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CHAPTER NINE. ASPIRATIONS FOR IMPROVEMENT

Context and analysis

9.1 The initiatives introduced as part of the modernisation agenda are designed to improve service delivery across all areas of the NHS in Scotland. As well as examining people's satisfaction with the services they received, users of each of the main service areas were asked whether they thought there was a need to improve a range of facilities and aspects of services.

9.2 The facilities and aspects of service identified are likely to impact on people's satisfaction with the service they receive. Some relate to access, such as car parking, getting through by telephone and having ramps and handrails available. Others are about the responsiveness of the health service (being listened to), choice (availability of convenient appointment times, choice of what or when you eat in hospital), the way in which professionals communicate with patients (being given information you can understand about your treatment or condition, being encouraged to ask questions) and the quality of services and facilities (cleanliness, being treated with dignity). People's view about the need for improvement of some of these facilities and aspects of service were explored in 2000 and others reflect changes to the NHS which have been introduced since then.

9.3 Not all of the facilities or service aspects apply to all service areas (e.g. ramps and handrails for telephone consultations) and the questions were tailored accordingly. The findings are presented separately in terms of facilities and aspects of services for each service area however a number of common themes emerge across the NHS services explored in the survey and these are discussed at the end of the chapter.

IMPROVEMENTS

Out-of-hours service

9.4 More than a third of people using out of hours services thought there was a need to improve child friendly facilities and convenient car parking. Relatively few people mentioned a need for improvement of other facilities, however having ramps and handrails, the comfort of the waiting room and having child friendly facilities were perceived to be in greater need of improvement for Out-of-hours services than other service areas (Table 9.1).

Table 9.1: Thinking about the last time you used the out-of-hours service, please tell me to what extent you feel improvements are needed to the following facilities?

Base: all who have been to the out-of-hours service in the last 12 months = 178

* All percentages in this Chapter are horizontal

9.5 Nearly four in ten Out-of-hours service users (38%) felt that there was a need for improvement of the professional having enough knowledge of their situation to deal with them effectively, with 16% of users saying there is a great need for improvement in this area. This finding is consistent with the fact that less than one-fifth of respondents saw their own GP at an Out-of-hours service (Table 9.2).

9.6 Just over a third of all service users (36%) thought that the speed of receiving results from tests could be improved, even allowing for that fact that this aspect of service did not apply to a fifth of users.

9.7 Almost a third of users (32%) felt that encouragement to ask questions could be improved. Linked to this, three in ten said that there was need to improve patient's understanding about their treatment or condition. Communication is a key issue addressed in 'Patient Focus and Public Involvement', which states that patients should expect to be given information that is clear and advice that is understandable.

9.8 Areas which do not initially appear to require improvement are being treated with dignity and having privacy respected, however in the latter case, it appears that there is more work required in this area for Out-of-hours services than for other service areas, in particular Primary Care (see Table 9.11). From a policy point of view, with documents such as 'Partnership for Care' placing emphasis on the value of such behaviours, further work is needed in this area.

Table 9.2: Thinking about the last time you used the out-of-hours service, please tell me to what extent you feel improvements are needed to the following aspects of the service that you received?

Base: all who have used an out-of-hours service = 297

9.9 Those who had experienced telephone contact with the Out-of-hours service were asked to consider three specific aspects of the service that they had received - see Table 9.3. The base size here is low, and so caution must be exercised when examining the results. Nevertheless, service users identify a need to improve the convenience of times for the telephone calls.

Table 9.3: Thinking about the last time you used the out-of-hours service, please tell me to what extent you feel improvements are needed to the following aspects of the service that you received?

Base: all who had telephone contact with the Out-of-hours service = 51

Telephone consultation

9.10 Access issues were identified as most in need of improvement for users of telephone consultation with 42% wanting improvements in convenient times to call the professional, or for him/her to call back and 37% noting ease of getting through to the health professional (Table 9.4).

Table 9.4: Thinking about your last telephone consultation, please tell me to what extent you feel improvements are needed to the following aspects of the service that you received?

Base: all who have had a telephone consultation in the last twelve months = 369

Primary Care

9.11 The findings were broadly similar for each of the PHCT groups examined so they are aggregated. However, when people see another GP (not a locum), rather than their own doctor or a practice nurse, they identify a greater need for improvements to all aspects of services and facilities.

9.12 The largest single area identified for improvement in Primary Care is for convenient appointment times as was the case in the 2000 survey. This report has already noted the link between speed of access and overall satisfaction with the health service (see Chapter 5). Other improvements included getting through on the telephone, convenient car parking and better understanding of the information given about treatment or health conditions. With the exception of the latter point, all of these improvements are about access to services.

