Scottish Inpatient Patient Experience Survey 2010 Volume 1: National Results. An Official Statistics Publication for Scotland

Transcription

1 Scottish Inpatient Patient Experience Survey 2010 Volume 1: National Results An Official Statistics Publication for Scotland

2 Scottish Inpatient Patient Experience Survey 2010 Volume 1: National Results The Scottish Government, Edinburgh 2010

3 Crown copyright 2010 ISBN: The Scottish Government St Andrew s House Edinburgh EH1 3DG Produced for the Scottish Government by APS Group Scotland DPPAS10661 (10/10) Published by the Scottish Government, October 2010

4 TABLE OF CONTENTS FOREWORD FROM THE CHIEF EXECUTIVE OF NHS SCOTLAND... IV 1 EXECUTIVE SUMMARY... 1 Background... 1 Methodology... 1 Key findings... 2 National results... 2 Patient characteristics... 3 Hospital type INTRODUCTION... 5 Introduction... 5 Background to the Better Together Programme... 5 Aims of the Better Together Inpatient Survey... 6 Survey design... 7 Survey fieldwork and response... 7 Data analysis and interpretation... 8 Scope and structure of the report Other outputs from this survey RESULTS ADMISSION TO HOSPITAL Admission to hospital Views on admission overall In A&E I was told how long I would have to wait In A&E I was told what was happening in a way I could understand Overall, how would you rate the care and treatment you received during your time in A&E?. 13 If your hospital visit was planned in advance how did you feel about the length of time you waited to be admitted to hospital after being referred? Did the information you were given before attending hospital help you understand what would happen? From the time you arrived at hospital, how did you feel about the time you had to wait to get to a bed on the ward? Summary RESULTS THE HOSPITAL AND WARD The hospital and ward environment Views on the hospital environment overall The main ward or room I stayed in was clean The bathrooms and toilets were clean Not being bothered by noise My religious and spiritual needs were respected I was happy with the food and drink that I received Not being bothered or threatened by other patients or visitors I knew who was in charge of the ward Sharing a room or bay with members of the opposite sex Summary RESULTS CARE AND TREATMENT Care and treatment Views on care and treatment overall I was able to get adequate pain relief when I needed it I had privacy when being examined or treated I had privacy when my condition and treatment was discussed I got help with washing and dressing when I needed it I got help with eating and drinking when I needed it Before moving wards, a member of staff explained what would happen i

5 Moving wards was well managed Patient involvement in decisions around their care and treatment Summary RESULTS STAFF Views on staff overall Doctors There was enough time to talk to the doctors Doctors knew enough about my condition and treatment Doctors explained the risks and benefits of any treatment in a way I could understand Doctors talked in a way that helped me understand my condition and treatment Doctors gave me clear explanations about my operations and procedures Doctors told me how my operation or procedure had gone in a way I could understand Doctors listened to me if I had any concerns As far as I was aware doctors washed/ cleaned their hands at appropriate times Nurses There was enough time to talk to the nurses Nurses knew enough about my condition and treatment Nurses talked in a way that helped me understand my condition and treatment Nurses gave me clear explanations about my operations and procedures Nurses listened to me if I had any concerns As far as I was aware nurses washed/ cleaned their hands at appropriate times Staff working well together in organising your care Summary RESULTS LEAVING HOSPITAL Preparations and advice when leaving hospital Views on the overall arrangements for leaving hospital I was happy with how long I had to wait around when I was told I could go home I was given help with arranging transport I understood who to contact if I had any questions after leaving hospital I was told about any danger signals to watch for when I got home I was given advice on how to look after myself I was confident that any help I needed had been arranged for when I got home Medication I understood what my medicines were for I understood how and when to take my medicines I understood the possible side effects and what to do if I had any concerns Summary RESULTS IMPORTANCE VERSUS ACTUAL EXPERIENCE Areas of importance Actual patient experience Summary RESULTS PATIENT CHARACTERISTICS Overview of gender Overview of age Overview of self reported health status Health status overall experience Overview of health problem or disability Health problem or disability overall experience Overview of sexual orientation Sexual orientation overall experience Summary RESULTS HOSPITAL TYPE Hospital type Teaching hospitals ii

6 Large general hospitals General hospitals Long stay hospitals Community hospitals Summary RESULTS NHS BOARDS Ayrshire and Arran Borders Dumfries and Galloway Fife Forth Valley Grampian Greater Glasgow and Clyde Highland Lanarkshire Lothian Orkney Shetland Tayside Western Isles National Waiting Times Centre Summary RESULTS OTHER COMPARISONS Comparisons of NHS patients staying overnight in NHS hospitals with NHS patients staying overnight in private hospitals National comparisons Admission to hospital The hospital and ward Care and treatment Staff Leaving hospital Summary CONCLUSIONS National results Patient characteristics Hospital type Other comparisons Conclusion ANNEX A: PATIENT FEEDBACK ANNEX B: STATEMENT OF TABLE EXPLANATIONS ANNEX C: HOSPITAL TYPE BY BOARD AREA iii

7 FOREWORD FROM THE CHIEF EXECUTIVE OF NHS SCOTLAND This report presents the findings of the first Scottish Inpatient Patient Experience Survey. It provides information on the quality of healthcare experience for those who had an overnight stay in an acute hospital in all 14 territorial NHS Boards or at the National Waiting Times Centre (Golden Jubilee National Hospital). The survey was undertaken by approved contractors commissioned on an individual basis by each NHS Board. This report has been produced by the Better Together Coordination Centre (PricewaterhouseCoopers LLP) in collaboration with the Scottish Government, NHS Boards and the Information Services Division of NHS National Services Scotland. The survey - based on responses from over 30,000 inpatients aged 16 and over - provides us with an extremely valuable collection of data on the quality of healthcare experiences in hospitals in Scotland which is not available from other sources. The survey asked questions about peoples experiences of their admission, the hospital and ward environment, the care and treatment they received, staff and leaving hospital. NHS Boards and hospitals in Scotland have already been provided with provisional results and are now using the findings to identify areas for improvement. The findings will help us improve the quality of healthcare in Scotland by focusing us on the areas that people tell us are important to them. This work underpins the ambitions laid out in the NHS Scotland Healthcare Quality Strategy and will provide us with evidence of progress during coming years. The survey will be a valuable tool in measuring progress towards the national indicator for improving the quality of the healthcare experience. I should like to thank all those colleagues who have contributed their hard work in the design, delivery and analysis of the survey and preparing this report. Most importantly, I would like to thank the 30,880 people who gave their time to participate in the survey. Without their help, we would not have this valuable information resource. Kevin Woods Chief Executive, NHS Scotland Scottish Government Health Directorates iv

8 1 EXECUTIVE SUMMARY Background 1.1 This report presents the results for the 2010 Scottish Inpatient Patient Experience Survey which explored the experience of a sample of adult inpatients across Scotland on their recent hospital stay. The survey asked questions about peoples experiences of their admission, the hospital and ward environment, the care and treatment they received, staff and leaving hospital. It also asked about demographic characteristics. 1.2 Scotland s Patient Experience surveys are part of the Better Together programme which aims to support NHS Scotland in delivering high quality, equitable, person-centred care. In particular, it seeks to equip staff and patients with tools and techniques in order to embed patient experience as an integral part of NHS Scotland s core business. Patient feedback is collected as part of the programme through a range of approaches, including surveys and qualitative techniques. 1.3 This executive summary presents an overview of the methodology for, and findings from, the first Scottish Inpatient Survey conducted in Methodology 1.4 Patient feedback was gathered through a primarily postal 1 survey, which was developed on the basis of international literature and research on public priorities in Scotland regarding inpatient services. The questionnaire design involved a year of consultation with the Inpatient Measuring Experience Research Advisory Group and other key stakeholders; it was also ethically approved by the NHS National Research Ethics Service, North West Research Ethics Committee and piloted in the summer of The questionnaire was sent to a stratified random sample of adult inpatients (aged 16 years and over on discharge) who had an inpatient hospital stay between October 2008 and September This approach was designed to provide results for hospital sites, NHS Boards and nationally for Scotland as a whole. 1.6 In total, 62,308 survey packs were sent to patients and 30,880 were returned, giving an overall response rate of 50%. 1 Also available for completion online, by telephone and via text phone. 1

9 Key findings National results 1.7 Overall patients in Scotland reported positive feedback for their inpatient hospital stay across NHS Boards. 1.8 Of the five stages of the patient journey explored in the survey, the highest level of positive feedback related to staff (87% reported a positive experience overall), while the least positive was in relation to experience of leaving hospital (73% reported a positive experience overall). 1.9 Areas which achieved the highest levels of positive feedback at a national level included: Understanding how and when to take medicines (96% responded positively) Information given before attending hospital helped understanding of what would happen (96% responded positively) Having privacy when being examined and treated (94% responded positively) Understanding what medicines were for (94% responded positively) Getting adequate pain relief when needed (91% responded positively) The main room or ward stayed in was clean (90% responded positively) Length of time waiting to be admitted to hospital after being referred (89% responded positively) Nurses washing/cleaning hands at appropriate times (88% responded positively) 1.10 Areas which achieved the lowest levels of positive feedback included: In the A&E being told how long you would have to wait (53% responded positively) Not being bothered by noise (58% responded positively) Knowing who was in charge of the ward (64% responded positively) Religious and spiritual needs being respected (65% responded positively) Being given help arranging transport home (66% responded positively) 2

10 Getting help with eating and drinking when needed (69% responded positively) Being happy with the food and drink received (71% responded positively) Being happy with length of time waiting to go home and being confident in the help needed being arrange for arrival home (73% responded positively) Patient characteristics 1.11 Comparisons were made between different patient groups on the overall experience questions contained in the sections relating to the patient journey. The analysis showed differences between groups Males were more positive about their overall experience for all parts of the survey compared to females Older patients (aged 65 years and older) were more positive about their overall experience for all parts of the survey compared to patients aged under 65 years old Patients reporting themselves to be in good / fair health were more positive about their overall experience for all parts of the survey compared to patients in poor health Patients limited a little / a lot by a health problem or disability were less positive about their overall experience for all parts of the survey compared to patients who did not have a health problem or disability Heterosexual / straight patients were more positive about their overall experience for all parts of the survey compared to gay / lesbian / bisexual patients. Hospital type 1.17 The survey results were analysed on the basis of the type of hospital 2 patients had stayed in. Patients staying overnight in community and general hospitals were more likely to report a positive overall experience for all parts of the survey. Patients who had stayed in teaching and large hospitals were less likely to do so Patients in long stay hospitals were more likely to report positive experiences around the hospital and ward environment and leaving hospital. 2 Five different hospital types were included in the survey as follows: teaching hospitals, large general hospitals, general hospitals, long stay hospitals and community hospitals. 3

11 Other comparisons 1.19 An overview of findings for each NHS Board compared to the national average is provided within the report. Comparisons between NHS Boards results have not reported due to the different size and make-up of NHS Boards NHS patients staying at private hospitals generally had more positive results than NHS patients in NHS hospitals. However for two statements, the NHS patients staying in private hospitals achieved slightly lower positive results than for NHS patients staying in NHS hospitals (Length of time waited to be admitted to hospital after being referred was reasonable and religious and spiritual needs being respected) Comparisons with a selection of questions from the 2009 English inpatient survey were made with the Scottish 2010 inpatients survey. Both surveys show similar high levels of positive experience, although there were some areas of the survey where results in Scotland were different to those in England. However caution should be used interpreting these variations due to the different formats of the two surveys. Conclusion 1.22 The 2010 inpatient survey is the first time that patients across Scotland have been given the opportunity to provide feedback about their experiences. For the majority, their experiences are positive Areas with particularly high levels of positive feedback at a national level related to medicines, privacy, pain relief, cleanliness and staff hand hygiene, and waiting times Areas with the lowest levels of positive feedback at a national level were being told the wait in A&E, noise, knowing who was in charge of wards, religious and spiritual needs, help arranging transport home, food and drink (including help with eating and drinking), and length of time waiting to go home and having help at home arranged A minority of patients experiences were not as positive. This is particularly the case for women, younger people, disabled people and people who are lesbian, gay or bisexual The analysis and detail provided in this report will be reviewed and used by the Scottish Government and NHS Boards to highlight best practice and improve the quality of care for inpatients and to ensure the delivery of high quality, equitable, person-centred care across NHS Scotland. 4

