SALFORD ROYAL NHS FOUNDATION TRUST Patient and Staff Experience Committee

SALFORD ROYAL NHS FOUNDATION TRUST Patient and Staff Experience Committee 09 Subject Patient Experience Report Date of Meeting 1 st August 2013 Author(s) Presented by Summary Michele Morgan, Corporate Assistant Director of Nursing Elaine Inglesby Burke, Executive Nurse Director The Patient Experience Report provides information about feedback received from Salford Royal s patients and includes: 1. Near Real-time Patient Feedback Highlighting sustained improvements, in areas such as; Single-sex accommodation In-patients overall rating of care Cleanliness Privacy (out-patients) Areas focussed on for further improvement (now form part of Patient Experience Collaborative), include: Involvement in decisions about care Privacy (in-patients) Explanation of medication side-effects 2. The Nursing Assessment and Accreditation System (NAAS) Continually improving picture. 22 wards now at status. In May 2013, Salford Renal Unit lost status: amber on reassessment. Robust action plan in place: on-going improvement. The Community Assessment and Accreditation System (CAAS ) commenced November 2012. 22 services currently Green status. 3. National NHS Inpatient Survey 2012 Overall results placed SRFT as 13 th nationally, and 2 nd for patients A&E experiences. Action plan in place, to further improve areas including: Patients feeling safe in hospital Choice of food Doctors talking in front of patients. 4. Staffing Overview link to patient experience, SRFT approach and current actions described within the paper. Recommendation(s) FOIA Status: The patient and staff experience committee is asked to review this report and confirm suitability of current actions. This document is for full publication 1

1.0 Introduction The purpose of this paper is to update the Patient and Staff Experience Committee on the progress and outcomes gained from feedback by people who use the services of Salford Royal NHS Foundation Trust. The aim of gathering this data is to assure the Trust that it is providing care that is valued by service users and also inform colleagues of issues that need to be improved upon. The Trust gathers data on patient experience from a number of both national and local sources. This paper focuses upon the feedback gained from: - Near Real-time Patient Feedback ( formerly CRT ) - Nursing Assessment and Accreditation System (NAAS) - Community Assessment and Accreditation System ( CAAS ) - National Inpatient Survey results 2012 2.0 Near Real-time Patient Feedback Near Real-time Patient Feedback enables the Trust to identify patients experiences of their care by asking them to answer a series of questions. Monitoring the patients experience throughout 2012/13 formed part of the CQUIN payment framework and over time a number of the survey questions asked have changed to meet these requirements. A total of 6,788 inpatients have participated in the survey from April 2012 to the end of March 2013 and 4,254 outpatients during the same period. From mid November 2012 the Trusts local survey provider changed from CRT to Hospedia. In a joint partnership arrangement with Hospedia and Picker Europe Institute, results now go directly to Pickers survey website and are available to ward, departmental staff on a weekly basis, improving the frequency of results reporting and opportunities to take earlier action to improve. The inpatients survey is now completed using the bedside entertainment system ( free of charge ) and for outpatients via hand held devices. Aspects of the inpatient and outpatient feedback exercise currently included in the Trust s performance measures ( November 2012 April 2013, 6 months data ) are shown in tables 1 and 2 in appendix 1: 2.1 Inpatients Results From April 2013, it should be noted questions numbered 4-8 in table 1 are no longer National CQUINS in the 2013/14 contract, however they will continue to be monitored as performance measures included in the patient, family and carer collaborative and via the NAAS tool. 2.2 Outpatients Results 2

As advised by picker institute the Trust has reviewed Outpatients ( as with inpatient ) questions and criteria for response inclusion. A number of questions therefore show reduced % of positive responses ( previously combined ) as only the most positive responses have been reported to enable improvement to be the best. Further work is required to sustain continuous improvement in results in both inpatient and outpatient experience results. Ward and departmental action plans are also being scrutinised to identify where further support is required to implement actions to improve. 2.3 What Do the Results Tell Us? There are a number of areas where there is room for improvement. The table below outlines those areas for both the inpatient and outpatient settings together with work being developed. Setting Measure Work Developed Inpatient Inpatient Inpatient Inpatient Were you involved as much as you wanted to be in decisions about Your care and treatment? Were you given enough privacy when discussing your condition or Treatment? Did you find someone on the hospital staff to talk to about your worries and fears? Did a member of staff tell you about medication side effects to watch for when you went home? Area of focus for Patient Family and Carer (PFCE) Collaborative Current tests include: - Pad and pen by the bedside (used by patients to record any questions they may have, and also can be used by staff to note key information for patients and relatives - What matters most to me laminate (used to record what the patient says is most important to them during the admission and displayed at the bed head so care givers can refer to it - Testing of teachback to help understand how well information has been learned by patients - Open visiting hours Not a current area of focus for the PFCE Collaborative but will be developed during the collaborative with focus at learning session 3 (taking place in September 2013) Area of focus for PFCE Collaborative Current tests include: - Pad and pen by the bedside - Uniform key to ensure patients, carers and relatives know who is involved in their care - The concept of ward manager surgeries is being highlighted at learning session 3 and teams will be encouraged to develop tests in this area - Open visiting hours - Volunteer ward rounds Area of focus for PFCE Collaborative Current tests include: - Standard information sheets on common drugs prescribed in areas (e.g. for intestinal failure) - Posters displaying drug information 3

