WIREDGOV

Big improvements in hospital cleanliness and mixed-sex accommodation.  But Care Quality Commission urges NHS to tackle lack of information about medicines.

A major survey of 69,000 NHS hospital inpatients points to big improvements in cleanliness and a decline in mixed-sex accommodation, says the Care Quality Commission.

The Commission published the results of the 2009 NHS Inpatient Survey coordinated by Picker on behalf of CQC, covering 162 hospital trusts in England.

CQC said many of the survey questions relate to essential standards of quality and safety that trusts must meet under the new registration system that came into operation on 1 April. The information is used to monitor performance in the NHS.

In 2009, 64% of patients rated their hospital room as “very clean”, up from 60% in 2008 and 56% in 2002. The Commission said this mirrored year-on-year improvements in all questions related to infection control, such as whether bathrooms were clean and if staff washed their hands.

In 2009, the proportion of patients who reported sharing accommodation with the opposite sex fell significantly. For emergency patients, 21% said they initially stayed in mixed-sex accommodation, down from 29% in 2008. The proportion of people admitted from waiting lists to mixed-sex accommodation also decreased, from 10% in 2008 to 8% in 2009.

But the Commission said progress was disappointing in some important aspects of care and in some cases the experience of patients had got worse.

The survey showed significant room for improvement around the information given to people about medicines.  The proportion of patients who said they were not given enough information about the purpose of medicine they were given to take home has steadily increased, from 7% in 2002 to 8% in 2008 and 9% in 2009. In 2009, 45% of patients said they had not been given enough information about potential side effects of medication, up from 44% in 2008 and 2002.

The Commission said the NHS must address the lack of help for patients to eat. Almost one in five patients (18%) said they did not get enough help to eat their meals if they needed it – the same as in 2002. There was an increase in the proportion who said they “always” received enough help to eat, but a corresponding decrease in the proportion who said they “sometimes” received enough help.

Overall, 44% of people rated their care as “excellent”, 35% “very good”, 13% “good”, 5% “fair” and 2% “poor”. This shows improvement since 2002, when the figures were 38%, 36%, 17%, 7% and 2% respectively.

Cynthia Bower, CQC’s chief executive, said: “The survey results have shown year-on-year improvements in many important aspects of hospital care. Infection control and mixed-sex accommodation have been a big concern for patients, so it’s encouraging to see the substantial improvements in these areas.

“But there are also some persistent problems that the NHS is struggling to address. It is unacceptable that almost 50% of patients did not have the potential effects of medicine properly explained to them. I’m also concerned that some people who need help to eat are not getting enough assistance. These are fundamentals of care and it is time for the NHS to tackle these issues head-on.”

NHS trusts use the survey results to identify where improvements are needed and to track the experience of patients in hospital.

The Commission uses the survey results to monitor performance in the NHS. CQC analyses the survey results alongside a range of other information, such as findings from inspections, data on mortality and infection rates and intelligence from other organisations, to monitor compliance with the new essential standards of quality and safety and to help determine where further regulatory action is needed. 

Ms Bower said: "We are using more and more information from patients to help identify where we need to focus our efforts as the regulator. Many of these questions relate to the registration standards and we will be using this information from patients when we assess and inspect trusts.

“We expect every NHS hospital trust to pay close attention to their results and plan how they can improve the experience of hospital patients.”

-ends-

Notes to editors:

To see national trends, to view tables showing percentages for each question for each year of the survey, or to search for results for individual trusts, go to: /PatientSurveyInpatient2009

The survey was carried out between September 2009 and January 2010 and gathered the views of patients who were discharged from hospital before the end of August 2009. It covered adult acute and specialist hospital trusts (but not mental health hospital trusts).

Below is a summary of which aspects of patient experience improved, which declined and which stayed the same.

Improvements since the 2008 survey have been identified in the following areas.  A greater proportion of patients said:

• They waited no more than a month to be admitted to hospital for a planned admission.
• They never had to share a sleeping area in hospital (for example a room or bay) with a member of the opposite sex.
• They did not mind sharing a sleeping area with patients of the opposite sex if this happened when they were first admitted.
• They did not have to use the same bathroom or shower area as a member of the opposite sex.
• Wards, toilets and bathrooms were “very clean”.
• Doctors and nurses “always” washed or cleaned their hands between touching patients.
• They had a lockable place to store their personal belongings.
• There were “always or nearly always” enough nurses on duty to care for them.
• They “definitely” felt involved in decisions about their discharge.
• They received copies of letters between their GP and the hospital.
• The teamwork between doctors and nurses was “excellent”.
• They were asked to give their views about the quality of their care.
• They saw posters and leaflets about how to complain about their care.
• The overall quality of care they received was “excellent”.

