Confidence and trust in hospital staff high but overall improvements in people’s inpatient experience have stalled

Findings from the Care Quality Commissions (CQC’s) latest annual survey of people who stayed as an inpatient in hospital, published today (Thursday 20 June), show that most people had confidence in the doctors and nurses treating them and felt that staff answered their questions clearly.

However, across the majority of questions asked in the survey there has been no improvement since it was last carried out, and this year’s results show an increase in those reporting lengthy delays, greater dissatisfaction with the amount of information provided when leaving hospital, and those who felt a lack of involvement in their care.

Less than half of people surveyed (48%) rated their overall hospital inpatient experience as ‘nine or above’ out of ten which is down from 50% in 2017 and marks an end to the trend of year on year improvement previously seen for this question. 

The results of the 2018 inpatient survey, involving 144 NHS acute trusts in England, reveal what over 75,000 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 on their discharge arrangements.

The responses to the 2018 survey show:

• Most respondents (80%) felt they had “always” been treated with dignity and respect during their hospital stay (82% in 2017) and only 2% said they were not given enough privacy when being examined (unchanged since 2017).
• Of those who had an operation while in hospital, 80% said that staff answered their questions in a way they could understand “completely”. While this remains high, it has dropped slightly from 81% who said this in 2017.  
• More than two thirds of those surveyed (69%) said they “always” had confidence in the decisions made about their condition or treatment, a decrease from 71% in 2017.
• Just over a third (40%) of patients surveyed left hospital without written information telling them how to look after themselves after discharge (up from 38% in 2017), and of those who were given medication to take home, 44% were not told about the possible side effects to watch out for.
• Only 15% of respondents said that they had been asked to give their views on the quality of care received during their stay, compared to 20% in 2017, and around half (54%) felt they were definitely involved as much as they wanted to be in decisions about their care and treatment, down from 56% in 2017.
• Of those surveyed, 39% said they had to wait a long time before getting a bed (16% “definitely”, and 23 % “to some extent”). The proportion of those satisfied with the time they had to wait has decreased since last year (63% in 2017, down to 61% in 2018).
• Of the 41% of people who said that their discharge from hospital was delayed, over a quarter (26%) said they were delayed for longer than four hours. This is up from 24% in 2017.
• In 2018, fewer people said they had discussions with staff about the need for further health and social care services after they had been discharged (80% in 2018, compared to 81% in 2017). And, almost a quarter (24%) said they did not get enough support from health and social care professionals to manage their condition once they were back at home.

The responses to the 2018 survey show that patients admitted as an emergency reported a particularly poor experience of receiving information. Nine per cent said they had not been given “any” information about their condition and treatment while in A&E (8% in 2017) and 17% said they had not been given “enough” information 15% in 2017). In addition, responses were less positive across many question areas for younger patients (under 50-years old) and for those with a mental health condition.

As well as a report of the national findings, CQC has published the results for each of the 144 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:

“Most people continue to report positively about their interaction with staff, reflecting the significant efforts of healthcare professionals working tirelessly to meet increasing levels of demand in hospitals across the country.

“However, I am disappointed to see the overall lack of progress this year and that in some cases people are reporting poorer experiences, particularly around the quality of information when they were discharged and the integration of their care from different parts of the system. Last year’s survey showed a healthcare system still delivering improvements despite growing pressure. But this year, the improvement trend we have seen for the past six years has not been sustained.

“Staff are working incredibly hard, but it is clear we have reached a point where this alone is not enough. The mounting pressure on the system is having a direct impact on how people are experiencing inpatient care and the need for greater collaboration between local health and care services has never been more apparent.”

“I would like NHS trusts to reflect on their individual survey results to help them identify what individual changes they can make to help drive improvements, but there is a wider need for all parts of the health and care system to come together to support staff to manage the increased need for services and ensure the best quality of care for everyone.”

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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