Setting Measure Work Developed - Teachback to ensure information regarding drugs has been received Inpatient Inpatient & Outpatient Outpatient Outpatient Did hospital staff tell you who to contact if you were worried about your condition or treatment after you left hospital? If you had important questions to ask a doctor do you get answers you understand? When you arrived at OP how would you rate courtesy of receptionist? How likely are you to recommend our OP department to friends and family? Not a current area of focus for the PFCE Collaborative but will be developed during the collaborative with focus at learning session 3 This will be focussed on during the third learning session for the project as a number of medical staff have registered their intention to attend Customer service training has started for some areas of outpatients and is being developed further to cover more areas Teams from outpatients are in the PFCE collaborative and continue to contribute to Learning Sessions and develop tests of change aiming to improve overall patient experience, examples of these tests include: - Improve patient information regarding waiting times in clinic tested in 2 areas (Rheumatology & ENT) one person responsible for updating the boards across the area - Staff photographs will be displayed in areas - Feedback boxes available in every area 2.4 Community Patient Experience Community patient experience surveys are set to commence with Bowel and Bladder service. Questions have been verified by Picker and a hand held device will be trialled during next month. Results will, as with inpatients and outpatients be uploaded to the Picker frequent survey website. A more detailed rollout plan is currently in development. 3.0 Nursing Assessment and Accreditation System (NAAS) This performance assessment framework is based on the Trust s Safe, Clean, Personal approach to service delivery and provides evidence for the Care Quality Commission s essential standards of quality and safety. The NAAS is designed to support nurses in practice to understand how they deliver care, identify what works well and where further improvements are needed. Each ward has an assessment completed and will be accredited with a level 0 to 3. Wards will only achieve a green if there is demonstrable evidence of success on each of the three systems. Wards will only be given a blue rating ( status) after 4

achieving green for three consecutive assessments and meeting a set of additional criteria. To date, 22 wards have achieved status (safe, clean and personal every time). They are shown as blue in the summary table below, having demonstrated consistently high standards of care. 3.1 The current results to date show: Red Level 0 0 Amber Level 1 1 Salford Renal Unit Green Level 2 23 Blue Level 3 22 HCU / MIU / L2 / L3 / L6 / L8 / B1 / B2 / B5 / B7 / H1 / H4 / H6 / H8 / ICU / DSU / ASU / SRU / C1 / HU / M2 / M3 A further more detailed NAAS breakdown is attached as Appendix 2 3.2 CAAS ( Community Assessment and Accreditation System ) The CAAS was commenced in November 2012. There are approximately 50 areas to be assessed (this figure might change due to service reconfiguration). The majority of community services are within Salford Health Care Division although there are some that sit within other divisions. To date, 22 services have been assessed. Results are as follows: Red Level 0 0 Amber Level 1 0 Green Level 2 22 Blue Level 3 0 A breakdown of the individual community services assessed is shown as Appendix 3 The process clearly identifies where improvements have not been sustained and it therefore acts as a trigger for deeper investigations to take place. The tool also highlights issues of accountability and ownership at a ward,department and community service level. 4.0 CQC Review Report National Inpatient Survey 2012 The CQC Adult Inpatient Survey benchmark report was published on 16 th April 2013 and includes 156 acute and specialist NHS Trusts. Data in the report is represented with scores out of 10 and takes into account the number of respondants from each Trust as well as the scores for all other Trusts. 4.1 SRFT Results - Analysis In order to examine where the Trust needs to focus its efforts on improvement an analysis of results has been undertaken with the assistance of picker organisation. 5