12 2 INTRODUCTION Introduction 2.1 The Better Together Scottish Patient Experience Inpatient Survey is primarily a postal survey (also available for completion online, by telephone and via text phone), first conducted in early 2010 with the aim of establishing the experience of a sample of inpatients aged 16 years and over throughout Scotland on their recent hospital stay. The survey covers the areas of: admission to hospital; the hospital and ward; care and treatment; hospital staff; and arrangements for leaving hospital. A copy of the survey can be found in Annex A. 2.2 This report presents the detailed national findings of the first Better Together Inpatient Survey. It presents key findings at national level as well as by NHS Board and, where appropriate, by type of hospital. In addition, key findings by self-reported demographics 3 are included to provide further detail on the patterns of experience from each of the respondent groups who participated in the study. 2.3 Details of the survey design, fieldwork and analysis are available in the Scottish Inpatient Patient Experience Technical Report ( Background to the Better Together Programme 2.4 Better Together, Scotland s Patient Experience Programme, has been designed to support NHS Scotland to deliver high quality, equitable, personcentred care. The programme, in partnership with NHS Boards, GP practices, Information Services Division (ISD) of National Shared Services Scotland and national improvement programmes, aims to provide staff with the tools and techniques to embed experience into the design and delivery of continuous quality improvement and to provide opportunities for patients to share their experiences of healthcare in Scotland. 2.5 As part of the programme, patient experiences were collected using various approaches including surveys and qualitative techniques, to enable NHS Boards to make improvements through the use of practical techniques and tools. 2.6 The initial focus of the programme has been on three areas: Inpatients (reporting for the first time in September ); 3 For the purposes of national reporting, main demographic information has been presented only. It is expected that further analysis of patient demographics and exploration of issues by equality groups will be included in future topic reports. 4 Patients surveyed had an inpatient hospital stay between October 2008 and September

13 GP services (reporting for the first time in July 2010); and Long term conditions (this work has recently commenced in partnership with the Long Term Conditions Collaborative and the Long Term Conditions Alliance Scotland). 2.7 Specific areas of focus for the Better Together programme include: Building on and spreading existing good practice; Demonstrating local and national improvements; Contributing to measurable progress in Scotland-wide person-centred care; Testing new approaches that use patient experience for designing and planning services and improving existing healthcare services; and Integrating and aligning these approaches with the other national improvement programmes and initiatives in the Better Health, Better Care Action Plan. 2.8 Further information about the Better Together programme and results to date from the inpatient and GP surveys can be found at The Better Together work supports NHS Scotland s Quality Strategy by providing a basis for the measurement of quality as experienced by service users across Scotland, in addition to support for local improvement. The ultimate aim of the Quality Strategy is to deliver the highest quality healthcare services to people in Scotland, and through this to ensure that NHS Scotland is recognised by the people of Scotland as amongst the best in the world. Further information about the Quality Strategy can be found at: Aims of the Better Together Inpatient Survey 2.10 The survey s specific aims are to: a) Gain an understanding of the experiences of adult patients receiving services at NHS hospitals in Scotland; b) Provide NHS Boards and NHS sites with information about areas of best practice and areas for improvement; c) Determine the key drivers for positive inpatient experience within Scotland; d) Explore if and how differences exist in terms of experiences between patients of different ages groups, genders, ethnic groups, religious groups, sexual orientation, and disability status; and 6

14 e) Assess if and how the level of positive and negative experiences change over time, between NHS Boards and between NHS sites; and f) Examine whether positive experiences benefit patients in terms of their clinical outcome This report is primarily focused on aims a) to d). Given this is the first year of the survey, an exploration of change over time has not been undertaken. Over the latter part of 2010 and through 2011 it is expected that additional topic reports will be published on aims d) and f). Survey design 2.12 Initial work on the inpatient survey began in late 2008 and was developed over the period of a year in consultation with an Inpatient Measuring Experience Research Advisory Group and other key stakeholders as appropriate. It built on evidence gathered from international literature, research on public priorities in Scotland with respect to inpatient services, and consultation with health service consumers The aim was to develop a questionnaire which could be used as an annual tool to assess the experiences of adult patients receiving services at NHS hospitals in Scotland. To ensure that the survey was clear, robust and easy to complete, the survey materials were cognitively tested and also piloted in summer 2009 with four NHS Boards: Greater Glasgow and Clyde, Fife, Dumfries and Galloway, and Ayrshire and Arran The survey was peer reviewed by a leading academic and ethically approved by the NHS National Research Ethics Service, through the North West Research Ethics Committee, prior to being piloted. Survey fieldwork and response 2.15 The patient sample was designed to provide results at the level of individual hospital sites as well as at each of the 14 NHS Board level and the National Waiting Time Centre (NWTC) and nationally across Scotland. The survey was sent to a stratified sample of adult inpatients (aged 16 years old or above on discharge) who had an inpatient hospital stay (at least one overnight stay) between October 2008 and September Fieldwork was undertaken by NHS Boards beginning on 20 January 2010 on a rolling basis. NHS Boards started at different times, the last NHS Board distributed their surveys on 22 February 2010 and the survey closed on 23 7

15 April Survey packs were sent to each respondent by Approved Contractors 5 on behalf of each NHS Board. In total, 62,308 survey packs were sent to patients and 30,880 were returned, giving an overall response rate of 50% Of those patients who provided information about themselves: 6 per cent were aged 16-34, 14 per cent were aged 35-49, 27 per cent were aged and 52 per cent were 65 and over In addition, 38 per cent did not have any limiting illness or disability, and 42 per cent were male and 58 per cent were female. Ninety eight per cent indicated that they were heterosexual / straight whilst 2 per cent indicated that they were either gay / lesbian, bisexual or other Respondents were also asked to self-report their general health as either good, fair or poor. Forty seven per cent rated their health as good, 41 per cent as fair and 12 per cent as poor For information on the survey development design and sampling please refer to the technical report: Data analysis and interpretation 2.21 The survey data was collected and then entered by Approved Contractors. Anonymised data was then securely transferred to ISD 6 who carried out hospital site and Board level analysis. Anonymised data was then securely transferred to the Better Together Coordination Centre (PricewaterhouseCoopers LLP PwC 7 ) to carry out the NHS Board and national level analysis Prior to data analysis, sites which were identified as private hospital sites using the Scottish Health Service Costs Book were excluded for the purposes of reporting national NHS results for Scotland. A total of 307 cases from private hospital sites were excluded from national NHS results (if these were included, the survey response count would be 30,880). Separate analysis of private hospitals against national NHS results are provided in Section 11: Other comparisons. 5 Two Approved Contractors supported NHS Boards; they were Patient Perspective and Quality Health. Approved Contractors carried out the fieldwork element of the inpatient survey, organising the mail out of survey packs, issuing reminders to patients who did not respond, inputting and quality assurance of data and sending completed datasets of survey findings to the Coordination Centre. 6 ISD is Scotland s national organisation for health information, statistics and IT services. ISD had a role in site and Board analysis of the inpatient results as well as input to the overall survey development process and supporting on the approach to analysis and reporting of national results. 7 PwC s role was to develop the survey tools and methodologies for capturing data; support the survey fieldwork; and analyse and report on the results. 8

16 2.23 Valid percentages are reported in the report with those patients who replied that a question was not relevant or that they did not know the answer being excluded Throughout the report, weighted percentages have been presented unless otherwise stated. Weightings were applied to all cases within the data file based on the size of each site against the national population of inpatients for the period sampled to ensure that smaller sites were not over represented in the final results. Further information on how weightings were calculated and applied can be found in the technical report The survey used a stratified (by site or sub-site specialty level) sample design with weights applied to estimate national averages. One of the effects of using stratification and weighting is that standard errors for survey estimates are generally higher than the standard errors that would be derived from an unweighted simple random sample of the same size. The calculations of standard error and comments on statistical significance have taken the weighting and stratification into account (see chapter 8 of the Technical Report for more information) In chapters referring to NHS Boards comparison with the national average, type of Hospital and emergency versus planned admission results are discussed on the basis that they are statistically significant (at a 95% level of confidence). That is, that for an individual survey question the difference between the percentage of patients indicating a positive experience, for example in NHS Highland, and the national average (across the 14 NHS Boards and the National Waiting Times Centre) for the question is statistically significant For results in respect of gender, age, health status, health problem or disability and sexual orientation, comparisons are on the basis of them being statistically significant (at a 95% level of confidence) compared to each other. That is: male v female for gender, under 65 v 65 and over years for age, good / fair v poor for health status, limited a little / a lot v no for health problem or disability and heterosexual / straight v gay / lesbian / bisexual for sexuality. Design effects were not taken into account for this analysis as information on the inpatient population was not available (e.g. on sexual orientation) If there is no reference in the report to a particular Board, demographic group or hospital type it can be assumed that their result is not significantly different from the national average In interpreting the results, consideration should also be given to the varying size of NHS Boards in Scotland. For example NHS Orkney as an island board has one hospital with an inpatient population of 412 at the time of the survey, whereas Glasgow as a large board has 16 hospitals with an inpatient population of 82,634. Across Boards there is a large variation in geographic coverage, population sizes and hospital sites, as well as hospital type and this should be borne in mind when reviewing survey findings. 9

17 2.30 In addition where results for a Board are indicated to be significantly less than the Scottish average in this report, it may be the case that one or two specific hospital sites within Board areas are influencing this. Equally if a Board has a large number of hospitals it might be that their Board level results are average or above average but that one or two specific hospital sites within the Board area are performing significantly below the national average. Scope and structure of the report 2.31 The remainder of this report presents patient experience results from the survey in order of the hospital inpatient journey. The report also considers the importance patients placed on a number of key areas relating to their hospital stay and their actual experience of these areas. In addition, it considers results by NHS Boards, patient demographics and hospital type, as well as comparing the overall results with those of the 2009 English Inpatient Survey. It is structured as follows: Results Admission to hospital; Results The hospital and ward; Results Care and treatment; Results Staff; Results Leaving hospital; Results - Importance versus actual experience; Results Patient characteristics; Results Hospital type Results NHS Board Results - Other comparisons (NHS patients in NHS hospitals and NHS patients in private hospitals, and English Inpatient Survey results for 2009); Conclusions; and Annexes. Other outputs from this survey 2.32 This report focuses on the national results for the Scottish Inpatient Survey More detailed results for NHS Boards and individual hospital sites are available at: 10

18 3 RESULTS ADMISSION TO HOSPITAL Admission to hospital 3.1 This section of the report considers patients admission to hospital. It discusses the findings relating to patients who were admitted to hospital either from a waiting list / planned in advance, or who were admitted as an emergency. In addition, results are presented from questions on patient experience (where relevant) of A&E and overall experience of admission to hospital. Views on admission overall 3.2 Patients generally rated their admission to hospital positively, with 81 per cent describing it as either excellent or good, 13 per cent stating it as fair and 6 per cent describing it as poor or very poor. These results are illustrated in Chart 3.1. Chart 3.1: Overall, how would you rate your admission to hospital? Excellent Good Fair Poor Very poor Q9. Percentage of patients 3.3 In terms of patients route of admission into hospital, emergency or urgent patients were less likely to score their overall admission to hospital positively (77%). Patients who were admitted from a waiting list or planned were more likely to report a positive overall experience of their admission to hospital (86%). 3.4 Table 3.1 summarises patient responses to questions regarding admission to hospital. Annex B presents in tabular format which survey responses were classed as positive, neither positive nor negative or negative for each question. 3.5 As illustrated in Table 3.1, the responses ranged from 53 per cent of patients who stated that they were told how long they would have to wait in A&E, to 96 per cent of waiting list or planned in advance patients who agreed that the 11

