Scottish Health and Care Experience Survey 2013/14 - Technical Report
Scottish Health and Care Experience Survey 2013/14. This is a postal survey which was sent to a random sample of patients who were registered with a GP in Scotland in October 2013. This report contains details of the survey design and development.
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3 Survey Design
Survey development
3.1 The survey was redeveloped during summer 2013 with an aim of widening it beyond primary care to cover local care and support services as well as the experience of unpaid carers. These new areas reflect a number of aspirations underpinning the integration of Health and Care in Scotland proposed under the Public Bodies (Joint Working) (Scotland) Bill[4]. A series of health and wellbeing outcomes are proposed under the Bill[5] and it is anticipated that the survey findings relating to users' experience of social care services and carers' experiences will be used to understand how services are impacting on people, and where improvements are required.
3.2 Improvements were also made to a number of existing primary care questions and a number of new questions were introduced around medical tests and errors. The existing primary care questions were largely based on the ones used for the 2011/12 Patient Experience Survey of GP and Local NHS Services, which was itself based on the questionnaire for the preceding survey. Details on the development of the 2011/12 questionnaire are available in the previous survey's technical report at:
http://www.gov.scot/Publications/2012/05/1477
3.3 The redevelopment of the survey involved discussions with a range of policy leads to find out what areas they would like the survey to cover. For the social care and carers questions, we consulted key stakeholders from NHSScotland, the Scottish Government and the Health and Integration Outcomes Working Group, which comprises representatives from carers organisations and third sector, the Community Care Benchmarking Group and the Convention of Scottish Local Authorities (COSLA). We also took into account our experience of using the questions previously and feedback from users.
3.4 Consultation workshops were held with members of the public to test out any potential changes and find out what was important to them. The survey was then cognitively tested with members of the public to ensure that the new questions worked well in terms of understanding the purpose of the questions and the response scales.
Cognitive testing
3.5 Over the 16th and the 17th of October, Picker Institute Europe carried out 21 interviews with Scottish General Practitioner (GP) patients. The interviews were completed over two days, to allow discussions to be had and amendments to be made during the evening between days.
3.6 Participants were recruited via a local recruitment agency, and screened to allow for the most diverse group of age, gender and ethnicity. The group consisted of
- 10 males and 11 females
- 17 people describing themselves as 'white British', the remaining 4 indicating they were Indian/Pakistani, Chinese, Portuguese and mixed race
- Ages ranging from 23 to 73
- 7 participants indicated they had a degree or higher
Changes to 2013/14 survey, compared with previous surveys
New questions
3.7 While the 2011/12 survey was specifically about primary care health services, new sections were added relating to social care and to carers. A copy of the 2013/14 patient survey can be found in Annex B. The 2011/12 survey can be found as an annex of the previous technical report:
http://www.gov.scot/Publications/2012/05/1477
3.8 New questions in 2013/14 are shown in Table 1 below:
Table 1 New questions for the 2013/14 survey
| Question number |
Question |
Reason the question was added |
|---|---|---|
| 15d |
The doctor took account of the things that matter to me |
In order to capture a key aspect of person-centred care policy, additional questions relating to taking account of the things that matter to patients/service users were added. |
| 16d |
The nurse took account of the things that matter to me |
|
| 20 |
In the last twelve months have you had any blood tests, x-rays or any other tests arranged by your GP practice? |
In previous surveys, recurring themes in the free text comments related to tests arranged by GP practices and how results were communicated. In response to this, and in recognition that tests are a common and important aspect of primary care, we included a number of questions relating to tests arranged by the GP practice. |
| 21a |
It was explained to me why a test was needed |
|
| 21b |
I was satisfied with the length of time I waited for my results |
|
| 21c |
I was satisfied with the way I received my results |
|
| 21d |
The results of the test were explained to me in a way I could understand |
|
| 24 |
In the past year do you believe a mistake was made in your treatment or care by your GP practice (including for example in test results, medicines prescribed, diagnosis)? |
In line with the healthcare quality strategy outcome for NHS Scotland that 'Healthcare is safe for every person, every time', questions were included to provide an insight into the prevalence of mistakes as well as patients' experiences of how mistakes were dealt with. |
| 25 |
Were you satisfied with how it was dealt with overall? |
|
| 31f |
[with regards out-of-hours service] I felt that people took account of the things that matter to me |
In order to capture a key aspect of person-centred care policy, additional questions relating to taking account of the things that matter to patients/service users were added. |
| 34 |
In the last 12 months have you had help or support with everyday living |
In light of the integration of health and care in Scotland proposed under the Public Bodies (Joint Working) (Scotland) Bill, the survey was widened beyond primary care services to include aspects of care and support, and caring. |
| 35 |
Did you get help from the services provided by, for example, the Council, NHS, voluntary organisations, or private agencies - including services you paid for? |
|
| 36a |
People took account of the things that matter to me |
|
| 36b |
I had a say in how my help, care or support was provided |
|
| 36c |
I was treated with respect |
|
| 36d |
I was treated with compassion and understanding |
|
| 36e |
My health and care services seemed to be well coordinated |
|
| 36f |
I was supported to live as independently as possible |
|
| 36g |
I felt safe |
|
| 36h |
The help, care or support improved or maintained my quality of life |
|
| 37 |
Overall, how would you rate your help, care or support services? |
|
| 44 |
