Patient experiences of using health and social care

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Image source: https://www.healthwatch.co.uk/

Each month, thousands of people share their views with Healthwatch about health and social care services. This report covers the period from October to December 2019 and provides a snapshot of people’s care based on the experiences of 8,690 people.

This report aims to provide NHS and social care leaders with a summary of:

  • Key issues the public have told Healthwatch about primary, secondary, mental health and social care support.
  • The top questions people are seeking advice about.

Full report: What people are telling us: October – December 2019 | Healthwatch

What matters to people using A&E

Healthwatch | February 2020 | What matters to people using A&E

Healthwatch’s latest briefing illustrates the chain of factors which impact on people’s experiences in A&E. 

To inform NHS England’s Clinical Review of Standards, Healthwatch have been helping to understand the impact of potential new targets by finding out what matters most to patients and the public when it comes to A&E.

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The purpose of our research is not to argue for or against replacing the current four-hour target, but to inform the ongoing debate.

Their research adds to previous work by providing analysis of 330 patient interviews carried out by local Healthwatch in six of the 14 hospitals testing proposed A&E targets. We also look at 6,000 free text comments gathered through the Friends and Family Test, analysed by Healthwatch Suffolk, to contextualise our findings.

The headline message:
Time alone doesn’t dictate how people feel about their experience of A&E. Overall patient experience is also shaped by:

  • The quality of clinical care they receive
  • The quality and frequency of the communication
  • The attitude of staff and whether they have time to offer empathetic care
  • Whether the A&E is working well with other services, such as NHS 111 and GPs
  • The quality of the A&E facilities themselves, including things that can make the experience of long waits easier on people, such as access to food and drink (Source: Healthwatch)

What matters to people using A&E briefing

Virtual clinics

This website includes a range of resources aimed at supporting colleagues / partners in the planning and implementation of non face-to-face models of care | UCL Partners

This guide, developed in collaboration with NHS clinicians, managers and patients, provides a comprehensive guide to setting up non-face-to-face clinics (also known as virtual clinics).

These can help reduce unnecessary outpatient visits, saving time and money for patients and the health service.

The NHS aims to avoid up to a third of the number of face-to-face outpatient visits over five years, removing the need for up to 30 million outpatient appointments each year.

The guide is free to use, delivered through both text and videos and includes how to develop a project plan and business case.

 

NIHR: Online patient feedback is mostly positive — but is not being used effectively

NIHR| January 2020 | Online patient feedback is mostly positive — but is not being used effectively

A mixed-methods study funded by the NIHR used five research streams to provide an overview of online patient feedback in the NHS.  The NIHR signal of the study underlines some highlights some key areas for improvement for organisations identified in the study  to help them make better use of online patient feedback. Importantly, the study suggests that managers could usefully review the infrastructure and processes for responding to feedback if they have not already done so (Source: NIHR).
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“Many clinicians may be surprised by the finding that the main motivation for patients who provide online feedback is to support the healthcare service, through either praise or a desire to help the service improve. What is less surprising is that, overall, healthcare providers lack the appropriate infrastructure to make good use of this feedback.

The findings of this study suggest that healthcare organisations could benefit from judicious engagement with online feedback, using it as one tool among many in a cycle of continuous quality improvement.  Elizabeth Murray, GP, Professor of eHealth and Primary Care, Co-Director of the eHealth Unit and Head of the Research Department of Primary Care and Population Health, University College London

Background: Online customer feedback has become routine in many industries, but it has yet to be harnessed for service improvement in health care. Objectives: To identify the current evidence on online patient feedback; to identify public and health professional attitudes and behaviour in relation to online patient feedback; to explore the experiences of patients in providing online feedback to the NHS; and to examine the practices and processes of online patient feedback within NHS trusts.
Design: A multimethod programme of five studies: (1) evidence synthesis and stakeholder consultation; (2) questionnaire survey of the public; (3) qualitative study of patients’ and carers’ experiences of creating and using online comment; (4) questionnaire surveys and a focus group of health-care professionals; and (5) ethnographic organisational case studies with four NHS secondary care provider organisations.

Setting: The UK.
Methods: We searched bibliographic databases and conducted hand-searches to January 2018. Synthesis was guided by themes arising from consultation with 15 stakeholders. We conducted a face-to-face survey of a representative sample of the UK population (n = 2036) and 37 purposively sampled qualitative semistructured interviews with people with experience of online feedback. We conducted online surveys of 1001 quota-sampled doctors and 749 nurses or midwives, and a focus group with five allied health professionals. We conducted ethnographic case studies at four NHS trusts, with a researcher spending 6–10 weeks at each site.

