NIHR Signal: Communication problems are top of patients’ concerns about hospital care

National Institute for Health Research | April 2019 | Communication problems are top of patients’ concerns about hospital care

A study that provides insight into patient concerns, trained volunteers to ask inpatients about their care aimed to find out what proportion of patients had concerns about their care. The researchers used this data to categorise and understand their concerns, and to assess whether these concerns were in line with the types of patient safety incidents identified by clinicians. 

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The surveys identified:

  • The biggest category of concern (21.7%) was communication, either from staff to patient, staff to staff, or patient to staff. Examples included confusion about when patients were due for surgery, with resulting uncertainty about when they could eat, and unnecessary missed meals. One in ten patients raised a safety concern of some kind.
  • Almost a quarter (23%) of patients surveyed raised an incident of concern, with a total of 1,155 incidents provided by 579 patients.
  • Staff shortage issues accounted for 13.2% of concerns. The ward environment was a concern for 12.2% of people, with noise and accessibility cited as examples. Other concerns included a perceived lack of compassion, dignity and respect for patients; medication issues including late, missed or wrong medication; delays in treatment, results or discharge; staff training, food and drink and ward management.
  • The assessing doctors said 406 of the 1,155 incidents reported (35%) qualified as patient safety incidents. They were most likely to identify medication issues as a safety issue, and least likely to flag up concerns about the ward environment. Although communication was the single biggest concern for patients, cited in 251 reports, only 54 of these (21.5%) were seen as patient safety issues by doctors.
  • Of identified patient safety reports, the doctors said 90% were probably or definitely avoidable. They also said 99% were of ‘negligible, minor or moderate’ severity. Only one incident identified by patients was categorised as of major severity.

The NIHR signal is available in full from NIHR 

Home to the unknown: getting hospital discharge right

This research explored patients’ unplanned stays in hospital and what it was like for them after they had returned home | British Red Cross

The research sought to reveal: patients’ experiences of being discharged from hospital; hospital systems and healthcare professionals’ experiences and perceptions of the discharge process; and what it was like for people returning home from hospital feeling more or less prepared.

As a result, it aimed to explore the impact of discharge on recovery and wellbeing and to identify opportunities to improve systems, communication and support.

Based on the experience of the British Red Cross and the research, the report argues:

  1. There is a substantial opportunity for commissioners and providers to harness the power of non-clinical support, including the voluntary and community sector (VCS), to relieve the pressure on the NHS and to create better outcomes for people and improved patient flow within and between health and social care providers.
  2. Every point of hand-off between clinical teams in hospital and from the hospital to the community is a potential point of success or failure for patient recovery. The report recommends that there is a clinical responsibility to ensure the effective management of these transitions, so that there is continuity of care and patients don’t fall through the gaps between teams.
  3. The report recommends that a five part ‘independence check’ should be completed as part of an improved approach to patient discharge – prior to discharge or within 72 hours of going home. This would help to inform the setting of a realistic discharge date and would include assessing:
  • Practical independence (for example, suitable home environment and adaptations)
  • Social independence (for example, risk of loneliness and social isolation, if they have meaningful connections and support networks)
  • Psychological independence (for example, how they are feeling about going home, dealing with stress associated with injury)
  • Physical independence (for example, washing, getting dressed, making tea) and mobility (for example, need for a short-term wheelchair loan)
  • Financial independence (for example, ability to cope with financial burdens).

Public satisfaction with the NHS and social care in 2018

Since 1983, NatCen Social Research’s British Social Attitudes survey has asked members of the public in England, Scotland and Wales about their views on the NHS and health and care issues more generally.  Alongside the Nuffield Trust, in this publication the King’s Fund  explores the findings from the 2018 survey.

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Image source: http://www.kingsfund.org.uk

The BSA is a ‘gold standard’ survey and is conducted the same way every year, with the data provideing a rich time trend going back to 1983. This adds a depth and context to the findings that no other measure of NHS satisfaction provides. As a result, when satisfaction changes in the BSA, we are as confident as we can be that it reflects a genuine change in public attitudes.

