National survey shows improvements in people being seen on time for their appointments and cleanliness in NHS outpatient departments but treatments still need to be better explained to patients.

Tuesday 14 Feb 2012 @ 17:54
Care Quality Commission

The national survey of NHS outpatients has shown improvement in the way that patients perceive key aspects of care including being seen on time or early for their appointment, cleanliness, respect, dignity and communication with doctors. However, there are still a number of areas where improvement is needed.

There has been an increase since the last outpatients survey in 2009 in the proportion of patients seen on time or early for their appointment. An increased proportion of all patients felt they were treated with respect and dignity, more patients reported that doctors gave explanations for the reasons for action or treatment, and gave understandable answers to questions. More outpatients also felt involved in decisions about their care and treatment.

The Commission today (Tuesday) published results from the fourth national outpatient survey, carried out by 163 acute trusts in England. Over 72,000 people who attended outpatient departments in April or May 2011 completed the survey. Fieldwork for the survey took place between June and October 2011.

Since 2009 the proportion of repeat attendees at outpatients departments who responded to the survey has increased, and fewer of the respondents had attended an outpatients appointment for the first time. This may have influenced the overall results of the survey and may explain some of the changes shown. The results of the survey also revealed that repeat attendees are more likely to have a long term condition. Of those who responded to the survey; first time attendees to the outpatient departments were more likely to receive explanations about treatments and tests and fewer repeat attendees reported having their treatments and test results explained fully in a way they could understand.

Overall the results show significant improvements in a number of aspects of patients’ experience, such as feeling:

that they were better involved in decisions about their care;
they were treated with respect and dignity;
that they had confidence and trust in other healthcare staff they saw; and,
that the outpatients department and toilets were ‘very clean’.

There remains room for improvement in key areas around explanations given to patients, such as explaining to patients how long they would have to wait for their appointment to start; what would happen during the treatment; why tests were needed; receiving results of tests; the risks and benefits of any treatment; the purpose of medication and the possible side effects.

Cynthia Bower, Chief Executive, CQC said: “Attending an outpatient clinic can be a stressful and worrying experience for some patients. It is therefore encouraging to see some improvement in basic aspects like being treated with respect and dignity and cleanliness. However, more still needs to be done to ensure that outpatients know what to expect, have tests and treatments explained to them clearly and are properly informed about the potential side effects of any medications they are prescribed."

“We have pledged to ensure the voices of everyone who uses care services are heard. We have produced reports for all of the trusts covered by the survey to underline the findings, and will continue to push for improvement through our assessment and registration systems.”

Ends

Summary

Since 2009 there has been an increase in the proportion of patients who took part in the survey who had visited the outpatients department before for the same condition (58% rising to 69% in 2011). This percentage of 69% matches the national figure reported for 2011. Some of the differences between the two survey years may, in part, be due to a decrease in 2011 in the proportions of survey respondents who attended the outpatients department for the first time. In addition, there is a higher proportion of people with long term conditions or illnesses within the group returning for repeat appointments (first appointment 51%, repeat appointment 80%).

Generally, there have been some improvements since the 2009 survey, such as:

Being seen on time or early for an appointment (24% compared with 19% in 2009);
In the cleanliness of the outpatient department (61% in 2009 and 65% in 2011) and cleanliness of toilets (57% in 2009, to 60% in 2011);
A higher proportion of outpatients rating the department as excellent (40% in 2009 to 44% in 2011); and
In being treated with respect and dignity (87% in 2009 to 89% in 2011);
More outpatients feeling that they were ‘definitely’ involved in decisions about their care and treatment (70% in 2009 to 72% in 2011);
Outpatients feeling that the ‘right amount’ of information was given to them about their condition and treatment (82% in 2009 to 83% in 2011).

More outpatients ‘definitely’ knew what would happen during their appointment (38% in 2009 to 45% in 2011) though this could be related to there being more respondents attending for repeat appointments.

There have also been improvements shown in some of the results of the questions asked about doctors:

In giving explanations for the reasons for action or treatment (77% in 2009 to 78% in 2011);
In getting answers from the doctor that they could understand, if they had questions to ask (71% in 2009 to 73% in 2011); and
In knowing enough about the outpatients’ medical history (82% in 2009 to 84% in 2011).

There has also been an increase in the proportion of respondents reporting that they ‘definitely’ got answers that they could understand from other professionals when asking important questions (73% in 2009 to 75% in 2011), and there has been an increase in those who felt they ‘definitely’ had confidence and trust in other professionals (81% in 2009 to 83% in 2011).

A considerable improvement was also shown in the proportion of respondents receiving copies of all letters sent between the hospital and their family doctor (35% to 46%).

Also encouraging was the finding that most outpatients waited less than 3 months for their first appointment (93%).

However, a number of findings have indicated a decline in performance:

More respondents reported that their appointment was changed to a later date by the hospital (21% in 2009 to 23% in 2011);
More respondents waiting longer than 15 minutes were not told how long they would have to wait (60% in 2009 to 61% in 2011); and
More respondents felt that the results of their tests were not explained in a way that they could understand (9% in 2009 to 11% in 2011).

There was also a decrease in the proportion who felt that staff ‘definitely’ explained what would happen during their treatment (80% in 2009 to 77% in 2011), and ‘definitely’ explained the risks and benefits before their treatment (72% in 2009 to 69% in 2011), and fewer felt that staff ‘completely’ told them about side effects of medication (45% in 2009 to 43% in 2011).

Overall more respondents reported that they did not have confidence and trust in their doctor (2% in 2009 to 3% in 2011).

Poor results were also shown in several other areas:

Only a third (33%) of first attendees were given a choice about appointment date and time;
7% of all respondents reported that ‘very few or none’ of the staff introduced themselves; and
of those with long term conditions or illnesses, 16% were not asked what was important to them in managing their condition and illness, and 17% felt their appointment had not helped them to better manage their condition or illness.

There has been no change since 2009 in the proportion of respondents who:

Were ‘never’ told the results of their tests (5%);
reported that doctors or other staff ‘definitely’ talked in front of them as if they weren’t there (4%);
did not receive ‘any information’ about their condition or treatment (6%);
‘definitely’ experienced one member of staff saying one thing and another saying something quite different (4%);
did not receive an explanation of the purpose of new medications (4%);
were ‘completely’ told about danger signals regarding their illness or treatment to watch for after going home (46%); and
felt that the main reason they went to the outpatients department was dealt with ‘completely’ to their satisfaction (74%).

About the Care Quality Commission

The Care Quality Commission (CQC) is the independent regulator of health and social care in England. We make sure that care in hospitals, dental practices, ambulances, care homes, people’s own homes and elsewhere meets government standards of quality and safety – the standards anyone should expect whenever or wherever they receive care. We also protect the interests of vulnerable people, including those whose rights are restricted under the Mental Health Act.

We register services if they meet government standards, we make unannounced inspections of services – both on a regular basis and in response to concerns – and we carry out investigations into why care fails to improve. We continually monitor information from our inspections, from information we collect nationally and locally, and from the public, local groups, care workers and whistleblowers. We put the views, experiences, health and wellbeing of people who use services at the centre of our work and we have a range of powers we can use to take action if people are getting poor care.