Patient’s experience of acute care takes a turn for the worse: will the NHS Long Term Plan correct the course?
The 2018 Adult Inpatient Survey received over 76,000 responses from recent patients. Feedback was given on all areas of care from admission to discharge for 144 NHS acute hospitals. The results of the survey indicate an urgent need for action on person centred care. In most areas of care, patient’s experiences have become worse in the last year. Tiffany Gooden, the project lead at Picker discusses the areas of concern and how they relate to the new strategic NHS Long Term Plan.
The aim of the recent NHS Long Term Plan is to bring more personalised, quick, and effective care to patients. If successful, the plan will reduce readmissions and pressure on staff and improve the quality of care. So what have patients said about the current situation?
The new strategy sets out a plan to strengthen patient choice for anyone still waiting for an appointment after six months. However, the 2018 results show that the vast majority of patients were not offered this choice at referral. Only 26% of patients were offered a choice of hospital, down from 27% last year. Also down is the proportion of patients that were ‘definitely’ involved in the decision made about their care and treatment – 56% said this compared to 54% in 2017. This shows that although policy has changed, the impact has been minimal.
With an ageing population and an increase in people with long-term conditions, the need for an effective integrated care system becomes increasingly important. An ambitious plan to improve integrated care systems has been described in the NHS Long Term Plan, including the creation of a new ‘integration index’ and system-wide objectives. To be effective, healthcare professionals must help patients to find the right services for their needs. In the last year, one in five (20%) of patients said that hospital staff did not discuss further social and health care services with them before leaving hospital. This is the highest since the question was introduced in 2012.
A new question added in the 2018 survey tells us that 81% of patients received the support and care they expected after discharge – one in five didn’t. Over the next five years, post-operative care will be expected to be delivered within two days of referral. If recovery support becomes faster as planned, we should expect the results to this question to improve.
Smooth and quick transitions from hospital have also been worse this last year. More patients were not given enough notice of their discharge (15% from 14% in 2017). Of the 41% of patients that had a delayed discharge, 26% of them had a delay longer than 4 hours. This has increased from 24% in 2017. Reducing unnecessary delay is imperative for the health and wellbeing of the patient. The NHS Long Term Plan sets out a strategy to have a care plan for patients with 14 hours of admission – but in many cases, 14 hours may be too soon to give an accurate discharge date.
The NHS Long Term Plan emphasises the need to increase the NHS workforce and provide better support to current employees. The results of the 2018 survey is indicative of this issue. Patients have reported worse experience of hospital staff involving them in decisions, providing them with clear and written information, supporting them physically and mentally, and treating them with respect and dignity. Particularly concerning is the drop in clear and printed information provided to patients about their medications – 66% said they ‘completely’ received this, the lowest it’s been since 2010. And just over half of patients (53%) said they ‘always’ received enough emotional support from hospital staff during their stay (the lowest since 2012).
The 2018 results are disappointing and invoke a great deal of concern for the NHS, an already pressured health system. Worsening experiences around post-discharge care are particularly concerning from this perspective, as poor coordination and support after people leave hospital is only likely to increase unplanned readmissions and to put more pressure on all sectors of health and social care. So will the roll out of the NHS Long Term Plan help with this declining patient satisfaction of acute care and treatment? Only time will tell – but we’ll be keeping a close eye on future survey results to see if this year’s declines can be arrested.