ANALYSIS
Inpatient feedback highlights gulf in trust performance The Care Quality Commission (CQC) has published the results of its 12th annual hospital inpatient survey, revealing little improvement in the way patients rate the care they receive. On the surface, the findings are positive – 84% of the 59,000 patients surveyed across England rated their
ALAMY
Inadequate nurse staffing and delayed discharges are among the problems highlighted in the CQC’s annual hospital survey. Jennifer Sprinks reports
overall experience as seven or higher out of ten. However, more than two fifths (42%) said there were delays in being discharged from hospital, with 61% citing the main reason as waiting for medicines. Of those delayed, 23% waited for longer than four hours.
How the trusts compare More than 100 trusts were rated as performing about the same as other organisations in either all or most of the 11 areas. 30 trusts performed ‘worse’ on one or more of the 11 areas. 15 organisations performed ‘better’ on all or nearly all of the 11 areas. Six trusts performed ‘worse’ than other organisations on nursing. Patients score how well nurses answered their questions, the confidence and trust they have in the nurses treating them, whether nurses talked in front of them as if they weren’t there and whether there were enough nurses on duty to care for them. The survey, conducted with patients who stayed in one of 154 acute and specialist NHS trusts for at least one night during June, July or August 2014, is compared with the findings from the previous year. CQC deputy chief inspector of hospitals Edward Baker has called on senior staff to review their results and see where improvements can be made. ‘The survey demonstrates the significant variation between the best and worst performing trusts,’ he says. ‘The results match findings from CQC’s inspections that highlight the variation between and within trusts.’ Ahead of the next survey, the CQC says it would like to see patients being discharged on time, people involved in decisions about their care, better communication with health professionals and call bells being answered in a timely way. Of the 57,996 patients responding to the nurse staffing question, just 60% said there were always or nearly always enough nurses on duty to care for them. Eleven per cent said there were rarely or never enough nurses on duty. This represents little improvement to the previous year’s survey, when 59% of the 61,497 patients who responded to the question said there were always or nearly always enough nurses.
12 june 3 :: vol 29 noRCNi.com 40 :: 2015 STANDARD Downloaded from by ${individualUser.displayName} on Nov 12, 2015. For personal use only. NoNURSING other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
ANALYSIS
Asked whether they have confidence and trust in the nurses treating them, 78% of 58,116 patients who responded to the question said ‘yes, always’ while 19% said ‘yes, sometimes’. Last year, 77% of the 61,668 who responded to the question said ‘yes, always’ and 20% said ‘yes, sometimes’.
Firing line
Commenting on the report, RCN general secretary Peter Carter says it is ‘unacceptable’ that patients are feeling the impact of low staffing levels. ‘Nurses are not responsible for setting staffing levels, yet they are the ones in the firing line when a lack of staff impacts on patients’ experiences.’ In 2013, research led by University of Southampton principal research fellow Jane Ball found strong evidence to show lower nurse staffing levels in hospitals are associated with worse outcomes for patients. In that study, of 2,917 nurses surveyed from 401 general medical/surgical wards in 46 general acute hospitals in England, 86% reported that one or more care activities had been left undone due to lack of time on their last shift. The care most frequently left undone included comforting, talking to or educating patients. Safe Staffing Alliance chair Susan Osborne says the CQC survey findings suggest a similar association between inadequate nurse staffing and aspects of care such as delayed discharge or patients not being helped to eat. ‘If we had safe staffing levels patients would
have somebody to talk to about their concerns and discharge planning would be improved. There should not be patients waiting for four hours to get home,’ says Ms Osborne. Since the Francis report into the failings at Mid Staffs, trusts across the UK have been investing more in recruiting nursing staff. Yet Ms Osborne says the numbers are insufficient to address the shortfall. She believes mandating nurse-to-patient ratios is the only way to ensure safe staffing on all wards.
