Www.england.nhs.uk Learning from Experience Monthly Bulletin 6 Review of the year: 2014

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Learning from Experience

Monthly Bulletin 6

Review of the year: 2014

www.england.nhs.uk 2

These slides are designed to communicate findings from NHS patient surveys

and other sources of insight to colleagues across NHS England.

We want to help ensure that the work of NHS England is informed by public

opinion and the experiences of patients and that we are consistently learning

from the data we collect.

We hope this will be the beginning of a wider conversation with colleagues and

would be delighted to discuss our work with you – please find our contact

details on the last slide.

Learning from Experience


1 Patient feedback in 2014 4

2 Barbara’s story5

3 Survey Evidence• Privacy, dignity and respect 6 - 7• Confidence & trust 8• Understanding and involving patients 9 - 10• Health management & transitions 11 -13

4 Generational analysis of NHS satisfaction 14 – 25

5 Resources26

6 Contact details and future editions 27

Contents


Who has taken part in the NHS survey programme in 2014?

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

NHS Staff Participants: 203,000 staffResponse rate: 49%Eligibility: All staff directly employed by NHS orgs on 1st Sept 2013Fieldwork: Sept - Dec 2014Coverage: 265 NHS organisations

Adult inpatientsParticipants: Over 62,400Response rate: 49%Eligibility: Adults (16+) who had spent at least one night in hospital and were not admitted to maternity or psychiatric units from June to August 2013. Fieldwork: Sept 2013 - Jan 2014Coverage: 156 acute and specialist NHS trusts

GP Patients (GPPS)Participants: Over 900,000Response rate: 34%Eligibility: Adults (18+) with an NHS number, continuously registered with a GP practice for at least 6 months Fieldwork: Jul – Sep 2013 & Jan – Mar 2014Coverage: 8,005 GP practices

Cancer patientsParticipants: Over 70,000 Response rate: 64%Eligibility: Adults (16+) with a cancer diagnosis, treated as day cases or inpatients in England from September to November 2013Fieldwork: Jan - April 2014Coverage: 153 NHS trusts

A&E patientsParticipants: almost 40,000Response rate: 34%Eligibility: Patients visiting A&E January to March 2014Fieldwork: May – Sept 2014Coverage:142 acute and specialist NHS trusts with a major accident and emergency department


A video that has influenced how people feel about dementia:

• A dementia training video, based on the experiences of a fictional patient, Barbara, has had a significant impact since its launch in September 2012

• Commissioned by Guys’ and St Thomas’ NHS Trust to help their staff develop awareness of people with dementia and the care of older people, and to reinforce trust values

• Evaluation by South Bank University showed that the film raised awareness of dementia and, more generally, patients’ experience and their need for help

You can watch the video (33 mins) by accessing the following link:https://www.youtube.com/watch?v=DtA2sMAjU_Y

Based on some of the issues highlighted by Barbara’s experience, the following analysis uses the data collected in 2014 to reflect on NHS performance over the past 12 months. The analysis covers the following aspects of patient experience:

• Privacy, dignity and respect

• Communication

• Understanding of patients and involving them in decision-making

• Transitions and care co-ordination

Barbara’s story

https://www.youtube.com/watch?v=DtA2sMAjU_Y

https://www.youtube.com/watch?v=DtA2sMAjU_Y


The majority of patients continued to report that they were treated with dignity and respect in 2014.

• The strong association between dignity and respect and overall experience implies that the way patients are treated is an important driver of overall experience (fig 1).

• For inpatients, being treated with respect and dignity is closely associated with involvement in decisions and privacy. While a high proportion of patients feel positive about these aspects of care, these questions also have relatively high proportions of “poor” responses compared to others.

Initiatives to improve experience in these areas have potential to have wider impacts.

Fig 1: Association between question scores for being treated with respect and dignity and overall experience, Inpatients 2013*, trust level

7 8 9 10

6

7

8

9

10

R² = 0.882198561817884

Treated with respect and dignity (scored responses)

Ove

rall

… (

0 to

10)

Patients’ feelings about dignity and respect are closely associated with other aspects of their experience:

*Results published in 2014, for inpatient stays in 2013.