19 information they received prior to attending hospital helped them to understand what would happen. Table 3.1: Summary of the results to questions regarding patients admission to hospital Statement or question Emergency or urgent patients In A&E I was told how long I would have to wait In A&E I was told what was happening in a way I could understand Overall, how would you rate the care and treatment you received during your time in A&E? Waiting list and planned in advance patients If your hospital visit was planned in advance how did you feel about the length of time you waited to be admitted to hospital after being referred? Did the information you were given before attending hospital help you understand what would happen? All patients From the time you arrived at hospital, how did you feel about the time you had to wait to get to a bed on the ward? * Not all rows add to 100% due to rounding. Positive % Neither positive nor negative % Negative % , , , , , ,051 Total base (unweighted) In A&E I was told how long I would have to wait 3.6 More than half (53%) of patients who went to the A&E department agreed that they were told how long they would have to wait, leaving 30% of patients who disagreed with this statement. In A&E I was told what was happening in a way I could understand 3.7 Overall, 84 per cent of the sample was in agreement that in the A&E department they were told what was happening in a way they could understand. Nine per cent of respondents disagreed with this statement. 12

20 Overall, how would you rate the care and treatment you received during your time in A&E? 3.8 Patients generally reported the care and treatment they received in A&E in a positive manner, with 83 per cent describing it as excellent or good and thirteen per cent describing it as fair and five per cent as poor or very poor. If your hospital visit was planned in advance how did you feel about the length of time you waited to be admitted to hospital after being referred? 3.9 Overall, 89 per cent of patients who had their hospital visit planned in advance stated that the length of time they waited to be admitted to hospital after being referred was reasonable. Almost one in ten (9%) stated that they felt their wait was too long. Did the information you were given before attending hospital help you understand what would happen? 3.10 A majority of patients (96%) were positive about the information they were given before attending hospital, with one per cent disagreeing with this statement. From the time you arrived at hospital, how did you feel about the time you had to wait to get to a bed on the ward? 3.11 Patient responses on how they felt about the time they had to wait to get to a bed indicated generally positive experiences (87%). Overall, 38 per cent of patients stated that they did not have to wait, and a further 49 per cent stated that their wait was reasonable. Thirteen per cent of patients reported that their wait was too long. Summary 3.12 In terms of patients positively reporting their overall experience of the hospital admission process, this section of the survey received the third highest level of positive feedback of the five stages of the patient journey explored The aspects that achieved higher levels of positive feedback included: Patients who were admitted to hospital from a waiting list/ planned in advance rather than an emergency or urgent admission; The information received before attending hospital helping patients to understand what would happen; and The length of time patients had to wait after being referred. 13

21 3.14 The aspects identified with lower levels of positive feedback included: Patients who attended A&E and were not admitted to hospital from a waiting list or planned in advance; and Patients being told how long they would have to wait in A&E. 14

22 4 RESULTS THE HOSPITAL AND WARD The hospital and ward environment 4.1 This section reports on the views of patients with regard to the hospital and ward environment. It provides the findings on patients experience of ward and bathroom cleanliness, their views on the food and drink provided, noise levels in the ward, as well as about any sense of feeling bothered or threatened by other patients, and clarity about who was in charge. The findings for patients who shared a room or bay with members of the opposite sex are presented as well as patients overall experience of the hospital environment. Views on the hospital environment overall 4.2 As illustrated in Chart 4.1, at a national level, the majority of patients reported their experience of the overall hospital environment positively. Seventy nine per cent described it as either excellent or good and 4 per cent rated it as poor or very poor. Chart 4.1: Overall, how would you rate the hospital environment? Excellent Good Fair Poor Very poor Q13. Percentage of patients 4.3 Patients were asked to rate their level of agreement to a range of statements about the hospital and environment using a five point scale ranging from strongly agree to strongly disagree. Table 4.1 presents the positive, negative and neutral results for each of these statements. 4.4 The results range from 58 per cent of respondents who stated that they were not bothered by noise to 90 per cent of patients who indicated that the main ward or room they stayed in was clean. 15

23 Table 4.1: Summary of the results of questions asked about the hospital environment* Statement The main ward or room I stayed in was clean Positive % Neither positive nor negative % Negative % ,870 The bathrooms and toilets were clean ,478 Not bothered by the noise ,397 My religious and spiritual needs were respected I was happy with the food and drink that I received Not bothered or threatened by other patients or visitors , , ,299 I knew who was in charge of the ward ,755 Total base (unweighted) * Not all rows add to 100% due to rounding. The main ward or room I stayed in was clean 4.5 Patients responded positively when asked to rate the cleanliness of the ward or room they stayed in; 90 per cent agreed that it was clean. Four per cent of respondents disagreed with this statement. This was the most positively reported upon statement as per the findings in Table 4.1. The bathrooms and toilets were clean 4.6 Results for this statement were less positive than those regarding the cleanliness of the main ward or room patients stayed in. Eighty four per cent of patients were in agreement that the bathrooms and toilets were clean. Nine per cent of patients disagreed with this statement. Not being bothered by noise 4.7 Fifty eight per cent of respondents were in agreement that they were not bothered by noise. A quarter of patients (25%) were bothered by the noise in their ward or room, while 17 per cent neither agreed d with this statement. My religious and spiritual needs were respected 4.8 Forty per cent of the sample chose not to answer this question, suggesting that for those patients, this may not have been an issue that they considered relevant to them personally. For those that did respond, 65 per cent felt that their religious and spiritual needs were respected and four per cent did not. A high proportion of respondents (31%) chose to neither agree. 16

24 I was happy with the food and drink that I received 4.9 Overall, just less than three quarters (71%) of respondents stated that they were happy with the food and drink they had received while in hospital. It is important to note however that almost a fifth of respondents (19%) were not happy with the food and drink they received. Not being bothered or threatened by other patients or visitors 4.10 A majority of patients were in agreement about not feeling threatened or bothered by other patients or visitors, with 80 per cent stating that this was not an issue for them. However, 13 per cent did feel bothered or threatened during their stay in hospital. I knew who was in charge of the ward 4.11 The results indicate that there was a lack of clarity amongst patients knowing who was in charge of the wards in a number of Scottish hospitals. Whilst 64 per cent of patients stated that they were aware of who was responsible for their ward, importantly a quarter (25%) of the total sample did not know who was in charge. Sharing a room or bay with members of the opposite sex 4.12 In addition to the statements identified in Table 4.1, patients were asked if they had shared a room or bay with a member of the opposite sex during their most recent stay in hospital, and if so, did they mind having to do this In total, 9 per cent of all respondents reported that they had shared a room or bay with someone of the opposite sex. Amongst those who had experienced this, views were mixed. Over two thirds (68%) did not mind having to share with someone of the opposite sex, while the remaining 32 per cent did mind. Summary 4.14 Overall experience of the hospital and ward environment received the second lowest level of positive feedback from the five areas covered in the survey Within hospital and ward environment, the aspects that achieved higher levels of positive feedback within the areas explored were: The cleanliness of the main ward or room; and The cleanliness of the bathrooms and toilets. 17

25 4.16 Areas where there were lower levels of positive feedback were: Noise levels in the wards; The food and drink provided; and Communication of who was in charge of the ward Respect for religious and spiritual needs was also an area where there was lower positive patient feedback, however forty per cent of the patient sample chose not to answer this question. 18

26 5 RESULTS CARE AND TREATMENT Care and treatment 5.1 This section reports on the views of patients with regard to the care and treatment they received during their hospital stay. It explores patients experience of being able to get adequate pain relief, having privacy when being examined or treated or when their condition and treatment was being discussed. It also considers patient experience of getting help with washing, dressing, eating and drinking when needed, their involvement in moving wards and how this was managed, as well as patients overall experience of their care and treatment. Views on care and treatment overall 5.2 At a national level, patients rated their overall care and treatment positively, with 84 per cent rating it as either excellent or good and 4 per cent describing it as poor or very poor, as illustrated in Chart 5.1. Chart 5.1: Overall, how would you rate your care and treatment during your stay in hospital? Excellent Good Fair Poor Very poor Q17 Percentage of patients 5.3 The analysis of patients experience of the various aspects of their care and treatment indicates that most areas performed well. Specific statements that patients responded to in relation to care and treatment are listed in Table The results for care and treatment range from 69 per cent of respondents who were positive about getting help with eating and drinking, to 94 per cent who described having privacy when being examined or treated. 19

27 Table 5.1: Summary of the results of questions asked about care and treatment* Statement Positive % Neither positive nor negative % Negative % Total base (unweighted) I was able to get adequate pain relief ,894 when I needed it I had privacy when being examined or ,606 treated I had privacy when my condition and ,330 treatment was discussed I got help with washing and dressing ,928 when I needed it I got help with eating and drinking when I ,113 needed it Before moving wards, a member of staff ,903 explained what would happen Moving wards was well managed ,599 * Not all rows add to 100% due to rounding. I was able to get adequate pain relief when I needed it 5.5 The majority of patients responded positively when asked about their ability to get adequate pain relief, with 91 per cent who agreed that they were able to get such pain relief when they needed it. Less than one in ten (6%) disagreed that they could not get adequate pain relief when they needed it. I had privacy when being examined or treated 5.6 Ninety four per cent of patients agreed that they had privacy when being examined or treated. Three per cent of respondents disagreed with this statement. I had privacy when my condition and treatment was discussed 5.7 With regard to privacy when discussing the patients condition and treatment, 85 per cent of respondents were in agreement with this statement, which was not as positive as feedback for privacy when being examined or treated. Eight per cent of respondents disagreed with this statement. I got help with washing and dressing when I needed it 5.8 Almost two thirds (65%) of patients needed help with washing and dressing (as indicated by the proportion who answered this question). At a national level 82 per cent of those who needed help indicated that they received it when required. Eight per cent of respondents disagreed with this statement. 20

28 I got help with eating and drinking when I needed it 5.9 The results indicate that 40 per cent of patients needed help with eating and drinking (as indicated by the proportion who answered this question). Amongst those who needed it, 69 per cent were of the opinion that they got help when required. It is worth noting, however, that 11 per cent felt that they did not receive help with eating and drinking when they needed it. Before moving wards, a member of staff explained what would happen 5.10 Fifty five per cent of the patient sample indicated that they had moved wards. Amongst those that had, 82 per cent reported that before moving wards, a member of staff explained what would happen. Ten per cent of patients disagreed with this statement. Moving wards was well managed 5.11 The findings for the management of moving wards were similar to those for whether an explanation had been provided about a ward move. Eight two per cent of patients who moved between wards reporting that this was well managed. Nine per cent of patients disagreed with this statement. Patient involvement in decisions around their care and treatment 5.12 In addition to the statements identified in Table 5.1, patients were asked how they felt about being involved in decisions about their care and treatment. Eighty four per cent stated that they were involved as much as they wanted to be; 13 per cent felt they were not involved enough, and two per cent felt they were involved much more than they wanted to be. A further two per cent indicated that they did not wish to be involved. Chart 5.2 illustrates these results. Chart 5.2: How did you feel about being involved in decisions about your care and treatment? More than they wanted to be As much as they wanted to be Not invovled enough Did not wish to be involved Q15 Percentage of patients 21

29 Summary 5.13 Overall experience of care and treatment received the second highest level of positive patient feedback of the five stages of the patient journey explored The areas that achieved higher levels of positive feedback within care and treatment were: The ability to get adequate pain relief; and Having privacy when being examined or treated An area that achieved a lower level of positive feedback within the care and treatment stage was: Patients getting help with eating and drinking when they needed it. 22