Results based on all Trusts in the survey have been calculated in the same way as for previous years and show SRFT in direct comparison highlighting the percentage of results in: Top 20% = 27% Above Average = 35% Average = 32% Below Average = 7% Bottom 20% = 0% A further more detailed breakdown of results, is attached as appendix 5 comparing SRFT results 2011 to 2012 and additionally rag rating comparison of the Trusts 2012 results to all other Trusts in the survey against each question. The CQC report highlights a number of areas where SRFT s results are significantly better when compared to the Trusts 2011 results as shown below: 4.2 Significantly improved results Questions 2011 2012 Q14 Sharing same bathroom/shower as patients of the opposite sex? 9.3 9.7 Q17 How Clean was the hospital room or ward that you were in? 9.2 9.4 4.3 Questionnaire Section Scores In addition to each individual question score each section has a composite score.the following table sets out the 10 survey section headings, SRFT s composite score and its position nationally in each section. Specialist Trusts have been removed. Section Composite Score SRFT Position 1. Emergency treatment 8.97 2 nd 2. Waiting list and planned admissions 9.03 80 th 3. Waiting to get a bed on a ward 7.89 37 th 4. The hospital and ward 8.48 6 th 5. Doctors 8.44 79 th 6. Nurses 8.33 58 th 7. Care and treatment 7.80 19 th 8. Operations and procedures 8.41 47 th 9. Leaving Hospital 7.48 8 th 10. Overall views and experiences 5.45 9 th The CQC have provided additional information with individual Trusts section scores, added together to give an overall survey score. This shows that SRFT lies 13 th overall nationally. ( top 10% ) 5.0 Safe Staffing/ Nursing Establishments. When considering the quality of patient experience, the Trust recognises the importance of ensuring staffing establishments are at correct levels to ensure safe delivery of care. 6

The review of nursing establishments is complex and any method of determining staffing has limitations. There is no one solution to determining safe staffing and therefore triangulation of methods is essential. Using the combination of approach will provide greater confidence in the decisions taken. The setting of establishments should triangulate from three different sources: Workload measurement based information (acuity/dependency & activity) using a validated tool. Benchmarking with other organisations Professional consultation We have for some time used a national model to determine our nursing establishments and assure ourselves that staffing numbers are adequate to deliver safe quality care. The model applied is the Association United Kingdom University Hospitals (AUKUH). The AUKUH Acuity and Dependency Tool was developed to help NHS hospitals measure patient acuity and/or dependency to inform evidence-based decision making on staffing and workforce. The tool, when allied to Nurse Sensitive Indicators (NSIs), will also offer nurses a reliable method against which to deliver evidence-based workforce plans to support existing services or the development of new services. The AUKUH Acuity/Dependency tool is based upon the classification of levels of care of critical care patients (Comprehensive Critical Care, DH 2000). These classifications have been adapted to support measurement across a range of wards/specialties. We have until recently only completed part of the model where the identified number of beds for each ward, the WTE budgeted staffing numbers determine the nurse to bed ratio and nationally this has been expected to be 1.1 or higher. This has been based upon professional judgement and the numbers of qualified and unqualified nurses required to care for a designated number of beds. Currently all wards within SRFT meet this criteria. During June/July 2013 we carried out an acuity audit where each ward collected data based on the classification of levels of care at the same point each day for a period of 21 days in order to ensure a consistent approach. Some areas with high patient turnover collected data at three points during a twenty four hour period such as ICU, HCU, EAU etc. The collected data is then calculated using the model and it identifies the nursing numbers and skill mix required to provide care to this level of acuity/dependency of patient. It is suggested that this audit will be conducted twice yearly (January and June) and it is anticipated that this acuity and dependency measurement will enable identification of trends across seasons and in response to changing demographics and healthcare needs. It is envisaged that this evidence base will support workforce plans for nursing that should accurately predict and enable resources to be identified to support nursing establishments. 5.1 Ratio of 1 RN to 8 patients The Safe Staffing Alliance whose members are senior expert nurses issued an unprecedented warning in May 2013 that patient care is unsafe on wards where each nurse is looking after more than 8 patients. The 1:8 figure is based on evidence from Southampton University, Kings College London and National Nursing Research Unit. At SRFT we meet this figure on all our general acute wards during the day. 7

