Effective research doesn’t just collect data; it listens to people. By building inclusivity into research from the start, we not only make participation easier, but we also ensure communities are truly heard, leading to findings which can be harnessed to drive meaningful change.

If you’re looking to design inclusive research, this article will share key learnings from a research project we conducted on behalf of StepChange, a national debt advice charity, and Equifax, a credit reporting agency. The research aimed to understand the challenges neurodivergent people face when accessing the help they need with their debt, and to identify how services could be designed to better meet their needs. This was a mixed-methods project involving an online survey and qualitative interviews with neurodivergent people who were struggling with debt.

So, firstly, what is neurodivergence? It is a term used to describe people whose brain functions differently to what is considered typical. In the UK, it is estimated that around 1 in 7 people are neurodivergent. Neurodivergence is an umbrella term, which includes people with ADHD, autism, dyslexia, dyscalculia and other differences that affect how the brain processes information. Inclusive research should aim to be considerate of these cognitive differences, supporting full and fair participation for all.

From the outset, we recognised that taking a fully inclusive approach would empower participants to share their personal experiences and challenges. This not only made participation easier; it led to richer, more representative insights.

Here are four key things to consider when designing inclusive research for neurodivergent participants:

1. Embed lived experience input throughout

Beyond the survey and interviews, we sought the involvement of people with lived experience of neurodivergence at every possible stage – from designing our method right through to analysis and reporting.

We gathered input in a number of different ways, allowing ‘experts by experience’ to feed back in a way that suited them. At one end of the scale, we gave people the chance to provide bitesize input, like asking interview participants for their perspectives on how we should present our research findings. This led us to produce an additional short report and an animated video summarising the research. We also asked neurodivergent colleague networks to review our research materials and ensure they were accessible and worded appropriately.

For more detailed lived experience input, we built in time to cognitively test the survey with neurodivergent participants before launch. The feedback from this approach was invaluable and identified improvements that we otherwise wouldn’t have detected. For example, we found that open response text boxes needed clear instructions on what was expected from those completing the survey, along with reassurance that participants shouldn’t worry about spelling or grammar.

Getting meaningful lived experience input can require careful planning and time, but there are always ways to incorporate it, and it enables richer, more grounded insights.

2. Provide choice and flexibility

Neurodivergent people can present in many different ways. This includes people with the same cognitive differences, such as ADHD or autism. Therefore, what works for one neurodivergent person may not necessarily work for someone else.

A truly inclusive approach therefore should aim to consider individuals’ diverse needs. For example, we designed the interviews to be flexible, as we knew participants may find certain types of communication more suitable than others. Participants had the choice of speaking to a researcher over the telephone, online, or via a live chat function. They also had the opportunity to preview the research questions to help provide reassurance ahead of the interview, as well as the ability to take breaks, as an hour-long interview can be demanding.  Providing this choice made the research accessible, meaning people were able to participate in the way that best suited them.

3. Be proactive in offering support

During this project, we found that stigma and fear of misunderstanding can prevent people from asking for support during debt advice interactions. This experience can also apply to participating in research.

Therefore, when it came to the recruitment of interview participants, instead of simply asking if they needed support to be able to fully participate, we listed examples of what was available and reassured them that additional accommodations could be easily arranged. This proactive approach gave participants the confidence to ask for support, with the knowledge that we were truly able to support them. Having their support needs met meant that participants felt valued, comfortable, and able to contribute to the research.

4. Use direct, everyday language

Research materials should aim to be clear and direct, using plain language that is easy to understand for all participants. When technical terms or specialist concepts are necessary, they ought to be explained in simple, accessible ways. Ideally, this could include visuals, such as a diagram, to support different modes of cognitive processing. This approach ensures participants know exactly what is expected of them and can engage confidently with the research.

It’s important not to assume that everyone shares the same level of understanding. This is where lived experience input becomes invaluable. For example, when we tested our survey with people who had ADHD and autism, we discovered that not all participants were familiar with the term ‘neurodivergence’. By explaining the term and placing it in context, we made the survey more accessible and ensured participants did not feel excluded by unfamiliar language.

Conclusion

Although this project was designed specifically for neurodivergent participants, the lessons we learned are universal. What makes research more accessible for neurodivergent people also makes it more accessible for everyone. Direct language, flexibility, proactive support, and lived experience input benefit all participants and lead to higher-quality, more representative insights.

Inclusive research is not only good practice; it is essential for generating findings that truly represent those we engage.

Find more about our research with StepChange and Equifax here: Different Minds, Shared Challenges. StepChange

The animated video below was produced to introduce the key research findings:

If you would like to know more about our inclusive research practices, contact sam.shaw@qaresearch.co.uk

In this three-part series, Qa Research explore how critical challenges facing the NHS could be addressed by more effectively using high-level patient data and meaningful public engagement.

Part 1 explores current healthcare issues

We all need and value our health over almost anything else. In the UK, we rely on the NHS to look after us and we take pride in the institution that’s been running for three-quarters of a century. However, with Labour’s recent landslide election victory, Keir Starmer’s government is inheriting an NHS in dire straits, needing to adapt to evolving healthcare needs such as advancements in medical technology and changes in disease prevalence, all the while dealing with historic cuts to NHS funding.

This series looks to explore how the NHS can tackle these challenges through using patient voices and data to really make an impact where it matters.

Public satisfaction with the NHS is at its lowest ebb

The Labour government’s starting point with the NHS is not a positive picture. The British Social Attitudes survey reported the lowest level of satisfaction with the NHS on record (in the 40 years since the survey began). In it, less than a quarter (24%) of Brits were satisfied with the NHS, an unprecedented 29% drop in satisfaction since 2020. Indeed, a staggering 52% were actively dissatisfied with the health service, citing inadequate healthcare spending as a major concern. In a survey that we at Qa Research recently conducted with Understanding Patient Data, a similar picture emerged, with 85% agreeing ‘I am concerned with the state of the NHS’ (representative sample of 1000 UK residents). The healthcare system’s current challenges significantly impact public satisfaction, which only serves to emphasise the need for improvements.

But where are these concerns coming from?

In the BSA survey, the top reasons for dissatisfaction with the NHS were ‘waiting times’ (71%) and ‘staffing shortages’ (54%). These two major issues are prominent in the media and resonate with past projects we at Qa have carried out with regional NHS and health system partners. When it comes down to it, it’s quite simple; people want quick access to healthcare when they need it and enough high-quality staff to feel safe and cared for, ensuring timely patient care.

What are the major challenges facing the NHS today that need addressing?

The current picture of the UK’s health and care system is one of immense pressure, heavily influenced by health economics, including financial challenges. For a more detailed look, publications such as The King’s Fund, The Health Foundation and the Economics Observatory have done an excellent job of laying out the challenges facing the NHS.

In this article we have picked out four of the key pressures we have observed over the years.

1. Care backlog and patient flow

A major factor in current NHS issues is the sheer backlog of elective care built up during Covid-19, meaning that waiting lists for treatment are stacking up. Recent research from the University of Edinburgh suggests this backlog is not likely to be cleared by 2025. Delays in providing care to patients, including emergency care, further exacerbate the situation.

On top of this, in the UK we don’t have the flexibility other European countries do in terms of hospital beds; in the EU there are on average 5 beds per 1000 people, but only 2.4 in the UK. This is only compounded by issues with social care, as hospital beds are ‘blocked’ due to delayed discharge. Combine this with the NHS’ limited scope to invest in preventative care and tackle health problems ‘upstream’, it means patients are living for longer but with more health conditions.

These NHS challenges mean many patients are now struggling to get the right care at the right time.

2. Partnership and integration of health services

Newly-founded Integrated Care Systems, most of which are working with significant budget deficits, are considering how to best collaborate locally all the while being assessed under new ‘capability’ ratings.

It is a challenging time for the fledgling Integrated Care Systems and their governing bodies Integrated Care Boards, many of whom are considering significant restructures in order to balance the books. On top of this, all different partners in the system may have different structures, different ways of working and different IT systems, which only makes things more difficult.

3. Widening health inequalities

Health inequalities are avoidable differences in life expectancy, health conditions and qualities of life between different groups in society. These have been widening in recent years, despite being a priority of the NHS Long Term Plan to tackle it. NHS services are working to close this widening gap in health outcomes which are affected by wealth, geography and other factors.

Combined with a population that is living for longer, people living with multiple health conditions at once (known as co-morbidities), this means more complexity in the support the NHS needs to deliver. The NHS will have to adapt to this new reality, addressing health inequalities through a strong focus on public health.

4. Strikes and staffing challenges

The NHS is currently functioning in a climate of prolonged industrial action and key shortage professions, meaning Health Secretary Wes Streeting is inheriting a workforce in distress and willing to strike over working conditions.

The impact of these strikes? There are four main impacts, of course starting with patients who experience rescheduled appointments or impacts on the quality of care they receive. This can significantly affect patient outcomes. Another major impact is on the healthcare workers who ultimately have to keep the NHS running on skeleton staff, and deal with the increased backlog when the strike is over, taking a physical and emotional toll. For striking staff, loss of income or the difficult decision on whether to strike can impact them too. Stress and burnout is high in the NHS, with many opting to leave the sector, which only makes the problem worse for those who stay.

Beyond those directly involved with the NHS, public trust and opinion towards NHS staff as well as politicians can be damaged by ongoing strike action, as we found in recent work with Bradford Health and Care Partnership. And of course, every strike costs the NHS money, with consultants and expensive agency staff being drafted in to cover.

Why explore these NHS challenges now?

Through our wide-ranging research with NHS patients, communities and health sector stakeholders the issues highlighted in this article have been mentioned repeatedly. The policy and funding landscape certainly exacerbates them, as do major health incidents like Covid-19, but the issues have been bubbling for years, decades even.

2024 has potential to be a year of change in how the NHS is managed as the future of our health service formed a crucial part of Labour’s successful election campaign. Indeed, now they are in government, Labour will be looking to fulfil their manifesto pledge to not only cut waiting lists, but to work towards a ‘fairer Britain, where everyone lives well for longer’.

So what can be done to solve these challenges?

Certainly the challenges are great. In the first year of the new government, the country will be watching their progress on pledges to halve the gap in healthy life expectancy and cut NHS waiting times with 40,000 more appointments every week.

When looking to address these challenges, there is so much patient data and evidence out there to drive decision making, and patients are keen to have their voices heard and be part of the future of the NHS.

However, ‘data-driven’ and ‘patient-centred’ decisions often feel like two opposite ends of the spectrum and can operate in silos. Perhaps a united, cohesive approach could drive more efficient, impactful decisions in the NHS?

Next month in part 2 we explore how supportive patients are of having their data used to power decision-making and what this could mean for solving NHS challenges.

Tourism delivers undeniable benefits. Visitors to our own city of York spent £1.2 billion in 2022 alone, helping to support 17,000 jobs. 

But this can create challenges. York is a small, medieval city with a population numbering a little more than 200,000. Yet it welcomed 8.9 million tourists in 2022. Such a large influx of visitors can sometimes cause residents to voice concerns about the impact on the city as a place to live.

