11 August 2016
Nora Cooke O'Dowd

Nora Cooke O'Dowd

Research Analyst
QualityWatch

This month our indicator updates mostly relate to data from the NHS Adult Inpatient Survey. The survey, which runs annually, records the perceptions of a sample of patients aged 16 and over who stayed overnight at an NHS hospital in one of 150 NHS Trusts in England during July 2015. It covers a range of topics related to the quality of patient care including communication with medical professionals, standards of cleanliness and involvement in decisions about their care and treatment. Older data from the Outpatient Survey, which was discontinued in 2011, is reported to allow comparison.

We also invited Jane Mordue, Interim Chair of Healthwatch England, to comment on these data. She has written a blog for us sharing soe of her reflections.  

How did patients rate the care they received?

People rated the overall care experience positively. Since 2012, inpatients have been asked to rate their overall care experience on a zero to 10 scale (0 being a poor experience and 10 a very good experience). In 2012 and 2013, 87% of inpatients rated their care with a score of six or above, increasing to 89% in 2014 and 2015. Forty nine per cent of respondents gave the highest rankings (either a 9 or 10 rating) in 2014 and 2015.

Cleanliness in acute settings

The proportion of patients who felt that the hospital room or ward they were in was "very clean" has been increasing over the past 10 years, from 53% in 2006, to 71% in 2015. In 2015, 98% of respondents said their room or ward was "fairly" or "very" clean.

Similarly, there was a sizable increase in the proportion of patients who reported that the toilets and bathrooms they used in hospital were clean: in 2015, 64% of respondents said the toilets were very clean compared to 48% in 2006. Over the same time, the proportion of patients reporting the toilets and bathrooms as not at all clean decreased from 3% to 1% of respondents.

Dignity and respect in acute settings

In 2015, 84% of patients reported they had always felt they were treated with respect and dignity during their stay in hospital, which has been consistent since 2005. The percentage of inpatients who felt they were not treated with dignity and respect during their hospital stay remained constant at 3% after 2005, and fell to 2% in 2015.

The proportion of inpatients who always felt they were given enough privacy when being examined or treated increased from 88% in 2005 to 91% in 2015. In A&E, however, the proportion of inpatients who felt they had definitely been given enough privacy when being examined or treated decreased from 81% in 2005 to a low of 75% in 2010, though it subsequently increased to 79% in 2015. On average, people treated in A&E gave scores 21% lower than those not treated in A&E. Each year, 2% of respondents said they did not receive enough privacy.

The Operating Framework for the NHS in England 2012/13 highlighted that mixed-sex accommodation (MSA) should continue to be reduced to ensure that people have a positive experience of care. The rate of MSA breaches has been decreasing over time and has remained very low, below one per 1,000 finished consultant episodes, since July 2011.

In 2015, 97% of patients did not feel threatened during their stay in hospital by other patients or visitors. This has remained constant since 2007.

Do people feel involved in decisions about their care?

The proportion of people who definitely felt they had been involved in decisions about their care and treatment has increased from 53% in 2005 to 60% in 2015. The proportion who felt they had not been involved decreased slightly to 9% in 2015 from 11% ten years previous. There has been little variation in how much information respondents felt they were given about their condition. The majority of respondents (80%) felt they received the right amount of information about their condition or treatment and this did not change significantly from 2005 to 2014. 77% of respondents in A&E felt they had received the right amount of information, up from 74% in 2006.

Over this period, one-fifth of inpatients felt they did not receive enough information and 1% felt they received too much. Again, the picture looks different in A&E, where 9% of respondents in 2015 said they were not given any information about their treatment or condition, although this has decreased from 12% in 2005.

Clinicians ignoring patients

The proportion of patients responding that members of staff talked in front of them as if they were not there has decreased overall for both staff doctors and nurses between 2005 and 2015. Having been broadly constant for six years, the proportion of patients who felt ignored began to decrease from 2011/12 when the proportion for nurses dropped from 22% to 19%, and from 27% to 24% for doctors. This stayed constant for three years and dropped further to 18% for nurses and 22% for doctors in 2015, with an increased sample size. Despite this recent improvement, there remains a proportion of patients who felt that staff talked about them as if they were not there. There is thus potentially still scope for improvement in this area of patient experience.

Cancelled operations

A large proportion of inpatients reported that they didn't have their admission date changed, and this has remained between 79% and 80% of respondents since 2005. In 2015, 17% reported that they had their appointment date changed once and 4% reported it had changed two or three times. In any year, a small 0.3% reported their appointment time had changed four times or more.

Post-discharge information

A substantial proportion (41% in 2015) of inpatient survey participants said that they were not told about medication side effects to watch for once they went home. There was a statistically significant increase between 2010 (37%) and 2014 (39%), although no significant change was seen in 2015.

There has been a statistically significant increase in the proportion of respondents who were told about danger signals to watch for after discharge from hospital. The proportion who felt they were completely informed increased from 39% in 2005 to 44% in 2014, where it remained in 2015. One-fifth were informed to some extent, whilst 35% were not warned about the danger signals at all.

There was a statistically significant increase in the proportion of respondents who were told by staff who to contact if they had any worries about their condition or treatment after discharge. This increased from 76% in 2005 to 78% in 2014, where it remained in 2015.


Next month we will be reporting on updates to indicators relating to GP patient experience.

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