We never have less than 2 registered nurses on a night shift and if such a rare occurrence should happen then the Executive on Call is notified. We are currently looking at a piece of work to consider 3 registered nurses on a night shift. 5.2 Daily Staffing Rotas Each Divisional Director of Nursing has a daily view of nurse staffing across the clinical divisions. This information is up to date for the morning of the shift. Nurse staffing is discussed at all the capacity meetings held 4 times daily. The clinical divisions now provide senior nurse cover at the weekend. They carry a bleep and are there to support the site coordinator by ensuring that staffing is addressed in their areas. Weekend nurse staffing rotas are discussed at the Friday capacity meetings to ensure that cover arrangements have been made. 5.3 Safe Staffing Steering Group/Staffing Boards To support this piece of work a Safe Staffing Steering Group has been established with membership consisting of senior nurses, quality improvement facilitator and workforce to address initially the use of the AUKUH staffing model. The group will also consider how we share with our patients and families in an open and transparent way the numbers of nursing staff on our wards at each shift by the introduction of staffing boards on every ward. The board identifies the coordinator for the area and the numbers of registered and unregistered nurses that the ward should have and the numbers they actually have for the shift. Early feedback from the use of the boards demonstrates they are extremely useful for patients and families and staff believe they are a good idea. A mock up board has been designed following early feedback and once the design agreed boards ordered to complement our existing ward information boards. 5.4 12 Hour Shift Working The 12 hour shift working has now been implemented in all areas of the hospital since 22nd July 2013. The liberated time from the implementation of this shift working is to ensure that all ward manager/matron in a supervisory role to allow them to have overview of the ward and provide support to patients, families and staff. The supervisory ward manager role is encouraged on all wards, but when staffing numbers are reduced due to short term sickness or absence they are included in the establishment providing direct patient care. These areas of work underpin our approach to ensure that establishments are set and that wards are staffed to provide safe care. 6.0 Monitoring and Assurance Whilst the methods of capturing the patients experience, provide measurable data on the quality of care provided; it is clear there are a number of areas where the Trust should focus efforts to improve. Areas highlighted in appendix 5 as below average have been circulated to Divisions and have formed the basis of an initial Trust action 8

plan. These specific questions have been incorporated into the local frequent feedback survey, with results available weekly and are included in year 1 priorities for the patient experience strategy. Future assurance reports will detail progress over time. 9

Data Collection: Appendix 1 Patient experience data is collected via the bedside television system (Hospedia) and through the hand held Patient Experience Trackers (PET). Comparative Results November 2012 April 2013 Table 1 Inpatients Question Nov - 12 Dec - 12 Jan - 13 Feb - 13 Mar - 13 Apr - 13 1. When you were first admitted to a bed on a ward, did you share a sleeping area eg room or bay with patients of the opposite sex? ( No ) No results No results 94% 96% 93% 93% 2. If you moved to another ward, did you ever share a sleeping area eg room or bay with patients of the opposite sex? (No ) 97% 96% 96% 93% 97% 97% 3. While staying in hospital, did you ever use the same bathroom or shower area as patients of the opposite sex? ( No) 97% 95% 94% 94% 95% 96% 4. Were you involved as much as you wanted to be in decisions about Your care and treatment? ( yes definitely ) 59% 57% 65% 67% 68% 68% 5. Were you given enough privacy when discussing your condition or Treatment? ( yes always ) 74% 77% 80% 83% 80% 82% 6. Did you find someone on the hospital staff to talk to about your worries and fears ( yes always ) 60% 57% 66% 64% 62% 66% 7. Did a member of staff tell you about medication side effects to watch for when you went home? ( yes completely & I did not need an explanation ) 63% 58% 65% 72% 72% 67% 8. Did hospital staff tell you who to contact if you were worried about your condition or treatment after you left hospital? ( yes ) 81% 80% 86% 84% 87% 86% 9. When you had important questions to ask a doctor, did you get answers yo understand? ( yes always ) 63% 60% 72% 71% 68% 70% 10.Do doctors talk in front of you as if you are not there? ( No ) - added June 2013 -------- -------- --------- -------- ---------- --------- 11. Overall, how would you rate the care you received? ( excellent, very good ) 93% 95% 90% 92% 91% 93% Composite Score questions 4 8 national patient experience CQUINS 67.4% 65.8% 72.4% 74% 73.8% 10