Many people (42% of internet users in the general population) read online feedback from other patients. Fewer people (8%) write online feedback, but when they do one of their main reasons is to give praise. Most online feedback is positive in its tone and people describe caring about the NHS and wanting to help it (‘caring for care’). They also want their feedback to elicit a response as part of a conversation. Many professionals, especially doctors, are cautious about online feedback, believing it to be mainly critical and unrepresentative, and rarely encourage it. From a NHS trust perspective, online patient feedback is creating new forms of response-ability (organisations needing the infrastructure to address multiple channels and increasing amounts of online feedback) and responsivity (ensuring responses are swift and publicly visible).

Limitations: This work provides only a cross-sectional snapshot of a fast-emerging phenomenon. Questionnaire surveys can be limited by response bias. The quota sample of doctors and volunteer sample of nurses may not be representative. The ethnographic work was limited in its interrogation of differences between sites. Conclusions: Providing and using online feedback are becoming more common for patients who are often motivated to give praise and to help the NHS improve, but health organisations and professionals are cautious and not fully prepared to use online feedback for service improvement. We identified several disconnections between patient motivations and staff and organisational perspectives, which will need to be resolved if NHS services are to engage with this source of constructive criticism and commentary from patients.
Future work: Intervention studies could measure online feedback as an intervention for service improvement and longitudinal studies could examine use over time, including unanticipated consequences. Content analyses could look for new knowledge on specific tests or treatments. Methodological work is needed to identify the best approaches to analysing feedback.
Full text of this article is available from the NIHR Journals Library 
Full Signal available from NIHR 

Improving care by using patient feedback

Improving care by using patient feedback | The National Institute for Health Research (NIHR)

This themed review features nine new research studies about using patient experience data in the NHS which show what organisations are doing now and what could be done better. The evidence ranges from hospital wards to general practice to mental health settings. There are also insights into new ways of mining and analysing big data, using online feedback and approaches to involving patients in making sense of feedback and driving improvements.

Full document: Improving care by using patient feedback

Long waiting times for GP appointments are unacceptable, says RCGP. College calls on Government to prioritise general practice which has been ‘running on empty for too long’

Royal College of General Practice | January 2020 | Long waiting times for GP appointments are unacceptable, says RCGP. College calls on Government to prioritise general practice which has been ‘running on empty for too long’ 

Responding to a feature that ran in The Sunday Times (in last Sunday’s edition, 5 January 2019), Professor Martin Marshall, Chair of the Royal College of GPs, said: “It is totally unacceptable to expect patients to wait weeks for a GP appointment. Patients -and GPs – deserve better. 

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“However, the situation in which we find ourselves has not happened overnight, and the College has been sounding the alarm bells for many years.

Over 1m patients are seen in general practice every day, and GPs are doing their best but the service cannot keep stretching. There are limits beyond which GPs can no longer guarantee safe care to patients and the potential for error or misdiagnosis increases.

“There is also the risk that long waiting times for a GP appointment will deter some patients from seeing a GP at all, which could mean they seek help at a much later stage when the problem is much more serious.

“Pressure of workload is taking its toll on the health and wellbeing of GPs themselves. For too many, the job has become untenable, with the result that they are burning out and leaving the profession before their time.

“It is extremely encouraging that we have more GPs in training than ever before, but it takes a long time to qualify and we need urgent action to retain existing GPs and ensure they are supported to remain in the profession and that the job of a frontline GP becomes ‘do-able’ again.” (Source: RCGP)

Related:

The Times Eleven million patients wait more than three weeks to see GP

Story also reported in:

BBC News GP shortages cause ‘unacceptable’ patient waits

Health and social care experiences

This quarterly briefing aims to provide health and social care professionals with a summary of the issues raised with Healthwatch

Between July and September over 10,500 people shared their experiences of using health and social care with Healthwatch. This briefing looks at 128 reports published by local Healthwatch and aims to provide health and social care professionals with a summary of the issues people have raised with us.

What issues does the briefing look at?

  • Emerging themes across primary care, hospital care, social care and mental health. For example, the importance of good communication when GP services are changing and people’s mental health and physical health not being given equal consideration in A&E.
  • In focus – the support available for people with incontinence and how services can help by making sure patients can easily access the continence products they need.
  • Spotlight on experiences – the challenges people from diverse ethnic communities can face when using health and care services.

Full briefing: What have people been telling us?  A summary of our evidence – July to September 2019 | Healthwatch

People share what a good A&E experience looks like

Healthwatch | October  2019 | People share what a good A&E experience looks like

New research from Healthwatch  shows that the public value a wide range of factors when it comes to good care in A&E; Healthwatch polled 1700 people in July and October of this year about what they thought about the four-hour A&E waiting time target.

The NHS is currently reviewing this measure as well as other national targets in elective care, cancer, and mental health, to reflect the changing environment so that people receive the best possible care.

The NHS Access Standards Review proposal includes:

  • The introduction of average waiting time measures. This would mark a move away from maximum waiting times, such as the four-hour A&E target and 18-week target for routine operations.
  • New measures to support faster initial assessment and treatment for those with the most urgent needs.