Older patients typically give more positive responses when asked about their experiences of NHS servicesOlder patients are more likely to report that they were treated with respect and dignity and had confidence and trust in the people treating them. However, some of the variation in experience across age groups may be a natural consequence of differences in expectations and cultures rather than systematic differences in performance.

Older patients do not consistently report more positive experiences: those over 75 are less likely than younger patients to report that they understand the explanations given to them about their treatment and medicines during inpatient stays (fig 2).

-14

-12

-10

-8

-6

-4

-2

0

2

4

6

8

10

12

65-69 70-74 75-79 80-84 85+

Treated with dignity Procedure explained

Medicines explained

Experiences of older people can be improved by ensuring that they understand the information they are given.

This bar indicates that the score for “Did a member of staff explain the purpose of the medicines you were to take at home in a way you could understand?“ is 12 points lower for patients aged 85+ than for those aged 16-64

Fig 2: Difference in survey question scores by age-group, relative to those aged 16-64. Inpatients , 2013


Almost all patients have confidence and trust in the doctors or nurses that treated them

In both primary and secondary care, patients are more likely to have confidence in doctors than in nurses. However, while confidence in doctors has remained stable over time, confidence in nurses is growing: 77% of inpatients reported “always” having confidence and trust in nurses in 2013 compared to 74% of patients in 2005.

Confidence and trust vary across patient groups:

Cancer patients living in the most deprived geographical areas are more positive than those in the least deprived areas about confidence and trust in all the staff who treated them.

The latest A&E survey shows that: • Patients from white backgrounds are

the most likely to trust those examining and treating them; those from mixed and black White Other Asian Mixed Black

70

72

74

76

78

80

82

84

86

88

90

Fig 3: Did you have confidence and trust in the doctors and nurses examining and treating you? Scores by ethnic group. A&E 2014

0

backgrounds are least likely to feel this way (fig 3).

• Patients with long-standing conditions are less likely than those without to report confidence and trust in the staff treating them.


Patients’ feelings about involvement in decisions about their care vary across settingsPatients’ right to participate in decisions is stated in the NHS Constitution, underpinned by the NHS Mandate objective ‘to ensure the NHS becomes dramatically better at involving patients and their carers…’.

Over time, patients are reporting slightly more involvement in decisions in secondary care:

• The latest results show that more inpatients and A&E attendees feel sufficiently involved in decisions about their care and treatment than previously (A&E: 63%, inpatients: 56%)

• Inpatients increasingly “definitely” feel involved in discharge decisions (54%, 2014)

• In 2014, more A&E attendees felt that their family (or someone close) had enough opportunity to talk to a doctor than in 2013 (61%).

However, despite improvements:

• one in 10 inpatients still do not feel sufficiently involved in care and treatment decisions.

• more than 1 in 4 inpatients (28%) did not feel that their family (or someone close to them) was given all the information they needed to help care for them.

Yes, definitely Yes, to some extent No0%

10%

20%

30%

40%

50%

2012 2013

Fig 4: ‘Did the doctors or nurses give your family or someone close to you all the information they needed to help care for you?’ Inpatients 2013


Feedback from both staff and patients shows concern about staffing levels (Fig 5):

• almost half (47%) of acute staff felt that their organisation needed more staff for them to do their job properly and,

• 1 in 10 (11%) patients felt that there were “rarely or never enough nurses” on duty to care for them in hospital.

Although patients generally feel positive about relationships with staff, both groups are aware of room for improvement:

Patients report finding it increasingly difficult to find staff to talk to

Fig 5: Association between patient and staff opinion of whether there are sufficient staff at each organisation to care for patients

While more than three-quarters (76%) of patients receiving inpatient care reported being able to find a member of hospital staff to talk to about their worries and fears, the proportion of people feeling this way has been declining over time, from 79% in 2005.

• 1 in 7 inpatients (14%) did not feel that they got enough emotional support from hospital staff during their stay,

• Only 7 out of 10 staff members feel able to deliver the patient care that they aspire to.