30 6 RESULTS STAFF 6.1 This section discusses patients views and experiences of the doctors and nurses they came into contact with during their hospital stay. It considers whether they thought that staff worked well together in organising their care, and their views on a range of areas including the extent to which they felt they had been listened to and how well their doctors and nurses had explained their condition and treatment. In addition, this section presents patients overall rating of all the staff they had come into contact with. Views on staff overall 6.2 As illustrated in Chart 6.1, at a national level the majority of patients were positive regarding the contact they had with staff. Eighty seven per cent described their experience as either excellent or good. This was in comparison to 3 per cent of respondents who described the staff they had met as poor or very poor. Chart 6.1: Overall, how would you rate all the staff who you came into contact with? Excellent Good Fair Poor Very poor Q21 Percentage of patients 6.3 The survey results indicated that waiting list or planned in advance respondents provided higher positive scores for the staff they had come into contact with (90%) compared to those respondents who had attended hospital as emergency or urgent cases (85%). Doctors 6.4 Patients were asked to respond to a number of statements regarding their experiences of the doctors they had come into contact with during their most recent hospital stay. These results are illustrated in Table The responses ranged from 78 per cent who agreed that there was enough time to talk to doctors, to 87 per cent who described a positive experience across a number of areas relating to the doctors they encountered. 23

31 Table 6.1: Summary of the results of questions asked about doctors encountered* Statement There was enough time to talk to the doctors Doctors knew enough about my condition and treatment Doctors explained the risks and benefits of any treatment in a way I could understand Doctors talked in a way that helped me understand my condition and treatment Doctors gave me clear explanations about my operations and procedures (e.g. what would happen, how I could expect to feel) Doctors told me how my operation or procedure had gone in a way I could understand Doctors listened to me if I had any concerns As far as I was aware doctors washed/ cleaned their hands at appropriate times * Not all rows add to 100% due to rounding. Positive % Neither positive nor negative % Negative % , , , , , , , ,273 Total base (unweighted) There was enough time to talk to the doctors 6.6 Slightly more than three-quarters of respondents (78%) felt they had adequate time to talk to doctors during their most recent visit. Twelve per cent of respondents felt that there was not adequate time to talk to doctors. Doctors knew enough about my condition and treatment 6.7 Over four fifths (87%) of patients reported that doctors knew enough about their condition and treatment. Seven per cent of respondents disagreed with this statement. Doctors explained the risks and benefits of any treatment in a way I could understand 6.8 In line with the level of agreement for doctors speaking to patients in a way that helped them to understand their condition and treatment, patients also agreed to the same degree (87%) that doctors had explained the risks and benefits of any treatment in a way they could understand. Seven per cent of respondents disagreed with this statement. 24

32 Doctors talked in a way that helped me understand my condition and treatment 6.9 Eighty seven per cent of patients were in agreement that doctors spoke to them in a way that helped them to understand their condition and treatment. Six per cent of respondents disagreed with this statement. Doctors gave me clear explanations about my operations and procedures 6.10 Eighty six per cent of respondents were in agreement that doctors gave them clear explanations about any operations and procedures. Seven per cent of respondents disagreed with this statement. Doctors told me how my operation or procedure had gone in a way I could understand 6.11 Eighty seven per cent of patients were in agreement that doctors had told them how their operation or procedure had gone in a way they could understand. Six per cent of respondents disagreed with this statement. Doctors listened to me if I had any concerns 6.12 Feedback from respondents on doctors listening to them if they had any questions or concerns was in line (86%) with their agreement around doctors giving them clear explanations about any operations and procedures. Six per cent of patients disagreed with this statement. As far as I was aware doctors washed/ cleaned their hands at appropriate times 6.13 Overall 85 per cent of patients agreed that doctors washed their hands at appropriate times. Five per cent of respondents disagreed with this statement. Nurses 6.14 Patients were also asked for their views in a number of areas relating to the contact they had with nurses. These findings are illustrated in Table The responses range from 77 per cent of patients who agreed that nurses gave them clear explanations about their operations and procedures to 88 per cent who stated that as far as they were aware, nurses cleaned their hands at appropriate times. 25

33 Table 6.2: Summary the results of questions asked about nurses encountered* Statement There was enough time to talk to the nurses Nurses knew enough about my condition and treatment Nurses talked in a way that helped me understand my condition and treatment Nurses gave me clear explanations about my operations and procedures (e.g. what would happen, how I could expect to feel) Nurses listened to me if I had any concerns As far as I was aware nurses washed/ cleaned their hands at appropriate times * Not all rows add to 100% due to rounding. Positive % Neither positive nor negative % Negative % , , , , , ,955 Total base (unweighted) There was enough time to talk to the nurses 6.16 Seventy nine per cent of patients indicated that there had been enough time to talk to nurses. Twelve per cent of respondents disagreed with this statement. This statement was one of the lower ranking statements in relation to nurses. Nurses knew enough about my condition and treatment 6.17 Overall, 82 per cent of respondents agreed that nurses knew enough about their condition and treatment. Eight per cent of patients disagreed with this statement. Nurses talked in a way that helped me understand my condition and treatment 6.18 Eighty one per cent of respondents agreed that nurses talked in a way that helped them to understand their condition and treatment. Eight per cent of respondents disagreed with this statement. Nurses gave me clear explanations about my operations and procedures 6.19 Just over three quarters of respondents (77%) agreed that nurses gave clear explanations about operations and procedures. Ten per cent of patients disagreed with this statement. 26

34 Nurses listened to me if I had any concerns 6.20 Eighty five per cent of all respondents were in agreement that nurses listened to them if they had any concerns. Seven per cent of patients disagreed with this statement. As far as I was aware nurses washed/ cleaned their hands at appropriate times 6.21 A majority of patients (88%) agreed that nurses washed their hands at appropriate times. Four per cent of patients disagreed with this statement. Staff working well together in organising your care 6.22 In addition to the statements identified in Tables 6.1 and 6.2, patients were asked if they agreed staff had worked well together in organising their care Eighty four per cent of patients were in agreement with this statement, while 7 per cent disagreed with it. Summary 6.24 At a national level, patients contact and interactions with staff received the highest level of overall positive patient experience feedback across the five aspects of the patient journey investigated Within the staff section, the areas that achieved higher levels of positive feedback were: Doctors knowing enough about patients care and treatment and talking in a way that helped patients to understand this; Doctors explaining in an understandable way: the risks and benefits of any treatment; and indicating how the patients operation or procedure had gone; and Nurses cleaning their hands at appropriate times and listening to patients if they had any concerns Areas where there were lower levels of positive feedback were: The time patients have to talk to doctors and nurses; and Nurses explanations about operations and procedures provided to patients. 27

35 7 RESULTS LEAVING HOSPITAL Preparations and advice when leaving hospital 7.1 This section reports on the experiences of patients with regard to leaving hospital after their most recent stay. It explores patients experiences of how long they had to wait after being told they could go home, being given help with transport, advice on who to contact if they had any questions, advice on danger signals, how to look after themselves and any help arranged for when they got home. 7.2 In addition, this section investigates patient experience of medication, including whether patients understood what the medicines were for, if they understood how and when to take them and their understanding of the side effects. This section also presents patients rating for their overall experience of the arrangements for leaving hospital. Views on the overall arrangements for leaving hospital 7.3 As illustrated in Chart 7.1, at a national level almost three quarters (73%) of patients reported their overall experience of leaving hospital as either excellent or good and 8 per cent reported it as poor or very poor. Chart 7.1: Overall, how would you rate the arrangements made for you leaving hospital? Excellent Good Fair Poor Very poor Q24 Percentage of patients 7.4 An analysis of patients experience of the various aspects of the arrangements for leaving hospital reveals that some areas attracted less positive feedback. The specific statements that patients responded to are listed in Table The results range from 66 per cent of respondents who agreed that they were given help with arranging transport to 81 per cent of patients who indicated that they understood who to contact if they had any questions after leaving hospital. 28

36 Table 7.1: Summary results of questions asked about the arrangements for leaving hospital* Statement I was happy with how long I had to wait around when I was told I could go home Positive % Neither positive nor negative % Negative % ,583 I was given help with arranging transport ,087 I understood who to contact if I had any questions after leaving hospital I was told about any danger signals to watch for when I got home I was given advice on how to look after myself I was confident that any help I needed had been arranged for when I got home * Not all rows add to 100% due to rounding , , , ,300 Total base (unweighted) I was happy with how long I had to wait around when I was told I could go home 7.6 Almost three quarters (73%) of patients were in agreement that they were happy with how long they had to wait around when they were told they could go home. Just under a fifth (19%) of respondents disagreed. I was given help with arranging transport 7.7 Being given help with arranging transport was relevant to 46 per cent of the sample and is the lowest performing area with regard to the leaving hospital process. Amongst those who needed help with arranging transport, two thirds (66%) reported that they were given help. Twenty two per cent of respondents disagreed with this statement. I understood who to contact if I had any questions after leaving hospital 7.8 Understanding who to contact after leaving hospital received the highest rating of positive patient experience in the leaving hospital section, with 81 per cent reporting that they understood who to contact if they had any questions after leaving hospital. Twelve per cent of respondents disagreed with this statement. I was told about any danger signals to watch for when I got home 7.9 Overall, almost three quarters (73%) of patients reported that they were told about any danger signals to watch for when they got home. Seventeen per cent of respondents disagreed with this statement. 29

37 I was given advice on how to look after myself 7.10 Over three quarters (78%) of patients indicated that they were given advice on how to look after themselves. Thirteen per cent of respondents disagreed with this statement. I was confident that any help I needed had been arranged for when I got home 7.11 Of those patients that responded to this statement (60% of the total sample), almost three quarters (74%) of patients indicated they were confident that any help they needed had been arranged for when they got home. Fifteen per cent of respondents disagreed with this statement. Medication 7.12 In addition to the statements identified in Table 7.1, patients were asked about their experience of the various aspects of medication. Analysis of these results reveals positive feedback, especially in relation to understanding what medicines were for and how and when to take them. The specific statements that patients responded to are listed in Table The results range from 80 per cent of patients agreeing that they understood the possible side effects of medicines and what to do if they had any concerns, to 96 per cent stating that they understood how and when to take their medicines. Table 7.2: Summary of the results of questions asked about medication* Statement I understood what my medicines were for I understood how and when to take my medicines I understood the possible side effects and what to do if I had any concerns * Not all rows add to 100% due to rounding. Positive % Neither positive nor negative % Negative % , , ,950 Total base (unweighted) I understood what my medicines were for 7.14 Overall, 94 per cent of patients reported that they understood what their medicines were for. Three per cent of respondents disagreed with this statement. 30

38 I understood how and when to take my medicines 7.15 Overall the results were positive for this statement, with 96 per cent indicating that they understood how and when to take medicines. Two per cent of respondents disagreed with this statement. I understood the possible side effects and what to do if I had any concerns 7.16 Over three quarters (80%) of patients reported that they understood the possible side effects of their medicines and what to do if they had any concerns. Ten per cent of respondents disagreed with this statement. Summary 7.17 Overall patients experiences of leaving hospital was the least positive of the five stages of the patient journey contained in the survey Areas with the leaving hospital stage that achieved higher levels of positive feedback included: Patients understanding who to contact if they had any questions after leaving hospital; and Being given advice on how to look after themselves Areas where there was a lower level of positive feedback included: Patients being given help with arranging transport; and Length of wait before going home and danger signs to look for once at home The medication questions achieved positive results, especially with regards to patients understanding what their medicines were for and how and when to take them An area where there was a lower level of positive feedback for medication was patients having an explanation about possible side effects and what to do if they had any concerns. 31