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Healthwatch reports that:

  • Awareness of current targets is low
  • People aren’t clear when the clock starts ticking
  • Average waiting times are easier to understand and more helpful
  • Waiting times are less important to people than other aspects of their experience
  • One in ten are happy to wait ‘as long as necessary’ to be treated and discharged for a non-urgent condition
  • Although many people visit A&E without seeking external advice, most are advised to attend by another service
  • Most people are not told how long they should expect to be in A&E when they arrive
  • Time in the department is the not the best indicator of people’s overall experience of A& E.

Healthwatch asked the people they surveyed to rate a series of factors based on what they think should be prioritised in A&E.

1. Prioritise treating patients with the highest level of need (89%)

2. Deliver the right tests and treatment within an hour where people are thought to have a life-threatening condition (88%)

3. Assess patients quickly on arrival so that their level of need can be determined (86%)

4. Offer pain relief while waiting if appropriate (71%)

5. Give people an estimated waiting time on arrival and informing them of any changes (65%)

6. Ensure staff are on hand to provide support while people wait to begin treatment (63%)

7. Admit or discharge all patients as soon as possible (62%)

8. Make information about current waiting times available to people before arriving at A&E and provide information on alternative services (59%)

9. Make sure that people who have been in the A&E department the longest are prioritised (50%)

10. Communicate to patients that a safe number of staff are working (49%)

11. Help people to avoid being admitted to a hospital ward overnight wherever possible, even if that means they spend longer in A&E (48%)

12. Admit or discharge a set proportion (currently 95%) of patients within a set timeframe (currently four hours) (46%)

The percentages reported reflect the proportion of people who gave each factor a high priority rating (4+ on a scale of 1-5).

The four-hour A&E waiting time target was brought in 15 years ago and sets out a national standard that at least 95% of patients attending A&E should be admitted, transferred or discharged within four hours.

The NHS is reviewing this measure as well as other national targets in elective care, cancer, and mental health, to reflect the changing environment so that people receive the best possible care.

The NHS Access Standards Review proposal includes:

  • The introduction of average waiting time measures. This would mark a move away from maximum waiting times, such as the four-hour A&E target and 18-week target for routine operations.
  • New measures to support faster initial assessment and treatment for those with the most urgent needs.

See also:

NHS England Public back NHS plans for new rapid care measures

2018 Urgent And Emergency Care Survey Statistical Release

This survey looked at people’s experiences of using Type 1 (major A&E) and Type 3 (urgent care centres, minor injury units, urgent treatment centres) urgent and emergency care services, from decision to attend to leaving | Care quality Commission

132 trusts took part in the survey, of which 63 trusts had both a Type 1 and a Type 3 department, and 69 trusts had only a Type 1 A&E. The survey only includes Type 3 departments that are run directly by acute trusts, and not those run in collaboration with, or exclusively by others.

Key findings for England

The majority of people were positive about most aspects of the urgent or emergency care they received. Results across both type 1 and type 3 services have remained generally stable and have not significantly changed between 2016 and 2018.

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Respondents in both the type 1 and type 3 surveys were very positive when answering questions about their interactions with staff. For example, the majority of respondents ‘definitely’ felt listened to, ‘definitely’ had confidence and trust in the staff examining and treating them and felt they were treated with respect and dignity ‘all of the time’. Staff are also generally providing clear explanations to most people about their treatment.

The survey results suggest there is scope for improvement in a number of areas across both service types, including:

  • waiting times
  • help from staff to control their pain
  • information provision when leaving A&E or the urgent care centre

Certain groups of patients consistently reported poorer experiences of urgent and emergency care services, including:

  • younger type 1 respondents (aged 16 to 35)
  • type 1 respondents who said that they had been to the same A&E about the same condition or something related to it within the past week
  • for both type 1 and type 3 respondents, people whose visit to A&E or the urgent care centre lasts for more than four hours

Further detail at Care Quality Commission

Full report: Urgent and emergency care survey 2018: Statistical release

Travelling to and from NHS services

There and back – what people tell us about their experiences of travelling to and from NHS services | Healthwatch England

Healthwatch England has carried out a nationwide conversation on the NHS Long Term Plan, engaging with over 30,000 people across the country. They found that travel was a key issue, with nine out of 10 people saying that convenient ways of getting to and from health services is important to them. Indeed, people put transport above other things, such as choice over where to be treated and improving digital access to services.

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Image source: http://www.healthwatch.co.uk

This briefing brings collates information about people’s experiences of getting to and from appointments at hospitals, GP surgeries and other NHS services. It looks at the different methods of transport, as well as sharing some examples of promising practice. It is intended to help leaders in the NHS understand the barriers people face and explore possible solutions.

Full document: There and back: what people tell us about their experiences of travelling to and from NHS services | Healthwatch