What exactly is over-tourism and how does it impact other destinations? Is it possible to shape a tourism policy that allows residents and visitors to co-exist in harmony? And is a tourism tax part of the solution?  

Our mission: to do a deep-dive into the issue, find some answers and hope they are useful in shaping a sustainable solution that works for everyone – businesses, residents and policymakers. 

What is over-tourism?

Over-tourism occurs when destinations experience an unsustainable number of visitors, leading to overcrowding, a strain on local services and environmental degradation. 

Popular tourist destinations across the world have attempted to tackle the issue head on. Large cruise ships were banned from the Giudecca Canal in Venice in 2021 after protests from residents. In 2023, Amsterdam introduced a campaign aimed at discouraging tourists due to antisocial behaviour. 

York has yet to take similar action, even though residents have voiced concerns about overcrowding. Qa’s own research over the years has revealed the tensions wrought by the impact of tourism in the city – with some local families choosing to avoid the centre on Saturdays for fear of running into groups of stags and hens. 

Aware of these feelings, the city council has stated that they want to “reduce some of the negative impacts of tourism”.  

So how does a place like York address these challenges without damaging the economic benefits on which the city relies? 

The tourist tax: a sustainable solution? 

Implementing a tourist tax is often touted as a solution to over-tourism. The tax has been introduced in popular European destinations, including Rome, Barcelona and the Canary Islands.  

In the UK, Manchester became the first city to impose a tourist tax in early 2023. Other destinations are contemplating the idea. 

Tourist taxes are collected from overnight visitors. Hotels and other accommodation providers charge visitors an additional fee. The money is spent on things like cultural and environmental preservation, street cleaning, enhanced local infrastructure, and events.  

The costs that tourists incur are typically small. In Manchester, accommodation providers charge visitors an extra £1 per room per night. 

In theory, tourist taxes seek to encourage sustainable tourism by taking some of the tax burden from residents and re-investing the proceeds to help make the destination a better place to live, work and visit.

How could research contribute to the debate?

To help inform the debate we wanted to find out the extent to which a tourist tax could work in York. To do that, we set out to answer two main questions. Firstly, what do businesses that rely on tourism think about the idea? And, secondly, could a tourist tax foster a more harmonious relationship between visitors and residents? 

The hospitality sector’s view

As part of our research, we talked to representatives of the hospitality sector in York. They voiced concerns that a tourist tax might deter visitors.  

Tourism is a competitive industry. There are fears that the extra cost might persuade potential visitors to choose an alternative destination that has no such scheme. As things stand, that includes most of the rest of the UK. 

Another concern from the hospitality sector is how and where the tourist tax revenues would be spent. Who would oversee the collection and distribution of the money? How would the investment schemes be chosen? Might it be siphoned off to help cash-strapped councils meet their deficits, rather than being spent on schemes that overtly benefit the tourism industry? 

That said, our research found that the hospitality sector is not implacably opposed to the idea, and is more open to a mechanism which would bring together the various stakeholders – hoteliers collecting the levy, the destination management team and the local authority – to manage a tourist tax.

That would allow for a collective approach to setting and spending the tax. It could also incorporate a strategy to analyse the effectiveness of the investment and measure any improvements that were introduced.  

And such a body could actively promote a more harmonious relationship between the tourism industry and York residents.  

• Read part two here: Over-tourism: What do residents and holidaymakers think of a tourist tax?
• Read part three here: Over-tourism: Could a tourist tax create harmony between residents and visitors?
  
• For more information about Qa Research’s work in tourism, contact Richard Bryan, Managing Director, at richard.bryan@qaresearch.co.uk and 01904 6320394

In our previous article, we outlined the scale of the pressure and impact that can be caused by debt – and noted that the ongoing cost of living crisis means this has the potential to get worse before it gets better.

We explored the impact on people struggling to cope with spiralling bills, and the ways that organisations, often inadvertently, can sometimes make things worse.

Now we want to look at strategies that will make a positive difference. From our years of in-depth research across an array of sectors, including water, energy, transport and the NHS, we know there are ways to engage with and support people in financial straits which work – both for the individual and the organisation.

And it begins with compassion.

Empathy is key

An understanding, compassionate approach is the bedrock of positive engagement. And positive engagement leads to positive outcomes.

Financial hardship is hugely stressful. The cost of living crisis means many previously ‘comfortable’ households now have to choose between heating and eating.

When our researchers talk to people who have been in this debilitating situation, they tell us: ‘We just want them to listen and understand’.

Organisations that do both, do better.

Give customers back control

People who see their debts mount suffer acute stress – caused largely by a sense of losing control. Fear, guilt, panic and anxiety can quickly follow. People often feel a sense of shame too. There’s a stigma associated with money troubles.

One interviewee told us: ‘Debt – it kills your spirit.’

If you can help them regain that sense of control, you will change your customers’ perspective, minimise any feelings of shame and improve their mental wellbeing.

The first step is to allay their fears. Assure them that no negative consequences are imminent, such as cutting off supplies, sending in bailiffs or taking legal action.

Once they are reassured on that point, you can begin to work with them on a plan to resolve the crisis.

This could be a debt holiday, a discounted bill, a payment plan or similar. Something that will simultaneously relieve the pressure and give them back some sense of control.

In an instant, what seemed to be a financial dead end can be opened up. The customer can look to the future with confidence rather than dread.

Keep in touch – the right way

Keeping in contact is critical, of course – but the style of communication is equally important. All communications with the customer should be support-based and non-threatening.

Always keep in mind that this is not a one-size-fits-all situation. Every customer is different and dealing with unique circumstances, so communications should be personal to them. Agree a communications plan that they are happy with – including the type of communication and how often the contact should be made – and stick to it.

And after the initial way forward has been agreed, don’t disappear into radio silence. Check in on them. Is everything OK? How can we help?

Don’t always depend on digital

The move towards digital communications was accelerated by the Covid pandemic. Increasingly, organisations rely on emails, messages, websites and apps to keep in touch.

But not everyone is comfortable in the digital world.

For those who aren’t, ensure there are other channels available. Make it easy to find your phone number and postal address, as there are still plenty of people who prefer printed letters.

By making communications as comfortable and convenient as possible for each individual customer, you are much more likely to keep them engaged.

And go the extra mile. Many people struggle with form filling, particularly when it comes to financial affairs. Offer to talk them through it, or put them in touch with support agencies such as Citizens Advice who provide a range of services for free.

Keep expectations real

People get used to discounted bills or payment holidays, and can sometimes react badly when they end. So always be clear about the timetable being set up, and be open about when payments are set to increase again. Check in along the way to ensure they are still happy with the plan and the timetable.

Our research shows that most people react negatively to short-term ‘sticking plaster’ solutions. Work with them on a longer-term plan.

And remember their circumstances can change for the better or worse, so be ready to be flexible.

Conclusion

The successful strategy to help people struggling to pay their bills should…

• Involve listening at all times
• Show appreciation that everyone’s circumstances are different
• Develop communications and payment plans tailored to each customer
• Take a medium to long-term approach
• Be understanding, realistic and flexible.

Our research shows organisations that adopt this style of open, compassionate approach are seen as the most helpful and supportive, develop stronger customer relations and garner the most positive feedback. And that ultimately results in successful plans to pay down debts and prevent future debt.

To put it in a nutshell, your ultimate aim – as one Qa interviewee told us – is to give customers ‘one less thing to worry about’.

See also our first blog on steps to avoid when your customers struggle to pay their bills

If you would like to know more our research with those experiencing debt and financial difficulty, contact georgina.culliford@qaresearch.co.uk

The cost of living crisis is pushing more people to the financial limit. It is affecting millions, from traditionally vulnerable low income households to families who were previously considered to be ‘comfortable’.

Key triggers include: huge hikes in energy prices, food inflation and rising rent and mortgage payments. According to the Office for National Statistics, 94% of UK adults have seen an increase in their cost of living. Meanwhile, household income is set to drop by 4.3% this financial year, the biggest fall since records began in 1956.

At Qa Research, we see the impacts of these challenges up close. We specialise in engaging people who come from disadvantaged backgrounds and who sit on the economic fringes of society, a place where every penny counts.

Working with sectors including water, energy, transport, the NHS and universities, our in-depth research has led to insights into some effective ways to help struggling customers – and, critically, understanding things that can make people’s circumstances worse.

The impact

Money worries have acute and lasting effects on people’s mental health. Some of the people we’ve interviewed told us of simply desperate measures they’ve been forced into to mitigate dire financial situations: not heating their home, skipping meals, washing in a bucket – even eating raw potatoes.

The loss of control, the damage to personal pride and self esteem, and a sense of shame fuels high levels of stress, anxiety and can worsen mental health. When you contact a customer in this situation, they are not in a good place.

The debt spiral

If money is impossibly tight, things can quickly spiral out of someone’s control. They might miss a direct debit because they run out of money after rent and food. Then one missed payment easily becomes two.

The strain is enormous. And can cause some people to start to ignore or avoid tackling their growing debts.

What customers don’t need

You lie awake with worry. You don’t know where to turn. What would make things worse?

• A threatening letter
• A call from a company representative who is unable to deviate from a set script, offering little help and no hope
• To be made to feel bad for getting into difficulty and asking for help.

The impact of any one of these responses is to exacerbate the customer’s already negative feelings. Increased guilt and fear lead people to shut down and opt out. Soon, they won’t respond to emails or answer phone calls.

The consequences

Once a customer in need has stopped communicating, organisations are sometimes left to consider more extreme measures. Cutting them off, taking them to court, sending in the bailiffs.

But this only serves to widen the trust gap, to the point where it can’t be bridged.

The more heavy handed a company becomes, the more its reputation can suffer. In our socially connected times, it doesn’t take long for a brand to go from positive reviews to being positively toxic.

Happily, all this can be avoided. There is a better way. In part two of our blog, we will outline steps you can consider when seeking to help a customer who is struggling to pay their bills

If you would like to know more our research with those experiencing debt and financial difficulty, contact georgina.culliford@qaresearch.co.uk

The philosopher George Santayana once said: “Those who cannot remember the past are condemned to repeat it”.

But when I chaired the Social Research Association event on ‘Using Archives in Social Research’, I wasn’t sure how digging up data from years gone by could help me as a social researcher very much focused on the present and future.

In fact, thanks to the amazing insights from our fascinating speakers –

• Angela Whitecross, University of Manchester
• Phyllis Macfarlane, Archive of Market and Social Research
• Christina Magder, UK Data Service
• Annie Irvine, Kings College London

– I learned a lot. Here are three of my observations about using the past to illuminate the present in social research.

1) Check if existing data can help contextualise or even replace fieldwork

Research ethics encourage us to minimise the burden on participants as far as possible, and this includes preventing them from becoming ‘over-researched’.