39 8 RESULTS IMPORTANCE VERSUS ACTUAL EXPERIENCE 8.1 This section explores the areas of the patient experience that were rated most important to patients, and then goes on to look at their actual experience in each area. Areas of importance 8.2 Table 8.1 illustrates the list of statements that patients were asked to consider in terms of how important or unimportant they were during their most recent hospital stay, along with the results of how each area was rated. Table 8.1: Summary results of how important each of the following statements are to patients* Statement Very important % Important % Quite important % Not important or of little importance % Total base (unweighted) Being treated with ,688 respect Being treated with care ,675 Getting the best ,574 treatment for my condition Trusting the people ,751 looking after me Understanding what ,524 was happening to me Being as physically ,668 comfortable as I could expect to be Being confident I could look after myself when I left hospital ,773 * Not all rows add to 100% due to rounding. 8.3 Not surprisingly all of the aspects of patient experience listed were considered to be important by patients, with all being described as very important or important by more than 9 in 10 patients. 8.4 Analysing further, it is clear that some aspects of the patient experience were however prioritised over others. This can be seen when looking at the percentage who rated each statement as very important. Getting the best treatment for their condition, and trusting the people who look after them would appear to be patients highest priorities while in hospital. Although still considered important, being treated with respect would be a lower relative priority for patients, along with being physically comfortable and patients being confident about looking after themselves when they leave hospital. 32

40 Actual patient experience 8.5 The analysis of actual patient experience of these areas is illustrated in Table 8.2, where the specific statements that patients responded to are listed. 8.6 The findings were very similar across each of the different areas of patient experience that were investigated, with around 9 in 10 respondents providing positive feedback on each statement. This was largely also the case when findings were considered by NHS Board, but not always when considered by NHS hospital site (see individual hospital reports at ). Table 8.2: Summary results of whether or not each of the following happened during the patients stay in hospital* Statement Positive % Neither positive nor negative % Negative % I was treated with respect ,753 I was treated with care ,682 I got the best treatment for my condition ,048 I trusted the people looking after me ,656 I understood what was happening to me ,421 Total base (unweighted) I was as physically comfortable as I could expect to be I was confident I could look after myself when I left hospital * Not all rows add to 100% due to rounding , ,896 Summary 8.7 Overall, all aspects of patient experience that were explored were rated as important for patients responding to the survey. Patients actual experience of these areas also tended to be positive overall, with around or close to 9 in 10 respondents in agreement with the statements posed. 33

41 9 RESULTS PATIENT CHARACTERISTICS 9.1 This section of the report presents the survey results by patient characteristic, considering gender, age, self-reported health status, health problem or disability and sexual orientation. Analysis of results for these patient characteristics focus on the statements relating to patients overall experience of each stage of the patient journey only. The findings provided in this section focuses on those that are statistically significant. Overview of gender 9.2 Respondents to the survey were asked to indicate their gender and Table 9.1 outlines that a total of 12,603 (42%) respondents were male and 17,570 (58%) respondents were female. Table 9.1: Profile of respondents by gender Gender Respondent Profile Total no. of respondents Male 12,603 42% Female 17,570 58% TOTAL 8 30, % % (unweighted) 9.3 The following paragraphs highlight the overall results for each stage of the patient journey where the differences between males and females were statistically significant. Gender overall experience 9.4 Table 9.2 summarises how patients reported their overall experience from A&E and admission right through to leaving hospital. 8 The total indicated varies across the different aspects of patient characteristics investigated as not all patients provided answers for these questions in a consistent manner. 34

42 Table 9.2: Overall patient experience results by gender Gender Male Female Overall, how would you rate the care and treatment you received during your time in A&E? Overall positive experience % Overall, how would you rate your admission to hospital? Overall, how would you rate the hospital environment? Overall, how would you rate your care and treatment during your stay in hospital? Overall, how would you rate all the staff who you came into contact with? Overall, how would you rate the arrangements made for you leaving hospital? Males reported a more positive overall experience at all stages of the patient journey compared to females, and the differences were statistically significant: With regard to the care and treatment received in A&E, males reported a more positive experience (85%) than females (81%); In terms of the overall hospital admission process, males reported a more positive experience (82%) than females (80%); For the overall hospital and ward environment, males reported a more positive experience (81%) than females (77%); With regard to the overall care and treatment that patients received, males reported a more positive experience (87%) than females (82%); In terms of their overall experience of the staff they encountered, males reported a more positive experience (90%) than females (84%); and For the overall experience of arrangements made for leaving hospital, males reported a more positive experience (75%) than females (72%). Overview of age 9.6 Respondents were asked to record their age in the survey: year olds, year olds, year olds and 65 years old or over. As illustrated in Table 9.3, over half of all respondents were aged 65 years old and over (52% of all respondents), whilst 27 per cent of respondents were between 50 and 64 years old. Fourteen per cent of respondents were aged between 35 and 49 years and 6 per cent were aged between 16 and 34 years. 35

43 9.7 Consideration was given to further analysis and breakdown of the 65 years old and over age band, however only small differences were discernible between those aged 65 to 79 year olds and 80 and over year groups. It was therefore decided that an older age group of 65 years old and over would provide the most useful approach to analysing the views of older patients. Table 9.3: Profile of respondents by age Age Respondent Profile Total no. of respondents ,874 6% ,221 14% ,965 27% ,238 52% TOTAL 29, % % (unweighted) 9.8 For the purposes of analysis, ages were re-coded into two bands: younger patients i.e. patients under 65 years old (combining year olds, year olds, year olds) and older patients aged 65 years old and over. 9.9 The following paragraphs highlight the overall results for each stage of the patient journey where differences by patient age were statistically significant. Age overall experience 9.10 Table 9.4 summarises how patients reported their overall experience from A&E and admission right through to leaving hospital. Table 9.4: Overall patient experience results by age Age Overall, how would you rate the care and treatment you received during your time in A&E? Overall, how would you rate your admission to hospital? Overall, how would you rate the hospital environment? Overall, how would you rate your care and treatment during your stay in hospital? Overall, how would you rate all the staff who you came into contact with? Overall, how would you rate the arrangements made for you leaving hospital? Younger patients (under 65 years old) Overall positive experience % Older patients (65 years old and over) 36

44 9.11 Older patients reported a more positive overall experience at all stages of the patient journey compared to younger patients, and these differences were statistically significant: With regard to the care and treatment received in A&E, older patients reported a more positive experience (86%) than younger patients (80%); In terms of the overall hospital admission process, older patients reported a more positive experience (83%) than younger patients (79%); For the overall hospital and ward environment, older patients reported a more positive experience (83%) than younger patients (75%); With regard to the overall care and treatment that patients received, older patients reported a more positive experience (88%) than younger patients (81%); In terms of their overall experience of the staff they encountered, older patients reported a more positive experience (90%) than younger patients (84%); and For the overall experience of arrangements made for leaving hospital, older patients reported a more positive experience (78%) than younger patients (69%). Overview of self reported health status 9.12 Respondents were asked to self-report their general health as either good, fair or poor. Table 9.5 shows that 47 per cent rated their health as good, 41 per cent as fair and 12 per cent as poor. Table 9.5: Profile of respondents self-reported general health status Health Status Respondent Profile Total no. of respondents Good 13,624 47% Fair 11,707 41% Poor 3,443 12% TOTAL 28, % % (unweighted) 9.13 For the purposes of analysis, patient responses were re-coded into two categories: good / fair health (combining those who reported themselves to be in good or fair health) and those who reported that they were in poor health The following paragraphs highlight the overall results for each stage of the patient journey where the differences between those in good / fair and poor health were statistically significant. 37

45 Health status overall experience 9.15 Table 9.6 summarises how patients reported their overall experience from A&E and admission right through to leaving hospital. Table 9.6: Overall patient experience results by health status Health Status Good / Fair Poor Overall, how would you rate the care and treatment you received during your time in A&E? Overall, how would you rate your admission to hospital? Overall positive experience % Overall, how would you rate the hospital environment? Overall, how would you rate your care and treatment during your stay in hospital? Overall, how would you rate all the staff who you came into contact with? Overall, how would you rate the arrangements made for you leaving hospital? Patients in good / fair health reported a more positive overall experience at all stages of the patient journey compared to patients in poor health, and these differences were statistically significant: With regard to the overall care and treatment received in A&E, patients in good / fair health reported a more positive experience (84%) than those in poor health (73%); In terms of admission to hospital, those who indicated that they had good / fair health were more positive (83%) about their overall experience of admission, compared to those who had poor health (69%); Within hospital environment, overall positive experience was 81 per cent for those with good / fair health, and 67 per cent for those with poor health; Overall experience of care and treatment was 86 per cent for respondents in good / fair health and 72 per cent for respondents with poor health; Experiences of staff that patients came into contact with during their stay were most positive for patients with good / fair health (88%), compared to 76 per cent for patients with poor health; and Positive views on overall experience of leaving hospital was highest for those with good / fair health (75%) and 61 per cent for those with poor health. 38

46 Overview of health problem or disability 9.17 Patients were asked if they had a health problem or disability which has lasted, or is expected to last at least 12 months and which limits their day-today activities. Table 9.7 shows that 63 per cent had a health problem or disability which limited them either a lot or a little. Table 9.7: Health problem or disability which limits day-to-day activities Health Problem or Disability Respondent Profile Total no. of respondents Yes, limited a lot 8,907 32% Yes, limited a little 8,696 31% No 10,636 38% TOTAL 28, % * Not all rows add to 100% due to rounding. % (unweighted)* 9.18 For the purposes of analysis, patient responses were re-coded into two categories: limited a little / limited a lot by a health problem or disability (combining those who reported themselves to be limited to some extent by a health problem or disability) and those who reported that they were not limited by a health problem or disability The following paragraphs highlight the overall results for each stage of the patient journey where the differences between those who were limited a little / limited a lot and those who were not were statistically significant. Health problem or disability overall experience 9.20 Table 9.8 summarises how patients reported their overall experience from A&E and admission right through to leaving hospital. Table 9.8: Overall patient experience results by health problem Health problem or disability Yes, limited a little / limited a lot Overall, how would you rate the care and treatment you received during your time in A&E? Overall, how would you rate your admission to hospital? Overall, how would you rate the hospital environment? Overall, how would you rate your care and treatment during your stay in hospital? Overall, how would you rate all the staff who you came into contact with? Overall, how would you rate the arrangements made for you leaving hospital? No Overall positive experience %

47 9.21 Patients who were limited a lot / a little by a health problem or disability reported a less positive overall experience at all stages of the patient journey compared to patients who did not have a health problem or disability, and these differences were statistically significant: With regard to the overall care and treatment received in A&E, patients who did not have a health problem reported a more positive experience (84%) than patients limited a little / a lot by a health problem or disability (82%); In terms of admission to hospital, those who indicated that they did not have a health problem reported a more positive experience (83%) than patients limited a little / a lot by a health problem or disability (80%); Within hospital environment, overall positive experience was 80 per cent for those who did not have a health problem and 78 per cent for patients limited a little / a lot by a health problem or disability; Overall experience of care and treatment was 86 per cent for those who did not have a health problem and 83 per cent for patients limited a little / a lot by a health problem or disability; Experiences of staff that patients came into contact with during their stay were most positive for patients who did not have a health problem (89%) and 86 per cent for patients limited a little / a lot by a health problem or disability; and Positive views on overall experience of leaving hospital was highest for those who did not have a health problem (74%) and 73 per cent for patients limited a little / a lot by a health problem or disability. Overview of sexual orientation 9.22 Respondents were asked which of four options best described themselves: heterosexual / straight, gay / lesbian, bisexual or other. Most respondents (98%) indicated that they were heterosexual / straight whilst 2 per cent indicated that they were either gay / lesbian, bisexual or other. Table 9.9: Sexual orientation Sexual orientation Respondent Profile Total no. of respondents Heterosexual / Straight 26, % Gay / Lesbian % Bisexual % Other % TOTAL 26, % % (unweighted) 40

