Survey of inpatients 2005 - Briefing note

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1 Survey of patients 2005

Services for inpatients
The third annual survey of adult inpatients in acute and specialist hospitals has captured the views
and experiences of more than 80,000 people at 169 NHS trusts 1 across England.
Surveys are an important way of gathering patients’ experiences and listening to patients’ views.
The results are used by NHS trusts to help them set priorities to ensure they are delivering a better
service for patients. They are also used by the Healthcare Commission as part of its annual health
check to help measure the quality of care being provided to patients. Measuring and reporting
patient experiences in a structured way helps ensure that improving patient experience remains a
priority for NHS trusts.

All 169 NHS acute and specialist trusts in England with services for adult inpatients undertook the
survey in the autumn of 2005. Each trust identified 850 adult patients (excluding maternity and
psychiatry patients) who had stayed in hospital for at least one night and who were discharged
from hospital between June and August 2005. Questionnaires were sent to 139,562 patients
between September and November 2005 with a response rate of 59%.

All the trusts involved in the survey have received detailed reports containing the results of their
own survey and benchmarking these against those of other NHS trusts. These reports are
available, along with results from previous surveys (conducted in 2002 and 2003/04), on the
Healthcare Commission’s website: www.healthcarecommission.org.uk. Here we highlight some of
the key findings from the 2005 survey and describe how the experience of patients has changed
over the three surveys. To enable this survey to be compared with previous years, we focus on
the 80,258 respondents who were aged 18 years and over. The large number of people who
responded to this survey means that it is highly unlikely that any differences mentioned in this
report have occurred by chance but represent a real change between surveys.

Patients who responded to the survey had entered hospital by one of two main routes: • 54% had been admitted urgently via the emergency department (A&E) • 46% had a planned admission via a GP referral waiting list
Patient care and treatment
Overall, 92% of patients rated the care they had received as ‘excellent’, ‘very good’ or ‘good’ and
almost 79% said they were ‘always’ treated with respect and dignity. 1 Although all 169 acute and specialist trusts in England took part in the survey, results from four trusts have been excluded from the analysis because of problems with their sample or data returns. 2
Just over half of patients (53%) were ‘definitely’ involved as much as they wanted to be in
decisions about their care and treatment and a further 37% were involved ‘to some extent’. Both
figures show a small improvement over the previous year. It is important that patients are given
information to help them make these decisions. Almost four fifths of patients (79%) said they were
given the right amount of information, but one fifth (20%) thought they were given too little. These
figures are unchanged from the previous survey.

There has been a slight improvement in the privacy patients had when they were in hospital, with
71% saying they ‘always’ had enough privacy when discussing their condition or treatment
(compared with 69% in both 2003/2004 and 2002). Nearly nine out of ten patients (88%) said they ‘always’ had enough privacy when being examined or treated (compared with 87% in both
2003/2004 and 2002).

Over half of patients (58%) said there were ‘always’, or ‘nearly always’ enough nurses on duty to
care for them in hospital, with 11% saying there were ‘rarely or never enough’. These figures are
unchanged from the previous survey. However, fewer patients who used the call button (59%) said
it was answered within two minutes compared with 2003/2004 (63%). Of those patients who said
they needed help to eat their meals, 18% said they did not get enough help and 21% that they only
got enough help ‘sometimes’. Ambulance care
Just over half (53%) of patients who were admitted as an emergency travelled to hospital in an
ambulance.

Nine out of ten patients (90%) who travelled to the hospital by ambulance ‘definitely’ found the
ambulance crew reassuring, and 95% said the ambulance crew ‘always’ treated them with respect
and dignity. Two thirds of patients (66%) said the ambulance crew had ‘definitely’ explained their
care and treatment to them in a way they could understand and three quarters (75%) felt
everything had been done to help control any pain they experienced.

Emergency department
Most patients thought the order in which patients were seen in the emergency department was fair
(95%). Almost three quarters (73%) said they were given the right amount of information about
their condition or treatment, though 15% said they were not given enough information and 11%
said they were not provided with any information. Almost four fifths (79%) of patients ‘definitely’
had enough privacy when being treated or examined in the emergency department.
Admission to hospital
All trusts should ensure a maximum four hour wait in the emergency department from arrival to
admission. This survey cannot be used directly to measure this standard because, for example, it
only includes those patients who are admitted to hospital and it excludes children and young
people. Nevertheless, for those respondents who were admitted from the emergency department
the survey shows consistent improvement over time. Fewer emergency patients said that they had
to wait four hours or longer before being admitted to a bed on a ward from the emergency
department (25% compared with 26% in 2003/2004 and 34% in 2002). However, fewer
emergency patients recalled being admitted quickly, with about one third (32%) admitted in less
than an hour, compared with 43% in 2003/2004.

The NHS Plan states that by April 2004 the maximum waiting time for elective admissions should
be nine months. Ninety-two per cent of patients who had been on a waiting list said they waited
nine months or less to be admitted and a greater proportion thought they were admitted as soon as
necessary (up from 70% in 2003/2004 to 72%). More than a quarter (27%) of people who had 3 been on a waiting list said they were offered a choice of admission dates (compared with 24% in
2003/2004), However, 20% had their admission date changed at least once.