It’s important to consider what data already exists before jumping into field without thinking. This could be quantitative survey data from the UK Data Archive, which contains over 8,500 datasets Or perhaps a dive into the longitudinal qualitative exploration of personal and family relationships over time, which can be found in the Timescapes archive.

Sure, our exact research questions and focus are extremely unlikely to exist already. But there could be incredibly useful contextualising information that might shed new light on a topic or change the focus of a project entirely.

It’s certainly something worth exploring in the early stages to ensure the research questions are as informed as possible – although this scoping time must be built into the project timetable.

2) History is constantly being rewritten, but archives are a snapshot in time

One thing that struck me when listening to the speakers was the relative ‘purity’ of the data in archives.

‘History’ is a constantly shifting entity that is continually being rewritten. In contrast, archived social or market research is fairly static.

Quantitative surveys or qualitative interviews are collected. Transcripts are created, analysed and written into reports. And that’s how it stays.

As a result, we have perfectly preserved snapshots of the attitudes or language of that time, even if that wasn’t the focus of the original project.

As an example, the NHS Voices of Covid-19 project was already documenting personal testimonies about health for the NHS at 70 project when Covid struck.

It was perfectly placed to capture and preserve real-time snapshots of attitudes to health and care throughout the pandemic; an invaluable resource of social history that can inform our research of a post-Covid world.

Another, slightly different example is the Archive of Market and Social Research, which holds decades worth of studies on everything from vegetarianism to attitudes towards the environment.

The reports, usually from research agencies, can tell us an awful lot about attitudes at the time, but also the language and framing of such issues over time. This can help us understand how present day attitudes have formed and evolved.

3) Don’t be afraid to ask for help when re-purposing archived data

There is an increased focus within academia on creating and using archives (in part to encourage more responsible and ethical practice). However using archives is still relatively new to many researchers.

The idea of taking data someone else has collected and re-purposing it with an entirely different focus can seem daunting or uncomfortable. What if you interpret it completely differently, having not been in the room with the participant? What if the original research team object to having the data used in this way? What if access is denied?

The response from the speakers is clear. Ask!

Archivists are extremely knowledgeable. Most are happy to give free advice on applying for access, as ultimately they want people to engage with the collections they carefully curate.

Likewise, engaging with the original research team of a study is not only permitted, but recommended. This can only help you understand the archived data better.

Certainly there’s a balance to be struck on how involved they are with the new project, but ultimately most would be thrilled to have their data interpreted in a fresh new way.

Georgina Culliford is a research manager at Qa Research. You can contact her on georgina.culliford@qaresearch.co.uk or 01904 632 039

Photography: Age Barros on Unsplash

Like many destinations, York is struggling with its own popularity. Millions of tourists visit the small city every year, which can impact the environment and its infrastructure, and cause tension between residents and visitors. 

But does that have to be inevitable; or could a more sustainable model address these issues? One proposed solution is a tourist tax. In part one of this series, we found qualified support from York’s hospitality leaders; and part two found both locals and visitors that we interviewed supported the concept. 

It is, of course, one thing to back a policy in principle. But how could it work in the real world? And in a way that its benefits will last?  

Tourist taxes at work

1. Manchester

York could look to other cities which have already introduced a tourist tax for inspiration. In Manchester, hotels and short stay serviced apartments in the city centre above a certain rateable value are required to pay a levy, which they can reclaim by charging tourists £1 per room per night. 

There is a lot to be learned from how Manchester has structured its tourist tax. In most European destinations such a levy is collected by local government. In England, local authorities are not allowed by law to enact a tourist tax. 

So the private hotel sector has taken the lead, establishing the Accommodation Business Improvement District (ABID) to administer a tourist levy, with the support of Manchester and Salford City Councils.

Could this be a pathway for York to follow? 

The Manchester ABID has three areas for investment of the tax, with very clear aims:

• to create and amplify marketing campaigns that would drive overnight stays
• to secure large-scale events, conferences, and festivals in low-season months;
• and to improve guest welcome and street cleanliness to ensure that guests who do visit Manchester have the best possible experience and are encouraged to return.

As we have seen in our previous articles, how the money is spent is of crucial importance to all the stakeholders in York. The revenue from Manchester’s levy is spent on measures aiming to increase visitor numbers but also improve the look and feel of some of the city’s infrastructure.

2. Amsterdam

Amsterdam might prove to be a more relevant model when it comes to spending the tax revenue. A highly popular tourist destination, Amsterdam struggles with the number and type of tourists it attracts. Residents often complain about noisy and ill-behaved visitors.  

The revenue from its tourist tax is aimed at improving the quality of life of residents by dealing with the consequences of over-tourism. The funds are spent on green and recreational spaces, local community resources, conservation, and street cleaning. 

A tourist tax for York? 

With a fifth of York’s 8.9 million visitors staying overnight in the city every year, a small accommodation charge for overnight visitors could raise considerable funds. 

When we spoke to tourists and residents for our research, they felt that any revenue could be spent on dealing with the impacts of over-tourism, making the city a better place for residents to live and tourists to visit.  

Some of the suggestions of where to spend the money included:  

• street cleaning 
• planning to reduce overcrowding 
• more events for residents as well as tourists 
• and support for homeless people. 

Our research also found that people would be supportive of a tourist tax only if the revenue was spent transparently.  

Visitors and residents alike were concerned that the tax might end up subsidising the local authority, allowing the council to reduce its funding on maintenance and infrastructure.  

These insights demonstrate that – to ensure the widest possible support for the tourist tax and to enable the hospitality sector to come on board – the revenue may need to be ring-fenced for additional and visible improvements to the city. 

Our research suggests that the organisation set up to administer such a scheme would need to be explicit and open about its objectives. And it could attempt to be inclusive too. York hospitality leaders told us they want a body that brings together all the relevant stakeholders. 

Next steps 

Our research participants identified and understood the challenges created by over-tourism in York. And they could see that a tourist tax might have a role to play in tackling such issues. 

If York could build on that consensus and use it to shape an approach to the tourist tax which is also tailored to the city’s needs, then progress is possible. 

We will be sharing our research with stakeholders and policymakers. It is then for the wider city to consider what to do next.

But our insights do indicate that a future York, which thrives on sustainable tourism, with visitors and residents living together in something approaching harmony, is far from an impossibility.  

• Read part one here: Over-tourism: Is a tourist tax the answer?
• Read part two here: Over-tourism: What do residents and holidaymakers think of a tourist tax?

• For more information about Qa’s work in qualitative research, contact Richard Bryan, Managing Director, at richard.bryan@qaresearch.co.uk and 01904 6320394

We established in part one that over-tourism is causing challenges in destinations across the world, not least the friction generated between visitors and residents. We also examined the case for a tourist tax as a possible mechanism to address these issues. 

Meanwhile, hospitality leaders in our home city of York, while expressing concerns about the impact of such a tax, told us they were open to the idea – if tourism sector representatives were part of a collective approach to setting and spending the tax. 

But what about the other major stakeholders – visitors to York, and those who live in the city? Would they embrace or reject a tourist tax? The support of both would be crucial in its successful implementation. So we took to the city’s streets to get the views of both. 

The views of residents and tourists

The concern created by over-tourism was evident in our interviews with York residents. Typical comments included: 

• “For me it detracts from the town” 
• “The streets are very crowded. That can be annoying at times” 

Residents brought up a variety of concerns. These included overcrowding, the strain placed by tourism on local services, issues related to litter, and the prevalence of Airbnb properties making it even more expensive to buy or rent a home in York. 

Meanwhile, visitors we spoke to were overwhelmingly positive about the city and their tourism experience. They were also more positive about the cleanliness of York than the residents.

Strikingly, there was unanimous support from those we interviewed across both groups for the principle of a tourist tax. Visitor comments included: 

• “It’s OK, because the tax is used to keep the cities clean” 
• “Happy to pay it if that means keeping the place beautified and cleaned and welcoming to tourists” 

And one resident said a pound a night didn’t go far enough:  

• “I think they could up that to £5 a night” 

Critically, the implementation of a tourist tax would not deter the people we interviewed from visiting York: 

• “It wouldn’t affect my decision [to visit]” 
• “It wouldn’t put me off. I’d still come” 

While a tourism tax was welcomed in principle by those we researched, residents did raise questions about how and where the money would be spent.  

Our research made it clear that transparency would be crucial if a tourist tax was to be successful. Locals said they would wish to be kept informed about the purpose and progress of the tax – and, crucially, be able to observe its tangible impact on York. 

A consensus – now what?

Our purpose in embarking on this research was to gain insights that could help policymakers in popular visitor destinations make changes to boost sustainable tourism, which in turn supported residents and tourists to co-exist in greater harmony. 

Specifically, would a tourist tax help this to come about? 

We’ve now established that residents and tourists we spoke to could be in favour of the tax. And – with the right set up and commitment to where the money is invested – hospitality leaders in York might be ready to support the policy too. 

• In our third and final blog we discuss how a tourist tax could be implemented in York in such a way as to achieve these aims 
• Read part one here: Over-tourism: Is a tourist tax the answer?

Research methods 

• All participants took part in a semi-structured interview, using a discussion guide to prompt conversation 
• Interviews lasted up to 10 minutes 
• Participants ranged from local residents to visitors staying overnight in the city from the UK and overseas 

• For more information about Qa’s work in qualitative research, contact Richard Bryan, Managing Director, at richard.bryan@qaresearch.co.uk and 01904 6320394

Health inequalities are increasing in the UK. Yet, at the same time, local authorities are charged with ensuring their residents have healthier futures.

It’s a huge challenge. One tool councils use to help assess the full scale of that challenge is the Joint Strategic Needs Assessment. This research helps to identify the health characteristics of people in their area, as well as the community’s needs and priorities.

Qa Research regularly helps local authorities, health and social care organisations, to collate, collect, and analyse such information. Doing so, it can become all too easy to consider people’s health needs as problems to be addressed.

But what if we flip this on its head? What if we start by looking at the positives?

This is something we are increasingly working with organisations to achieve. Instead of focusing on what isn’t going so well we focus on what is going well – and how we can build on that to ultimately address the identified ‘need’.

Here’s an example.

For one local authority, we identified that breastfeeding rates in certain communities remain consistently low, despite ongoing efforts to address this. When it came to action-planning it was important to reframe how we thought about the issue.

Let’s not focus on those that do not breastfeed. Instead let’s focus on those that do.

In every community at least some mothers breastfeed. The important step is to learn about what enables and supports these women to breastfeed, and consider how this can be shared more widely in the community.

Championing communities

Ultimately, it’s about moving to asset-based approaches to public health (ie building on existing strengths). Nesta have produced this short film outlining asset-based approaches being taken by three local authority areas.

Looking at research findings through an asset-based lens can provide useful clues about how to encourage community ownership and engagement, as opposed to focusing on purely service-based responses, or simply ‘fixing what’s wrong’.

And this approach will only become more important as resources and public funding are increasingly stretched.

Let’s champion strength and potential in communities and build this into our research from the onset. We often find that research participants are interested in becoming more involved in services, in supporting their peers and tackling local issues head-on – if they are given the knowledge, capacity and support to do so.

