might actually be more worried about something else. It is instructive to look back at issues worrying the public – and for this I draw on IPSOS Mori’s tracker.

-Back in the 1970s and early 1980s, people were most worried about prices. Inflation of course was rampant, over 20% at some points during 1980.

-In the 80s and into the mid 90s (under Thatcher and Major), people worried most about unemployment.

-For the first part of Tony Blair’s tenure, people worried about the NHS. Later, their concerns turned to immigration/race relations.  

But since 2008 concerns have squarely been about the economy. So perhaps, against our intuition, it isn’t the actual pound in our pockets that concerns quite as much as the competence of the government on the economy. A point reflected by Times Columnist Danny Finkelstein who reminded us that it is one thing to have a strategy to turn the economy around, it is quite another to get the public to believe you will deliver on it.

If this is the case, the biggest impact in terms of a living standards election might be on turnout, since voters might not trust any of the parties to sort out the difficulties.

Or, perhaps, the question might tell us something about esteem and identity. People might react against the very term “struggling”, even if they are having to budget very carefully, tighten their belts, and are worse off than they were.  Politicians are quick to invent terms that they think will resonate with whom they are trying to appeal to: alarm clock Britain, something for something, strivers and skivers, twitching curtains….strugglers might be another term that people aren’t keen to identify with, even if they are.

There isn’t one catch-all policy on living standards.

There is another reason why it might be hard to put living standards at the heart of the election debate. The YouGov data clearly shows the difficulty of making capital out of individual circumstances, since there are very different concerns.

For older people the issue might be petrol. Younger people can’t afford a car - so it’s housing. And British Social Attitudes finds one group that is really struggling - single parents – but this group doesn’t determine elections.

In contrast of course, there are some issues that resonate across the spectrum. The NHS being one example, and on this, there have been warning signs for the coalition as satisfaction has fallen and not yet recovered.

On one level, it is axiomatic that people’s own experiences will be relevant to any election debate. But perhaps not in a straightforward way: (a) perceived (in)competence on the overall economy might keep people away from the polling stations (b) politicians should think carefully about making assumptions and the language they use  (c) people might not want to be reminded how badly off they are. This might attack their self esteem.

Will living standards decide the next election?

Love doesn’t mean living together

1 in 10 Brits is in a relationship but not living with their partner.

Couples living apart account for around 1 in 10 British adults – a sizeable minority. Most are wrongly classified as single on forms, in the Census and by the Government. Not only is it frustrating for the couples themselves, but it also leads to inaccurate assumptions. So let’s bust a few myths about couples who share a life but not a home.

First off, it’s not just teenagers or people who’ve been seeing each other for a couple of months. 2 in 5 had been together for 3 years or more, while just 1 in 5 had been together for less than 6 months. Although about a third did say that it was ‘too early’ on in their relationship , the majority gave other reasons. Many of them were indeed in their late teens or early twenties, but the majority were over 25.

Second, nor is it just for the rich and famous or high-flying professionals. Couples that don’t live together hail from all walks of life: 3 in 5 of them are in intermediate jobs, blue collar workers or unemployed. In fact, their socio-economic make-up is little different from the general population. So it’s not just for those couples who can afford a house each.

Third, living apart doesn’t mean these relationships are casual or lacking in commitment. 33% live alone (twice as many as the general population), and yet they are not on their own. Many provide care or support for their partners when they are ill or in a difficult situation and are in frequent contact with each other. One of the people we interviewed said, “every morning on his way to work, he phones me. He phones me at lunchtime…on the way home from work…when he gets in bed at night.”

Fourth, they see “living apart” relationships as sexually exclusive. 87% felt that sleeping with other people was wrong, differing little from their view about cohabiting couples – which is about 89%. And although some said they’d been involved in overlapping sexual relationships in the past, none said that this was their current situation.

So couples who live apart aren’t just young or famous and many are in committed, intimate relationships, just like cohabiting relationships. The only difference is that they slip under the radar; 1 in 5 who are classified as ‘single’ on the Census are not. Sadly, this statistical blind spot effectively excludes couples living apart from discussion about policy and decisions about service provision. Hopefully, our work into this area goes some way in changing that.

Love doesn’t mean living together