Patients’ experiences had deteriorated in several areas since the 2008 survey. A smaller proportion of patients said:

• They were provided with enough information about their condition or treatment on the ward.
• They were given enough information about their condition or treatment while in the emergency department.
• They were given enough privacy when being examined or treated in the emergency department.
• They were offered a choice of admission date.
• They were not bothered by noise at night from staff.
• They rated the hospital food as “good” (although there was no change in the proportion of those rating it as “very good”).
• Their questions were answered by nurses in a way they could understand.
• They “always” had trust and confidence in the nurses treating them.
• Their family or someone close to them had the opportunity to talk to a doctor if they wanted to.
• Staff “definitely” did enough to control their pain.
• The call button was answered within “0 minutes/right away”.
• The purposes and side effects of their medicines, and how to take them, had been “completely” explained to them in a way they could understand.

No statistically significant changes since 2008 were identified in the following areas:

• Waiting times to be admitted from the A&E Department.
• Patients’ reports of the time they waited to be admitted to a bed on a ward after arrival at the hospital.
• Patients’ privacy when being examined or treated on the ward and when discussing their condition or treatment on the ward.
• Patients being bothered by noise at night from other patients.
• Patients feeling threatened by other patients or visitors on the ward.
• Patients being offered a choice of food.
• Patients’ trust and confidence in doctors.
• Doctors or nurses talking in front of patients as if they were not there.
• Patients being as involved as much as they would like to be in decisions about their care and treatment.
• Patients who required help to eat their meals receiving it.
• A member of staff explaining the risks and benefits of an operation or procedure in a way patients could understand.
• Patients feeling informed about what would happen during operations or procedures.
• Patients being told how they should expect to feel after their operation or procedure.
• Patients experiencing a delay to their discharge from hospital.
• Provision of written or printed information about what patients should do after leaving hospital.
• Patients wanting to complain about the care they received.

What we are publishing:

• National briefing outlining significant trends and issues.
• Tables of national results with comparisons to previous years and highlighting changes that are statistically significant.
• Results of each trust under the ‘Find a care service’ search tool on the CQC website, identifying where a trust did significantly ‘better’ than, ‘worse’ than, or ‘about the same’ as other trusts for each question and for groups of questions.
• A report for each trust comparing their results to all other trusts.

The data from the survey will be deposited in the UK Data Archive at the University of Essex.

For further information please contact the CQC press office on 0207 448 9401 or out of hours on 07917 232 143. 

About the Care Quality Commission

The Care Quality Commission (CQC) is the independent regulator of all health and adult social care in England. We inspect all health and adult social care services in England, whether they are provided by the NHS, local authorities, private companies or voluntary organisations. We also seek to protect the interests of people whose rights are restricted under the Mental Health Act. We make sure that essential common standards of quality are met everywhere care is provided, from hospitals to private care homes, and we work towards their improvement. We promote the rights and interests of people who use services and we have a wide range of enforcement powers to take action on their behalf if services are unacceptably poor.

Our work brings together (for the first time) independent regulation of health, mental health and adult social care. Before 1 April 2009, this work was carried out by the Healthcare Commission, the Mental Health Act Commission and the Commission for Social Care Inspection.

Our aim is to make sure that better care is provided for everyone, whether it is in hospital, in care homes, in people’s own homes, or anywhere else that care is provided.

Registration: The Health and Social Care Act 2008 introduced a new, single registration system that applies to both health and adult social care.  The new system will make sure that people can expect services to meet new essential standards of quality and safety that respect their dignity and protect their rights.  The new system is focused on outcomes, rather than systems and processes, and places the views and experiences of people who use services at its centre.

Since 1 April 2010, all NHS care providers are required by law to be registered with CQC and must show that they are meeting the essential standards. All adult social care and independent healthcare providers must be registered under the 2008 Act (which replaces the Care Standards Act 2000) from 1 October this year. Registration isn’t just about initial application for registration.  We will continuously monitor compliance with the essential standards as part of a new, more dynamic, responsive and robust system of regulation.