It’s often that next step that’s missing. We may not always be able to ‘co-produce’ services in its truest form, but we can connect better, follow-through better. Let’s get more of those feedback loops in place. Let’s get organisations connected with the people they need to connect with, rather than just hear what they have to say via a third party.

Admittedly, this approach requires more resources. Such asset-based approaches need driving forward by organisations, and that takes investment.

However, when we focus on strengths, we find it becomes a virtuous circle. Mobilising interest and engagement motivates everyone involved, from the residents themselves through to the public and third sector workers who support them.

Top tips

Collaborate on the ‘what next’

Researchers want to know they’re making a difference with their work, that the voices of those consulted are truly being heard. With everyday access to online meetings it’s easier than ever to involve a wide-range of people in discussions about what the research means and how the findings are best taken forward. Involve the researchers!

Take those with lived experience with you!

How many times have you sat in meetings deliberating key research/evaluation findings looked around and there has been no one with lived experience in the room? Let’s involve those with LE more, and better, right through the research process. Let’s really show them their views and experiences matter, they are the experts and we need to value this.

Flip the ‘problem’

Instead of focusing on why people ‘don’t’ or ‘can’t’, look also at those who ‘do’ and ‘can’ – this might uncover something we could otherwise miss.

Becky Gulc is a research manager at Qa Research. You can contact her on becky.gulc@qaresearch.co.uk or 01904 632 039

How do you make research accessible? And by that, I mean really accessible – to the commissioning organisation, to service users, to all stakeholders?

Any professional piece of research will conclude with a detailed report, comprehensively setting out the work undertaken and the insights gained. But not everyone finds it easy to digest a dense and complex written publication. And those in busy, stressful jobs may struggle to set aside the time to read such a report.

So are there supplementary ways we can reach target audiences – perhaps using more engaging methods?

Happily, the answer is a resounding yes – which was confirmed to me at this year’s annual conference of the Social Research Association. For me, the theme of the virtual conference was creativity, with social researchers invited to display their most creative responses to a project in a research compendium.

We submitted an animation we had created to showcase some of the key insights we delivered for NHS Leeds, which has had an excellent response.

Elsewhere people had dreamed up some amazingly imaginative ways to present research, which I go into more detail about below. It seems the sector is buzzing with ideas of how to interact with organisations, audiences and stakeholders in fresh and engaging ways.

For some, these approaches may seem unconventional, and perhaps even a little daunting. But done well, they have the potential to put across key findings to a wide audience in a much more accessible way.

Here are three examples that really caught my eye.

1. Creative presentations

A number of truly creative ways to present data and insights were showcased at the conference. One that particularly intrigued me was a comic strip story, which chronicled how much difference a disabled people’s organisation made to its users.

Written by Dr Helen Kara and drawn by Julian Gray, it was a compelling way to present a case study of one person’s journey through various services. Just as importantly, for people working in the hard-pressed public sector, it is a relatively quick and actively enjoyable way to consume some very relevant insights.

It was based on findings from the Strengthening Voices, Realising Rights disability initiative set up by Trust for London – you can read more about that here.

2. Deliberative research

At Qa, we have undertaken deliberative research – which aims to involve the public in decision-making in a meaningful way – in the form of half-day qualitative consultations. But the project showcased here took this approach to a new level.

Sarah Castel from Involve presented about their work on the ‘Climate Assembly UK’, the first UK-wide citizens’ assembly on climate change. Commissioned by six Select Committees of the House of Commons, more than a hundred assembly members met over six weekends – a remarkable commitment.

Such long-form research empowered people to take on a huge and seemingly insurmountable subject like climate change, to debate it properly and to challenge each other’s views. Gradually they reached a point where the assembly was shaping solutions rather than just identifying the problems.

Moreover, because it allows people to draw on their lived experience and learn from others’ lived experience, the eventual answers will hopefully be both relevant and robust.

3. Peer research

At the conference we heard from Shelter about the value of peer research, from the peer researchers themselves.

The charity trained people with lived experience of homelessness to undertake research to design new services for homeless women. The success of this project shows how effective peer research can be, particularly around such a challenging and sensitive subject.

Having someone with lived experience changes the dynamic of an interview. It places the interviewees at the heart of the story, drawing out new insights. And there are benefits for the peer researcher too, in terms of gaining self-confidence and career skills.

These are just a handful of examples of the innovation taking place in the research sector right now. Challenging times have called for fresh thinking, and this can only benefit organisations and stakeholders as we go into an uncertain future.

Georgina Culliford is Senior Research Executive at Qa Research. You can contact her on georgina.culliford@qaresearch.co.uk or 01904 632 039

Photograph: Julian Gray art (artist) published in Helen Kara’s ‘Here to help you’ comic book 

We are living in an increasingly online world, and the pandemic has only accelerated that trend. So it is natural that many organisations are putting more time and resources into digital engagement.

However, this poses a risk. Recent research showed that Covid has intensified the digital divide. Around eight million people don’t have access to the internet, and of course it is the poorest who are hit the hardest by the widening information gap.

Many of the organisations that we have conducted customer insight or social research for have been pushing forward on digital engagement, and there are clear advantages to a more extensive online strategy. But we know from experience that a speedy switch to digitisation can leave behind some of the very customers and audiences they’re there to serve.

Here are a few things to consider before embarking on a digital-only engagement plan.

1. Understand your target audience

Who is your customer or service-user? Are they mostly tech savvy and comfortable accessing services online? In that case, starting a digital conversation might be the best approach. However, many of the companies and service providers we work with require feedback from audiences you might define as ‘hard to reach’ – and they are usually hard to reach digitally too.

2. Adjust your approach

The digitally excluded are not going to see the social media messaging shared by most organisations today. So how do you reach them? We worked with a utility provider who needed to gather insights into the most effective ways to encourage behaviour change among a particular customer group to improve the company’s environmental performance.

We drew up a careful and targeted plan to engage with them, using both telephone and face-to-face interviews. It proved crucial to generating real ‘this is how it is’ insight. Not everyone wants to or is able to speak to us over digital engagement platforms just because we can. Appropriateness and flexibility are key.

3. Go digital with the right people

On the flip side, we’ve found that some people are far more likely to engage in a consultation via digital channels. We’ve recorded notable successes in engaging younger audiences via health messaging and responding to calls for volunteers through social media. These same audiences did not always respond favourably to more traditional approaches, through phone calls for example.

4. Check-in after making changes

Even a well-intentioned plan to be inclusive can have unforeseen circumstances. One charity we worked with moved from a mainly printed newsletter to a mainly digital one. The idea was that those without emails could still request a paper version of the information, so everyone would be happy. But some of the service users who had no email addresses were unaware of the switch and so didn’t request paper versions. It meant messages were failing to get through to some of the key people they were aimed at, leaving them feeling disengaged. So before and after making changes to a communication strategy, check-in with the most vulnerable to ensure you take them with you.

Conclusion

Every communications strategy and consultation process should consider the needs of the digitally excluded and unconfident. After the rush to go online created by the pandemic, it is time to take another look at the needs of audiences and customer bases. Can you take them on the digital journey with you? If not, how do you keep them engaged? Put together a mixed and targeted plan of action, underscored with genuine consultation, and you can develop your online communication systems without leaving anyone behind.

Becky Gulc is a research manager at Qa Research. You can contact her on becky.gulc@qaresearch.co.uk or 01904 632 039

Photograph: Creative Christians on Unsplash

Covid-19 has thrown into sharp relief deep-rooted inequalities in UK health care. Vulnerable people and poorer communities have suffered disproportionately during the pandemic.

So Sir Michael Marmot’s 2010 landmark study of health inequalities has never been more relevant – as his 2020 post-Covid update makes clear. The Marmot Review proposes that healthcare resources are allocated on a ‘sliding scale’ based on deprivation and need; the greater need, the greater share of the pot. He coined this ‘proportionate universalism’.

But how to apply the principle to real policy, real people? The NHS and local authorities in Leeds recently launched an ambitious framework to do just that.

Before they introduced the plan, NHS Leeds CCG worked with us at Qa to answer a key question. How would the city’s residents react to the idea of the unequal distribution of healthcare resources?

We undertook a piece of research that provided qualitative insights on Leeds residents’ views.

Here are three key lessons I learned about how to communicate the strategy in a way that got the public on board.

1. Visualising a concept aids understanding

Free healthcare for all is the cornerstone of the NHS. So how to introduce the idea of equity in a system that prides itself on equality?

We used this cartoon to illustrate the differences between equality and equity; that people’s health does not start on a level playing field. Throughout the focus groups and interviews we held with the public, this proved a really effective way to get the concept across.

Most people were highly supportive:

• once they understood why equity and proportionate universalism were needed, and
• once they were assured that their own access to key NHS services would not be affected.

Lesson: Use images to communicate the reasons why a specific approach is needed, particularly when dealing with a concept which is not widely understood, like equity. Make efforts to reassure people that their own access to key services will be unaffected.

2. Each local area is different – get to know your people, postcodes and politics

Each city and neighbourhood comes with its own pockets of wealth and deprivation. In Leeds, some of the most affluent postcodes sit back-to-back with areas with the highest level of deprivation in the country.

Through open discussion with residents, we learned that pitching this strategy in terms of the wealthy areas subsidising the less well off areas could risk reinforcing local stereotypes and divisions. That could create an ‘us and them’ culture, rather than focus on a unified community effort.

Language was also important. While policy often refers to ‘deprived’ areas (based on the Index of Multiple Deprivation), labelling a community or postcode as deprived was alienating and insulting to people who live in these areas and take pride in their community.

Lesson: Talk to the people in your communities, so you get to know what language, divisions and stereotypes to avoid – and which to tap into for successful communications.

This project was presented at Social Research Association event on health inequality – watch above

3. Human stories can overcome ingrained attitudes

Most people backed the proposal to direct more health resources to those in greater need. However, some struggled to support the idea, saying it was wrong to give more to those ‘unwilling to help themselves’.

In other words, does everyone ‘deserve’ this extra help?

In reality, multiple complex factors contribute to any kind of inequality. Health outcomes are linked to housing, income, mental health and so much more. But this isn’t always easily understood by the general public.

Humanising the concept, by giving real life examples of people who live in the same town, allows others to empathise – and understand why the extra help is needed, and fully deserved.

Lesson: By telling real-life stories, local authorities can take an abstract and sometimes controversial concept like proportionate universalism, and show that it really is needed and can make a difference to real people’s lives, right in their home town.

These three lessons helped an ambitious strategy like the one in Leeds land positively when launched, by connecting authorities with their population’s views on health inequality.

Georgina Culliford is Senior Research Executive at Qa Research

Photograph (top): Tim Lumley on Unsplash

Photograph (bottom): Online Public Health.GWU

The UK is committed to becoming carbon neutral by 2050 – even signing the resolution into law. But if this is to come about, it will take a huge effort not just from the government but from all of us as individuals.

