Most patients are positive about their hospital care, but discharge delays and access to support once home remain a concern – particularly for the frail

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 felt their fundamental needs were met, 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 access to support and further services once at home. This was a particular concern for people who self-reported as being frail.

Published today (Thursday 2 July), the results of the 2019 adult inpatient survey, involving 143 NHS acute trusts in England, reveal what almost 77,000 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 survey has been conducted annually since 2004. In 2019, new analysis was undertaken to better understand how supported frail patients felt after leaving hospital.

The 2019 survey findings show:

• Most respondents (81%) felt they had “always” been treated with dignity and respect during their hospital stay (80% in 2018) and 90% said they were “always” given enough privacy when being examined (unchanged since 2018, but up from 87% in 2010).
• Of those who had an operation while in hospital, 80% said that staff answered their questions in a way they could understand “completely”. This remains unchanged since 2018 but is an increase of five per cent since 2010, showing gradual improvement over time.
• More than three-quarters of those surveyed (79%) said they “always” had confidence and trust in the doctors treating them (unchanged since 2018).
• Responses to questions about cleanliness, choice of food and hydration were overwhelmingly positive. Ninety-seven per cent said their hospital room or ward was “‘very clean” or “fairly clean”; 79% said they were “always” given a choice of food and; 93% said they were given enough to drink.
• For patients with a planned admission to hospital, more experienced a change to their scheduled admission date (21% in 2019 compared to 20% in 2018). A fifth (21%) reported that their admission date had been changed by the hospital at least once, and 5% reported two or three changes.
• Of those surveyed, the proportion who said they had to wait a long time before getting a bed has increased since last year (39% in 2018, up to 42% in 2019).
• Over half of respondents (59%) said they were “always” able to get help from staff in a reasonable amount of time, leaving a large proportion (41%) who were either sometimes able to get help (33%) or not able to get help at all (8%).
• Just over a third of patients surveyed (40%) left hospital without printed or written information telling them what they should do or not do after discharge (unchanged since 2018 but up from 33% in 2013). And, of those who were given medication to take home, 44% were not told about the possible side effects to watch out for.
• Of the 41% of people who said that their discharge from hospital was delayed, 89% waited longer than one hour, and over a quarter (26%) said they were delayed for longer than four hours.
• In 2019, 80% of those surveyed said they had discussions with staff about the need for further health and social care services after they had been discharged. However, only 70% of frail people reported having had such discussions.
• In addition, a third of frail people (33%) responding to the survey said the care and support they expected was not available when they needed it after leaving hospital. This is significantly higher than the 20% of non-frail patients who said this.

As well as a report of the national findings, CQC has published the results for each of the 143 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 and their overall experience as an inpatient - reflecting the significant efforts of healthcare professionals working tirelessly to provide care in hospitals across the country. However, I am disappointed to see some people describing a poorer experience in accessing inpatient services in the first place, and further problems when leaving hospital.

“This year’s results indicate that people are facing longer discharge delays and reveal continued concerns around the quality of information provided when they are ready to return home. It is particularly worrying that for people who self-report as being frail, the difficulties in accessing support after leaving hospital were even greater.

“The recent Covid-19 crisis has highlighted in very stark terms the interdependency of health and social care. While this survey was carried out before the pandemic spread to the UK, the results provide further evidence for the need for greater collaboration and demonstrate that where services are not integrated, this can have a detrimental impact on how people experience care.

“NHS trusts should reflect on their own survey results to help identify what individual changes they can make to drive improvements, but there is also a wider need for all parts of the health and care system to come together to support staff in managing the gradual return of more routine inpatient services alongside continued Covid-19 demand, 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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