SPC Charts for Measures Performing Below 90% 11

Table 2 Outpatients November 2012 April 2013 Question Nov - 12 Dec - 12 Jan - 13 Feb - 13 Mar - 13 Apr - 13 1.How clean was the Outpatient Dept? ( Very Clean/fairly clean ) 99% 100% 99% 98% 98% 100% 2.Cleanliness Toilets ( very clean/fairly clean ) 98% 100% 99% 96% 97% 99% 3.Privacy discussing condition ( yes definitely ) 99% 94% 89% 92% 92% 94% 4 Privacy being examined ( yes definitely) 99% 93% 92% 93% 93% 95% 5 If you had important questions to ask a doctor do you get answers you understand? ( yes definitely ) 77% 85% 87% 87% 86% 88% 6. When you arrived at OP how would you rate courtesy of receptionist? ( excellent/very good ) 93% 97% 89% 90% 90% 87% 7. How likely are you to recommend our OP dept to friends and family? ( extremely likely ) 62% 84% 66% 70% 72% 70% NB All inpatients and outpatients question response criteria advised by Picker Institute. Outpatients - Questions 1 & 2 show % of combined very clean/fairly clean. Outpatients - Question 7 wording has been altered to reflect National Friends and Family test wording with only extremely likely results shown. ( not subject to national reporting currently ) SPC Charts for Measures Performing Below 90% 12

Appendix 2 1 st Assessment 2 nd Assessment 3 rd Assessment B1 24.10.08 14.08.09 30.07.10 4 th Assessment 6/10/10 B2 04.03.09 04.09.09 05.08.10 24.05.11 5 th Assessment 6 th Assessment 27/09/2011 04.09.12 29/01/12 7 th Assessment 26/07/2012 14/06/13 8 th Assessment B3 / M2 10.03.09 15.01.10 17.09.10 25.02.11 23.11.11 09.08.12 24/09/12 23/05/13 B5 17.10.08 30.07.09 24.10.10 03.09.10 15.06.11 26.04.11 25.06.12 08.05.13 B6 20.01.09 26.08.09 20.11.09 08.04.10 12.11.10 02.08.11 22.03.12 20.06.12 12.02.13 B7 08.10.08 20.08.09 03.08.10 09.06.11 21.2.12 24.10.12 B8 23.03.09 21.10.09 08.06.10 08.09.10 15.11.11 12.04.12 15.01.12 C1 10.02.09 19.05.10 25.03.11 12.01.12 21.2.12 1.3.13 C2 01.12.09 19.05.10 25.03.11 08.08.11 11.01.12 23.11.12 H1 14.04.09 26.03.10 16.02.11 23/05/11 15.03.12 15.03.13 H2 23.10.08 05.03.09 02.02.10 16.11.10 31.01.11 29.09.11 01.06.12 06.02.13 H3 13.02.09 16.10.09 29.04.10 20.01.11 09.02.12 31.01.13 21.05.13 H4 28.10.08 23.07.09 15.07.10 6/10/10 26.10.11 02.10.12 H5 24.03.09 21.05.10 22.07.11 07.12.11 05.12.12 H7 15.01.09 18.08.09 14.05.10 02.03.11 08.07.11 20.01.12 19.11.12 H8 22.04.09 18.05.10 27.01.11 23/05/11 28.02.12 20.03.13 HU(Haem unit) 30.03.09 14.04.10 30.09.11 29/01/12 08.11.12 SRU 07.04.09 05.03.10 14.02.11 06.06.11 29.03.12 16.10.12 26.11.12 L2 02.02.11 23.02.12 03/10/2012 26.11.12 L3 23.08.11 02.05.12 25.06.12 19.04.13 9 th Assessment 13

L4 (formally L7) 09.02.09 08.07.09 14.12.09 10.09.10 16.06.11 22.05.12 30.01.13 L5 10.11.08 27.11.09 24.08.10 09.08.11 28.05.12 25.10.12 L6 04.12.08 20.01.10 17.08.10 6/10/10 12.10.11 13.09.12 L7 (new ward)** Opened April 2012 19/07/13 L8 27.11.08 20.03.09 22.06.10 28.10.10 19.04.11 15.09.11 08.06.12 20.12.12 28.02.13 EAU 20.10.08 29.01.10 29.01.10 24.09.10 17.08.11 01.05.12 29.10.12 18.03.13 ANU 06.04.09 22.01.10 15.09.10 24.10.11 10.12.12 16.04.13 Renal Unit 21.04.09 10.03.10 20.04.11 15.05.12 25.06.12 30/05/13 HCU 13.10.08 21.07.09 16.08.10 MIU 23.02.09 23.03.10 12.01.11 ASU 09.03.09 30.06.10 18.05.11 A&E 06.07.09 06.05.10 06.04.11 PANDA 03.06.09 19.07.10 DSU 29.06.09 25.06.10 15.08.11 SHDU 24.04.09 12.03.10 04.02.11 6/10/10 23/05/11 20/09/11 20/09/11 29/01/12 07/10/2011 05/07/2012 09/07/13 27/01/2012 07.02.13 18/07/2012 11.01.13 NHDU 04.06.09 10.06.10 19.07.11 08.02.12 09.01.13 SAL 02.07.09 11.06.10 ICU 26.06.09 11.06.10 25.08.11 01.08.12 24/09/2012 Recovery 1 & 3 01.07.09 30.06.10 08.08.12 Maples 21.05.09 21.08.09 23.11.10 M3 16.02.09 19.03.10 24.03.11 TAU * 24.08.12 09.04.13 Bolton RU Wigan RU 23/08/2012 Rochdale RU Heartly green 07.06.12 04.03.13 29/01/12 21.06.12 04/06/13 15.08.12 14