As part of my work with Qa, I have been researching people’s attitudes towards carbon efficiency. From what I’ve found, it is safe to say we have a long way to go to make that 2050 target attainable.

So here I set out three of the key challenges my work has identified; and then three potential ways we might start to generate behaviour change on the scale required.

The challenges

1. The perception gap

Working with focus groups representing a good cross-section of the British public, I have become aware of a perception gap.

First of all, while most people are aware that we need to do more to safeguard the planet, there is limited understanding of the meaning behind specific terms like carbon emissions, net zero, or carbon neutrality.

Secondly, most people already consider that they are behaving properly. The majority of respondents will say they recycle, turn the lights off when they leave a room, reuse plastic bags and buy some eco-products. But this barely skims the surface of what’s required – there is a gulf between people’s current ‘green’ behaviour and what experts say is needed to reach carbon neutrality.

Thirdly, 2050 seems a long way off. The impacts of individual behaviours on emissions are not felt immediately. That can make any discussions on the subject seem distant and abstract – even though action is needed now.

2. Change is confusing and difficult

We are now being bombarded by messages about how to live greener, and the differing impacts of all our actions on climate emissions. In isolation these can make sense but, taken together, can become overwhelming.

Even a single issue has its challenges. Many respondents like the idea of fitting solar panels, both to save money on energy bills and to help the planet. But there are many hoops to jump through, including: weighing up the financial outlay versus return on investment; choosing the right product and fitter; evaluating whether householders will stay in their property for long enough to reap the dividends, and so on.

3. Financial incentives can be viewed with suspicion

Some of the work I have been undertaking considers the impact of financial rewards and penalties on people’s potential take-up of energy efficient measures for their home or commercial property.

Our focus groups were given the environmental context behind the schemes – and the benefits to wider society. But many viewed even financial rewards through a prism of self-interest, asking questions like:

• will I benefit financially?
• will someone else benefit?
• will I have to pay more to subsidise energy-saving measures for other people?

Potential solutions

1. Persuade people they are part of the problem

Communication campaigns that attempt to nudge people to change their behaviour can have an effect. But that only goes so far.

To create the paradigm shift required, we need to make carbon-emitting behaviour socially unacceptable.

We can look at successful public health campaigns to give us a lead on this. A generation or two ago, drink driving was widely accepted, despite being against the law. But hard-hitting campaigns mean that today, a drink-driver is a social pariah. Could people who recklessly disregard their carbon footprint one day have a similar status in society?

2. Lead by example

By necessity, a lot of the messages urging us to adopt greener behaviours are delivered from ‘on high’ – via the government, council or corporation.

So, these institutions should take the lead. If a taxpayer is being asked to do more, and yet sees their town hall with all its lights left on at night, they will ask: ‘why should I?’ But if they see ministers cycling to meetings, rather than taking their ministerial car, then the message becomes: ‘we’re all in this together’.

3. Test and refine financial incentives

Our work investigating the efficacy of financial schemes to change behaviour has proved one thing: that there is no one-size-fits-all solution.

Here, I would suggest a three-part approach. Firstly, make any scheme as simple to take up as possible. Widespread recycling was only adopted when householders no longer had to traipse to a bottle bank, but could leave their waste for recycling on the doorstep for council collection.

Secondly, any scheme should be allied to an educational programme to make it known that everyone will benefit – not just those who directly save money. The aim would be to change attitudes from, ‘why should my neighbour get a discount on their electric car?’, to ‘it’s great that my neighbour has an electric car, which benefits the air I breathe and the planet as a whole’.

Thirdly, and perhaps most crucially, multiple different financial incentive schemes should be trialled, and each properly analysed for their effectiveness – with the results widely shared.

By learning as we go, we will be in a better position to design schemes that can be upscaled to help generate the behaviour change our planet needs to see.

Nick How is Research Director at Qa Research. You can contact him at nick.how@qaresearch.co.uk or on 01904 632 039

Photograph: Ulleo on Pixabay

Home First is a significant behaviour change programme. The ambition is to introduce a city-wide ethos where the emphasis across the health and social care system is to care for people at home whenever we can, or if they are admitted to hospital, get them back home again as soon as possible.

There are two reasons why we are establishing the Home First programme. The initiative forms part of a local and national drive to improve patient flow within the health and care system. That means ensuring that we have an efficient system so that a patient can leave hospital as soon as they are well enough, reducing the risk to them of secondary infections, while freeing up beds.

Allied to that is a revised approach to people with chronic health conditions. These include older patients who are frail and vulnerable to falls, as well as those with long-term illnesses. How can we care for them at home, or within the community, so they don’t need to be admitted to hospital?

We’ve always sought to reduce the time patients are in hospital, because we know an unnecessarily extended stay has an impact on their health. But the need to do this has become more pressing as, along with all parts of the NHS, we face significantly increased demand. And in 2018 both the Care Quality Commission and health consultants Newton Europe found that delayed patient discharge was an area that we needed to work on in Leeds, while acknowledging the strengths of our inter-agency relationships.

Better for patients

The project is at an early stage. We want it to be a solution co-produced with key stakeholders including patients and health and social care workers. As the communications lead, I know how important it is for us to both get the message right, and to communicate it to people at the right time.

Our approach in Leeds is to get people home as soon as possible or keeping people well at home so they don’t get admitted in the first place – not as a money saving exercise, but because it’s better for them. It mustn’t appear like some sort of health conveyor belt. This is very much a patient-centred approach, but looking at each individual and asking how they could stay at home for longer, wherever home might be.

Equally it is no use waiting for a patient to be admitted to hospital before adopting the Home First approach. We need to prepare the ground long before that so that the public are aware of our emphasis on efficient patient flows, and why that is important for their health and wellbeing. They need to be aware that in Leeds, we work to keep you at home for as long as possible, or to get you back home sooner.

There is some fantastic work already happening in Leeds. We have social workers supporting frontline hospital staff for example. But there are information gaps that can contribute to delayed discharge – a patient may be well enough to leave the ward but hospital staff are unsure where to send them for re-ablement support, for example.

Supporting staff

We need to introduce systems that support decision-making staff across the health and social care system. That joined-up approach is critical – for example, it might mean care home staff working more closely alongside GPs.

We began to develop Home First with an event which is helping us to shape the key messages, and identifying who the key influencers are who can help us deliver those messages to the wider Leeds public.

Qa Research had worked with us on previous occasions to identify issues and challenges within the health and social care system. And in this case their deliberative way of working was more suited to our needs than more traditional research routes.

This time we asked Qa to help us find out what people thought of the whole ethos of Home First – how do they feel about us encouraging people to stay at home for longer or go home sooner? What are their concerns about the approach? And what should be our key messages when communicating what the programme is all about?

Key insights

One key insight that emerged from that work was that some people thought Home First was a service rather than an approach. So now we have to think carefully about how we pitch it so people understand that it is a city-wide ethos and way of working, rather than a new service.

Home First is a change in the way we work to deliver health care and the expectation of people, both to the 850,000 residents in the Leeds area, and to the many patients who come into the area for treatment in our teaching hospitals trust, which is one of the largest in Europe. We will be developing the concept internally in the first half of 2020 before considering how we translate that into a public-facing campaign.

We have made excellent progress in our Home First plan. It will take time to develop a concerted effort across the health and care system and then translate that to our local population. But the rewards, in terms of better patient wellbeing, more efficient treatment and reduced pressure on staff, will be well worth the effort.

Shak Rafiq is Communications Manager at NHS Leeds CCG

Photograph: Healthcare Professionals on iStock

People aged between 40 and 74 can go for a free NHS Health Check, which aims to spot early signs of stroke, kidney disease, heart disease, type 2 diabetes and dementia.

Yet more than half of us who are invited for a check – 54% – do not take it up. Why is the take-up so low when we’re constantly being urged to lead more healthy lives?

Of course it can be challenging to get an appointment at GP surgeries. And to be fair, how many of us would take the time to make an appointment for an NHS Health Check if we’re feeling fine?

But the fact we lead busy lives should not be seen as a good enough reason to fail to look after ourselves.

Then there is the impact on the NHS to consider. Yes, it takes resources to carry out a health check. But the estimated cost of care for a person in the first 12 months after a stroke is £45,409. The cost of diabetes to the NHS in England and Wales is estimated to be £25,000 per minute.

So there’s a clear economic case for encouraging more people to access health checks and screening programmes, which can identify risks early and set in place preventative measures.

A different approach

So what if health screening is taken out of the GP surgery or health centre and into the community? At Qa we’ve been exploring this approach.

With one of our clients we’ve looked at two specific programmes: blood pressure and atrial fibrillation testing, done through community pharmacies and in the workplace.

Taking services out into the wider world is never going to be straightforward, and it won’t be appropriate for every type of health check. But the approach can and does work.

What we uncovered were specific factors which appear to be critical to success. Here are four of our key discoveries.

1. Skillset

You’re asking people to deliver community testing – but do they have the skills required? Not only the clinical expertise, but the soft skills too. The right approach is key. If you are looking to educate people on lifestyle matters, consider techniques such as motivational interviewing – will this be a new skill to learn? Are the right people being trained? Will they be required to work with new systems? What implications does this have?

2. Insight

Insight work is key, both prior to commissioning services and when contemplating the approach to working with particular employers. Consider the demographics: is the required reach practical for the community pharmacies who are interested? Troubleshoot challenges they may face.

For workplace consultations, what are the practical considerations – do people work shifts, how can they best be engaged? By troubleshooting beforehand you can identify and eliminate possible risks.

3. Buy-in

Buy-in – particularly in the case of employee testing – is a key driver of success. If an employer’s chief executive, HR department and seniors managers are enthused by, and committed to, the idea of making testing available to all employees a workable model can unfold. Understanding the merits of participation, both for the employer and employees, is key to instilling buy-in.

4. Existing commitments

Community pharmacies are keen to offer additional services and support people in their area but they face increasing funding and staffing pressures. So it is essential that the resources required for additional services are identified before the point of application, and that those commissioning the services agree to commit the appropriate budget.

Conclusion

Anyone thinking about taking screening services into the community should bear these findings in mind.

Community health screening can be done, and done well, and there is certainly appetite for driving such services forward, particularly through the community pharmacy model.

Meanwhile employers are placing a greater emphasis on the health and wellbeing of their employees. A relatively simple step, such as allowing health screening within work time, can appeal to managers as a way to demonstrate that they value the wellbeing of their staff.

However, to make any new scheme work requires planning, consultation and partnership.

Becky Gulc is a research manager at Qa Research. You can contact her on becky.gulc@qaresearch.co.uk or 01904 632 039

Photograph: Online Marketing on Unsplash

With its beautiful harbour, Gothic ruin and colourful history, Whitby is a wonderful place to visit. The town on the North Yorkshire coast has always been popular with families and we usually go a couple of times a year.

But on my latest visit I noticed something new. And it revealed a number of insights which tie in closely to the research work we undertake with UK tourism organisations.

