There have been encouraging improvements in nursing care in hospitals but people with mental health conditions continue to report worse experiences, according to the latest national inpatient survey.
The results of the 2017 inpatient survey, which documents the experiences of more than 70,000 adult patients and involved every NHS acute trust in the country, suggest some positive trends in basic nursing, especially in the way staff interact with patients.
“This report makes disturbing reading and is not good news for mental health equality”
However, the results, published today by the Care Quality Commission, show people with a mental health condition continue to report poorer than average all round experiences – a trend described as a “disturbing” by the Royal College of Nursing.
The survey results show the majority of hospital patients are happy with the care they receive and have confidence in the nurses and doctors treating them.
Since 2015, there has been a “meaningful positive change” in the proportion of patients reporting they “always” have confidence and trust in the nurses who cared for them, said the survey report.
In 2017, more than three quarters of patients – 78% – said they “always” had confidence and trust in the nurses treating them, up from 77% the previous year and compared with 72% in 2009. A further 19% said it was “sometimes” the case, while just 3% said they had no confidence or trust in nurses.
However, the data shows younger patients aged 16 to 35, those with dementia and those with a mental health condition had less trust and confidence in staff.
Meanwhile, 50% of patients said they “always knew” who the nurse in charge of their care, “a slight but significant increase” on 49% in 2016, the first time this question was asked.
“It is vital that those working in acute hospitals have enough understanding of mental health problems”
On nursing staff levels, the survey shows the proportion of patients reporting there were “always or nearly always” enough nurses on duty has remained pretty much the same over the past eight years.
In 2017, 59% said there were “always or nearly always” enough nurses – the same proportion as in 2016 – while 30% said this was the case “sometimes”. Meanwhile, 11% reported there were “rarely or never enough nurses”.
More patients felt nurses “definitely” answered important questions in a way they could understand – 69% in 2017, up from 68% the year before and compared with 64% in 2009.
In 2017, 26% said this sometimes happened, while 5% said nurses did not answer their questions clearly.
Over time the proportion of patients reporting nurses talked in front of them as if they were not there has reduced from more than one in five in 2009 to 17% in 2017, with 13% saying this happened sometimes and 4% saying it happened often.
“This trend suggests there is an underlying change in behaviours leading to a more positive patient experience in this area,” said the CQC in its report on the survey.
“Concerns remain over how long NHS staff can continue to act as shock-absorbers”
Professor Ted Baker, CQC chief inspector of hospitals, said positive feedback about interaction with staff was “a testament to the efforts of healthcare professionals working tirelessly to provide high quality care to those that need it”.
However, he also highlighted areas for improvement, especially arrangements on when to discharge and the level of emotional support that patients were offered during their hospital.
He also expressed concern about the ongoing disparity between the experiences of those with a mental health condition and those without.
“This is an area which hospitals must address to ensure that people with physical and mental health conditions are treated equally in acute settings,” he said.
Survey questions about aspects of basic care show performance has remained stable but suggest there is room for improvement.
For example, the 2017 survey results found 17% of patients said they did not get enough help from staff to eat their meals, while 10% said they did not get enough help to wash or stay clean.
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Nearly two thirds of patients – 65% – said they were in pain at some point during their hospital stay. In all, 69% said they felt hospital staff “definitely” did everything they could to control pain, while 24% said it happened sometimes and 7% said staff did not do everything they could to help with pain control.
Less than two thirds – 62% – of patients left hospital with written information telling them how to look after themselves after discharge – down 5% since 2009. Meanwhile, 43% of patients who were given medication to take home were not told of the possible side effects.
While 54% felt that they were “definitely” involved in decisions about their discharge from hospital, this still leaves 46% who did not feel “fully” involved, noted the regulator.
In all, 41% said their discharge was delayed, representing no change from last year. Nearly a quarter – 24% – were delayed for more than four hours with most delays – 72% – down to waiting for medication.
Patient feedback regarding the amount of emotional support they received while in hospital remained unchanged from previous years, with 38% saying they “definitely” had someone to talk to about their worries and fears during their hospital stay.
However, 27% felt they had no one, an increase of 2% since 2016. In particular, younger patients reported feeling less supported emotionally compared with other age groups.
For a second year running, responses were less positive across most areas for patients with a mental health condition. As well as reporting less confidence and trust in staff, people with a mental health problem felt they were treated with less respect and dignity and felt less informed about their care.
This patient group gave lower than average scores in relation to whether their needs, values and preferences were fully considered, and for the quality of the co-ordination and integration of their care.
How we reported the findings from some earlier NHS inpatient surveys:
The RCN described the trend as worrying and said it was largely down to lack of funding for mental health services. “This report makes disturbing reading and is not good news for mental health equality,” said Tim Coupland, RCN lead for parity of esteem.
He said: “The government’s pledge to deliver parity of esteem for those with mental health conditions still feels out of reach, and that is largely down to a failure to fund and support services adequately.”
He flagged up a recent survey by the RCN, which found nurses felt they had the right skills to deliver equal treatment “but need more resources to do so”.
“Patients with mental health conditions need better access to the same essential services that most people with physical health problems routinely get,” said Mr Coupland.
Paul Farmer, chief executive of mental health charity Mind, said more must be done to provide care for people that took into account both their physical and mental health needs.
“It is vital that those working in acute hospitals have enough understanding of mental health problems, so that they can provide holistic care,” he said.
“We also know, and this is picked up in the findings, that much more needs to be done to co-ordinate and integrate the healthcare received by people with mental health problems,” he added.
Dan Wellings, senior fellow at influential health think-tank the King’s Fund, said the survey data showed the NHS was “for the most part, managing to find ways to provide a positive experience for patients in the face of severe constraints on funding and staffing levels”.
However, he questioned how long this could continue. “Concerns remain over how long NHS staff can continue to act as shock-absorbers for the pressures facing NHS organisations,” he said.
“Continuing to improve patient experience depends on having sufficient staff so the new 10-year workforce strategy must go hand in hand with the forthcoming NHS funding settlement,” he added.