Community Assessment and Accreditation System (CAAS) Appendix 3 Area 1 st Assessment 2 nd Assessment 3 rd Assessment 1 Eccles Integrated DN Care Team 27.02.13 2 Irlam Integrated DN Care Team 14.12.12 3 Walkden / Little Hulton Integrated DN Care Team 03.01.13 4 Swinton Integrated DN Care Team 15.01.13 29.05.13 5 Claremont Integrated DN Care Team 19.02.13 6 Ordsall Integrated DN Care Team 12.02.13 7 Lower Broughton Integrated DN Care Team 04.01.13 8 Out of Hours DN Team 29.01.13 9 Intermediate Rehab Team 26.11.12 10 Discharge Assessment Team 11 Community Tissue Viability 23.01.13 12 Rapid Response 13 Community IV therapy team 14 Community diabetes 15

15 Bladder and bowel service 09.01.13 16 Cardiac rehabilitation 17 Higher Broughton Health Visitors 04.12.12 18 Eccles Health Visitors 03.04.13 19 Walkden Health Visitors 16.04.13 20 Irlam HV Team 12.03.13 21 Lance Burn HV Team 24.04.13 22 Swinton HV Team 30.04.13 23 Little Hulton HV Team 05.03.13 24 Langworthy Health Visiting Community 06.06.13 25 Vulnerable young person s service 17.06.13 26 School nursing 01.07.13 27 Childrens community nursing unscheduled care 28 Childrens community nursing special schools and learning disabilities 29 Childrens community nursing Diana Team 30 Paediatric Asthma service 25.06.13 31 Childrens community nursing outpatients 32 Family liaison nurse 33 Paediatric physio and OT service 16

34 Community paediatrics 35 Paediatric speech and language 36 Orthoptics 37 GPOOH 38 Salford Care Health Practice Non Salford Healthcare Divisions 39 Anticoagulant 40 Audiology 41 MSK CATs and osteoporosis 42 Neurology 43 Occupational therapy 44 Orthotics 45 Physiotherapy / CNRT 46 Podiatry 47 Adult SALT 48 Palliative Care Counsellors 49 Community dental 50 Sexual health 17

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Appendix 5 SRFT SCORES - SELF RESULTS COMPARISON 2011 AND 2012 AND COMPARISON TO OTHERS Question text Score2011 Score2012 comparison to others rag rating Q3 While you were in the A&E Department, how much information about your condition or treatment was given to you? 8.5 8.6 Top 20% Q4 Were you given enough privacy when being examined or treated in the A&E Department? 9.3 9.3 Top 20% Q6 How do you feel about the length of time you were on the waiting list before your admission to hospital? 8.0 8.3 Average Q7 Was your admission date changed by the hospital? 9.1 9.2 Average Q8 In your opinion, had the specialist you saw in hospital been given all of the necessary information about your condition 9.6 Average or illness from the person who referred you? Q9 From the time you arrived at the hospital, did you feel that you had to wait a long time to get to a bed on a ward? 7.8 7.9 Above average Q11 Did you ever share a sleeping area with patients of the opposite sex? 8.8 9.3 Average Q14 While staying in hospital, did you ever use the same bathroom or shower area as patients of the opposite sex? 9.3 9.7 Top 20% Q15 Were you ever bothered by noise at night from other patients? 6.2 6.5 Above average Q16 Were you ever bothered by noise at night from hospital staff? 8.1 8.2 Above average Q17 In your opinion, how clean was the hospital room or ward that you were in? 9.2 9.4 Top 20% Q18 How clean were the toilets and bathrooms that you used in hospital? 8.9 9.0 Top 20% Q19 Did you feel threatened during your stay in hospital by other patients or visitors? 9.7 9.6 Below average Q20 Were hand-wash gels available for patients and visitors to use? 9.7 9.6 Average Q21 How would you rate the hospital food? 6.1 5.7 Above average Q22 Were you offered a choice of food? 8.6 8.5 Below average Q23 Did you get enough help from staff to eat your meals? 7.1 7.8 Above average Q24 When you had important questions to ask a doctor, did you get answers that you could understand? 8.4 8.0 Below average Q25 Did you have confidence and trust in the doctors treating you? 9.1 9.0 Above average Q26 Did doctors talk in front of you as if you weren t there? 8.3 8.3 Below average 19