5 5.5 6 6.5 7 7.5 8 8.5 9 9.5 10

10

20

30

40

50

60

Patient view: Enough nurses on duty to provide care (scored responses)

Sta

ff v

iew

: E

no

ug

h s

taff

at

the

org

anis

a-ti

on

to

do

jo

b p

rop

erly

(p

erce

nta

ge

agre

e)


The majority of patients (93%) feel confident in managing their own health…

…however, 1 in 10 people (11%) with a long-standing health condition do not feel confident to manage their own health, compared to 3% of those in full health.

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

5% 9% 19% 67%

Within the previous week Between 1 week & 1 month earlier

More than a month earlier No

33%14%

Fig 6: ‘Before your most recent visit to A&E, had you previously been to this A&E about the same condition or something related to it?’ (answered by all), A&E 2014

Those who don’t feel confident to manage their health may be more likely to rely on NHS services (Fig 6):

• one-third (33%) of people responding to the A&E survey had attended the same A&E with the same or a related condition previously;

• almost 1 in 7 (14%) patients attended with the same or a related condition within the previous month.


Most patients with a long-standing health condition feel that they receive enough support to manage their health……Cancer patients also tend to feel that services work for them: • more than 2 in 3 (68%) felt that the GPs and nurses at the practice did everything they could

to support them1. However, 1 in 10 felt that their practice could have done more.

• While six in 10 patients (60%) definitely got the help they needed from health or social services after leaving hospital, almost 2 in 10 (18%) did not feel that they got this help2.

The fact that one-third (33%) of people arriving at A&E were advised to go to the A&E Department by another health professional, including 17% who were referred by a GP could raise questions about the effectiveness of these services to manage patients that might not need to attend A&E.

I decided that I needed to go

The ambulance service

Somebody else

A GP from my local surgery

An NHS telephone advisor

Doctor or nurse at a WiC / MIU

Some other health professional

A GP out of hours service

0% 5% 10% 15% 20% 25% 30%

27%

26%

14%

14%

7%

5%

4%

3%

33%

Fig 7: ‘who advised you to go to the A&E Department?’ A&E 2014

1 Of those whose general practice was involved in their treatment2 Of those who felt they needed it.


Evidence from multiple surveys shows that experience of discharge is an area for improvement

Almost 1 in 5 (18%) inpatients reported that staff did not take their family or home situation into account when planning their discharge1.

A similar proportion (19%), reported that staff did not discuss with them about any additional equipment or adaptations required at home.

Almost half (45%) of patients leaving A&E reported that staff did not take their family or home life into account:

• Even though older groups of patients were more likely to report that their home situation was taken into account, more than 1 in 5 (22%) still reported that this was not the case (fig 8).

16-35

36-50

51-65

66-75

76-85

>86

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

31%

31%

36%

44%

49%

58%

18%

16%

15%

15%

18%

20%

50%

53%

49%

41%

33%

22%

Yes, completely Yes, to some extent No

Fig 8: ‘Did hospital staff take your family or home situation into account when you were leaving the A&E Department?’ by patient age

Source: A&E 2014. Note: respondents who said it was not necessary to do this, or that they did not know or could not say have been excluded

1Of those who felt it necessary

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Generational analysis of satisfaction with the NHS

British Social Attitudes survey data

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18 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 to 84 85 +

5% 6% 4% 4% 3%

14% 13%11% 10% 8%

6% 4% 5%

49% 48%

46%43%

41%

35%31% 30%

30% 31%37% 42%

47%

57%64% 64%

Why do older people always report such a better experience of GPs?

Base: All respondents who answered the question (948,758) Source: GP Patient Survey 2013-2014

Very good

Fairly good

Neither

Poor

Overall, how would you describe your experience of your GP surgery?

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It’s much easier for older people to get an appointment…

Is satisfaction simply a question of access?

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Please tell me whether on the whole you agree or disagree with each of the following statements…GPs are best placed to understand which services their patients need

But older people also seem to have more underlying faith in GPs

Base: Adults aged 16+ in England, Winter 2013: 16 - 24 (139); 25 – 34 (169); 35 – 54 (335); 55 – 64 (155); 65 – 74 (119); 75 and over (99*)

Source: Ipsos MORI/DH Perceptions of the NHS Tracker

16 - 24 25 - 34 35 - 54 55 - 64 65 - 74 75 and over

71% 71% 77% 78% 91% 90%

*Small base size means comparison of figures and trends is indicative only

% Agree

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So do we simply become more appreciative of GPs as we get older and become more reliant on them?

