What does the NHS adult inpatient survey tell us about health inequalities?

Laura Tuhou looks at results from the 2020 adult inpatient survey, coordinated by Ipsos MORI on behalf of the Care Quality Commission, to see what the data tells us about health inequalities.

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  • Laura Tuhou Public Affairs
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The adult inpatient survey, commissioned by the Care Quality Commission (CQC), has run annually since 2002. It provides insight into the quality of patient experience in NHS hospitals in England, and also collects information about patients’ demographics (including characteristics protected by the Equality Act 2010, such as age, long-term condition, religion and ethnicity). This article summarises the findings of analysis of 14 key experience questions by subgroups, and the results highlight inequalities in patient experience by several demographics.

Age

Across the questions included in the subgroup 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 involved in decisions about their care and discharge. In addition, the youngest group rated their overall experience significantly lower than others (as shown in Figure 1). On the other hand, people in the two youngest groups (16-35 and 36-50) had a better than average experience with regard to being asked for their views. This is consistent with previous research that shows patient satisfaction tends to be higher in older patients. It is possible that the lower satisfaction of younger patients reflects relatively high expectations that cannot be easily met. As patients become more familiar with health care delivery over time, their expectations may decrease with a resultant increase in their satisfaction.1

Figure 1. Overall experience in hospital by age group

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 all questions included in the subgroup analysis, except whether their family or home situation was taken into account when leaving hospital, discussions of further care, post-discharge care, and being asked for their views. This overall poorer experience is consistent with findings from the CQC’s COVID-19 Inpatient Survey which captured patient experience during the first peak of the pandemic in April and May 2020, and is discussed in more depth in a previously published article by Ipsos MORI. Caring for patients with Alzheimer’s or dementia in a hospital setting is complex, and existing difficulties that were exacerbated by the pandemic continue to contribute to poorer experiences.
  • People with deafness or hearing loss, and those with blindness or partial sight, had poorer than average experiences with keeping in touch with family and friends, and receiving reassurance from staff. Deaf people also reported poorer experiences relating to involvement in their care and treatment, and involvement in decisions about being discharged from hospital, while blind people had poorer experiences with trust in nurses, staff availability, being treated with respect, and overall experience. This may indicate a training need, to enable staff to engage more effectively with patients who have different communication requirements. Previous studies by organisations such as the Royal National Institute for Blind People (Scotland)2 and Healthwatch Islington3 have also identified inequalities of access to healthcare for people with communication differences. Both recommended that healthcare staff should receive training to enhance awareness of how to support the physical and emotional needs of these patients.
  • Patients with a mental health condition also reported poorer experiences across the majority of questions included in the subgroup analysis, including trust in doctors and nurses; receiving consistent information about their care and treatment; availability of (and reassurance from) staff; being treated with respect; and overall experience.
  • People considered frail also had a poorer experience across all questions included in the analysis. In this context, frailty refers to older people who are at highest risk of adverse outcomes such as falls, disability, admission to hospital, or the need for long-term care. This finding feeds into previous research which has shown that a more proactive, integrated, person-centred and community-based response to frailty is required.4

Religion

Patients who described their religion as Christian had better than average experiences overall, along with better experiences in terms of having trust in doctors and nurses, receiving consistent information, staff reassurance, staff availability, being involved in decisions about their care, involvement in discharge, and being treated with respect. By contrast, Jewish people reported poorer experiences in relation to staff availability, and Muslim people had poorer experiences of being able to keep in touch with friends and family while they were in the hospital. Previous research suggests that patients who had conversations about religion and spirituality with their healthcare team were the most satisfied with their overall care. This may indicate a need for broader staff training on cultural and religious awareness, to improve the hospital experience of people of other faiths.5

COVID-19 treatment status

For the purposes of this study, patients were defined on the basis of having been ‘treated for COVID-19’ and may not have always received a COVID-positive diagnosis. Overall there were minimal differences between the experience of COVID-19 and non-COVID-19 patients. Those treated for COVID-19 had a poorer overall experience and poorer experiences of staff availability, but overall the findings suggest that the care provided for patients in hospital during November 2020 was consistent. This contrasts with the results from the CQC’s COVID-19 Inpatient Survey which took place during the peak of the pandemic (April and May 2020) and showed large differences between the two patient groups. The difference between these findings may be attributable to the progress made in caring for patients with COVID-19 since the pandemic began.

Conclusion

This data provides invaluable insight into the ongoing challenges presented by health inequalities in England – and importantly can provide insight both at a national level and for individual NHS trusts. The NHS has made a commitment to address health inequalities as part of the Long Term Plan, and data from the adult inpatient survey will be an important source of information to assess progress on this in the future.

Technical note

  • Ipsos MORI 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 2020. The survey was conducted using a mixed methods approach, combining online and paper questionnaire modes. A total of 73,015 patients responded to the survey (an adjusted response rate of 46%) and fieldwork took place between January 2021 and May 2021.
  • 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/
  • The data for this analysis is unweighted.
  • Results for the adult inpatient 2020 survey are not comparable with results from previous years. This is because of a change in survey methodology, extensive redevelopment of the questionnaire, and a different sampling month. More information on this is available in the survey development report.
  • 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.

References

  1. Jaipaul, C. K. and Rosenthal, G. E. (2003). Are Older Patients More Satisfied With Hospital Care Than Younger Patients? Journal of General Internal Medicine, 18(1), pp. 23-30. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1494807/
  2. Thurston, M. and Thurston, A. (2010) Accessibility of health information for blind and partially sighted people. Centre for Educational and Psychosocial Research for RNIB Scotland. https://www.rnib.org.uk/sites/default/files/accessibility_healthcare_information.pdf
  3. Experiences of Deaf service users in local hospitals, Healthwatch Islington report. https://www.healthwatchislington.co.uk/sites/healthwatchislington.co.uk/files/Report%20on%20Deaf%20Service%20User%20event.pdf
  4. Turner, G. and Clegg, A. (2014) Best practice guidelines for the management of frailty: a British Geriatrics Society, Age UK and Royal College of General Practitioners report. Age and Ageing, 43(6), pp. 744–747. https://academic.oup.com/ageing/article/43/6/744/10186?login=true
  5. Williams, J. A., Meltzer, D., Arora, V., Chung, G., Curlin, F. A. (2011) Attention to Inpatients’ Religious and Spiritual Concerns: Predictors and Association with Patient Satisfaction. Journal of General Internal Medicine, (26) pp. 1265-1271. https://doi.org/10.1007/s11606-011-1781-y

The author(s)

  • Laura Tuhou Public Affairs

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