Do you look after, or give any regular help or support to family members, friends, neighbours or others because of either long-term physical / mental ill-health / disability or problems related to old age? |
In light of the integration of health and care in Scotland proposed under the Public Bodies (Joint Working) (Scotland) Bill new questions were added to capture the experiences of carers. One of the proposed health and wellbeing outcomes relates to carers and therefore a series of questions were added to provide a better understanding of the wellbeing of carers and the impact of caring on people's lives. |
| 45a |
I have a good balance between caring and other things in my life |
|
| 45b |
I am still able to spend enough time with people I want to spend time with |
|
| 45c |
Caring has had a negative impact on my health and wellbeing |
|
| 45d |
I have a say in services provided for the person I look after |
|
| 45e |
Services are well coordinated for the person(s) I look after |
|
| 45f |
I feel supported to continue caring |
|
| 46c |
Comments about care and support services [comments box] |
In line with the rationale for additional sections relating to care and support services, an additional comments box was included to allow respondents to leave free text comments on the subject of care and support services |
| 52 |
In general, how well do you feel that you are able to look after your own health? |
One of the outcomes proposed under the Public Bodies (Joint Working) (Scotland) Bill is around people being able to look after and improve their own health and wellbeing and live in good health for longer. It is anticipated that the results from question will used alongside other information sources to provide a greater understanding of the health and wellbeing of the local population. |
| 53 |
Thinking about the good and the bad things that make up your quality of life, how would you rate your quality of life as a whole? |
This question was added to provide more information on the health and wellbeing of people in addition to information on about how people rate their health. Quality of life is complex area and will be impacted by a range of factors and so this question allows respondents to make a judgement about their quality of life based on their individual circumstances and experiences. It will be used to see whether quality of life influences people's experiences and outcomes. |
| 58 |
What best describes the accommodation you live in? |
This question was added to better understand the circumstances in which people live. It will be used to understand whether factors such living circumstances influences people's experiences and outcomes. |
Changed questions
3.9 A number of changes were made to the survey questionnaire to take into account feedback from patients and stakeholders during cognitive testing interviews and consumer panels. All tested well with patients and stakeholders and were therefore introduced in the 2013/14 questionnaire.
3.10 Changed questions for 2013/14 are shown below:
Table 2 Questions that were changed in 2011/12
| Question no. in 2013/14 |
Question in 2013/14 |
Question no. in 2011/12 |
Question in 2011/12 |
Reason for Changes |
|---|---|---|---|---|
| Change applied throughout the whole questionnaire |
All questions or answers/statements containing 'GP practice'. |
Change applied to all questionnaire |
All questions or answers/statements containing 'GP surgery'. |
All references to 'GP surgery' have been replaced by 'GP practice' as this term is more commonly used in Scotland. |
| 17 |
Are you involved as much as you want to be in decisions about your care and treatment? Options were changed to : |
19 |
Options were: |
Options were changed to make them to improve understanding and make them shorter too. |
| 18 |
Question text was changed to: 'Did you see any health professionals at your GP practice in the last 12 months about something that affected your ability to work or get to work?' |
20 |
'Did you see any health professionals in the last 12 months about something that affected your ability to work?' |
Question was broadened out to definitively encompass those who were not currently in employment, but that had a condition that would affect their ability to work or find work. |
| 19 |
Question text was changed to: 'The last time this happened, did they have a discussion with you about your ability to work or get work?' Options were changed to: - Yes, and it was useful |
21 |
The last time this happened, did they discuss your ability to work with you? - Yes, we had a useful discussion about my ability to work |
Question was broadened out to definitively encompass those who were not currently in employment but that had a condition that would affect their ability to work or find work. As part of this, the response options were shortened to make the question more readily understandable to respondents. |
| 26a |
'How much do you agree or disagree with each of the following about how you are treated by the staff at your GP practice?' Statement was changed to: 'I am treated with respect'. |
24 |
Statement was: 'I am treated with respect and dignity'. |
This was simplified as the previous statement encompassed two slightly different areas. The change also brought the survey in line with other experience surveys using similar statements. |
| 26b |
'How much do you agree or disagree with each of the following about how you are treated by the staff at your GP practice?' Statement was changed to: 'I am treated with compassion and understanding'. |
24 |
Statement was: 'I am treated with kindness and understanding'. |
This was changed in order to be in line with other surveys using similar statements. |
| 56 |
'Which of the following options best describes how you think of yourself?' Option 2 was changed to: 'Gay or Lesbian'. |
46 |
Option 2 was: Homosexual / Gay or Lesbian. |
We changed this option to bring the question in line with current guidance for demographic questions relating to how individuals think of themselves. |
Questions that were in the 2011/12 survey but not in the 2013/14 survey
3.11 The 2011/12 survey asked respondents to select all the NHS services that they had used in the past 12 months. This question was removed, as insufficient use of the data was made to justify the question's continued inclusion.
3.12 In the 2011/12 survey, patients were asked "How clean is your GP surgery of health centre". This question was removed from the survey because it was simply not an issue for the vast majority of practices: 99% of respondents felt that their practice was very clean or fairly clean. Where this was an issue, the problem will have been identified by the 2011/12 survey.
Contact
Email: Andrew Paterson
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