Learning from Experience Monthly Bulletin 6 Review of the year: 2014

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 2

1Patient feedback in Barbara’s story5 3Survey Evidence Privacy, dignity and respect6 - 7 Confidence & trust8 Understanding and involving patients Health management & transitions Generational analysis of NHS satisfaction14 – 25 5Resources26 6Contact details and future editions27 Contents 3

Who has taken part in the NHS survey programme in 2014? JanFebMarAprMayJunJulAugSepOctNovDec NHS Staff Participants: 203,000 staff Response rate: 49% Eligibility: All staff directly employed by NHS orgs on 1 st Sept 2013 Fieldwork: Sept - Dec 2014 Coverage: 265 NHS organisations Adult inpatients Participants: Over 62,400 Response 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 Fieldwork: Sept Jan 2014 Coverage: 156 acute and specialist NHS trusts GP Patients (GPPS) Participants: Over 900,000 Response 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 2014 Coverage: 8,005 GP practices Cancer patients Participants: 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 2013 Fieldwork: Jan - April 2014 Coverage: 153 NHS trusts A&E patients Participants: almost 40,000 Response rate: 34% Eligibility: Patients visiting A&E January to March 2014 Fieldwork: May – Sept 2014 Coverage:142 acute and specialist NHS trusts with a major accident and emergency department 4

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: 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 5

The majority of patients continued to report that they were treated with dignity and respect in 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 Patients’ feelings about dignity and respect are closely associated with other aspects of their experience: 6 *Results published in 2014, for inpatient stays in 2013.

Older patients typically give more positive responses when asked about their experiences of NHS services Older 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). 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 Fig 2: Difference in survey question scores by age-group, relative to those aged Inpatients,

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

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 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. 10

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. 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. 11

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 them 1. 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 help 2. 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. 33% Fig 7: ‘who advised you to go to the A&E Department?’ A&E Of those whose general practice was involved in their treatment 2 Of those who felt they needed it. 12

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 discharge 1. 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). 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 Note: respondents who said it was not necessary to do this, or that they did not know or could not say have been excluded 1 Of those who felt it necessary 13

Generational analysis of satisfaction with the NHS British Social Attitudes survey data

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 Very good Fairly good Neither Poor Overall, how would you describe your experience of your GP surgery?

It’s much easier for older people to get an appointment… Is satisfaction simply a question of access?

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: (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 and over 71% 77%78%91%90% *Small base size means comparison of figures and trends is indicative only % Agree

So do we simply become more appreciative of GPs as we get older and become more reliant on them? Not quite…

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? % Satisfied Base: All data points represent >200 responses Source: British Social Attitudes survey Analysis by Ipsos MORI 1. Overall satisfaction is relatively flat 2. But generations are different – and stay different 3. Later generations are less satisfied with GPs

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 Analysis by Ipsos MORI % Satisfied

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

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 responses Source: British Social Attitudes survey Analysis by Ipsos MORI % 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

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? Proportion of UK population from each generational grouping Source: Eurostat/Ipsos MORI 2010: All adults aged over : All adults aged under : All adults aged between 45 and : All adults aged between 44 and : All adults aged under 31 24

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

Resources CQC Survey Programme documentation and results: Cancer Patient Experience Survey: GP Patient Survey: NHS Staff Survey: 26

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 Analytical Services (Patients & Information) Insight Team: 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 23 rd January If you would like to join the webinar, please contact to receive 27