48 9.23 For the purposes of analysis, patient responses were re-coded into two categories: heterosexual / straight and gay/lesbian/bisexual (combining those who reported themselves to be gay / lesbian and those identifying themselves as bisexual) The following paragraphs highlight the overall results for each stage of the patient journey where the differences between those who were heterosexual / straight and those who were gay / lesbian / bisexual were statistically significant. Sexual orientation overall experience 9.25 Table 9.10 summarises how patients reported their overall experience from A&E and admission right through to leaving hospital. Table 9.10: Overall patient experience results by sexual orientation Sexual orientation Heterosexual / straight Overall, how would you rate the care and treatment you received during your time in A&E? Overall, how would you rate your admission to hospital? Overall, how would you rate the hospital environment? Overall, how would you rate your care and treatment during your stay in hospital? Overall, how would you rate all the staff who you came into contact with? Overall, how would you rate the arrangements made for you leaving hospital? Overall positive experience % Gay / lesbian / bisexual 9.26 Heterosexual / straight patients reported a more positive overall experience at all stages of the patient journey compared to gay / lesbian / bisexual patients, and these differences were statistically significant in all stages: With regard to the overall care and treatment received in A&E, heterosexual / straight patients reported a more positive experience (82%) than gay / lesbian / bisexual/ patients (65%); In terms of admission to hospital, heterosexual / straight patients reported a more positive experience (81%) than gay / lesbian / bisexual/ patients (75%); Within hospital environment, overall positive experience was higher for heterosexual / straight patients (79%) compared to gay / lesbian / bisexual/ patients (70%); 41

49 Overall experience of care and treatment was 84 per cent for heterosexual / straight patients and 75 per cent for gay / lesbian / bisexual/ patients; Experiences of staff that patients came into contact with during their stay were most positive for heterosexual / straight patients (87%) compared to gay / lesbian / bisexual/ patients (78%); and Positive views on overall experience of leaving hospital was higher for heterosexual / straight patients (73%) and 53 per cent for gay / lesbian / bisexual/ patients. Summary 9.27 Males were more positive about their overall experience at all stages of the patient journey compared to females Older patients (aged 65 years and older) were more positive about their overall experience at all stages of the patient journey compared to patients under 65 years old Patients reporting themselves to be in good / fair health were more positive about their overall experience at all stages of the patient journey compared to patients in poor health Patients limited a little / a lot by a health problem or disability were less positive about their overall experience at each stage of the patient journey compared to patients who did not have a health problem or disability Heterosexual / straight patients were more positive about their overall experience at all stages of the patient journey compared to gay / lesbian / bisexual patients. 42

50 10 RESULTS HOSPITAL TYPE 10.1 This section of the report explores the survey results across the different Scottish hospital types included in the survey. Hospital type 10.2 Findings for respondents to the survey were categorised on the basis of type of hospital patients had stayed in. Five different hospital types were included in the survey as follows: Teaching hospitals; Large general hospitals; General hospitals; Long stay hospitals; and Community hospitals Annex C presents the different hospital types included in the survey by NHS Board area The following paragraphs provide an overview of findings in general for each of these hospital types and reports where results were either statistically more significant or less, than the national average. Teaching hospitals 10.5 Hospitals in this category are major teaching hospitals covering a full range of services and with special units. Eight teaching hospitals were included in the survey Patients who had stayed in a teaching hospital did not report a significantly more positive experience across any of the patient journey stages Patients who had stayed in a teaching hospital were less likely to report a positive experience about: Being told how long they would have to wait in A&E (50%) and time to wait to get a bed (86%); Cleanliness of ward or room (89%) and bathroom and toilets (82%); Religious and spiritual needs being met (63%) and being happy with the food and drink (66%); Knowing who was in charge of the ward (62%); 43

51 Getting help with washing and dressing (79%) and eating and drinking when needed (66%); Awareness of doctors washing/cleaning their hands (84%) and nurses (87%); and Being given help with arranging transport (61%) and confident that help needed had been arranged for when at home (72%). Large general hospitals 10.8 Hospitals in this category are larger general hospitals with some teaching units, usually over 250 average staffed beds. Eighteen large general hospitals were included in the survey Patients who had stayed in a large general hospital did not report a signifncatly more positive experience across any of the patient journey stages Patients who had stayed in a large general hospital were less likely to report a positive experience about: Overall hospital admission experience (79%) and time to wait to get a bed (86%); Overall experience of the hospital ward and environment (77%); Being able to get adequate pain relief when needed (90%); Being involved as much as they wanted to be in decisions about their care and treatment (82%); Overall experience of care and treatment (82%); Doctors knowing enough about patient s condition and treatment (85%) and explaining risks and benefits in an understandable way (86%); also doctors giving clear explanations about operations (85%) and telling patients how operations had gone in an understandable way (86%); All aspects of interactions with nursing staff, apart from having enough time to talk with nurses and awareness of them washing/cleaning their hands; and All aspects of leaving hospital apart from getting help when arranging transport, having confidence that arrangements for any help needed at home had been made and questions in relation to medicines. General hospitals Hospitals in this category are smaller general hospitals, usually having 250 or fewer staffed beds. Fourteen general hospitals were included in the survey. 44

52 10.12 Patients who had stayed in a general hospital were significantly more likely to report a positive experience about: All aspects of admission to hospital apart from being told how long they would have to wait in A&E, the waiting time between referral and hospital admission and receiving helpful information prior to attending hospital; All aspects of hospital and ward environment apart from religious and spiritual needs being respected; All aspects of care and treatment apart from privacy when being examined and treated and explanations about moving wards and the management of such moves; Having enough time to talk with doctors (83%) and them knowing enough about patients condition and treatment (89%) and doctors listening if patients had any concerns (88%); All aspects of interactions with nursing staff; Staff working well together in organising their care (90%) and their overall experience of staff (92%); and All aspects of leaving hospital and questions in relation to medicines except for understanding how and when to take medicines Patients who had stayed in a general hospital did not report a significantly less positive experience across any of the patient journey stages compared to the national average findings. Long stay hospitals Twenty-nine long stay hospitals were included in the survey. Hospitals in this category cover a mix of: Long stay hospitals (over 100 average staffed beds) - long stay geriatric units controlled by geriatrician; Small long stay hospitals (100 and under average staffed beds) - long stay geriatric units controlled by geriatrician; Long stay/acute hospitals - long stay geriatric units with some medical and surgical services; and Long stay/psychiatric hospitals - long stay geriatric units with geriatric psychiatry Patients who had stayed in a long stay hospital were significantly more likely to report a positive experience about: 45

53 Overall hospital admission experience (86%) and time to wait to get a bed on the ward (93%); The cleanliness of the bathrooms (88%), their religious and spiritual needs being respected (72%), being happy with the food and drink (78%) and knowing who was in charge of the ward (69%); Getting help with washing and dressing when needed (90%) and help with eating and drinking when needed (77%); and All aspects of leaving hospital, apart from being told about the danger signals to look for when at home, who to contact with any queries and questions in relation to medication Patients who had stayed in a long stay hospital were significantly less likely to report a positive experience about: Receiving helpful information prior to attending hospital (90%); Feeling bothered or threatened by other patients or visitors (76%); Doctors explaining in an understandable way the risks and benefits of any treatment (83%); Doctors talking in a way to help patients understand their condition and treatment (84%) and listening to any questions or concerns (83%); Understanding what medicines were for (90%). Community hospitals Fifty-eight community hospitals across ten NHS Boards were involved in the survey Patients who had stayed in a community hospital were significantly more likely to report a positive experience about: All aspects of admission to hospital apart from receiving helpful information prior to attending hospital; All aspects of hospital ward and environment apart from feeling bothered or threatened by other patients or visitors and minding sharing a room or bay with a member of the opposite sex; All aspects of care and treatment apart from explanations about moving wards; Doctors having enough time to talk (84%), knowing enough about patient s condition and treatment (90%), listening to any questions or concerns (89%) and awareness of doctors washing their hands at appropriate times (89%); 46

54 All aspects of interactions with nursing staff; Staff working well together in organising their care (89%) and overall experience of staff (92%); and All aspects of leaving hospital apart from being told about the danger signals to look for when at home and questions in relation to medicines Patients who had stayed in a community hospital were significantly less likely to report a positive experience about: Receiving helpful information prior to attending hospital (86%). Summary Patients in community and general hospitals were more likely to report a positive overall experience at all five stages of the patient journey, from admission through to leaving hospital and for a majority of questions asked in relation to each stage of the patient journey Those patients who had stayed in teaching and large general hospitals were less likely to report a more positive experience across all five stages of the patient journey Patients in long stay hospitals were more likely to report positive experiences around the hospital and ward environment and leaving hospital. 47

55 11 RESULTS NHS BOARDS 11.1 This chapter of the report compares the survey results for each individual NHS Board with the national average. In particular it provides information on areas where patients at Boards reported significantly more positive experiences compared to the national average, and areas where patients were significantly less likely to describe a positive experience NHS Boards results for each question in the survey are not provided in this chapter and have been published separately at Its worth noting that results being reported above the national average may be in the 50 s and 60 s due to the national average being a low score. For example, in Ayrshire and Arran the positive score for being told how long respondents had to wait is 58%. This appears as significantly higher than the national average as the average score is low at 53%. Conversely in Ayrshire and Arran the positive score for the helpfulness of the information provided before attending hospital is high (94%) but it is still below the national average (96%) In interpreting the results, consideration should also be given to the varying size of NHS Boards in Scotland. For example NHS Orkney as an island board has one hospital with an annual inpatient population of 412 at the time of the survey, whereas Glasgow as a large board has 16 hospitals with an inpatient population of 82,634. Across Boards there is a large variation in geographic coverage, population sizes and hospital sites as well as hospital type which should be borne in mind when reviewing survey findings. For example, as shown in the last chapter on results by type of hospital, the results for both community and general hospitals were generally more positive than other hospital types. This means that where there is a greater mix of these types of hospitals within boards, results may be more positive. A description of the sample size, the sites sampled and the type of hospital included within in each board is provided below alongside the results for each Board. Annex C details the types of hospitals included in each Board. Ayrshire and Arran 11.5 In NHS Ayrshire and Arran 3,597 surveys were returned (a 47% response rate) across nine NHS hospital sites. This included two large general hospitals, one general hospital, three long stay hospitals and three community hospitals Patients from NHS Ayrshire and Arran were significantly more likely to report positive feedback on: Being told how long they would have to wait in A&E (58%); 48

56 Overall care and treatment that they received during their time in A&E (86%); Ward and room cleanliness (93%) and that the bathroom and toilets were clean (89%); Happiness with the food and drink they received (82%); Knowing who was in charge of the ward (67%); Overall experience of the hospital and ward environment (82%); Receiving help with washing and dressing (84%) and eating and drinking when needed (75%); Awareness that doctors (88%) and nurses (90%) washed/cleaned their hands at appropriate times; Having enough time to talk to nurses (82%); and Receiving help with arranging transport (76%) NHS Ayrshire and Arran patients were significantly less likely to report a positive experience for: Not being bothered by noise (53%); Sharing a room or bay with members of the opposite sex (60%); and Doctors telling them how their operation or procedure had gone in a way they could understand (85%). Borders 11.8 In NHS Borders 643 surveys were returned (a 52% response rate).across six NHS hospital sites. This included one large general hospital, one long stay hospital and four community hospitals Patients from NHS Borders were significantly more likely to indicate a positive experience for: For those on a waiting list or whose admission was planned in advance, the length of time between referral and admission (94%); Overall experience of care and treatment received in A&E (90%); The helpfulness of the information provided before attending hospital (99%) and time to wait to get a bed on the ward (90%); Overall experience of admission process to hospital (88%); 49

