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Mental health patients report poorer hospital experiences

Discharge arrangements also below par, finds survey

Jo Carlowe

Thursday, 14 June 2018

Young people and those with mental health problems experience a poorer than average inpatient experience, new data shows.

The Care Quality Commission (CQC) this week published its Adult inpatient survey 2017 * which revealed that the majority of people who stayed as an inpatient in hospital were happy with the care they received and had confidence in the medical staff.

However, survey respondents were less positive about arrangements and information received when leaving hospital, and those with a mental health condition reported a poorer than average experience across most question areas, repeating a trend found in previous patient surveys.

The results of the 2017 inpatient survey, involving every NHS acute trust in the country, to reveal what over 70,000 adults who had stayed in hospital for at least one night during July last year said about the care they received.

Responses to the 2017 survey showed a number of improvements over time particularly in relation to patient’s interactions with hospital staff. In 2017, the majority (82%) thought they were “always” treated with respect and dignity, (compared to 78% in 2009) and more people said they “always” had confidence in the nurses treating them (78% in 2017 compared to 77% in 2016 and 72% in 2009).

However, younger patients (aged 16-35), those with dementia or Alzheimer’s disease and those with a mental health condition reported having less confidence and trust in the staff caring for them.

Younger patients (aged 16-35) reported feeling less supported emotionally compared with other age groups, and, for a second year running, responses were less positive across most areas for patients with a mental health condition. Those with mental health conditions said they had less confidence and trust in hospital staff, thought they were treated with less respect and dignity and felt less informed about their care. These patients gave lower than average scores in relation to whether their needs, values and preferences were fully considered, and for the quality of the coordination and integration of their care.

Paul Farmer, chief executive of Mind, the mental health charity, described the findings as “concerning”.

“Those working in and commissioning services need to use these results to look at how care can be improved to address this inequality…It is vital that those working in acute hospitals have enough understanding of mental health problems so that they can provide holistic care. We also know, and this is picked up in the findings, that much more needs to be done to coordinate and integrate the healthcare received by people with mental health problems. This principle is the basis of several recommendations in the Five Year Forward View and underlines why this plan is so important; services need to improve so that, regardless of your mental health background, you get the quality of care that you need.”

And Tim Coupland, Royal College of Nursing lead for Parity of Esteem, said: “This report makes disturbing reading and is not good news for mental health equality. 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.

"We recently surveyed nurses about this issue - they told us they have 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”.

The survey also revealed dissatisfaction with discharge arrangements from hospitals. Less than two-thirds (62%) of patients surveyed left hospital with written information telling them how to look after themselves after discharge, a decrease of 5% since 2009, and 43% of patients who were given medication to take home were not told of the possible side effects (44% in 2016).

While 54% felt that they were “definitely” involved in decisions about their discharge from hospital, this still left 46% who did not feel “fully” involved. Also, 41% of those surveyed said that their discharge was delayed, representing no change from last year. Around one in four (24%) of these people were delayed for longer than four hours and the majority of total delays were a result of waiting for medication (72%).

Commenting on the findings overall, Professor Ted Baker, chief inspector of Hospitals said: “It is encouraging that the results show some areas of improvement with experiences of information provision, quality of communication and the level of confidence in doctors and nurses all performing better than in previous years. This positive feedback regarding interaction with staff is a testament to the efforts of healthcare professionals working tirelessly to provide high quality care to those that need it.

“However, scope for further improvement remains, particularly in relation to how patients are involved and informed in their discharge arrangements and the level of emotional support offered to patients during their hospital stay.”

He added: “This year’s survey results also show a continued disparity between the experiences of people with a mental health condition and those without. This is an area which hospitals must address to ensure that that people with physical and mental health conditions are treated equally in acute settings.

“I would like NHS trusts to reflect on their individual survey results to understand what their patients really think about the care and treatment they provide. This will help them to identify what they need to change to drive further improvements in the quality of care for everyone.”

*Adult inpatient survey 2017. Conducted by the Care Quality Commission, June 2018.

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