Has nine years of patient feedback helped improve their experience? Part 2 of 2
The NHS adult inpatient survey, developed by Picker, is one of the largest and longest running collections of patient experience information anywhere in the world. Each year, 1,250 people recently treated by each of England’s 151 NHS hospital providers are invited to share their experiences of the care they received. With the 2018 survey due for publication this week, Tiffany Gooden looks back at evidence on person centred care from the last nine years of the survey.
Clear information, communication and support for self-care
Communication is at the heart of people’s interactions with healthcare professionals, and research shows that effective communication is both valued by patients and associated with better treatment outcomes. The NHS inpatient survey captures the quality of communication and information for patients from a number of questions.
The proportion of patients that said doctors and nurses ‘always’ gave them answers to their questions in a way they could understand was increasing as of last year: In 2009, 65% said this about doctors and 64% said this about nurses. By 2017, this increased to 68% and 69%, respectively. However, the proportion of patients that said different members of staff did not say anything conflicting fell slightly following a peak of 67% in 2015 – it declined to 66% for 2016 and 2017.
Between 2009 and 2017, the majority of inpatients (60% average) had an operation or procedure during their stay. In that time, the quality of communication around operations or procedures has improved. In 2017, 81% said members of staff completely answered their questions about the operation or procedure in a way they could understand – an increase from 75% in 2009. Similarly, the proportion of patients that said they were told how they could expect to feel after the operation or procedure increased from 55% to 62% over the 9 year period. Sixty-nine percent of patients in 2017 stated that members of staff completely explained how the operation or procedure had gone, another increase from 2009 when 64% said this.
There’s been consistent subpar findings over the years for members of staff ‘completely’ explaining the purpose of medications to the patient (74% average) and ‘definitely’ telling them how to take their medication (75% average). Patients being ‘completely’ provided with clear, printed information about their medication was increasing until 2015 but the trend stopped with an average of 70% that have said this between 2015 and 2017. Particularly concerning is the consistently low proportion of patients that have stated they were completely told about medication side effects to watch out for after leaving hospital – 36% in 2009 increased to a peak of 39% in 2015 only to drop down to 38% in 2016 and 2017. This is worrying as research shows that failing to inform patients about potential side effects is associated with a significant increase in risk of post-hospital drug adverse events, which can in turn lead to avoidable readmissions and harm to patients.
Attention to physical and environmental needs
It is important that patients are able to rest and relax in a positive environment to help them concentrate on getting better. Though, the proportion of patients that have not been bothered by noise at night from other patients was consistent aside from a peak in 2015 (60%) whereas patients that said the same about hospital staff was consistent until a peak in 2017 (80%). Patients that stated that the hospital room or ward they were in was ‘very clean’ has steadily increased from 63% in 2009 to 70% in 2017. These figures are still unacceptably low.
Just more than half of patients consistently stated that they ‘always’ got enough help from staff to eat their meals (63% average). With a slightly higher consistent proportion, patients that stated that hospital staff ‘definitely’ did everything they could to help control their pain was on average 68%. However, this means that approximately one in three patients felt staff could have done more to control their pain.
Ensuring patients have their physical and environmental needs adhered to during their inpatient stay and after discharge is extremely vital for a patient’s safety and wellbeing. Unfortunately, this is not happening for far too many patients.
A low proportion of patients stated that hospital staff ‘completely’ took their family and home situation into account when planning their discharge (59% average since 2012). Further to this, one in five patients, on average from 2012, have not had hospital staff discuss with them whether they would need any additional equipment in their home or any adaptations made to their home after leaving hospital.
Effective treatment delivered by trusted professionals
At the lowest point, 77% of patients in 2014 said they always had confidence and trust in the doctors treating them. Since then, an upward trend was seen, with an increase to 80% in 2017 (also the highest over the nine-year period). There was a more stable positive trend over the nine years in the proportion of patients that said they always had confidence and trust in the nurses treating them – 72% in 2009 increasing to 78% in 2017.
Whilst patients’ reports about their experiences with doctors have changed relatively little over the last nine years, the improvements around nursing have been encouraging. These appear to have followed the Francis Inquiry into Mid Staffs, suggesting that a policy focus on improving compassionate care may have been effective.
Involvement of, and support for, family and carers
A new question was introduced in 2017 that asked patients whether doctors or nurses gave their family, friends or carers all the information needed to help care for them. Whilst there is no trend data to report on for this question, it is hoped that this will show an increase over the years ahead. Just under half (49%) said ‘yes, definitely’ to this question in 2017. We know that family and carers looking after patients can lead to feelings of social isolation, stress and anxiety. Therefore, it is imperative that health care professionals do better in this area, ensuring to provide as much help and support to family and carers as the patients themselves.
What to look for in the upcoming 2018 results
This two-part blog series has provided a review of trends in person centred care in NHS acute settings over the last nine years. With the publication of the 2018 results we will be able to identify whether trends have continued, and which areas of care have still not changed, marking a decade of stagnation.
A particular challenge this year will be whether improvements around experiences with doctors and nurses can be maintained in the face of pressures on staff: the NHS Staff Survey 2018 highlighted an increase in the proportion of staff experiencing work related stress, and research shows that staff wellbeing is a leading indicator of patient experience. Recent policy releases including the NHS Long Term Plan and the Interim NHS People Plan have a parallel focus on these issues as priorities: the 2018 inpatient survey results will set the scene and shine a light on the areas that need attention.