57 The food and drink they received in the hospital and ward (86%); and Overall experience of the hospital and ward environment (86%) They were significantly less likely to report a positive experience with regard to: Knowing who was in charge of the ward (58%). Dumfries and Galloway In NHS Dumfries and Galloway 1,781 surveys were returned (a 53% response rate) across eleven hospital sites. This included one large general hospital, one general hospital, four long stay, four community hospitals and one other location Respondents from NHS Dumfries and Galloway were significantly more likely to provide positive feedback on: Being happy with the food and drink they received (88%); Overall experience of the hospital and ward environment (85%); and Having enough time to talk to doctors (83%) Patients at this Board were significantly less likely to report a positive experience about: Knowing who was in charge of the ward (56%). Fife In NHS Fife a total of 1,175 surveys were returned (a 46% response rate) across eight NHS hospital sites. This included two large general hospitals, one general and one long stay hospital, and four community hospitals Respondents from NHS Fife were significantly more likely to indicate positive feedback on: The helpfulness of the information they were provided with prior to attending hospital (97%) Patients from this Board were significantly less likely to report a positive experience about: Overall experience of the care and treatment they received during their time in A&E (79%); The ward or room they stayed in being clean (87%); and 50

58 Overall experience of care and treatment during their hospital stay (82%). Forth Valley In NHS Forth Valley a total of 811 surveys were returned (a 47% response rate) across eight NHS hospital sites. This included two large general hospitals, four long stay hospitals, one community hospital and one other site Respondents from this Board were significantly more likely to indicate positive feedback on: The helpfulness of the information of the information that was provided prior to attending hospital (97%); The food and drink they received (74%); and Awareness of nurses washing/cleaning their hands (90%) Respondents from this Board were significantly less likely to indicate positive feedback on: The length of time to wait to get a bed on a ward (83%); Overall experience of admission to hospital (72%); The ward or room they stayed in being clean (86%); Having their religious and spiritual needs respected (56%); Overall experience of the hospital and ward environment (69%); Having privacy when being examined or treated (93%) and privacy when their condition and treatment was discussed (81%); Explanations received when moving wards (77%) and involvement in decisions around their care and treatment (78%); Overall experience of care and treatment (77%); All aspects of staffing apart from awareness of doctors and nurses washing/cleaning their hands; and All aspects of leaving hospital with the exception of getting help to arrange transport, understanding who to contact after leaving hospital, if required, understanding what their medicines were for, and how and when to take them. 51

59 Grampian In NHS Grampian a total of 4,422 surveys were returned (a 54% response rate) across twenty five NHS hospital sites. This included one teaching hospital, one general and one long stay hospital, nineteen community hospitals and three other locations With regard to patients from NHS Grampian they were significantly more likely to report a positive experience about: Being happy with the food and drink they received (75%); Sharing a room or bay with members of the opposite sex (78%); and Understanding what their medicines were for (95%) Patients from this board were significantly less likely to be positive about: For those on a waiting list or whose admission was planned in advance, the length of time between referral and admission (87%); The helpfulness of information received prior to attending hospital (93%); Cleanliness of the ward or room (87%) and also how clean the bathrooms and toilets were (82%); Knowing who was in charge of the ward (61%); How well staff worked together (82%); and How long they had to wait around when told they could go home (71%). Greater Glasgow and Clyde In NHS Greater Glasgow and Clyde a total of 8,834 surveys were returned (a 47% response rate) across fourteen NHS hospital sites. This included four teaching and four large general hospitals, one general, three long stay hospitals and two other locations Patients from NHS Greater Glasgow and Clyde did not report a significantly more positive experience across any of the patient journey stages compared to national average findings Patients from this Board were significantly less likely to describe positive experiences about: In A&E, being told how long they would have to wait (45%); In A&E, being told what was happening in a way they could understand (82%); 52

60 Overall experience of care and treatment received during their time in A&E (78%); The length of time to wait to get to a bed on the ward (85%); Overall experience of admission to hospital (78%); The cleanliness of bathrooms and toilets (83%); Their religious and spiritual needs being respected (63%); The food and drink they received (60%); Overall experience of the hospital and ward environment (74%); The care and treatment they received during their hospital stay (83%); Overall experience of staff they came into contact with (86%); The help they received when arranging transport on leaving hospital (60%); and Overall experience of arrangements made for leaving hospital (71%). Highland In NHS Highland a total of 3,551 surveys were returned (a 55% response rate) across twenty three NHS hospital sites. This included one large general hospital, four general hospitals, six long stay, eleven community hospitals and one other location Patients from NHS Highland were significantly more likely to provide positive feedback on: All aspects of their admission to hospital apart from the length of time waited between referral and admission and information provided pre attending hospital being helpful; Their experience of the hospital ward and environment, with the exception of sharing a room or bay with members of the opposite sex; All aspects of the care and treatment received; All aspects of staff interactions; and All aspects of leaving hospital with the exception of getting help arranging transport, understanding how and when to take medication and understanding the possible side effects and what to do if any concerns. 53

61 11.28 Patients from NHS Highland did not report a significantly less positive experience across any of the patient journey stages compared to national average findings. Lanarkshire In NHS Lanarkshire a total of 1,202 surveys were returned (a 43% response rate) across eight NHS hospital sites. This included three large general hospitals, four community hospitals and one other location Respondents from this Board provided significantly more positive responses regarding: Not being bothered by noise in the hospital and ward (62%); Religious and spiritual needs being respected (68%) Respondents from this Board provided significantly less positive responses regarding: Care and treatment in A&E (80%), the length of time to wait to get to a bed on the ward (84%), and their overall admission to hospital experience (76%); The ward or room (88%) and bathrooms and toilets being clean (82%); Being happy with the food or drink they received (52%); Knowing who was in charge of the ward (61%); Overall experience of the hospital and ward environment (71%); All aspects of care and treatment with the exception of having privacy when being examined or treated or when their condition and treatment was being discussed; Doctors knowing enough about patients conditions and treatment (85%); Doctors explaining the risks and benefits of treatment in a way they could understand (85%); Doctors talking to patients in a way that helped them understand their condition and treatment (86%); All aspects of interactions with nurses; How well staff work together (81%) as well as overall staff experience (82%); and 54

62 All aspects of leaving hospital apart from confidence around getting help arranged for going home if needed and statements in relation to medication. Lothian In NHS Lothian a total of 1,621 surveys were returned (a 44% response rate) across eight NHS hospital sites. This included two teaching hospitals, one large general hospital, four long stay hospitals and one other location Respondents from this Board provided significantly more positive responses regarding: Overall experience of the hospital and ward environment (82%) NHS Lothian patients provided significantly less positive responses regarding: Religious and spiritual needs being respected (61%); Knowing who was in charge of the ward (61%); Getting help with washing and dressing when needed (78%) and also with eating and drinking when needed (64%); The management of moving wards (80%); Doctors (82%) and nurses (86%) washing/cleaning their hands at appropriate times; Getting help with arranging transport on leaving hospital (62%); and Understanding what medicines were for (92%) the possible side effects and what to do if they had any concerns (78%). Orkney In NHS Orkney 150 surveys were returned (a 61% response rate) across one NHS Board site. This was at one general hospital Patients from NHS Orkney were significantly more likely to provide positive feedback on: The helpfulness of information provided prior to attending hospital (100%) and time to wait to get a bed on the ward (97%); Overall experience of the hospital admission experience (94%); Being happy with the food and drink received (88%); Overall experience of the hospital and ward environment (90%); 55

63 Overall experience of care and treatment during their hospital stay (95%); Having enough time to talk to doctors (91%) and nurses (91%); Awareness of nurses washing/cleaning their hands at appropriate times (97%); and Understanding how and when to take their medication (100%) Patients from NHS Orkney did not report a significantly less positive experience across any of the patient journey stages compared to national average findings. Shetland In NHS Shetland a total of 299 surveys were returned (a 53% response rate) across one NHS hospital site. This was at one general hospital Patients from NHS Shetland were significantly more likely to indicate a positive experience about: In A&E, being told what was happening in a way they could understand (93%) and time to wait to get a bed on the ward (93%); For those on a waiting list or whose admission was planned in advance, the length of time between referral and admission (99%); Sharing a room or bay with members of the opposite sex (100%); Overall experience of care and treatment in A&E (94%); Overall experience of hospital admission experience (90%); and Overall experience of the hospital and ward environment (88%) Patients from NHS Shetland did not report a significantly less positive experience across any of the patient journey stages compared to national average findings. Tayside In NHS Tayside a total of 1,380 surveys were returned (a 50% response rate) thirteen NHS hospital sites. This included one teaching and one large general hospital, two general and two long stay hospitals, and seven community hospitals Respondents from NHS Tayside were significantly more likely to report positive feedback on: 56

64 All aspects of their admission to hospital apart from the length of time waited between referral and admission and information provided pre attending hospital being helpful; The main ward or room they stayed in was clean (93%); The food and drink they received (75%); Overall experience of the hospital and ward environment (84%); All aspects of their care and treatment except for privacy when being examined or treated and privacy when their treatment or condition was discussed; Doctors (89%) and nurses (85%) knowing about their condition and treatment; Nurses providing explanations about their operation or procedure (80%); Doctors explaining how their operation or procedure had gone in a way they could understand (89%); Doctors (88%) and nurses (89%) listening if they had any questions or concerns; Overall experience of staff they came into contact with (91%); Getting help with arranging transport on leaving hospital (71%); Being given advice on how to look after themselves on leaving hospital (81%); and Overall experience of the arrangements made for leaving hospital (79%) Patients from NHS Tayside did not report a significantly less positive experience across any of the patient journey stages compared to national average findings. Western Isles In NHS Western Isles a total of 404 surveys were returned (a 51% response rate) across three NHS hospital sites. This included one general hospital, one community hospital, and one other location With regard to NHS Western Isles patients they were significantly more likely to report positively about: Time to wait to get a bed on the ward (92%); The ward or room (98%) and bathrooms and toilets being clean (97%); 57

65 Having their religious and spiritual needs respected (84%); The food and drink they received (89%); Knowing who was in charge of the ward (75%); The overall hospital environment (92%); Getting help with washing and dressing when needed (93%); Getting help with eating and drinking when needed (83%); The overall care and treatment received (92%); All aspects of interactions with nurses; Overall experience of staff they came into contact with (92%); How long they had to wait around when told they could go home (84%); and Getting help with arranging transport on leaving hospital (82%); Advice given on how to look after themselves on leaving hospital (86%); Understanding the possible side effects of medication and what to do if they had any concerns (88%); and Overall experience of the arrangements made for leaving hospital (82%) Patients from NHS Western Isles did not report a significantly less positive experience across any of the patient journey stages compared to national average findings. National Waiting Times Centre At the National Waiting Times Centre a total of 1,010 surveys were returned (a 72% response rate) across one hospital site Patients treated at the National Waiting Times Centre were significantly more likely to report a positive experience for: All aspects of hospital admission and overall experience, with the exception of the length of time between referral and admission; All aspects of the hospital and ward environment and overall experience; All aspects of care and treatment and overall experience; All aspects of staffing and overall experience; and 58

66 All aspects of leaving hospital, arrangements made and overall experience Patients treated at the NWTC did not report a significantly less positive experience across any of the patient journey stages compared to national average findings. Summary There was variation in the experiences of patients between Boards, with some boards showing significant differences above the national average and/or some showing significant differences below the national average. Caution should be applied when interpreting these variations due to the different size and make-up of NHS Boards. More detailed information on the results for individual hospital sites and Boards is available separately at: 59

