CQC: hospital patients waiting too long but trust in nurses

The Care Quality Commission (CQC) published its 2023 adult inpatient survey today (21 August), which asked 63,500 adults at 131 acute and specialist NHS trusts across England about their experiences in hospital.

“Overall, satisfaction rates remain far lower than they were pre-Covid”

Nicola Wise

The survey showed that just more than half (56%) of respondents felt there were “always” enough nurses to care for them in hospital, an improvement from 52% in the 2022 survey.

However, this was still lower than 2020, when 62% of respondents told CQC there were enough nurses.

The majority of respondents said they had positive experiences with nurses, doctors and other clinicians.

The CQC’s report found that around three quarters of people (72%) said they “always” got understandable answers to questions they had about their care from doctors and nurses, and 63% said they were “always” able to get a member of staff to help them when they needed it.

For doctors, the question around understandable answers was consistent with 2022, but for nurses this was a 1% decrease.

Confidence in nurses remained largely consistent, falling also by only 1% in the survey. In 2022, 79% of respondents said they always had confidence and trust in nurses, which fell to 78% in the 2023 survey published today.

Other areas of care relating to nurses remained consistently high, with 75% of respondents saying both doctors and nurses included them in conversations.

Further, the majority of survey respondents said they were always offered food which met dietary needs, were able to bring medication into hospital with them if needed, and had enough to drink during their time in hospital.

However, the latest survey results revealed a decline in patient experiences when being discharged and while waiting for admission.

Among patients who were in hospital for elective care, 42% said they would have liked to have been admitted sooner, compared with 39% who said this in 2022.

Almost half (43%) of elective patients said their health deteriorated while waiting to be admitted, an increase from 41% in 2022.

Meanwhile, 48% of patients said they were given enough notice about when they were going to leave hospital – the same as 2022 but down from 53% in 2020.

More than a quarter (29%) said they had little to no involvement in decisions made about their discharge, compared to 25% in 2022, with a third (33%) saying they had a “great deal” of involvement, down from 37% the previous year.

Less than half of patients (46%) in the latest survey said they received enough support from health and social care services after discharge.

Overall experience of inpatient care was rated as a nine or 10 out of 10 by 51% of respondents, compared with 50% in 2022 and 56% in 2020.

In total, 4% of respondents scored their overall experience as zero or one.

“Trust leaders also want to see investment across the health and care system”

Julian Hartley

Nicola Wise, CQC director of secondary and specialist healthcare, said the lack of improvement on the survey scores was “disappointing”.

She said: “Overall, satisfaction rates remain far lower than they were pre-Covid with delays in accessing care and poorly coordinated discharge from hospital both clear factors impacting on the quality of people’s hospital stay.

“It’s also concerning that we’ve seen an increase in the number of people who feel their health deteriorated while they waited for elective care – further evidence that the current imbalance between patient demand and treatment capacity is putting people at risk.

“What is encouraging is that the majority of people surveyed continue to report positively about their interactions with staff – we know that staff and leaders are doing all they can to minimise delays, manage the flow of patients from admission through to discharge and provide compassionate person-centred care.”

Ms Wise added that staff must work to improve the experience of patients throughout their time in hospital, but that this must be “supported by continued efforts to address staff shortages, improve retention of our highly skilled workforce and ensure recognition of the commitment and dedication from frontline staff”.

Sir Julian Hartley, NHS Providers chief executive, agreed with Ms Wise; he said the high scores around positive interactions with frontline staff was a “testament” to the workforce’s hard work and dedication.

However, he said: “With pressures mounting across the whole health and care system and an ongoing mismatch between capacity and demand, it is vital we pull every lever to get NHS performance back on track.

“Alongside measures to boost recruitment and retention of hardworking NHS staff, trust leaders also want to see investment across the health and care system, including ambulance, community, mental health, primary and social care services, to help ease the burden on hugely overstretched hospitals.”