Not quite…

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Overall satisfaction with GPs hasn’t changed over time…but the pre-war generation has always been more satisfied

How satisfied or dissatisfied are you with the NHS as regards … local doctors or GPs?

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Pre war (before 1945) Baby boomers (1945-65) Generation x (1966-1979) Generation y (1980-2000)

% Satisfied

Base: All data points represent >200 responsesSource: British Social Attitudes survey

Analysis by Ipsos MORI http://www.ipsos-mori-generations.com/

1. Overall satisfaction is relatively flat

2. But generations are different – and stay different

3. Later generations are less satisfied with GPs

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The distinction is even more marked when we look at overall satisfaction with the NHS…

“How satisfied or dissatisfied would you say you are with the way in which the National Health Service runs nowadays?”

Base: All data points represent >200 responses

Source: British Social Attitudes survey


1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%


1. Overall satisfaction has increased since early 1990s (though now falling?)2. But pre-war generation have always been much happier with NHS3. Younger generations are close to each other in attitude – i.e. less satisfied

% Satisfied

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Is it because the pre-war generation have a better understanding of life before the NHS?

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1987 1989 1991 1993 1994 1995 1996 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100%

10%

20%

30%

40%

50%

60%

70%


The pattern holds true in many other similar areas, such as the principle of welfare spending“The government should spend more money on welfare benefits for the poor, even if it leads to higher taxes”

Base: All data points represent >200 responsesSource: British Social Attitudes survey


% Agree

1. Decline in support for welfare across the board

2. But the generational difference is incredibly marked

3. Younger generations are less open to welfare

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Attitudes seem less a question of how old you are, than of when you were born and raised


So will our changing demographic result in much lower overall satisfaction with the NHS?

83 84 85 86 87 89 90 91 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 100%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

% sample universe from pre war generation

% Generation y

% Generation x

% Baby boomers

1983: All adults aged 39 and over

Proportion of UK population from each generational grouping

Source: Eurostat/Ipsos MORI

2010: All adults aged over 66

1983: All adults aged under 39

2010: All adults aged between

45 and 65

2010: All adults aged between

44 and 31

2010: All adults aged under 31

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And to what extent is satisfaction a result of services received, rather than a product of our differing expectations about, or gratitude for, the NHS?

Overall, how satisfied or dissatisfied are you with the running of the National Health Service nowadays?

Base: Adults in England aged 16+, Summer 2012: Ipsos MORI aggregate analysis (22422) Source: Ipsos MORI/DH Perceptions of the NHS Tracker

South East

Eastern

London

West Midlands

East Midlands

South West

Yorks & Humber

North West

North East

61%

63%

64%

64%

65%

66%

67%

69%

72%

% Satisfied


Resources

CQC Survey Programme documentation and results:

http://www.cqc.org.uk/content/surveys

http://www.nhssurveys.org/

Cancer Patient Experience Survey:

https://www.quality-health.co.uk/surveys/national-cancer-patient-experience-survey

GP Patient Survey:

https://gp-patient.co.uk/surveys-and-reports

NHS Staff Survey:

http://www.nhsstaffsurveys.com/Page/1006/Latest-Results/2013-Results/












Plans for future editions

Feedback

We would be pleased to receive your comments, questions or suggestions about this and future slide packs.

If you would like to provide any feedback on this publication please email:

Analytical Services (Patients & Information)

[email protected]; [email protected]

Insight Team:

[email protected]

Forthcoming publications

This monthly slide pack series is co-produced by NHS England's Analytical Services and Insight Team in the Patients & Information Directorate.

Themes for upcoming slide packs:

February 2015: Accident & Emergency

March 2015: GP Patient Survey results

April 2015: NHS Staff experience

Webinar

The teams will present these slides and host a Q&A on a webinar at:

• 2pm – 3pm on 23rd January 2015.

If you would like to join the webinar, please contact [email protected] to receive details.

mailto:[email protected]



mailto:[email protected]?subject=Monthly%20Snapshots:%20Webinar

Documents

Www.england.nhs.uk Learning from Experience Monthly Bulletin 6 Review of the year: 2014