Chinese tourism boom

What struck me was how many visitors from China were exploring the resort. There were scores of Chinese tourists taking in Whitby’s sights, sounds, food and drink.

This development certainly reflects a more general trend. VisitBritain is expecting 483,000 visits from China to the UK in 2019, up 43% on 2017.

And it is a trend likely to continue – research this year by TripAdvisor recorded an increase of 133% in Chinese travellers researching UK destinations between 2018 and the same period in 2019.

Interestingly, the Whitby visitors were mainly younger people, in their twenties, often in couples but without children.

This reflects a significant shift in the sector. As our research found, Chinese inbound tourism is now subdivided into distinct markets, including free independent travellers (FITs).

FITs have individual control over where they go and what they do, and are often affluent millennials.

Textbook attraction

One of the highlights of a trip to Whitby is the fish and chips. We called in to the famous Magpie restaurant for lunch – and many of the other tables were taken by Chinese visitors.

This may help to explain why so many had made the journey to the Yorkshire coast – after all it’s quite a diversion from more well-trodden tourist spots like London and Edinburgh.

Our research found that Chinese visitors want a uniquely British experience they can share with friends and family back home. And this is often tied to our culture, whether that means the royal family, famous fictional characters like Harry Potter, or food and drink.

Fish and chips is a must for many tourists from China, for two reasons. In 2015 Chinese president Xi Jinping famously tucked in to the national dish with then prime minister David Cameron.

And the meal is also an ever-present in the textbooks Chinese students use to learn English.

Any tourism destination hoping to increase its share of this lucrative market will benefit from finding a similar cross-cultural reference point.

Cash concerns

Clearly Whitby is doing something right to attract so many visitors from China. But I left with the nagging feeling that the town wasn’t maximising the opportunity.

During my trip I called in to a jewellers to buy a present for a family member made from the famous Whitby jet.

I was planning to pay with my phone, using Apple Pay – only to be told the shop didn’t take it.

This rang alarm bells. As VisitBritain puts it, “Mobile payments are becoming more and more popular in China, and travellers appreciate being able to use those abroad as well.”

I mentioned this to the shop assistant, who seemed unaware of the situation.

Chinese travellers are among the world’s biggest-spending tourists. This year they are forecast to spend £1 billion on UK high streets and leisure destinations.

And much of this buying spree is done via their mobiles, using one of two tech platforms – Alipay and WeChat Pay.

According to the Chinese digital marketing site DigiPanda, 60% of payments in the UK by Chinese tourists were via these mobile apps.

It was great to see a place like Whitby welcoming so many people from China, even on a chilly November day. For me, the town only needs to make a few modifications to its tourism offer, based on the insights our research into the market has revealed, to fully seize the opportunity on their doorstep.

Since writing this article we have seen China come in to focus due to the coronavirus and efforts at airports around the world to prevent it spreading. But let’s hope that the superb work undertaken by tourism organisations in the UK to welcome Chinese visitors is not too badly damaged and that before long the virus will contract and we can get back to business as usual.

Photograph: Postbyte on Pixabay

Taking part in sport and physical exercise brings a host of benefits. The UK government’s four primary outcomes for sports participation are all focused on the gains for individuals and wider society, with funding exclusively reserved for sporting projects that are able to deliver:

• Better physical health;
• Enhanced mental wellbeing;
• Improved ‘individual development’ (including self-confidence, esteem and personal resilience); and
• Increased social trust and community cohesion.

Increasing participation in physical exercise across society is seen by the government as a key way to reduce the incidence and severity of major health issues that exert ever-increasing pressure on our health and care services.

The Chief Medical Officers publish guidelines on the amount of exercise individuals should take in order to get maximum benefit. The recommendation currently stands at 150 minutes of moderate intensity activity per week for adults.

While 63% of UK adults are ‘active’ in accordance with these guidelines, Sport England’s latest research found this is true of only 45% of disabled adults, or adults with long-term health conditions.

Worse still, only 37% of adults with three or more impairments meet the guidelines.

Although a small increase in the number of disabled people meeting the criteria for being active has been observed over the last few years, no such increase has been seen for those with multiple health problems or conditions.

How do we get more disabled people to participate?

Clearly the barriers that disabled people face when it comes to taking part are different to those experienced by their non-disabled peers. These are not just logistical issues meaning that, for example, accessing sporting venues can be difficult for a wheelchair user. Barriers include a lack of suitable activity provision for people with physical, sensory, or other conditions, and likely a lack of opportunities local to them.

The cost of taking part may be a concern, given that the financial circumstances of disabled people are often complex. And psychological barriers exist, including concerns over finding people of a similar standard to play sport with, self-confidence, and concerns over the attitudes of others towards disabled people.

Further research is needed to fully understand the barriers faced by disabled people and those with long-term health conditions and impairments when it comes to participating in sport and physical recreation.

In this respect, disabled people should not be seen as one homogeneous group; after all, there are a myriad different disabilities and health conditions, and these are likely to present their own specific barriers and challenges.

OK, there are barriers. But what about the benefits?

A plethora of research data consistently demonstrates the physical health benefits of being active. There is increasing evidence, too, to suggest that mental health is positively influenced by taking the recommended level of exercise.

Active adults report a higher level of life satisfaction compared with those who take little or no exercise. They report being happier, too. These findings are no less true for disabled people or people with long-term health conditions.

Further, research undertaken by Tennis Foundation, now part of the Lawn Tennis Association, revealed that almost half of surveyed participants from their disability tennis programme felt less stressed and less frustrated since starting to play tennis.

However, some of the benefits of sports participation for disabled people may differ from the population as a whole.

This group often reports the importance of being able to ‘do things with friends and family’ and cites sport as being the factor that gets them out of the house. It would also seem that the social aspect of taking part with others is of particular importance for disabled people, as this allows them to make new friends and expand social circles.

More than for non-disabled people perhaps, taking part in exercise gives disabled people a sense of empowerment.

Opportunities for everyone

If the government is to fulfil its ambition of making sport and physical activity a key catalyst for social and health change, it needs to ensure that opportunities to get active, and stay active, are made available to anyone and everyone, irrespective of their gender, ethnicity, age, disability status, or any other factor.

More needs to be done to tailor these opportunities to individuals’ needs, making sure that participating is attractive, easy and fun.

As a nation we need to do more to get these opportunities right – removing any barriers and offering the benefits that people seek. This is especially true for those with impairments or disabilities.

Ben Thatcher is a research manager at Qa Research. You can contact him on ben.thatcher@qaresearch.co.uk or 01904 632 039

Photography: Audi Nissen on Unsplash

But such enduring popularity has not left the city complacent. Tourism organisations recognise that the sector is more competitive than ever with travellers constantly on the lookout for new and different experiences.

So Bath has been exploring how the latest technology can add value to its visitor experience. The city was at the heart of a pioneering 5G Smart Tourism trial – using the most cutting-edge technology out there. And that followed a project which encouraged families to explore the city via an augmented reality (AR) app.

At Qa Research, we have been working with key players in the tourism industry to investigate the challenges and benefits of using AR and VR (virtual reality). So we were eager to learn more about the lessons Bath has learned from its immersive initiatives.

Rebecca Clay, Heritage Marketing Manager for Bath and North East Somerset Council (The Roman Baths, Fashion Museum, Victoria Art Gallery, Bath Film Office and Bath Record Office) shared some invaluable insights with us.

The 5G trial

The 5G Smart Tourism trial, overseen by the West of England Combined Authority and funded by the Department for Digital, Culture, Media & Sport, brought together 25 organisations to explore the potential of this futuristic technology.

As part of the scheme an app was developed that told the story of three periods in the Roman Baths history. When you moved your phone around key spots in the museum, the past came to life with 360º video overlaid on the scene in front of you – complete with the mythical King Bladud’s pigs.

It was a significant undertaking, which saw special technology installed once the baths had closed over two nights in December 2018, and removed again before they reopened.

Among those working on the project were the University of Bristol’s Smart Internet Lab and BBC Research & Development. Specially invited guests tried the new app.

“It worked really well – it was super smooth,” Rebecca said. “It was very much done on a test basis to see what the future technology might be able to deliver. It was lovely to see families engaging with the content and each other around the stories.

“The content was so real that when the app was pointed at the roof and you began to see it crumble people actually ducked!”

The potential – and the challenges

The Roman Baths with Bath Abbey behind. Photograph: Colin Hawkins / visitbath.co.uk

The experiment revealed the “amazing” potential of 5G – there’s no way you could stream such rich video content over the 4G network.

But because the Roman Baths attracts 1.2 million visitors a year, it would be impossible to run something like this as part of the main attraction without bringing it to a standstill, Rebecca said. Given the uneven nature of the ancient Roman pavements visitors walk on, immersive devices would present a high risk

This was a technology that required “a nice empty space” she said – citing the experience at Nottingham Castle where visitors can use AR to watch it go up in flames. In the case of the Roman Baths, it would have to be confined to specific events and not form part of the everyday visitor experience.

“And it would probably be something supplementary to an event: you might have storytelling with an AR or VR imagining of what the storyteller was saying,” she said.

“Because the experiences are just over too quickly. And I think people might get quite fatigued by them if you tried to create an event around VR or AR entirely.”

You also have to consider how much this tech adds to what’s already there: “From an experiential point of view, the magic of the Great Bath at the Roman Baths is the Great Bath itself. You don’t want to detract from that and VR can be quite an alienating experience.”

Making it commercially viable was another challenge. “The content that the BBC and Aardman created for us was so incredible – I can’t even think about the amount of money that would have cost us. We couldn’t have done it without the funding.”

The dragons’ egg trail

The year before the 5G trial, Bath and North East Somerset’s Heritage Services commissioned an AR app tied in with the Here Be Dragons exhibition at the Victoria Art Gallery.

Families would use the app to collect virtual 3D dragons’ eggs from various locations – a Pokemon Go-style challenge that was designed to encourage people to explore beyond the congested summertime city centre.

“That was a really great project. It was something we could talk to families about who were in the queue for the Roman Baths,” Rebecca said.

“It worked really well for us and was downloaded over 2500 times! And we found families doing it together as a shared experience which was really important for us. When you make it more of a trail – and the Forestry Commission are the best example of this with their Gruffalo Trail – it’s very much a family activity.”

Collaboration is key

The app helped make Here Be Dragons the second-most successful in the gallery’s history.

There was a drawback – and again this was cost. They had hoped they could ‘re-skin’ the app for a reasonable outlay, and turn the dragons’ eggs into Roman coins for a February half term promotion the following year.

But that was almost as expensive as the creation of the original app, and so the plan was changed to use QR codes instead.

Collaboration is key if tourism destinations are going to make the most of these immersive technologies, Rebecca believes.

“Talk to your universities. We’re really lucky we are surrounded by top quality Universities including the University of the West of England with whizzy business schools and technology departments.”

“Working with students is great, because they’re the ones who you might want to target  to consume it. They know what’s going to work and what’s not going to work for them.”