Q27 When you had important questions to ask a nurse, did you get answers that you could understand? 8.3 8.3 Average Q28 Did you have confidence and trust in the nurses treating you? 8.6 8.7 Average Q29 Did nurses talk in front of you as if you weren t there? 8.8 8.9 Above average Q30 In your opinion, were there enough nurses on duty to care for you in hospital? 7.8 7.4 Average Q31 Sometimes in a hospital, a member of staff will say one thing and another will say something quite different. Did this 8.2 8.1 Above average happen to you? Q32 Were you involved as much as you wanted to be in decisions about your care and treatment? 7.4 7.5 Above average Q33 How much information about your condition or treatment was given to you? 8.7 8.4 Top 20% Q34 Did you find someone on the hospital staff to talk to about your worries and fears? 6.5 6.2 Top 20% Q35 Do you feel you got enough emotional support from hospital staff during your stay? 7.4 7.3 Above average Q36 Were you given enough privacy when discussing your condition or treatment? 8.3 8.7 Top 20% Q37 Were you given enough privacy when being examined or treated? 9.5 9.5 Average Q39 Do you think the hospital staff did everything they could to help control your pain? 8.4 8.1 Average Q40 How many minutes after you used the call button did it usually take before you got the help you needed? 6.7 6.3 Above average Q42 Beforehand, did a member of staff explain the risks and benefits of the operation or procedure in a way you could 9.2 8.9 Average understand? Q43 Beforehand, did a member of staff explain what would be done during the operation or procedure? 8.8 8.7 Above average Q44 Beforehand, did a member of staff answer your questions about the operation or procedure in a way you could 9.0 8.8 Average understand? Q45 Beforehand, were you told how you could expect to feel after you had the operation or procedure? 7.4 7.3 Above average Q47 Before the operation or procedure, did the anaesthetist or another member of staff explain how he or she would put you to sleep or control your pain in a way you could understand? 9.2 9.1 Average Q48 After the operation or procedure, did a member of staff explain how the operation or procedure had gone in a way you 8.2 7.8 Average could understand? Q49 Did you feel you were involved in decisions about your discharge from hospital? 7.3 7.2 Top 20% Q50 Were you given enough notice about when you were going to be discharged? 7.4 Top 20% Q52 On the day you left hospital, was your discharge delayed/main reason? 6.7 6.4 Average 20

Q53 How long was the delay? 7.7 7.6 Average Q54 Before you left hospital, were you given any written or printed information about what you should or should not do 6.6 7.1 Above average after leaving hospital? Q55 Did a member of staff explain the purpose of the medicines you were to take at home in a way you could understand? 8.6 8.5 Above average Q56 Did a member of staff tell you about medication side effects to watch for when you went home? 4.5 4.8 Average Q57 Were you told how to take your medication in a way you could understand? 8.4 8.6 Top 20% Q58 Were you given clear written or printed information about your medicines? 7.5 8.4 Top 20% Q59 Did a member of staff tell you about any danger signals you should watch for after you went home? 5.1 5.4 Above average Q60 Did hospital staff take your family or home situation into account when planning your discharge? 7.4 Above average Q61 Did the doctors or nurses give your family or someone close to you all the information they needed to help care for 5.9 6.1 Above average you? Q62 Did hospital staff tell you who to contact if you were worried about your condition or treatment after you left hospital? 7.7 8.0 Above average Q63 Did hospital staff discuss with you whether you would need any additional equipment in your home, or any 8.3 Average adaptations made to your home, after leaving hospital? Q64 Did hospital staff discuss with you whether you may need any further health or social care services after leaving 8.7 Above average hospital? Q65 Did you receive copies of letters sent between hospital doctors and your family doctor (GP)? 8.3 8.5 Top 20% Q66 Were the letters written in a way that you could understand? 8.6 8.7 Average Q67 Overall, did you feel you were treated with respect and dignity while you were in the hospital? 9.2 9.0 Above average Q68 Overall... 8.1 Top 20% Q69 During your hospital stay, were you ever asked to give your views on the quality of your care? 1.8 1.7 Top 20% Q70 Did you see, or were you given, any information explaining how to complain to the hospital about the care you received? 2.9 Top 20% 21

