NHS inpatient satisfaction falls for first time in six years

Adult inpatient survey 2018 | Care Quality Commission (CQC)

The results of the latest inpatient survey show what over 75,000 adults who stayed in hospital for at least one night in July last year said about the care they received. The survey covered the 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 their discharge arrangements. The results are provided for England as a whole and by NHS trust.

feedback-3676922_1920Across 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.

Most results for the 2018 Adult Inpatient Survey have slightly declined since last year or remained static.

Positive findings:

  • Relationships with the medical and nursing staff are usually positive although there is a small decline compared to last year. For example, patients reported that overall, doctors and nurses answered their questions in a way they understood.
  • Trust in doctor and nurse is high, although declining slightly compared to last year.
  • Fundamental needs of most patients are being met in terms of food, hydration and rest.
  • The proportion of patients reporting being given enough privacy when being examined or treated continues to be very high.

However, this year’s results indicate that there are many areas in need of improvement:

  • Patients are reporting poorer experience when it comes to the integration of their care.
  • Patients are reporting that they are waiting too long at admission and longer than previous years at discharge.
  • At the time of being discharged, significant numbers of patients were unsure about their situation. This includes not being given appropriate information about their care after leaving the hospital, and not receiving enough notice.
  • Significant numbers of patients reported not being sufficiently involved in decisions regarding their care and treatment.

Certain groups of patients consistently reported poorer experiences of their time in hospital, including

  • Patients with a mental health condition
  • Younger patients (aged 16 to 35)
  • Patients who were admitted in an emergency

Full report: Adult inpatient survey 2018

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

See also:

 

Smartphones improve adherence for TB treatment, instead of direct supervision

NIHR | June 2019 | Smartphones instead of direct supervision can improve adherence rates for TB treatment

New research indicates that for people who require direct supervision, also known as directly-observed therapy in community and outpatient settings,  using smartphones and clinical attendance can improve levels of adherence. 

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Observation is reserved for those at risk of not completing treatment because they have socially complex lives or mental illness. The study aimed to identify whether video surveillance can improve levels of adherence.

The randomised controlled trial (RCT) included over 200 patients, randomised into receiving standard observation or video observation; direct observations were carried out between three and five times per week, those assigned to video observation by smartphone were trained to record video footage of them taking each dose (Source: NIHR).

Read the NIHR Signal here 

Full reference: Story, A. 2019| Smartphone-enabled video-observed versus directly observed treatment for tuberculosis: a multicentre, analyst-blinded, randomised, controlled superiority trial | The Lancet | DOI:https://doi.org/10.1016/S0140-6736(18)32993-3

Abstract 

Background Directly observed treatment (DOT) has been the standard of care for tuberculosis since the early 1990s, but it is inconvenient for patients and service providers. Video-observed therapy (VOT) has been conditionally recommended by WHO as an alternative to DOT. We tested whether levels of treatment observation were improved with VOT.

Methods We did a multicentre, analyst-blinded, randomised controlled superiority trial in 22 clinics in England (UK). Eligible participants were patients aged at least 16 years with active pulmonary or non-pulmonary tuberculosis who were eligible for DOT according to local guidance. Exclusion criteria included patients who did not have access to charging a smartphone. We randomly assigned participants to either VOT (daily remote observation using a smartphone app) or DOT (observations done three to five times per week in the home, community, or clinic settings). Randomisation was done by the SealedEnvelope service using minimisation. DOT involved treatment observation by a health-care or lay worker, with any remaining daily doses self-administered. VOT was provided by a centralised service in London. Patients were trained to record and send videos of every dose ingested 7 days per week using a smartphone app. Trained treatment observers viewed these videos through a password-protected website. Patients were also encouraged to report adverse drug events on the videos. Smartphones and data plans were provided free of charge by study investigators. DOT or VOT observation records were completed by observers until treatment or study end. The primary outcome was completion of 80% or more scheduled treatment observations over the first 2 months following enrolment. Intention-to-treat (ITT) and restricted (including only patients completing at least 1 week of observation on allocated arm) analyses were done. Superiority was determined by a 15% difference in the proportion of patients with the primary outcome (60% vs 75%). This trial is registered with the International Standard Randomised Controlled Trials Number registry, number ISRCTN26184967.

Findings Between Sept 1, 2014, and Oct 1, 2016, we randomly assigned 226 patients; 112 to VOT and 114 to DOT. Overall, 131 (58%) patients had a history of homelessness, imprisonment, drug use, alcohol problems or mental health problems. In the ITT analysis, 78 (70%) of 112 patients on VOT achieved more than or equal to 80% scheduled observations successfully completed during the first 2 months compared with 35 (31%) of 114 on DOT. In the restricted analysis, 78 (77%) of 101 patients on VOT achieved the primary outcome compared with 35 (63%) of 56 on DOT. Stomach pain, nausea, and vomiting were the most common adverse events reported (in 16 [14%] of 112 on VOT and nine [8%] of 114 on DOT). Interpretation VOT was a more effective approach to observation of tuberculosis treatment than DOT.

The full article is available from The Lancet

Furhter details of the NIHR Signal can be found here

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