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Executive summary
Introduction
1. This research was commissioned to inform the development of a new programme - Better Together, Scotland's Patient Experience Programme - which will systematically collect patient experience information across NHS Scotland and use this information to drive forward service improvements.
2. This report qualitatively examines the aspects of their health care that Scottish patients view as being important. The research includes the views of hospital inpatients, people with a long-term health condition and the views of people about general practice services. The results of this research will be used to help design a range of instruments which will gather patient's experiences of healthcare as inpatients, users of GP services and people with long-term conditions.
Methods
3. Eight focus groups and four in-depth interviews were carried out between November 2007 and February 2008. Three focus groups covered hospital inpatients; three covered long-term conditions; and two focus groups plus four in-depth interviews covered general practice services. The research was designed to cover Health Boards throughout Scotland and be representative of rural, urban and remote populations and areas of high and low deprivation.
4. An additional two focus groups were carried out in June and July 2008 to cover people from Black and Minority Ethnic Groups and people from particular religion and faith groups. Six interviews were also completed with lesbian, gay, bisexual and transgender people. A total of 82 patients/service users were included in the research.
Main Findings
5. In general terms, patients hold the NHS in Scotland in very high regard. They are thankful to have the NHS, appreciate that they don't have to pay directly for their care and treatment and see more positives than negatives about the services provided. However, patients who have had a negative experience tend to remember that over and above their positive experiences. The results of the groups fell into 5 main themes: access to systems and staff; environment and facilities; good communication and information; expert clinical care; and continuity and coordination 1.
Access to systems and staff
6. Regarding GP Services, most patients had experienced their appointment being delayed. Some happily accept a wait of any length; some accept a short wait and others find that waiting is unacceptable, because of the implication of having to wait on their other plans.
7. Patients appreciated their practices being open later in the evenings and on weekends if possible. The option of a telephone consultation was viewed positively.
8. Most of the GP practices offered same-day appointment systems. However, it was important that people could get through to their practice by telephone to book an appointment and some patients did have trouble with this and found it difficult to get a convenient appointment. For practices offering same-day appointments, some also allowed people to book in advance. For practices that only booked appointments in advance some patients had to wait up to 3 weeks for an appointment.
9. For inpatients, it was important for people that they were assessed and treated quickly in an emergency. Patients appreciated knowing which doctor was in charge of their care and being able to see that doctor. They were particularly perturbed if they didn't see their doctor or surgeon before an operation.
10. People with a long-term condition felt reassured to have details of a healthcare professional that they could contact at any time about their care or treatment.
11. Access to specialist services could be problematic and costly for patients from more remote and rural areas.
Environment and facilities
12. Patients appreciated their GP practice being close to home and easy to reach. Some liked the fact that they had a big practice that provided a wide range of services whilst others liked to have a small and more personal GP practice.
13. For most hospital inpatients, the hospital was in a convenient location for them, although those travelling by public transport sometimes faced long journeys. Getting NHS transport was sometimes difficult. Some patients found car-parking was limited at particular times of the day and the cost of parking at some sites was seen as high.
14. Cleanliness was of concern to most patients, with variation being seen between hospitals and within hospitals. Poor cleanliness was linked by some patients to infection control which was a major worry to them. Hand washing by staff was not always evident.
15. Patient had low expectations of hospital food, and the quality of food varied between hospitals. Some patients were worried that no-one checked whether patients had eaten any food.
16. Some of the women patients were concerned about having to share mixed-sex wards and bathroom facilities.
17. Some patients had difficulty in sleeping at night through noise from patients or staff and a few patients complained about a lack of privacy on the ward when discussing their condition with staff.
18. Entertainment facilities were important for patients but these varied between hospitals from nothing being provided at some hospitals to full entertainment systems at others. Some of the systems were seen as an expensive luxury.
19. Some patients from particular religions or faiths found it difficult to find a neutral (non Christian) place to pray and were sometimes unable to get copies of their prayer books.
Good communication and information
20. Patient saw good communication with staff as being an essential part of their care and treatment.
21. It was seen as important that doctors and other staff should be good at listening explaining things, should use plain, everyday language and have a good bed-side manner. Patients had difficulty in communicating with some staff, and there were particular problems for some patients with staff that had poor spoken English.
22. The amount of information was also very important to patients, many of whom received the right amount of information, although some had difficulty in getting the information they needed, and at the times that they needed it.
23. The format of information was also important for some people, for example people who have a visual impairment and require information in Braille.
Expert clinical care
24. Fundamental for all of the patients was that they were given the best quality care and treatment for their condition or illness. Some patients gave specific examples of where the skills and knowledge of NHS staff kept them alive. However, other patients also gave examples of where they were wrongly diagnosed or where they didn't have confidence in the NHS staff.
25. Patients expected staff to be well trained and kept up-to-date with new developments.
26. For some patients, clinical skills of staff were seen as much more important than communication skills.
Continuity and coordination of care
27. Patients wanted continuity of care and for their care to be well coordinated by the NHS staff treating them.
28. Patients wanted to see the same healthcare professionals as often as possible throughout their care and treatment and to know that staff communicated with each other to coordinate their care. Patients noted that they lost confidence in their care if staff gave them conflicting information.
29. For hospital inpatients, discharge planning was particularly important.
Equality issues
30. In general terms, the issues raised from the equality groups were very similar to the general groups, with a few specific additional concerns in each case. For example, access to a "neutral" place of prayer and access to representatives of their own religion or faith was an issue for some people in the religion group. Patients from BME/ethnicity group found access to suitable food to be particularly difficult on occasions. Some of the LGBT patients we interviewed felt that they were not well understood and that there was a lack of specific information available to them.
Conclusions
31. This research identified what patients and users of the NHS see as the most important issues for them about their condition and treatment.
32. Although patients were largely very positive towards the NHS they also described specific instances where improvements could be made.
33. The issues identified fall into 5 broad themes:
- Access to systems and staff
- Environment and facilities
- Good communication
- Expert clinical care
- Well coordinated care and treatment
34. The issues identified as being important and the subsequent themes are similar to themes identified from similar research elsewhere. For example, the Department of Health in England has 5 themes for their Public Service Agreement target on patient experience for both inpatient and primary care - Access and waiting, safe high quality co-ordinated care, better information more choice, building closer relationships and clean friendly and comfortable place to be.
35. While this research has described the issues that are important, this is only from the viewpoint of a relatively small group of people. This report doesn't set out to assess the relative importance to patients and users of each of the issues. The next step of this programme is to design questionnaires that will allow large numbers of patients to assess the importance of each issue to them, the results of which will be published separately.
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