Division of Clinical Support & Tertiary Medicine Division of Neurosciences & Renal Services Division of Surgery Division of Salford Health Care Division Ward Speciality Beds Budgeted Establishment wte Registered Nurses Un-registered Nurses Registered Nurses Un-registered Nurses Registered Nurses Un-registered Nurses Nurse to bed ratio Current Skill Mix % Wte Ratio per bed L2 Gastrology 24 28.06 18.57 9.49 66% 34% 0.77 0.40 1.2 L3 Cardiology 12 19.14 13.40 5.74 70% 30% 1.12 0.48 1.6 L5 Care of Elderly 24 26.61 16.85 9.76 63% 37% 0.70 0.41 1.1 L6 Endocrinology 24 26.61 16.85 9.76 63% 37% 0.70 0.41 1.1 L7 Care of Elderly 24 28.91 18.58 10.33 64% 36% 0.77 0.43 1.2 L8 Care of Elderly 25 26.63 16.87 9.76 63% 37% 0.67 0.39 1.1 H2 Respiratory 25 30.70 20.79 9.91 68% 32% 0.83 0.40 1.2 MIU Investigations unit 13 17.00 12.00 5.00 71% 29% 0.92 0.38 1.3 HCU Heart Care Unit 10 24.32 21.72 2.60 89% 11% 2.17 0.26 2.4 EAU Assessment Unit 55 92.38 65.40 26.98 71% 29% 1.19 0.49 1.7 MHDU High Dependency Unit 8 23.66 18.54 5.12 78% 22% 2.32 0.64 3.0 B1 General Surg 25 28.78 16.35 12.43 57% 43% 0.65 0.50 1.2 B2 General Surg 25 28.49 17.35 11.14 61% 39% 0.69 0.45 1.1 B5 Elective Ortho 18 20.01 10.82 9.18 54% 46% 0.60 0.51 1.1 B6 Ortho Trauma 32 45.35 26.40 18.94 58% 42% 0.83 0.59 1.4 H4 Urology 24 26.70 15.58 11.12 58% 42% 0.65 0.46 1.1 H5 Short Stay surgery 22 19.61 12.33 7.28 63% 37% 0.56 0.33 1.1 H8 IFU 21 37.89 29.55 8.34 78% 22% 1.41 0.40 1.8 DCU Day case unit 19 15.16 12.00 3.16 79% 21% 0.63 0.17 0.8 ICU Critical Care 15 108.50 96.02 12.03 88% 11% 6.40 0.80 7.2 SHDU Critical Care 12 44.35 35.75 8.60 81% 19% 2.98 0.72 3.7 NHDU Critical Care 8 28.08 22.75 5.30 81% 19% 2.84 0.66 3.5 CHU Heamatology 8 24.44 16.84 7.60 69% 31% 2.11 0.95 3.1 M3 Dermatology 14 16.00 9.50 6.50 59% 41% 0.68 0.46 1.1 B7 Acute NSU 25 34.62 21.73 12.89 63% 37% 0.87 0.52 1.4 B8 Acute NSU 25 38.75 25.02 13.73 65% 35% 1.00 0.55 1.6 TAU Trauma assess 23 52.56 31.73 20.83 60% 40% 1.38 0.91 2.3 Spinal Unit Short Stay surgery 13 24.71 15.40 9.31 62% 38% 0.21 0.20 0.4 Spinal Unit Complex Spine 17 0.74 0.40 1.1 H7 Elective Neuro surg 16 34.53 26.80 7.73 78% 22% 1.14 0.38 1.5 H7 High Care Beds 6 1.43 0.27 1.7 ASU Acute Stroke 18 35.16 23.36 11.80 66% 34% 1.30 0.66 2.0 SRU Stroke Rehab 16 23.23 13.89 9.34 60% 40% 0.87 0.58 1.5 C1 Neurology invest 17+6 19.63 14.03 5.60 71% 29% 0.61 0.24 0.9 C2 Neuro Rehab 20 33.38 19.19 14.19 57% 43% 0.96 0.71 1.7 The Maples Continuing Care 18 24.42 12.69 11.73 52% 48% 0.71 0.65 1.4 H3 Renal Med 25 42.53 27.56 14.97 65% 35% 1.10 0.60 1.7 ANU Acute Neuro Unit 27 31.80 18.86 12.94 59% 41% 0.70 0.48 1.2 Totals / Average 1182.70 811.07 371.13 1.29 0.49 22