‘PATIENTS SHOULD NOT WAIT FOUR HOURS TO GO HOME’ – Susan Osborne
‘If it is left to local decision makers, we get complete variation as to what is considered safe or unsafe staffing levels,’ she says. Barking, Havering and Redbridge University Hospitals NHS Trust was rated as performing ‘worse’ than other trusts on four of the 11 areas in the CQC survey, including A&E and nurses. Six months ago, the trust set up a discharge planning team, involving representatives from social services and community providers, senior officers and ward nurses. The team meets daily to discuss issues about patients being discharged. The trust is investing £1.5 million in recruiting 80 whole-time equivalent band 5 nurses
Key findings of the CQC hospital inpatient survey 84% rated their overall experience with a score of seven or above out of ten. 78% ‘always’ had confidence and trust in the nurses treating them (up from 77% in 2013). 62% stated that toilets and bathrooms they used in hospital were ‘very’ clean, while just 32% rated them as ‘fairly’ clean. 60% of respondents (up from 59% in 2013) felt there were ‘always or nearly always’ enough nurses on duty to care for them. 42% (up from 41% in 2013) said their discharge was delayed, with 61% saying this was because they had to wait for medicines. 17% of respondents who needed help to eat their meals said they did not get enough help from staff and just 19% ‘sometimes’ got enough assistance with eating. Go to www.cqc.org.uk/cqc_survey/3 to read the full findings
in 2015/16 to enable ward managers to have supervisory status. Trust interim chief nurse Wendy Matthews says: ‘We have shown quite a bit of improvement on a number of indicators. The survey was done last year when we were under special measures.’ Croydon Health Services NHS Trust was rated as performing worse than other trusts on five areas, including doctors, nurses and care and treatment, but has improved since last year’s survey. Director of nursing, midwifery and allied health professionals Michael Fanning says: ‘We are pleased to see the impact of our quality and workforce improvement work on patient experience, and recognise that we will need to build on this to further address the areas that matter most to patients.’
Care model
Liverpool Heart and Chest NHS Foundation Trust was one of just a few organisations that performed better than other trusts on all 11 areas in the survey. Trust lead nurse for patient and family experience and safeguarding Joanne Shaw says the organisation launched a model for patient and family-centred care three years ago to ensure patient feedback is used to drive improvements to care. The model involves a care partner programme where families can choose to get involved in their loved one’s care, such as in the discharge planning process. The trust also runs ‘engagement events’ with patients who have stayed in its hospitals in the previous six months. At management level, the trust’s chief executive leads a daily ‘safety huddle’ where ward managers and other senior staff can flag-up trends or problems, such as staffing shortages. ‘If organisations drive a culture of person- and family-centred care where patients and families are at the heart of what they do, then they will see improvements to care as a result of listening to patients,’ says Ms Shaw NS
NURSING june :: voluses 29 without no 40 ::permission. 2015 13 DownloadedSTANDARD from RCNi.com by ${individualUser.displayName} on Nov 12, 2015. For personal use only. No3other Copyright © 2015 RCNi Ltd. All rights reserved.
Inpatient feedback highlights gulf in trust performance The Care Quality Commission (CQC) has published the results of its 12th annual hospital inpatient survey, revealing little improvement in the way patients rate the care they receive. On the surface, the findings are positive – 84% of the 59,000 patients surveyed across England rated their
ALAMY
Inadequate nurse staffing and delayed discharges are among the problems highlighted in the CQC’s annual hospital survey. Jennifer Sprinks reports
overall experience as seven or higher out of ten. However, more than two fifths (42%) said there were delays in being discharged from hospital, with 61% citing the main reason as waiting for medicines. Of those delayed, 23% waited for longer than four hours.
How the trusts compare More than 100 trusts were rated as performing about the same as other organisations in either all or most of the 11 areas. 30 trusts performed ‘worse’ on one or more of the 11 areas. 15 organisations performed ‘better’ on all or nearly all of the 11 areas. Six trusts performed ‘worse’ than other organisations on nursing. Patients score how well nurses answered their questions, the confidence and trust they have in the nurses treating them, whether nurses talked in front of them as if they weren’t there and whether there were enough nurses on duty to care for them. The survey, conducted with patients who stayed in one of 154 acute and specialist NHS trusts for at least one night during June, July or August 2014, is compared with the findings from the previous year. CQC deputy chief inspector of hospitals Edward Baker has called on senior staff to review their results and see where improvements can be made. ‘The survey demonstrates the significant variation between the best and worst performing trusts,’ he says. ‘The results match findings from CQC’s inspections that highlight the variation between and within trusts.’ Ahead of the next survey, the CQC says it would like to see patients being discharged on time, people involved in decisions about their care, better communication with health professionals and call bells being answered in a timely way. Of the 57,996 patients responding to the nurse staffing question, just 60% said there were always or nearly always enough nurses on duty to care for them. Eleven per cent said there were rarely or never enough nurses on duty. This represents little improvement to the previous year’s survey, when 59% of the 61,497 patients who responded to the question said there were always or nearly always enough nurses.
12 june 3 :: vol 29 noRCNi.com 40 :: 2015 STANDARD Downloaded from by ${individualUser.displayName} on Nov 12, 2015. For personal use only. NoNURSING other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
ANALYSIS
Asked whether they have confidence and trust in the nurses treating them, 78% of 58,116 patients who responded to the question said ‘yes, always’ while 19% said ‘yes, sometimes’. Last year, 77% of the 61,668 who responded to the question said ‘yes, always’ and 20% said ‘yes, sometimes’.
