What does the NHS Adult Inpatient Survey tell us about how experiences of care differ?

What is the Adult Inpatient Survey?

The Adult Inpatient Survey, commissioned by the Care Quality Commission (CQC), looks at the experiences of adults that have been an inpatient at an NHS hospital. The survey has been running since 2002 and is published annually. The survey also collects information about patients’ demographics (including characteristics protected by the Equality Act 2010, such as age, long-term condition, religion and ethnicity), in order to understand differences in care.

What has changed in the past year?

Results from the survey show some changes in people’s experience of inpatient care compared with the previous survey in 2020. Although most patients report positive experiences, there is an increase in those reporting negative experiences for many questions.

Areas with the largest increase in negative results include:

• Waiting times to access a bed on a ward: 15% of respondents said they ‘had to wait far too long’ compared with 8% in 2020
• Support given by staff to meet fundamental needs: this year 70% of respondents reported ‘always’ getting help to wash or keep themselves clean, compared with 75% in 2020; while 65% said they ‘always’ got help to eat their meals, compared with 69% in 2020
• Availability of staff: 63% said they could ‘always’ get help from staff when they needed it, down from 67% in 2020. Although 55% said there were ‘always’ enough nurses on duty to care for them, this dropped from 62% saying this in 2020.
• Overall experience: there was a decrease in the most positive scores of 9 or 10 (where 10 is a very good experience) with just over half (52%) rating their experience as a 9 or 10 compared with 56% in 2020.

 An area where there has been improvement is patients being given information about what they should or should not do after leaving hospital: 78% said they were given information, an increase from 70% saying this in the 2020 survey.  

These results are in line with other national patient experience surveys, such as the GP Patient Survey, which also reported significant decreases in results for questions about overall experience of GP practices, the process of making GP appointments, NHS dental services and NHS services when the GP practice is closed. The overall national picture no longer seems to reflect the ‘gratitude bias’ that was evident during the pandemic, with latest polling data showing that over half (55%) of the UK public think the general standard of care has got worse in the past 12 months. 

What does the survey tell us about different experiences of hospital care?

Data from the survey can be analysed to understand differences in experience between various patient subgroups.

Age 

Across the core questions included in the analysis, younger people consistently reported poorer experiences than their older counterparts. For example, the youngest patients (aged 16-35) reported poorer experiences in relation to trust in doctors and nurses, receiving consistent information, and being treated with respect. On the other hand, those aged 51-65 and those aged 66 and above reported better experiences across these areas. This could be due to older patients having more realistic expectations of health and care services, or that older people tend to respond more positively in surveys. 

Admission Route

Patients who were admitted to inpatient services as the result of an emergency (via A&E or an urgent treatment centre) reported poorer experiences than those who were admitted for elective (planned) care. This was especially evident around admission to hospital, with 17% of emergency patients saying they had to wait ‘far too long’ to get a bed on a ward compared to only 3% of elective patients.

Base: All inpatient who participated in the Adult Inpatient Survey: Elective (19,418), Emergency (39,997). 

Number of nights in hospital

Patients who stayed in hospital for two nights or longer reported a poorer experience across a number of core questions included in the analysis, including consistency of information, trust in doctors and nurses, availability of staff, and being treated with respect. This is in contrast to patients who stayed in hospital for only one night, who reported a more positive experience for these questions. The only exception to this was where patients were asked about whether they had been asked to give their views on the quality of their care during their hospital stay; patients who stayed in hospital for two nights or longer were more likely to give a positive answer, whereas patients who stayed in hospital for one night were less likely to give a positive response.

Frailty

Patients who are considered frail were more likely to report poorer than average experiences across all core questions analysed in the survey, including being treated with respect, trust in doctors and nurses, getting help to keep in touch with family and friends, and consistency of information, amongst others. In this context, frailty refers to people who are at highest risk of adverse outcomes such as falls, isolation or mobility issues. 

Long-term condition

Patients who reported having a long-term condition generally reported a poorer experience. For example:

• Participants with dementia or Alzheimer’s disease reported poorer experiences across the majority of questions looked at in the survey, including whether they were treated with respect and dignity, staff availability, reassurance from staff about worries and fear and trust in doctors and nurses. 
• People with a neurological condition had poorer than average experiences with receiving consistent information, reassurance from staff, having trust in doctors and being treated with respect. These patients also reported poorer experiences relating to their involvement in care. This may indicate a training need, to enable staff to engage more effectively with patients who have different physical and emotional needs.

Conclusion

This survey provides invaluable insight into the post-pandemic experience of hospital services and adds to the national picture of care currently characterised by concern and pessimism. Despite these difficulties, there is still strong support from the public for the NHS, with 77% of the UK public believing it is ‘crucial to British society and we must do everything to maintain it’. This survey and other surveys that measure people’s experiences of care are vital for NHS Trusts to understand how they can improve their services to ensure all patients receive safe, effective and compassionate care.

More information can be found on the NHS Surveys website and the CQC website.

Technical note

• Ipsos coordinates the Adult Inpatient Survey on behalf of the CQC. NHS trusts selected a sample of 1,250 patients, aged 16 or over, who had stayed at least one night in hospital during November 2021. The survey was conducted using a mixed methods approach, combining online and paper questionnaire modes. A total of 62,235 patients responded to the survey (an adjusted response rate of 39%) and fieldwork took place between January 2022 and May 2022.

• The subgroup analysis referred to in this blog compares how different groups of patients rated their overall experiences of being a hospital inpatient by using a ‘multi-level model analysis’. More information on this analysis and the questions included can be found on the NHS Surveys website: https://nhssurveys.org/ 

• Results for the adult inpatient 2021 survey are comparable with results from 2020, but not with results from years prior to 2020 due to a change in survey methodology.

• For each question in the survey, the individual responses are converted into scores on a scale of 0 to 10. A score of 10 represents the best possible result and a score of 0 the worst.

• Further technical information and the full survey results can be found on the CQC website.