Scottish Inpatient Patient Experience Survey 2014 Volume 1: National Results

2. Introduction

2.1. The Scottish Inpatient Patient Experience 2014 is a postal survey which was sent in January 2014 to a random sample of patients aged 16 years or over who had an overnight hospital stay between April and September 2013. This is now the fourth inpatient survey, with previous ones having been conducted in 2010, 2011 and 2012.

2.2. The survey asks about people's experiences of: admission to hospital; the hospital and ward environment, care and treatment including errors, operations, hospital staff, arrangements for leaving hospital, and care and support services after leaving hospital. The survey was reviewed this year and a number of new questions were added, in particular relating to person-centred care and patient safety. There were also slight modifications to some existing questions. The questionnaire is contained in Annex A.

2.3. This report presents the detailed national findings from the survey. High level results for NHS Boards are also presented but individual reports with more detailed findings hospitals and NHS Boards are available at: http://www.careexperience.scot.nhs.uk/

2.4. Details of the survey design, fieldwork and analysis are available in the Inpatient Patient Experience Technical report at http://www.scotland.gov.uk/Topics/Statistics/Browse/Health/InpatientSurvey/inpatients2014

The Scottish Care Experience Programme

2.5. The Inpatient Patient Experience Survey is one of four national surveys of the Scottish Care Experience Survey Programme which is part of the Person-Centred Health and Care Portfolio. The surveys aim to provide local and national information on the quality of health and care services from the perspective of those using them. They allow local health and care providers to compare with other areas of Scotland and to track progress in improving the experiences of people.

2.6. The other national care experience surveys are:

• Health and Care Experience Survey
• Maternity Care Experience Survey
• Radiotherapy Survey

2.7. The survey programme supports the three quality ambitions of the 'Healthcare Quality Strategy for NHSScotland' (or Quality Strategy)^[1] - Safe, Effective, Person-centred by providing a basis for the measurement of quality as experienced by service users across Scotland. In particular the surveys support the person-centred quality ambition which is focused on putting people at the centre of care, ensuring that care that is responsive to individual personal preferences, needs and values, and assuring that individual values guide all care decisions.

2.8. The inpatient survey was carried out in partnership with Information Services Division(ISD) part of NHS National Services Scotland)^[2] whose role included sampling patients, producing analysis of NHS Board / hospital and national data and undertaking local reporting. The administration of the survey fieldwork was undertaken by an approved survey contractor Quality Health Ltd.

Aims of the Inpatient Patient Experience Survey

2.9. The survey's specific aims are:

For local improvement

• provide NHS hospitals with feedback on the experiences of their patients, relative to previous surveys and other areas in Scotland;
• provide NHS Boards with information on experiences in their respective board areas and on variation within and between boards;

National policy

• provide national results for the survey, identifying variation within and between local areas and if and how the level of positive and negative experiences have changed over time;
• highlight areas of best practice and areas for improvement;
• provide information for the National Performance Framework Indicator 'Improve the quality of the healthcare experience in Scotland';
• explore the variations in the experiences of different groups of patients.

Survey design

2.10. In consultation with NHS Boards and patients, a number of changes were made to the 2014 survey materials and the methodology for sampling patients:

• The sampling period was reduced from 12 months to 6 months to make it easier for patients to recall their experiences. This new approach meant that patients were sampled from a different period of the year (April to September 2013), thus excluding most of the winter months.
• Before adopting the revised sampling period change, we investigated whether patients whose hospital stay was during the Spring / Summer period were more positive than those in hospital during the winter months. We found small, statistically insignificant differences in experiences which tended to run in one direction - patients who were in hospital during spring were slightly more positive than those in hospital during winter months.
• When interpreting any improvements, it may therefore be worth bearing in mind that the changes to the survey sampling period may have partly contributed to any rises. However, it is likely that the increases occurring across the survey demonstrate genuine improvement in patients' experience.
• The sample was drawn centrally by ISD. Previously this was carried out by NHS Boards.
• New questions were introduced, for example around person-centred care and patient safety, and some of the existing questions were changed to ensure that they still capture what is important to people.

2.11. Further details of the changes made to the survey materials are contained in the technical report:
http://www.scotland.gov.uk/Topics/Statistics/Browse/Health/InpatientSurvey/inpatients2014

Survey fieldwork and response

2.12. The patient sample was designed to provide results for 122 individual hospitals as well as for the 14 NHS Boards, and the National Waiting Time Centre (NWTC) and nationally for Scotland. The survey was sent to a sample of adult inpatients (aged 16 years old or above on discharge) who had an NHS inpatient hospital stay (at least one overnight stay) between April and September 2013.

2.13. Fieldwork was undertaken by Quality Health Ltd, an approved survey contractor on behalf of the Scottish Government between 15 January 2014 and 17 March 2014. The survey closed on 22 April 2014. In total, 43,893 survey packs were sent to patients and 21,127 were returned, giving an overall response rate of 48%.

Demographics of respondents

2.14. We asked patients a number of questions about their demographic characteristics. Of those patients who answered these questions:

• 55 per cent were female and 45 per cent were male.
• Six per cent were aged 16-34, 12 per cent were aged 35-49, 26 per cent were aged 50-64, 25 per cent were aged 65-74 and 31 per cent were aged 75 or over.
• 98 per cent of people indicated that they were heterosexual / straight, whilst 2 per cent indicated that they were gay / lesbian, bisexual or 'other'.
• 43 per cent of people rated their health as good, 43 per cent as fair and 14 per cent as poor.
• Almost two-thirds of the people who provided information about themselves indicated that their day-to-day activities were either limited a lot (33%) or a little (32%) because of a health problem or disability which had lasted, or was expected to last, at least twelve months. The remaining respondents (35%) did not have any of their activities limited.

Data analysis and interpretation

2.15. The survey data was collected by the contractor Quality Health Ltd. Anonymised data was then securely transferred to NHS Information Services Division (ISD) who carried out the analysis.

2.16. In general, results are presented as the percentage of patients reporting a positive experience. Such percentages are calculated excluding any patients from the denominator who did not answer the question or answered "not relevant" or "don't know". Annex C shows which answers have been classed as positive and negative for each question.

2.17. Throughout the report, weighted percentages have been presented unless otherwise stated. Weights were applied to all survey responses based on the number of eligible inpatients at each hospital. This means that the contribution of each hospital to the NHS Board and Scotland results is proportional to the number of patients that were eligible for the survey. Further information on how weights were calculated and applied can be found in the technical report.

2.18. Differences from the 2012 survey results are only highlighted and discussed if they are statistically significant. Results in tables are marked in bold if they are significantly better or worse than in 2012. Further information on this is available in the technical report.

2.19. These statistics have been independently assessed by the UK Statistics Authority and are designated as National Statistics. The assessment report is available at http://www.statisticsauthority.gov.uk/assessment/assessment/assessment-reports/assessment-report-131---statistics-on-scottish-patient-experience.pdf.

Results for NHS Boards and hospitals

2.20. Individual reports have been prepared for NHS Boards and hospitals. These are available at the site below: http://www.careexperience.scot.nhs.uk/