Firing line
Commenting on the report, RCN general secretary Peter Carter says it is ‘unacceptable’ that patients are feeling the impact of low staffing levels. ‘Nurses are not responsible for setting staffing levels, yet they are the ones in the firing line when a lack of staff impacts on patients’ experiences.’ In 2013, research led by University of Southampton principal research fellow Jane Ball found strong evidence to show lower nurse staffing levels in hospitals are associated with worse outcomes for patients. In that study, of 2,917 nurses surveyed from 401 general medical/surgical wards in 46 general acute hospitals in England, 86% reported that one or more care activities had been left undone due to lack of time on their last shift. The care most frequently left undone included comforting, talking to or educating patients. Safe Staffing Alliance chair Susan Osborne says the CQC survey findings suggest a similar association between inadequate nurse staffing and aspects of care such as delayed discharge or patients not being helped to eat. ‘If we had safe staffing levels patients would
have somebody to talk to about their concerns and discharge planning would be improved. There should not be patients waiting for four hours to get home,’ says Ms Osborne. Since the Francis report into the failings at Mid Staffs, trusts across the UK have been investing more in recruiting nursing staff. Yet Ms Osborne says the numbers are insufficient to address the shortfall. She believes mandating nurse-to-patient ratios is the only way to ensure safe staffing on all wards.
‘PATIENTS SHOULD NOT WAIT FOUR HOURS TO GO HOME’ – Susan Osborne
‘If it is left to local decision makers, we get complete variation as to what is considered safe or unsafe staffing levels,’ she says. Barking, Havering and Redbridge University Hospitals NHS Trust was rated as performing ‘worse’ than other trusts on four of the 11 areas in the CQC survey, including A&E and nurses. Six months ago, the trust set up a discharge planning team, involving representatives from social services and community providers, senior officers and ward nurses. The team meets daily to discuss issues about patients being discharged. The trust is investing £1.5 million in recruiting 80 whole-time equivalent band 5 nurses
Key findings of the CQC hospital inpatient survey 84% rated their overall experience with a score of seven or above out of ten. 78% ‘always’ had confidence and trust in the nurses treating them (up from 77% in 2013). 62% stated that toilets and bathrooms they used in hospital were ‘very’ clean, while just 32% rated them as ‘fairly’ clean. 60% of respondents (up from 59% in 2013) felt there were ‘always or nearly always’ enough nurses on duty to care for them. 42% (up from 41% in 2013) said their discharge was delayed, with 61% saying this was because they had to wait for medicines. 17% of respondents who needed help to eat their meals said they did not get enough help from staff and just 19% ‘sometimes’ got enough assistance with eating. Go to www.cqc.org.uk/cqc_survey/3 to read the full findings
in 2015/16 to enable ward managers to have supervisory status. Trust interim chief nurse Wendy Matthews says: ‘We have shown quite a bit of improvement on a number of indicators. The survey was done last year when we were under special measures.’ Croydon Health Services NHS Trust was rated as performing worse than other trusts on five areas, including doctors, nurses and care and treatment, but has improved since last year’s survey. Director of nursing, midwifery and allied health professionals Michael Fanning says: ‘We are pleased to see the impact of our quality and workforce improvement work on patient experience, and recognise that we will need to build on this to further address the areas that matter most to patients.’
Care model
Liverpool Heart and Chest NHS Foundation Trust was one of just a few organisations that performed better than other trusts on all 11 areas in the survey. Trust lead nurse for patient and family experience and safeguarding Joanne Shaw says the organisation launched a model for patient and family-centred care three years ago to ensure patient feedback is used to drive improvements to care. The model involves a care partner programme where families can choose to get involved in their loved one’s care, such as in the discharge planning process. The trust also runs ‘engagement events’ with patients who have stayed in its hospitals in the previous six months. At management level, the trust’s chief executive leads a daily ‘safety huddle’ where ward managers and other senior staff can flag-up trends or problems, such as staffing shortages. ‘If organisations drive a culture of person- and family-centred care where patients and families are at the heart of what they do, then they will see improvements to care as a result of listening to patients,’ says Ms Shaw NS
NURSING june :: voluses 29 without no 40 ::permission. 2015 13 DownloadedSTANDARD from RCNi.com by ${individualUser.displayName} on Nov 12, 2015. For personal use only. No3other Copyright © 2015 RCNi Ltd. All rights reserved.