9.13 Table 9.5 shows the improvements identified for Own GP, Other GP and Practice Nurse. The general theme here is that patients identify more need for improvements when they see a GP other than their family doctor or the practice nurse despite the fact that their overall satisfaction with the actual contact (see Chapter 5) may have been nearly as high. It might be expected that people would think there was a need to improve "the professional having enough knowledge of your situation to deal with you effectively" given the continuity of care provided by the patient's own family doctor in comparison with another GP. The differences concerning being listened to by or having enough time with another GP may be explained by the relative unfamiliarity of the two parties. However, there is no obvious reason why car parking should be more in need of improvement if the patient sees a GP other than their own at the same surgery. There may be implications here for how patients perceive initiatives designed to speed access to services such as the 48 hour access guarantee.

Table 9.5: Thinking about your last visit to the surgery, please tell me to what extent you feel improvements are needed to the following facilities: all who said that there was ANY need for improvement.

Base: all questioned about visiting a healthcare professional at their local surgery

Home visits

9.14 Patients receiving home visits identified most need for improvement in the professional having enough knowledge of the situation to deal with the patient effectively (Table 9.6). Given that the health professional carrying out an emergency home visit was not usually the patient's own GP, this result is perhaps not surprising and reflects the findings of the 2000 survey. Other areas for improvement were about being given enough information regarding treatment and having enough time with the professional.

Table 9.6: Thinking about your last visit home visit, please tell me to what extent you feel improvements are needed to the following aspects of the service that you received?

Base: all who had a home visit as an emergency visit = 86

Outpatients

9.15 Table 9.7 shows that outpatients thought that availability of convenient appointment times was most in need of improvement (56%). More than half of outpatients (52%) thought that car parking would benefit from improvement including a third (34%) who saw a great need to improve this facility. Both appointment times and car parking were highlighted for improvement in the 2000 survey indicating that more work is required to improve access to outpatient services.

Table 9.7: Thinking about your last visit to the outpatient clinic, please tell me to what extent you feel improvements are needed to the following facilities?

Base: all who have been to an appointment at an outpatient clinic in the past twelve months = 856

9.16 The major issue in respect of service delivery was the speed of receiving test results from outpatient appointments (37%). Other areas which outpatients felt needed improvement were to do with communication - having enough time with the professional (29%), getting better information about treatment (28%) and being encouraged to ask questions (25%). These findings are broadly similar to those of the 2000 survey.

Table 9.8: Thinking about your last visit to an outpatient clinic, please tell me to what extent you feel improvements are needed to the following aspects of the service that you received?

Base: all who have been to an appointment at an outpatient clinic in the past twelve months = 856

Inpatient admissions

9.17 Almost half of all inpatients (45%) felt that improvements were needed to public transport services for visitors. As in 2000, choice of what and when to eat in hospitals would benefit from improvement (40% and 35% respectively) however this was less of an issue than it had been in the previous survey. In contrast with all of the other service areas, more than a quarter of inpatients (28%) felt that cleanliness could be improved.

Table 9.9: Thinking about your last experience as an inpatient, please tell me to what extent you feel improvements are needed to the following facilities?

Base: all who have been admitted as an inpatient in the past twelve months = 411

9.18 Nearly three in ten inpatients (29%) reported that at least some improvement was needed to the speed with which test results are received, and the same number said there was a need to improve the amount of time spent with the professional. These results also reflect the areas for improvement noted in the 2000 survey. A further quarter of inpatients wanted to see improvements to information given about their treatment. In common with other NHS service areas, it was reported that having privacy respected and being treated with dignity were least in need of improvement.

Table 9.10: Thinking about your last experience as an inpatient, please tell me to what extent you feel improvements are needed to the following aspects of the service that you received?

Base: all who have been admitted as an inpatient in the past twelve months = 411

common themes FOR IMPROVEMENTS across the NHS

9.19 This section examines common areas for improvement that were found across the different service areas. Table 9.11 summarises the findings for those facilities and aspects of service which applied across at least 5 of the 8 key service areas.

9.20 Across the NHS in Scotland, people identified a need to improve the convenience of car parking (40% on average) and the ease of getting through by telephone (37%). In addition to these access issues, 29% of users said that improvements were needed to child friendly facilities, in particular in Out-of-hours and outpatient services.

9.21 Communication was a lower, though still significant, area for improvement across all settings - this included being given information about treatment, having enough time with the professional, being encouraged to ask questions and the usefulness of the information given.

9.22 Other areas for improvement were more concentrated in certain service areas, for example, handrails and ramps were noted as needing improving for the Out-of-hours service and outpatient sites. At the other end of the scale, having privacy respected and being treated with dignity were not issues in Primary Care settings. The speed of receiving test results was not seen as an area for improvement in Primary Care but it was elsewhere, notably for those using Out-of-hours services and outpatient clinics.

9.23 Patients generally identified more improvements for Out-of-hours, home visit and outpatient services than the other areas of NHS provision.

Table 9.11 - Summary of improvements: all saying that there was a great need for improvements/some improvement was required

Base: all users of each service (Table includes only those issues examined for at least five out of the 8 service areas)

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