Key findings

Satisfaction with the NHS overall in 2018

  • Public satisfaction with the NHS overall continued to fall in 2018. Overall satisfaction was 53 per cent – a 3 percentage point drop from the previous year and the lowest level since 2007.
  • Older people were more satisfied than younger people: 61 per cent of those aged 65 and over were satisfied with the NHS compared to 51 per cent of those aged 18–64.
  • Satisfaction levels also differed between supporters of different political parties: 58 per cent of supporters of the Conservative party were satisfied compared to 51 per cent of supporters of the Labour party.
  • The four main reasons people gave for being satisfied with the NHS overall were: the quality of care; the fact that the NHS is free at the point of use; the range of services and treatments available; and the attitudes and behaviour of NHS staff.
  • The four main reasons people gave for being dissatisfied with the NHS overall were: long waiting times; staff shortages; a lack of funding; and money being wasted.

Full detail at The King’s Fund

Full publication: Public satisfaction with the NHS and social care in 2018: Results from the British Social Attitudes survey

See also:

The value of patient support programmes

NHS Confederation | January 2019| The value of patient support programmes

The NHS Confederation recently partnered with AbbVie to explore the value of industry-led patient support programmes and some of the barriers to greater use of them for NHS patients with long-term or chronic conditions. 

The recent publication of the Long Term Plan clearly demonstrates NHS England’s commitment to person-centred care, allowing people to better manage their own health and access personalised care when they need it.

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NHS Confederations’ briefing looks at what action is needed to overcome these barriers with the aim of encouraging more decision makers to consider whether they could contribute to improved and more personalised care of patients (Source: NHS Confederation).

The value of patient support programmes 

All.Can patient survey

All.Can UK | December 2018| First findings of All.Can patient survey revealed at UK Parliament event

More than a third (36 per cent) of cancer patients reported the greatest inefficiency as being their diagnosis finds the All. Can patient survey sought patients’ and carers’ perspectives on inefficiencies in cancer care.  40 per cent of people who participated in the survey had been initially diagnosed with something else. A similar proportion (34 per cent) also responded to say that they had a surplus of medication left over following treatment.

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All.Can worked with Quality Health to develop the patient survey. Quality Health was responsible for all aspects of survey administration and data analysis, with input from All.Can national initiatives and the international research and evidence working group.

The UK piloted the All.Can patient survey ahead of roll-out in other countries throughout 2018. The survey closed in the UK in August, but continued running until 30 November in Australia, Belgium, Canada, France, Italy, Poland, Spain and Sweden.  Data from an international version is also being analysed (Source: all-can.org).

Further details from All.Can

Bowel cancer waiting times figures revealed

University of Edinburgh | November 2018 |Bowel cancer waiting times figures revealed

Bowel cancer is the fourth most common cancer type, now researchers from the University of Edinburgh have shown that it takes 10% of  patients in England and Wales more than a year from recognising the symptoms to receiving treatment for their bowel cancer. They found that 10% of people with bowel cancer in Scotland waited more than 8 months to start treatment. 

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This international study included anonymised medical data from 3000 patients and their doctors in Australia, and Canada alongside the UK. Among their findings people in Wales took the longest to contact their GP once they had a health concern. Patients in Wales also waited the longest time (168 days)  to commence treatment,  which contrasts with Denmark (77 days. Researchers found that men and women in Wales took the longest to contact their doctor once they had noticed a health concern or symptom (Source: University of EdinburghUniversity of Edinburgh).

Full details from University of Edinburgh 

Advice line for GPs saves hours of travel for patients and £100k to be reinvested back into NHS

NHS England | November 2018 | Advice line for GPs saves hours of travel for patients and £100k to be reinvested back into NHS

The Walton Centre in Liverpool – the only specialist hospital trust in the UK dedicated to providing comprehensive neurology, neurosurgery, spinal and pain management services-   runs an advice line which means GPs in the Cheshire and Merseyside area can call neuro consultants for fast advice any weekday reducing extra patient appointments. 

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So far the service has received 181 calls 37% were resolved by the GP saving £51,698 which over a year saves around £100k.

Programme Director Julie Riley said: “We want to deliver services closer to home and when patients do come into hospital, support them so they can recover and go home quicker. From a patient point of view, we want to work in partnership with them. We, our consultant colleagues and GPs want to support them in self-management, where appropriate – rather than taking a paternalistic approach.”

Read the full case study at NHS England