There has been an improvement over the three surveys in how long both urgent and planned
admission patients recall having to wait before getting a bed on a ward. Nine per cent of patients
considered they ‘definitely’ waited ‘a long time’ to get a bed on a ward compared with 11% in
2003/2004 and 13% in 2002.
The hospital and ward environment

The surveys have indicated relatively stable perceptions of hospital cleanliness. The majority of
patients in the 2005 survey (92%) felt their hospital room or ward was either very clean or fairly
clean. However, the surveys also demonstrate that a persistent minority is less satisfied. In both
2005 and 2002, 8% reported their ward as either not very clean or not at all clean compared with
9% in 2003/04. Perceptions of the cleanliness of toilets and bathrooms follow a very similar pattern
with 86% of patients reporting favourably in 2005. Again, the minority of patients reporting negative
perceptions appears very consistent at 13% in 2005 and 12% in both 2003/04 and 2002.

Hand washing and cleaning reduces the risk of spreading infections in hospital. Observing hospital
staff washing or cleaning their hands may reassure patients who are concerned about the risks of
infection. The survey asked patients if they knew whether hospital staff washed or cleaned their
hands between touching patients. Many patients were unable to answer this question with 39% of
patients reporting that they did not know or could not remember if doctors had washed or cleaned
their hands and 25% for nurses. This is likely to be the case where, for example, hand basins are
not within the patient’s sight. Those patients who could remember reported that as far as they
knew: • two in three doctors ‘always’ washed or cleaned their hands between touching patients (67%) • 69% of nurses ‘always’ washed or cleaned their hands between touching patients
Fewer patients reported being bothered at night by noise from other patients (37% compared with
39% in 2003/04) and by hospital staff (18% compared with 19% in 2003/2004).

Over half of patients (54%) described the quality of hospital food as either ‘good’ or ‘very good’ and a further 31% as ‘fair’. These percentages have remained constant over the three surveys. Relationships with staff
Four in five patients (80%) ‘always’ had confidence and trust in the doctors, and almost three
quarters (74%) ‘always’ had confidence and trust in the nurses.

Six per cent of patients reported that doctors ‘often’ talked in front of them as if they weren’t there
and 22% did this ‘sometimes’. Five per cent said nurses ‘often’ talked in front of them as if they
weren’t there. There has been a slight increase in the proportion of patients reporting that nurses
‘sometimes’ talk in front of them as if they weren’t there (15% in 2002, 16% in 2003/2004 and 17%
in 2005).

When patients had important questions to ask a doctor, 67% said they ‘always’ got answers they
could understand, a slight improvement from 65% in both 2003/04 and 2002. Almost two thirds
(65%) of patients said that they ‘always’ received answers they could understand from nurses,
down from 68% in 2003/04 but a slight increase from 64% in 2002. There has also been a fall
(from 19% in 2002 to 16% in 2003/04 and 2005) in the number of patients saying that if a family
member or someone close to them wanted to talk to a doctor, they did not have enough
opportunity to do so.

However, there has been a decline in some other aspects of communication. It has become more
common for patients to report that staff are giving them conflicting information; 7% said they were 4 ‘often’ and 27% ‘sometimes’ given conflicting information by different members of staff compared
with 6% and 25% in 2003/04 and 6% and 24% in 2002. More patients said they were unable to find
someone on the hospital staff to talk to about their fears or worries (21%) compared with 17% in
2002. Operations and procedures
More than two thirds (68%) of patients who responded to the survey had an operation or procedure
while in hospital. Any operations or procedures taking place in NHS hospitals require informed
consent to be given in advance. Therefore it is important that patients receive accurate and
understandable information. Results suggested the majority of patients are receiving this
information: • four fifths (81%) said that a member of staff ‘completely’ explained the risks and benefits of the
operation or procedure in a way they could understand and 15% ‘to some extent’ • three quarters (76%) said that a member of staff ‘completely’ answered their questions about
the operation or procedure in a way they could understand and 21% ‘to some extent’ • three quarters (74%) said that a member of staff had ‘completely’ explained what would be
done in the operation or procedure and 21% ‘to some extent’ • of those who were given some form of anaesthetic, 83% said they received a complete
explanation from the anaesthetist that they could understand and 12% ‘to some extent’ • over half (55%) of patients said they were told how they could expect to feel after the operation
or procedure and 28% were told ‘to some extent’ • 63% said that after the operation or procedure, a member of staff had explained how the
operation or procedure had gone in a way they could understand and 24% ‘to some extent’ Leaving hospital
Almost two fifths of patients said their discharge had been delayed (38%), and more than half of
these were delayed two hours or more (53%), usually because they were waiting for medicines
from the pharmacy (61%).

The results of the survey suggest that better information should be provided to patients on
discharge. About four fifths (79%) of patients who had medicines to take home said they received a
complete explanation about the purposes of the medication, however, only two fifths (40%) said
they received a complete explanation about any side effects. Sixty two per cent said they were
given ‘completely’ clear written information about their medicines.

Two fifths of patients (40%) said they were not told about any danger signs they should watch for
after they went home, and almost one quarter (24%) said they were not told who to contact if they
were worried about their condition after leaving hospital.

To improve the understanding a patient had about their treatment and why they were being
referred, the NHS Plan states that correspondence between clinicians should be copied to
patients. However, only 35% of patients who responded to the survey said that they received
copies of letters sent between hospital doctors and their family doctor.

The 2005 acute inpatients survey was designed and coordinated by the Picker Institute Europe.
The Healthcare Commission will release further analyses of these survey data.


For more information about the Healthcare Commission please visit
www.healthcarecommission.org.uk