Inpatient experience during the coronavirus (COVID-19) pandemic

Summary of findings

The impact of the coronavirus (COVID-19) pandemic has been, and continues to be, profound. The virus has had a huge impact on the delivery of NHS care, with providers and staff having to adapt services at speed and under huge pressure, while ensuring hospitals remain a safe environment for patients and staff.

This survey asked patients to tell us about their hospital stay during the peak of the pandemic. Before this, there had been no systematic study of how patients felt about the care they received during this period.

The survey received feedback from 10,336 people who had received inpatient care in an NHS hospital and were discharged between 1 April and 31 May 2020, while the UK was in national lockdown. The unadjusted response rate was 42%. All data was collected between 14 August and 9 September 2020.

The report shows that people’s experiences of inpatient care were generally positive. Overall, most patients (83%) said they felt safe from the risk of catching COVID-19 in hospital. However, people diagnosed with the disease while in hospital felt less safe than patients who did not receive a COVID-19 diagnosis (68% and 84% respectively).

Patients with a COVID-19 diagnosis reported consistently poorer experiences than people who did not have the virus. The greatest differences were during discharge and knowing what would happen next with their care after leaving hospital.

Certain groups of patients consistently reported poorer experiences of care. Generally, people with dementia or Alzheimer’s, people with a mental health condition, and people with a neurological condition reported poorer experiences of most aspects of inpatient care. In addition, people who had an emergency admission reported more negative experiences, compared with patients who had a planned admission.

Like the annual adult inpatient survey, younger people (aged below 55) reported a more negative experience. Older patients (aged 75+) were more positive, except in relation to receiving information about their care and treatment in A&E or in terms of their involvement in decisions about their care or leaving hospital. These older patients also might have felt more isolated due to restrictions on visitors as they were more likely to say they were unable to keep in touch with family and friends during their stay.

Person-centred care

Overall, feedback on person-centred care was positive. The majority of patients said they were involved ‘a great deal’ or ‘a fair amount’ in decisions made about their care and treatment, as well as in decisions made about their discharge (77% and 73% respectively). Patients were similarly positive about the emotional support that they received from staff during their stay (70% said they ‘always’ had enough).

Information given about care and treatment, either while in A&E (for those admitted through that route), or during their stay in hospital, was also usually rated highly (71% and 77% respectively said they had the ‘right amount’). In addition, most people said they ‘always’ had confidence and trust in the staff treating them (83%).

However, COVID-19 patients were consistently less positive than people without a COVID-19 diagnosis on all measures of person-centred care.

• Survey results around person-centred care

Meeting patients’ fundamental needs

Patients reported that their fundamental needs were largely met, with most patients saying they got enough to drink while in hospital (92% said ‘yes’). Results relating to medicines were slightly less positive; 80% said they were ‘always’ able to take their own medicines when needed, and patients with COVID-19 were less likely to say this was the case.

• Survey results around meeting patients' fundamental needs

Infection prevention and control

Patients who were in hospital during the pandemic reported high levels of cleanliness; 80% said that their room or ward was very clean. Most also remembered seeing a range of infection control measures, including staff wearing personal protective equipment (PPE), handwashing, provision of waste bins, and cleaning of surfaces. Fewer people remembered seeing social distancing measures such as markers on the floor or signage at the entrance.

While this visible presence of measures reassured most people, a minority of patients were concerned about catching COVID-19 during their inpatient stay (83% said they felt ‘safe’ and 8% said they did not). These patients, who did not feel ‘safe’, were consistently less likely to remember seeing any infection control measures in their hospital room or ward.

• Survey results around infection prevention and control

Staff and communications

Overall, patients reported feeling positive about communicating with staff during their stay. For example, 77% said they were ‘always’ able to get attention from staff when they needed it. However, 24% said they were ‘never’ able to understand the information that staff gave them, and 27% said that this information was ‘sometimes’ or ‘often’ contradictory. A further 27% said that they could ‘sometimes’ or ‘never’ understand staff when they were talking when they were wearing PPE. Certain groups of patients found communicating with staff who were wearing PPE especially difficult. People aged 85 and over were less likely to always understand what they were being told, as were people with dementia or Alzheimer’s, patients who were deaf or hard of hearing, autistic people and those with a learning disability.

While most patients were able to keep in touch with their family and friends during the pandemic (75% said they were ‘often’ able to do this), 13% said they did not receive the help they needed to do so. Older patients, aged 75+, were less likely to say they were ‘often’ able to keep in touch with family and friends. In addition, patients with a sensory impairment, including people who were blind or deaf, as well as people with a learning disability, a mental health condition or neurological condition were also less likely to feel they were able to keep in touch ‘often’.

• Survey results around staff and communication

Patient discharge from hospital

Results show that people’s experiences of discharge were less positive than other aspects of their stay in hospital. Patients with COVID-19 reported poorer experiences on all measures. For example, patients with a COVID-19 diagnosis were more likely to say their home situation was not taken into account when leaving hospital (19% compared with 15% of patients who did not have the virus). Similarly, 32% with COVID-19 said they were not told who to contact should they become worried about their care or treatment after leaving hospital (compared with 24% for patients who did not have the virus) and 29% said they did not receive the post-discharge care and support they needed (25% non-COVID).

• Survey results around discharge from hospital

Overall experience

Reflecting the positive results across all areas of patient experience above, people were generally positive about their overall experience of adult inpatient services during the first wave of the pandemic. For example, 86% reported that they were ‘always’ treated with respect and dignity while in hospital, and when asked to provide a score for their overall experience from ‘0 – I had a very poor experience’ to ‘10 – I had a very good experience’, 86% gave a score of seven or above and just 7% rated their experience between 0 and 4.

• Survey results around patients' overall experience