67 12 RESULTS OTHER COMPARISONS 12.1 This section of the report compares results from NHS patients staying overnight in an NHS hospital with NHS patients who stayed overnight in a private hospital site in Scotland In addition, this section also makes some national comparisons, considering how the results for a number of questions 9 from the Scottish survey compare with the 2009 English inpatient survey However, it should be noted that the response scale for the English survey and wording of the questions varies from that applied in Scotland and whilst comparisons are useful, caution should be applied in drawing definitive conclusions between these results and those of the Scottish survey. Comparisons of NHS patients staying overnight in NHS hospitals with NHS patients staying overnight in private hospitals 12.4 This section compares the survey results for NHS patients treated in NHS hospital sites with NHS patients treated in seven private hospital sites 10. Note that comparisons between NHS and private hospital sites are not on the basis of statistical significance and that the data that is presented in Table 12.1 is unweighted data. Overall NHS patients at private hospitals generally provided more positive results than NHS patients treated in NHS hospitals. However, it should be borne in mind that there were a small numbers of patients in the sample from private hospitals (307 compared to 30,573 in NHS hospitals) For two statements, the NHS patients in private hospitals achieved slightly lower positive results than those treated in NHS hospitals (see Table 12.1). 9 The comparisons provided are on the basis of a selection of questions which were considered to broadly comparable between the two surveys. 10 The seven private hospitals were as follows: Carrick Glen (Ayrshire and Arran), Abbey Kings Park (Forth Valley), Albyn (Grampian), Glasgow Nuffield, Ross Hall (both Greater Glasgow and Clyde), Murrayfield (Lothian) and Fernbrae (Tayside). 60

68 Table 12.1: Comparative results for NHS patients at NHS and private hospital sites Question Answer option NHS locations - unweighted (total no. of respondents 30,573) Private hospital locations - unweighted (total no. of respondents 307) If your hospital visit was planned in advance how did you feel about the length of time you waited to be admitted to hospital after being referred? My religious and spiritual needs were respected It was reasonable 90% 86% It was too short 1% <1% It was too long 9% 13% Strongly agree / agree nor disagree Disagree / strongly disagree 67% 63% 30% 34% 3% 3% National comparisons 12.6 A number of the questions in the 2010 Scottish inpatient survey are broadly comparable to those in the 2009 English inpatient survey 11, a survey of inpatients in NHS hospitals in England. This section of the report compares the findings from both surveys where relevant. Care must be taken when making comparisons between the results as the wording of questions and response options to questions are different Other international comparisons with patient experience surveys proved more problematic for inclusion due to a mix of the level of comparability between the wording of questions posed and also the time period they related to. For example, the Commonwealth Fund International Health Policy survey in 2005 has ten broadly comparable questions; whereas the 2008 version of this survey only has three questions which could be viewed as relatively similar to any of those asked in the Scottish inpatient survey Looking at comparisons between Scotland and England some questions have been compared in terms of the percentage of patients answering negatively. This has been done where the negative responses for the two surveys are more comparable than the positive responses. 11 Source:Care Quality Commission, rvices.cfm 61

69 Admission to hospital 12.9 Table 12.2 presents findings from the English and Scottish inpatient surveys regarding patients experience of admission to hospital. Table 12.2: Comparative results for admission to hospital English 2009 Inpatient Survey question English 2009 Inpatient Survey question results Scottish 2009/2010 Inpatient Survey question Scottish 2009/2010 Inpatient Survey results Was your most recent hospital stay planned in advance or an emergency? When you arrived at the hospital did you go to the A&E Department? From the time you arrived at the hospital, did you feel that you had to wait a long time to get on to a bed on a ward? Waiting list or planned in advance 42% Was your most recent hospital stay planned in advance or an emergency? Emergency or urgent: Something else Yes 87% When you arrived at the hospital did you go to the A&E Department? Yes, definitely Waiting list or planned in advance 55% Emergency or urgent 3% 11% From the time you arrived at hospital, how did you feel about the time you had to wait to get to a bed on the ward 40% 60% Yes 75% It was too long 13% The hospital and ward Table 12.3 presents findings from the two surveys regarding patients views and experiences of the hospital and ward A similar percentage of patients in Scotland and England disagreed that their hospital room or ward, and toilets and bathrooms were clean Scottish patients seemed happier with the food and drink that they received although some of the difference may be because of the different response options Respondents to the 2010 survey in Scotland were less likely to have shared a room or bay with members of the opposite sex. 62

70 Table 12.3: Comparative results for the hospital and ward English 2009 Inpatient Survey question In your opinion how clean was the hospital room or ward that you were in? How clean were the toilets and bathrooms you used in hospital? How would you rate the hospital food? When you were first admitted to a bed on a ward, did you share a sleeping area with patients of the opposite sex? English 2009 Inpatient Survey question results Not very clean/ not at all clean Not very clean/ not at all clean Very good/ good Scottish 2009/2010 Inpatient Survey question 4% The main ward or room I stayed in was clean 7% The bathrooms and toilets were clean 55% I was happy with the food and drink I received No 82% During your most recent stay in hospital did you share a room or bay with members of the opposite sex? Scottish 2009/2010 Inpatient Survey results Strongly 5% disagree/ disagree Strongly 9% disagree/ disagree Strongly 71% agree/ agree No 91% Care and treatment Table 12.4 presents findings from the two surveys regarding patients views and experiences of care and treatment they received as an inpatient The results for care and treatment were similar for the English and Scottish surveys. The only major difference was for getting help with eating and drinking with 18 per cent of English patients not getting enough help compared to 11 per cent of Scottish patients. Table 12.4: Comparative results for care and treatment English 2009 Inpatient Survey question Do you think the hospital staff did everything they could to help control your pain? Were you given enough privacy when being examined or treated? Were you given enough privacy when discussing your condition or treatment? Did you get enough help from staff to eat your meals? Were you involved as much as you wanted to be in decisions about your care and treatment? English 2009 Inpatient Survey question results Scottish 2009/2010 Inpatient Survey question No 6% I was able to get adequate pain relief when I needed it. No 2% I had privacy when being examined or treated No 8% I had privacy when my condition and treatment was discussed No 18% I got help with eating and drinking when I needed it. No 11% How did you feel about being involved in decisions about your care and treatment? Scottish 2009/2010 Inpatient Survey results Strongly 6% disagree/ disagree Strongly disagree/ disagree Strongly disagree/ disagree Strongly disagree/ disagree I was not involved enough 3% 9% 11% 13% 63

71 Staff Table 12.5 presents findings from the two surveys regarding patients views of the staff they encountered during their most recent hospital stay The percentage of respondents that disagreed that nurses washed their hands was the same in Scotland and England (4%). Slightly more respondents in England (7%) disagreed that doctors washed their hands than in Scotland (5%). Table 12.5: Comparative results for staff English 2009 Inpatient Survey question As far as you know, did doctors wash their hands between touching patients? As far as you know, did nurses wash their hands between touching patients? English 2009 Inpatient Survey question results Scottish 2009/2010 Inpatient Survey question No 7% As far as I was aware doctors washed/ cleaned their hands at appropriate times No 4% As far as I was aware nurses washed/ cleaned their hands at appropriate times Scottish 2009/2010 Inpatient Survey results Strongly 5% disagree/ disagree Strongly disagree/ disagree 4% Leaving hospital Table 12.6 presents findings from the two surveys regarding patients views and experiences of leaving hospital There was a large difference in the percentage of patients that were not told of danger signals to watch for when they left hospital between Scotland (17%) and England (40%). Table 12.6: Comparative results for leaving hospital English 2009 Inpatient Survey question Did a member of staff tell you about any danger signals you should watch for after you went home? English 2009 Inpatient Survey question results Scottish 2009/2010 Inpatient Survey question No 40% I was told about any danger signals to watch for when I got home Scottish 2009/2010 Inpatient Survey results Strongly 17% disagree/ disagree Summary Results for NHS patients in private hospitals were overall more positive than for NHS patients treated in NHS hospitals, although the sample size was a lot smaller for such patients. 64

72 12.21 Comparison of results from the 2009 English inpatient survey and the Scottish results indicate some differences in the experience of patients. However care should be taken in interpretation of these differences as the wording of the questions and response options differ between the two surveys. 65

73 13 CONCLUSIONS 13.1 This report presents the findings from the first Scottish Inpatient Patient Experience survey. The findings are based on responses from over 30,000 inpatients from all 14 territorial NHS Boards and the National Waiting Times Centre (Golden Jubilee National Hospital). National results for each question from the survey have been presented in this report along with comparisons between the national average and NHS Board findings, hospital type and by some demographic patient groups. National results 13.1 Overall patients in Scotland reported positive feedback for their inpatient hospital stay across NHS Boards Of the five stages of the patient journey explored in the survey, the highest level of positive feedback related to overall experience of the staff (87% reported a positive experience overall). The least positive was in relation to overall experience of leaving hospital (73% reported a positive experience overall) Areas which achieved the highest levels of positive feedback at a national level included: Understanding how and when to take medicines (96% responded positively) Information given before attending hospital helped understanding of what would happen (96% responded positively) Having privacy when being examined and treated (94% responded positively) Understanding what medicines were for (94% responded positively) Getting adequate pain relief when needed (91% responded positively) The main room or ward stayed in was clean (90% responded positively) Length of time waiting to be admitted to hospital after being referred (89% responded positively) Nurses washing/cleaning hands at appropriate times (88% responded positively) 66

74 13.4 Areas which achieved the lowest levels of positive feedback included: In the A&E being told how long you would have to wait (53% responded positively) Not being bothered by noise (58% responded positively) Knowing who was in charge of the ward (64% responded positively) Religious and spiritual needs being respected (65% responded positively) Being given help arranging transport home (66% responded positively) Getting help with eating and drinking when needed (69% responded positively) Being happy with the food and drink received (71% responded positively) Being happy with length of time waiting to go home and being confident in the help needed being arrange for arrival home (73% responded positively) Patient characteristics 13.5 Males were more positive about their overall experience for all parts of the survey compared to females Older patients (aged 65 years and older) were more positive about their overall experience for all parts of the survey compared to patients aged under 65 years old Patients reporting themselves to be in good / fair health were more positive about their overall experience for all parts of the survey compared to patients in poor health Patients limited a little / a lot by a health problem or disability were less positive about their overall experience for all parts of the survey compared to patients who did not have a health problem or disability Heterosexual / straight patients were more positive about their overall experience for all parts of the survey compared to gay / lesbian / bisexual patients. Hospital type The survey findings indicate that a positive patient experience across all stages of the sections of the survey is more associated with those patients who stayed in community and general hospitals. This explains some of the variation in findings by Board level. 67

75 Other comparisons An overview of the findings for each NHS Board compared to the national average were presented in this report. Comparisons between NHS Boards results were not reported due to the differences in the characteristics of NHS Boards NHS patients in private hospitals generally reported a more positive overall experience than those treated in NHS hospitals, although the sample size was a lot smaller for such patients Comparisons with a selection of questions from the 2009 English inpatient survey were made with the Scottish 2010 inpatients survey. Both surveys showed similar high levels of positive experience, although there were some areas of the survey where results in Scotland were different to those in England. However caution should be used interpreting these variations due to the different formats of the two surveys. Conclusion This report has presented the national results for the first Scottish Inpatient Patient Experience Survey. It provides NHS Scotland with valuable collection of data on the quality of healthcare experiences in hospitals in Scotland which is not available from other sources Overall the findings showed that at national level the majority of patients reported positive experiences for their inpatient hospital stay. However positive experiences were not reported evenly among all patient groups Areas where there were particularly high levels of positive feedback at national level related to: medicines, being given privacy, pain relief, cleanliness of wards, staff hygiene and waiting times. Areas where there were lower levels of positive feedback related to: being informed about the wait in A&E, noise, knowing who was in charge of the ward religious and spiritual needs, help in arranging transport, food and drink (including help eating and drinking) The analysis and detail provided in this report will be reviewed and used by Scottish Government, NHS Boards and their staff to highlight best practice and improve the quality of care for patients. It is expected that further analysis of the data from the 2010 survey will be carried out to provide more detail on the differences, where relevant, between patients groups. In addition work will be carried out to examine whether positive experiences benefit patients in terms of their clinical outcome. 68

76 ANNEX A: PATIENT FEEDBACK 69

77 You can complete this survey online Patient Feedback Fill in this survey and help us improve hospital services 70