Patient surveys – recognised internationally as a key marker of the quality of care, and an important tool for improvement in the NHS – provide a unique perspective, complementing the wealth of other data on hospital performance gathered by trusts and regulators. Now, for the first time, The King’s Fund and Picker Institute Europe have analysed longitudinal inpatient survey data for acute trusts over a nine-year period (2005 to 2013).
The survey questions that were analysed (20 of a much larger number) were grouped into five aspects of care that matter most to patients: access and waiting; safe, high-quality co-ordinated care; better information, more choice; building better relationships; and a clean, comfortable and friendly place.
Over the nine-year period, national average scores increased for 14 questions but decreased for 6.
The biggest improvements have typically been driven by national initiatives and policies tackling high-profile problems – ward cleanliness being the clearest example.
Patients report poorer experiences now with some aspects of care (such as length of wait from hospital admission to a bed on a ward, and timely discharge from hospital) that reflect pressures in the wider health and care system.
Areas of care where patients generally reported poorer experiences showed erratic annual changes and wider variations in performance between trusts.
The ‘overall rating’ given by patients showed a small improvement, but national averages mask some very different patterns for individual trusts. Specialist trusts generally performed well, but London trusts had some of the lowest scores.
There is considerable potential for reducing variations in performance between trusts, as well as raising overall levels of performance.
Patient survey data is currently underutilised, both locally (to guide quality improvement) and nationally (for secondary research on the aggregated data, which could provide insights not observable at local level).
Aspects of care showing negative trends in inpatient experience, such as length of wait for admission, and timely discharge, are linked to wider system pressures. A concerted effort (on the part of policy-makers, regulators and commissioners) should be made to ease those pressures.
There is considerable scope for reducing variations in performance between trusts, as well as raising overall levels of performance. The overall patient experience could be improved by targeting areas of care for which all or most trusts perform less well – which are also typically those areas with the widest variation between trusts.