Back in 2017, the Stevenson Farmer review revealed the scale of the mental health at work problem in the UK.

One in six British workers are affected by mental health problems like anxiety, depression and stress every year – and 300,000 people with a long-term mental health problem lose their jobs each year.

This is very significant for all those affected. They have to rebuild their lives and seek ‘good work’ – the sort of role that would not lead to a recurrence of their ill health.

For older workers, aged 50 and above, the situation is exacerbated by a general increased difficulty in finding employment. For many, a period of mental health related work absence can lead to leaving the labour market altogether.

Social prescribing

We have recently been involved in an evaluation of a social prescribing pilot which aimed to support people aged 50-plus who were struggling with their mental health at work or were already off work on a fit note.

People seeing their GPs to discuss their fit note or low level mental health issues were referred to an adviser, based at the GP surgery. The adviser would then work with them using a holistic coaching approach to help them to return to work, stay at work with adjustments, support discussions with their employer, or in some cases, help them to plan a positive exit from their job.

GPs struggle to find the time to help in 10-minute appointments. Photograph: Free-Photos / Pixabay

The project significantly exceeded its original referral targets – revealing a very real demand for this type of approach. It also succeeded in meeting its aims – 70% of those supported were still employed at the end of the pilot.

The elements of success

So what was it about this approach that worked? We identified five key elements to success:

1. Proximity. Having a presence in the GP surgery was an advantage – people were in the right mind-set to seek support and there was no opportunity to put this off. As a result, virtually all referrals took up the support.
2. Time. As much as they might want to help, GPs are limited to appointments of ten minutes. The adviser offered one hour appointments over a number of weeks. People valued the time to talk and this was therapeutic in itself.
3. Independence. Speaking to someone outside of work and family was helpful in enabling people to gain a fresh perspective on their circumstances.
4. The focus on strengths. Helping people to see and use their own assets was an integral part of the process. For many, building up lost self-confidence was the first step towards a solution.
5. Flexibility. The support provided was not ‘off the shelf’ but a bespoke plan co-developed in response to each individual’s situation.

Finally, as one participant said:

“It has been tough but I have gradually regained self-confidence… [The project] has enabled me to steady the ship… and stop me giving it up altogether.”

Kay Silversides is a research manager at Qa Research. You can contact her on kay.silversides@qaresearch.co.uk or 01904 632 039

Recent media reports have highlighted how much missed GP appointments cost the NHS – the princely sum of £216m a year, which could pay for 2,325 full-time GPs.

The price paid for DNAs (‘do not attends’) is quite an eye-opener and clearly of concern. But this also raises a lot of questions, including why does this happen? And exactly who are the patients who are not turning up?

We know from our own research on behalf of Clinical Commissioning Groups (CCGs) that the reasons for DNAs are varied.

Patients most likely to miss appointments on a serial basis have high levels of social and health vulnerability

One key cause is the difficulty in cancelling appointments, particularly if you are relying on getting through on the phone to your GP surgery.

We hear frequently about the problems people face getting through to their surgery to make an appointment in the first place – who wants to go through that again to cancel?

Many areas have already implemented text options to make it easier to cancel an appointment. And the NHS Long Term Plan includes a raft of digital initiatives to make interacting with health services as convenient as online grocery shopping. With any luck, this will go some way to resolving this issue for the majority.

Vulnerable patients

However, a slightly knottier problem is what to do about the repeat or serial DNA-ers. A study led by the University of Glasgow and published in the Lancet identified that non-attendance rates in primary care are partly driven by a significant number of patients missing multiple appointments.

Nearly 20% of patients did not attend more than two appointments in the three-year study period.

Crucially, this research also found that the patients who are most likely to be missing appointments on a serial basis have high levels of social and health vulnerability, including long term mental health conditions . So, those that need healthcare the most are the most likely not to attend.

Clearly, this issue goes beyond the face value cost to the NHS and plays a role in perpetuating health inequalities.

Working together

The Long Term Plan talks about the approach to reducing health inequalities, including the need for local health systems to have a detailed understanding of the local population. This is no easy task and must delve deeper than an overview of deprivation stats.

As the Glasgow study also showed, socioeconomically deprived patients were also more likely to miss multiple appointments if they were registered in GP practices located in affluent urban areas, so to some extent blanket approaches to addressing health inequalities in typically deprived locations may not be enough.

Although addressing the issue of serial DNAs is only one issue amongst many in a local population, the renewed emphasis on collaboration and integration provides a real opportunity for partners to work together to harness the power of this data to target and engage with a potentially very vulnerable, hidden, local population.

Kay Silversides is a research manager at Qa Research. You can contact her on kay.silversides@qaresearch.co.uk or 01904 632 039

Photograph: rawpixel on Unsplash

The relationship between people and the NHS needs to change. Reduced spending on social care in conjunction with an ageing (and growing) population, poor lifestyle choices and staff shortages means that pressures on the NHS are greater than ever.

NHS figures have shown high increases in the number of people waiting at least a week to see a GP in recent years.

This is set in the context of millions of missed appointments each year. As many as one in four GP appointments could be defined as needless. These are cases where people didn’t need to see a health professional, could have managed with self-care, social prescribing or been treated by another professional such as a nurse or pharmacist.

Research commissioned by NHS England also shows that around a fifth of GP workload might be better handled by someone other than the GP.

Active signposting

One of the ideas for freeing up GP time and working towards increased efficiency in the system relates to active signposting, one of 10 High Impact Actions (HIAs) aimed at responding to challenges identified within the General Practice Forward View.

The idea is patient’s first point of contact would direct them to the most appropriate source of help, whilst often this will be to a GP this won’t always be the case.

Qa Research have been supporting CCGs to consult with members of the public about these HIAs. What we’ve learned so far is that people understand the rationale for active signposting and are in favour of it. They can see that this could potentially improve efficiency, reduce waiting times and result in cost savings from making better use of GP time.

Despite this the extent to which people back this shift is very much conditional on signposting being done correctly. There are fears and concerns amongst the public which will be challenging to overcome.

Patients’ concerns

There are concerns regarding the responsibility this places on reception staff to navigate people to the right service. The risk of ‘getting it wrong’ is considered too great for some.

There are fears of delays in diagnosis, misdiagnosis, and hidden needs not being unpicked (e.g. physical symptoms masking mental health issues).

“Would receptionists really be trained to know?”

A key concern is that vulnerable people, particularly the elderly, could fall through the net, downplaying symptoms and then perhaps not being signposted to a GP when they are the most in need.

“Possibly could miss bigger and more serious symptoms such as cancer and heart disease”

This fear and mistrust is set in the context of GP’s being seen as the ultimate ‘professional’ that people trust to diagnose. It’s also set in the context of the negative connotations some people hold of practice receptionists: obstructive, terse, cold.

“Who decides who sees the professionals?”

“People often feel judged by receptionists. People need to feel comfortable talking about their conditions with a receptionist.”

Are these the right people to navigate people to the right professional or service? There’s a question mark over this for many people – in particular in terms of their skills and knowledge and how people feel about answering questions about their ailments to these members of staff.

Two key considerations

So how can CCG’s combat these fears when they develop active signposting? Here are some considerations based on our research:

1. Labels matter. Does the title ‘receptionist’ convey trust, access, knowledge? Think about alternatives whilst being true to the skillsets people have. Some alternative suggestions we’ve had include: Patient Liaison/Support; Health Assistant.
2. Be transparent. First contact staff will undoubtedly receive training on how to navigate people to the right service/professional but it is perhaps key that the public are made aware of this training and that this shift towards signposting is happening. They need reassurance that signposting is a considered exercise with input behind the scenes from all levels of staff, a process which is regularly evaluated in practices.

“Educate public to make them aware of the system so they understand why receptionists might ask. Market on TV, radio, online. Make them aware it’ll save time and be quicker.”

Becky Gulc is a research manager at Qa Research. You can contact her on becky.gulc@qaresearch.co.uk or 01904 632 039

Photograph: Marcelohpsoares on Pixabay

Water is considered good value by most consumers. Research shows that this is especially true when they stop to work out how much they pay per week, and realise the service they get for their money.

And householders generally compare the water bill favourably to the cost of other utilities.

Even so there are pertinent questions now being asked over who should pay for some of the water companies’ biggest outlays.

The fatberg nightmare

Ahead of the recent PR19 submissions water companies consulted customers on many issues, including their willingness to pay for different levels of performance commitments.

However these studies did not consider the bigger question of who should be paying for the costs currently being passed onto all bill-payers.

As the water sector comes under intense political scrutiny over its profits and investments, perhaps now is the time to look at that question more closely.

One of the biggest – and most expensive – challenges facing water companies is the build up of fat in the sewers.

So-called fatbergs are proliferating, and the cost of removing them is put at £88m per year. Thames Water alone estimate the annual cost at £12m. And it is the customer who pays, through their water bill.

These ‘bergs’ are predominately made up of fats from restaurants, takeaways and domestic homes. They are bound together by wet wipes and similar products, which many people misguidedly believe to be safe to flush down the toilet.

But the real cost of two major fatberg culprits – fast food outlets and wet wipes – is not borne by the businesses involved. They don’t pay extra to the water companies to clear up the mess they help create, nor do they pass on the cost to their customers, who instead get a cheaper product devoid of its full environmental cost.

Instead the cost is placed entirely onto the water companies – and ultimately paid by everyone in higher water bills, regardless of their own behaviour.

Prevention better than cure

Reactive solutions – such as sending teams down into the sewers to dig out the fatbergs – are expensive and an ongoing cost.

They do nothing to reduce the problem at the source. If anything, this work absolves others from the need to address the issue and take responsibility for their actions – including the companies causing so much of the problem.

Every water company is trying to educate their commercial and domestic customers, promoting good behaviour with marketing messages on what we should and shouldn’t pour down the drain or flush down the toilet.

But is this enough? Should we consider more persuasive ways to prevent fatbergs, rather than waiting to deal with the horrible consequences?

The Irish solution

Should the fast food producers be held more responsible? Photograph: Pixabay

Perhaps the Irish model offers an effective and lasting solution.

In 2008 Dublin City Council introduced a licence and inspection scheme for food outlets, centred on their disposal of fat, oil and grease. This has reduced sewer blockages from 1,000 to 50 a year.

The city’s last major fatberg blockage was more than five years ago.

Contrast Dublin’s experience with London – a recent survey showed 90% of eateries in the capital do not have effective grease traps.

Shouldn’t food outlets without such grease traps bear the cost of removing ‘bergs’ in their neighbourhoods?

Shouldn’t manufacturers of wet wipes and similar non-biodegradable products which are routinely flushed down the toilet contribute to the damage this causes?

It is time for a more radical nationwide approach to preventing this problem at source. By making those responsible pay for the cost of their behaviour, we can keep the system flowing while reducing the financial burden on water companies and their customers.

