2010 Inpatient Services Survey reveals where NHS trusts are excelling - and falling down

EFFORTS to stamp out mixed-sex accommodation and improve infection control in hospitals across England have been recognised following the publication of the results of the Inpatient Services Survey 2010.

The annual exercise, led by the Care Quality Commission (CQC), was carried out at 161 acute trusts last summer, with feedback received from 50% of those questioned - a total of 66,000 patients. They were asked to comment on everything from the way staff spoke to them about their treatment to how clean the wards were and how often healthcare workers washed their hands.

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

And the results show an improvement in most key categories, although they highlighted ongoing challenges in the areas of supporting patients to eat properly and fully explaining the potential effects of various medications.

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

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

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

And she said trusts would be expected to use the information to improve services, adding: " The results from the survey are primarily intended for use by NHS trusts to help improve patient experience and their performance. The CQC will use the results in a range of ways, including setting out national and trust findings, informing patients and the public of trusts' results, and for regulatory activities such as the monitoring of ongoing compliance against the essential standards of quality and safety. The Department of Health will also use the results to measure performance against a range of indicators. In addition, w e expect every NHS hospital trust to pay close attention to their results and plan how they can improve the experience of hospital patients."

Findings in the key categories affecting estates and facilities management included:

  • SAME-SEX WARDS: In 2010, 94% of planned admissions and 86% of emergency admissions were treated in same-sex accommodation when first admitted. This compares to 92% and 79% respectively in 2009. Of those patients who were moved during their stay, 95% of planned admissions and 93% of emergency admissions were treated in line with privacy and dignity regulations, compared to 92% and 91% in the previous year. Where toilets and bathrooms were concerned, 80% of patients had access to single-sex facilities, with 19% having to share with members of the opposite sex and the remaining 2% sharing because the bathrooms had specialist bathing equipment
  • PRIVACY: 71% of patients said they were always given privacy when discussing their condition, compared to 70% in 2009 and 68% in 2002; 21% said they were sometimes given privacy, compared to 22% in 2009; and 8% felt they were not given enough privacy, unchanged from last year. When undergoing an examination, 89% said this was done in private, 10% were sometimes given privacy and 2% said they were not examined in private. These figures are unchanged from last year
  • NOISE: Similar to last year's figures, 40% of people said they were bothered by noise from other patients, while 21% were disturbed by noise from staff
  • CLEANLINESS: 66% of rooms and wards were rated as 'very clean', an improvement from 64% last year; 31% were said to be 'fairly clean', down from 32% in 2009; 3% said they were 'not very clean', unchanged from last year; and 1% said they were 'not at all clean', again unchanged from the previous survey. In terms of toilets and bathrooms, 59% were 'very clean' (51% in 2009); 36% said they were 'fairly clean' (36% in 2009); 5% said they were 'not very clean' (6% in 2009); and 1% said they were 'not at all clean', similar to last year
  • SECURITY: 4% of respondents said they felt threatened by other visitors; 33% could not lock away their valuables; and 4% had nowhere to put their valuables
  • FOOD: 21% of those questioned rated food as 'very good' (same as 2009); 35% as 'good' (36% in 2009); 30% as fair (same as 2009); and 14% as 'poor' (same as 2009). 79% said they were given a choice of food (78% in 2009); 15% were sometimes given a choice (16% in 2009); and 6% were not given a choice (same as 2009). However, 18% of patients said they were not given enough help to eat, which shows improvement on previous figures
  • INFECTION CONTROL: As far as patients were aware, 78% of doctors always washed their hands between patients (76% in 2009); 15% sometimes washed their hands (17% in 2009); and 7% never washed their hands (same as 2009. Among nurses, 79% always washed; 17% sometimes washed; and 4% did not wash, again these results are similar to last year's

Our patients are the best judges of our performance and it is reassuring to receive such a high level of feedback across the many aspects of care we provide.

Among the NHS organisations that scored favourably was the Queen Victoria NHS Foundation Trust (QVH) based in West Sussex. It achieved the highest scores of any hospital trust for 24 of the 63 questions asked. It also scored significantly higher than most other hospitals in 46 areas and for the remaining 17 questions scored around the same as most of the others. QVH was rated particularly highly for the cleanliness of rooms and wards (9.6/10) and toilets and bathrooms (9.4/10), which were again the best scores in the country.

Commenting on the success: Dr Adrian Bull, QVH chief executive, said: "These results are really heart-warming. At QVH we try to combine clinical excellence with a strong culture of personal care for everyone we treat. Patients are telling us that we're getting it right and all the staff at QVH can be proud of that."

The Robert Jones and Agnes Hunt Orthopaedic and District NHS Trust in Shropshire was the country's highest scorer in a record 14 categories. Chief executive, Wendy Farrington Chadd, said: "This is a fantastic result for the hospital with more than 96% of patients rating their care as good, very good or excellent and 99% saying they would recommend us to friends and family.

"Our staff work extremely hard to provide the highest quality of care and it is rewarding for us all to receive such positive feedback across the wide range of areas surveyed. Our patients are the best judges of our performance and it is reassuring to receive such a high level of feedback across the many aspects of care we provide."

Among those at the other end of the scale were Cheltenham General Hospital and Gloucestershire Royal Hospital, which came in the bottom 20% for cleanliness and for handwashing compliance among staff. It failed to reach the top fifth in any category. It did, however, perform well in terms of the provision of same-sex accommodation.

Spokeswoman Sarah Brown said: "Controlling infections and maintaining high standards of cleanliness within our hospitals is a key priority for the trust. Our rates for C. difficile and MRSA infections are falling significantly, which indicates that our strenuous efforts to tackle these are working.

"While the overall reporting of the patients' experience was rated as 'very good' to 'excellent' by 75% of respondents, there remain clear areas for improvement. These relate to the quality of communication, provision of information, involvement of patients and carers in decisions in care and the treatment and discharge experience. It is also clear that a different approach is required to ensure improvements to the patient experience. Work is underway and actions have been approved by the trust's board."

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