National survey shows some improvements in people’s hospital experiences but highlights concerns around discharge and inequalities for those with mental health conditions
The majority of people who stayed as an inpatient in hospital were happy with the care they received, had confidence in the doctors and nurses treating them and had a better overall experience, according to a national survey from the Care Quality Commission (CQC).
However, survey respondents were less positive about arrangements and information received when leaving hospital, and those with a mental health condition reported a poorer than average experience across most question areas, repeating a trend found in previous patient surveys.
Published today (Wednesday 13 June) the results of the 2017 inpatient survey, involving every NHS acute trust in the country, reveal what over 70,000 adults who had stayed in hospital for at least one night during July last year said about the care they received.
The survey asked people to give their opinions on the care they received, including quality of information and communication with staff, whether they were given enough privacy, the amount of support given to help them eat and drink and assist with personal hygiene, and on their discharge arrangements.
The responses to the 2017 survey show a number of improvements over time particularly in relation to patient’s interactions with hospital staff. In 2017, the majority (82%) thought they were ‘always’ treated with respect and dignity, (compared to 78% in 2009) and more people said they ‘always’ had confidence in the nurses treating them (78% in 2017 compared to 77% in 2016 and 72% in 2009).
However, younger patients (aged 16-35), those with dementia or Alzheimer’s disease and those with a mental health condition reported having less confidence and trust in the staff caring for them.
Over two thirds of those surveyed (69%) felt that nurses ‘definitely’ answered important questions in a way they could understand, up from 68% in 2016 (64% in 2009), and of those patients who had an operation while in hospital, 62% said they were ‘completely’ told how they could expect to feel after the procedure, compared to 58% in 2016 (55% in 2009).
Although half of respondents rated their overall experience while in hospital as nine or above out of 10, an increase of 2% since 2016, feedback in relation to discharge arrangements and information about care after leaving hospital remained one of the weakest aspects of patient experience.
Less than two-thirds (62%) of patients surveyed left hospital with written information telling them how to look after themselves after discharge, a decrease of 5% since 2009, and 43% of patients who were given medication to take home were not told of the possible side effects (44% in 2016).
While 54% felt that they were ‘definitely’ involved in decisions about their discharge from hospital, this still leaves 46% who did not feel ‘fully’ involved. Also, 41% of those surveyed said that their discharge was delayed, representing no change from last year. Around one in four (24%) of these people were delayed for longer than four hours and the majority of total delays were a result of waiting for medication (72%).
Patients feedback regarding the amount of emotional support they received while in hospital remains unchanged from previous years with almost two fifths (38%) of people surveyed saying they ‘definitely’ had someone to talk to about their worries and fears during their hospital stay. However, over a quarter (27%) felt they had no-one, an increase of 2% since 2016. In particular, younger patients (aged 16-35) reported feeling less supported emotionally compared with other age groups.
For a second year running, responses were less positive across most areas for patients with a mental health condition. Those with mental health conditions said they had less confidence and trust in hospital staff, thought they were treated with less respect and dignity and felt less informed about their care. These patients gave lower than average scores in relation to whether their needs, values and preferences were fully considered, and for the quality of the coordination and integration of their care. This repeats a trend found in the results of CQC’s 2017 surveys of children and young people and patients using A&E.
As well as a report of the national findings, CQC has published the results for each of the 148 individual trusts that took part, and a report identifying those trusts that have performed better or worse across the survey overall, so that people can see how their local services performed.
Professor Ted Baker, Chief Inspector of Hospitals said: “It is encouraging that the results show some areas of improvement with experiences of information provision, quality of communication and the level of confidence in doctors and nurses all performing better than in previous years. This positive feedback regarding interaction with staff is a testament to the efforts of healthcare professionals working tirelessly to provide high quality care to those that need it.
“However, scope for further improvement remains, particularly in relation to how patients are involved and informed in their discharge arrangements and the level of emotional support offered to patients during their hospital stay.
“This year’s survey results also show a continued disparity between the experiences of people with a mental health condition and those without. This is an area which hospitals must address to ensure that that people with physical and mental health conditions are treated equally in acute settings.
“I would like NHS trusts to reflect on their individual survey results to understand what their patients really think about the care and treatment they provide. This will help them to identify what they need to change to drive further improvements in the quality of care for everyone.”
Paul Farmer, Chief Executive of Mind, the mental health charity, said: “It is concerning that people with mental health problems consistently report worse experiences of acute care than those without. Those working in and commissioning services need to use these results to look at how care can be improved to address this inequality.
“Our physical and mental health are closely connected. Having a mental health problem can make it harder to look after your physical health, while the side effects of medication can also take their toll. Conversely, living with a long-term physical health problem can affect your mental wellbeing and lead to problems like depression. It is vital that those working in acute hospitals have enough understanding of mental health problems so that they can provide holistic care. We also know, and this is picked up in the findings, that much more needs to be done to coordinate and integrate the healthcare received by people with mental health problems. This principle is the basis of several recommendations in the Five Year Forward View and underlines why this plan is so important; services need to improve so that, regardless of your mental health background, you get the quality of care that you need.”
The survey findings have been shared with providers to review their individual results and take steps to address any areas where improvements are needed. CQC will continue to use the findings as part of its wider monitoring of the quality of hospital services and to plan and target its inspections.
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