Nick How is a research director at Qa. Contact him at nick.how@qaresearch.co.uk or on 01904 632039

Photograph (top): Images Money on Flickr

Photograph (bottom): Hans on Pixabay

In 2003/4, members of the Health Complexity Group based at the University of Exeter began designing a learning programme that would become Connecting Communities [C2].

The principles informing the design of the programme drew from primary empirical research on transformative processes of change that took place in a number of communities in the South-West of England.

They were informed by an understanding of the underlying dynamics of change processes derived from complexity theory.

Two key challenges

There were two key challenges that we faced in thinking about the design of C2:

1. Standard interventions didn’t work
Our research showed that standard interventions in our most economically disadvantaged communities made little or no difference to the lived reality of residents – and frequently made things worse.

Our intuition was that many of these interventions were designed by “experts” with little or no informed knowledge of the local communities for which they were designed.

Often the aim of the interventions would be to carry on doing what was already being done – but to do it “better”, that is more efficiently, or at greater scale. We wanted to design a programme that worked to create conditions locally that enabled residents, but in particular, service providers, to “do things differently”.

2. Can a local initiative work elsewhere?
We had seen how dramatic processes of change could occur in communities. The next step was to find out whether there were principles of working that allowed these processes to be translated to other communities.

Local conditions are never replicated from neighbourhood to neighbourhood – so does this mean that what works in one community cannot be translated to another?

Exploring new possibilities

We drew a fundamental insight from complexity theory. When communities are understood as complex “systems”, it is the relations between the members of the system that are decisive in determining its behaviours.

So our aim with C2 was to bring participants in the programme to a point where they would be able to explore new relationships, or change the nature of existing ones.

The first group to undertake C2 were a Neighbourhood Police Team, led by Sgt David Aynsley, based in Camborne, in West Cornwall.

At that time, youth anti-social behaviour, often fuelled by drug- and alcohol-dependence, had become a chronic problem in the town.

David’s story is below.

Remarkable outcomes

The outcomes that have followed from the TR14ers have been striking. So far 1,500 young people have taken part in the workshops – up to 60 people aged five to 24 each week.

As a result:

• educational attainment has increased
• truancy has reduced
• antisocial behaviour is down
• and there’s been a reduction in smoking.

The TR14ers are now peer-led and self-organising. They have been awarded the Queen’s Award for Voluntary Service and the TR14ers Community Dance Charity is supported by BBC Children in Need for the next three years.

They are using this funding to reach out to other youth groups from low-income communities, to develop qualifications around leadership and participation, and to develop nutrition skills.

But it is the way that the young people talk about the impact of the TR14ers on their own lives that is most telling:

As soon as you get in here, you’ve got that buzz, and you just want to keep going and going, so it’s really good … I love it … This is the best thing that’s ever happened in Camborne.

Before, I wouldn’t even speak to a police officer at all, but some of them, they just have you in stitches. You get to know them, not personally, but kind of personally … you can sit down and talk to them, and see how they are.

There was nothing, honestly, nothing to do in Camborne, well, apart from go around town. I love it here, it’s not even in words how much you can say how much I love it.

Interview from BBC Radio Cornwall

Dr Robin Durie is Senior Lecturer in politics at the University of Exeter

This blog by Kay Silversides launches the first in a range of topics we will be covering about preventative healthcare strategies – where it is needed, what has worked, what can work better will all be covered.

We start by revealing insights into preventative healthcare measures being taken to address the challenge of poor mental health amongst children and young people.

Young people’s mental health has been constantly in the news in recent years.

Worrying stories about the increasing numbers of children and teenagers struggling with anxiety, depression, self-harm, eating disorders and more have seen the issue rise to the top of the social and political agenda.

At Qa Research, we’ve been working on a project to gather the views of parents and pupils on preventative health information and advice. And this, too, has revealed a mental health gap.

We found that students and their parents were exposed to a considerable amount of information and advice on healthy eating and exercise, including within schools.

However, they told us there was a lack of reliable information and support around emotional health and wellbeing. And that was a particular problem in secondary schools, when mental health issues among young people increased.

“Society is so much more different to back when they [teachers] were younger. It was so easy, but now – you need to look nice, you need to have a good body, you need to do this – everything’s just stressing you.”
Secondary pupil

Emotional wellbeing

Research by Action for Children has found that 850,000 children have mental health problems in the UK.

Nationally that’s one in ten children. But almost three in ten of the children that the charity works with in a targeted way have emotional or mental health needs. And this peaks at almost half for 14 year olds.

Diagnosed mental illness is one thing. But there is also an urgent need to consider the day-to-day emotional health of children and young people. According to the Children’s Society young people’s happiness is at its lowest since 2010.

So where to start? Clearly, the role of the family is fundamental when it comes to supporting young people in their emotional development.

Sadly though, for some children this is where the problems begin.

School would be another obvious choice for informing and educating. However our research found that the relationship between academic achievement and emotional wellbeing is being overlooked – despite plenty of evidence demonstrating that happy minds learn better.

“School should the one place you can come and be happy…Kids don’t hate their education. They quite like their education – I like learning. They hate the environment – the way kids treat other kids, the way teachers treat kids”

Preventative programmes

This finding should not be seen as a criticism of hard-pressed teachers. But it is important to examine why many schools respond to negative behaviour – but not the causes. And why they often seem ill-equipped to help children and young people develop emotional resilience.

We identified two key reasons:

1. a lack of recognition of the importance of emotional learning within the achievement / results driven framework
2. the lack of a statutory standardised personal, social, health and economic (PSHE) curriculum which adequately covers emotional wellbeing and provides a toolbox of practical advice.

“We’ve got a few posters on the stairs and that’s about it.”
Secondary pupil

Parents in our research recognised the issues at stake and wished to see extended, positive examples of preventative programmes, such as stress-buster training, anger management and CBT-style thinking skills programmes.

They could see their children struggling with a range of issues but did not always feel equipped to help. As many parents know, sometimes they are the last people their children want to talk to about all that messy embarrassing stuff.

From our discussions with young people, we found that they did want to talk, face to face, with a real person. Online resources and chat sites were useful but didn’t hit the mark for everyone.

Also problematic for young people was identifying yourself as someone who was receiving help…

“It is like the walk of shame. It needs to be more open, not seen as such a bad thing. If you’re upset that should be something that’s seen as totally normal.

“If a friend or family can’t help you out, you should be able to walk into someone’s office and be able to speak to them. I have done it, people have seen you… the next thing you know you have got half your year group asking you about how you feel, why you have gone there”
Secondary pupil

What can be done?

As much as society is trying to destigmatise discussions on mental health with campaigns like ‘Time to Talk’ we aren’t there yet. So what can be done?

The solution would see the topic of mental wellbeing firmly embedded within schools and making it accessible to all – perhaps by standardising and making PSHE sessions statutory.

Organisations such as the PSHE Association have made a strong case for this. Other voices have gone one step further by calling for the introduction of a ‘wellbeing’ GCSE.

Now moves are underway to bring mental health into the school curriculum. The government announced in July that health education will be a mandatory part of the curriculum for all primary and secondary schools from autumn 2020.

As part of that, children will be taught how to build mental resilience and recognise when their peers are struggling with mental health issues.

Critics say this is taking too long. But it looks to be a very welcome step in the right direction.

One thing is certain. There needs to be a clear recognition that we need more than a ‘few posters on the stairs’ to help children and young people understand and look after their mental wellbeing.

For more information about the study contact research manager Kay Silversides at kay.silversides@qaresearch.co.uk or 01904 632 039

Photograph (top): Freestocks on Unsplash

Photograph (middle): Pxhere 

Photograph (bottom): Andrew Neel on Unsplash

Unsurprisingly his appearance garnered a lot of media attention. And photographs of Sir David wearing virtual reality goggles in order to feed an imaginary dinosaur went around the world.

Like many similar organisations, the York Museums Trust has decided to embrace this newest of technologies. But is this always the right thing to do?

What we did

Little research had been done to uncover the advantages – and pitfalls – of visitor attractions using VR and augmented reality (AR). So Landor Travel Publications, publisher of Group Travel Organiser Magazine Magazine and organiser of the Future Tourism conference, commissioned Qa Research to find out the sector’s experience of, and approach to, this brave new high-tech world.

We interviewed in depth many different kinds of attraction up and down the UK. Some had used this technology, and some hadn’t. We presented our findings first at Landor’s Future Tourism conference. And I would like to summarise them for you here.

Before going any further, this is how the attractions define each term:

• virtual reality: experiencing a real situation using virtual means, typically accessed via a headset
• augmented reality: blends reality and virtually created enhancements – accessed via a device, typically a smartphone.

Why offer VR and AR (and why not)?

There were a number of key reasons why attractions might want to use VR and AR.

First, they offer a wow factor. And the technology allows you to tell a story in a uniquely immersive way. It is recognised as being at the cutting edge of visitor experience provision, and so adds value to customers. And it can provide an additional revenue stream.

With so many positive boxes ticked, why wouldn’t you add VR and AR to the mix? Well it turns out there are several very valid reasons for thinking twice.

The tech can be the ‘wrong fit’ for somewhere aiming to offer a more ‘real’ experience.

As one of our interviewees told us:

“We offer an escape from digital & digital addictions… particularly for our family audiences.”

There’s no doubt VR can be disruptive, splitting up family groups and taking them of into their own worlds. Similarly it can create visitor conflict, as it may not appeal to all of the attraction’s segments.

Then there are the potential practical drawbacks. Investment in this area is expensive against unknown returns. You can suffer from technical problems – limited digital connectivity can cause major headaches – while the low take-up of some AR apps is another reason to question if the investment is worth it.

The positives – and the challenges

Those attractions that have used VR found that it made a trip more memorable, and so boosted visitor satisfaction rates. Another positive: the headsets can be used anywhere – they are not tethered to one site. That makes them more flexible than group simulators.

Some of the more practical considerations included the difficulty in knowing how many headsets are enough, the need for technical support to fix breakdowns – and the fact that some visitors can’t use them due to motion sickness.

“It enables you to offer something way beyond the ordinary”
Qa interviewee

Augmented reality, meanwhile, was thought to create a sense of fun and wonder by augmenting a visitor’s imagination. It can bring static exhibits to life before your eyes and enables the creation of new exhibit sets without major infrastructure changes.

Drawbacks of this technology included detracting from the authenticity of an attraction’s proposition, the limited connectivity in some areas, and the fact that some visitors’ phones may not have the available storage space availability to cope with another app.

Six things to consider

So if you are curious about using VR and AR, I’ll leave you with these thoughts to ponder…

• Think hard about the fit – is it really right for your attraction?
• Will it suit all your visitors, or do you need an alternative for the non-adopters?
• Have you the digital connectivity strength and speed to make it work?
• How many VR headsets will you need? Too few and there will be queues and frustration
• Don’t skimp on the investment – it will be obvious to visitors
• And if you are charging, make sure it delivers the wow factor!

For more information about the study contact Richard Bryan, Managing Director at richard.bryan@qaresearch.co.uk and 01904 632039

Photograph: Danny Lawson PA Images / Alamy Stock Photo