Patient Experience Report by West Midlands QI

NHS West Midlands February 2009

Summary ........................................................................................5 Introduction .................................................................................. 11 Overall satisfaction with care...................................................... 20 Wait for treatment ........................................................................ 24 Patient choice at time of referral................................................. 33 Making hospital appointments.................................................... 39 Aspects of care ............................................................................ 54 Aftercare ....................................................................................... 65 Recommendations for further research ..................................... 70 Appendices................................................................................... 73 Mailout and response rate figures Sample profile Guide to statistical reliability Guide to reading computer tables Questionnaire

18 Week Patient Experience Survey NHS West Midlands

This report presents the findings of a research study conducted by Ipsos MORI on behalf of the 17 PCTs within the West Midlands. The research aims to establish patients’ experiences of their care along the 18 week pathway from referral to treatment, and to assess whether patients are satisfied with the length of time they waited for treatment. The survey also aims to highlight local causes of patients’ dissatisfaction with access and what action can be taken to improve the service experience for patients, in line with the competencies outlined in the World Class Commissioning assurance framework. One of the main objectives of this research was to provide PCTs with the data necessary for their improvement plans. The research uses a self-completion postal methodology to collect the opinions of patients who have been referred by their GP or another healthcare professional to an NHS healthcare provider within the last 20 weeks for treatment or further assessment (i.e. with a ‘clock start’ around w/c 30 June and w/c 7 July). Due to restrictions around external access to patient records and patient confidentiality, the PCTs themselves were responsible for overseeing the sampling of patients and the administration of the survey mailout to this sample. Each PCT in the West Midlands paired up with one or two of its main healthcare providers. Most PCTs in the West Midlands used a sample of 1,500 patients – based on a rough estimate of a 33% response rate, this would result in the return of 500 questionnaires per PCT. The main fieldwork period took place between the 24th November 2008 and 2nd January 2009 (i.e. this was the designated period between the mailout of the questionnaires by Trusts and the cut-off date for the completed questionnaires to be returned). The survey aimed to collect patients’ perceptions of their care pathway, and the results reported here need to be considered with this in mind. Where differences between groups are identified, further investigation would be needed to uncover the reasons behind these perceptions.

Overall satisfaction with care Overall, patients tended to be very satisfied with their care, with only between two per cent and seven per cent in each PCT saying the care they received since they were told they needed treatment was poor or terrible. Across the West Midlands as a whole, approaching two in five said their care was excellent (37%). However, this did vary widely across PCTs –

18 Week Patient Experience Survey NHS West Midlands

Wait for treatment A majority of patients in each PCT were concerned about how long they would have to wait to receive treatment when they were first told they needed to see a specialist (54% across the region as a whole). Having said this, a sizeable minority across the region as a whole were not at all concerned (40%). In this way, perceptions of waiting times continue to lag behind the times the NHS is achieving. Despite being concerned about waiting times in advance, many patients were happy with the length of time they actually waited for treatment (77% in the West Midlands for those answering who had started treatment), while one in five thought they should have been treated sooner (20%). The improved waiting times may take time to filter through to the general public as more and more people begin to experience them. Among those who said they experienced some kind of delay in receiving treatment, the most common reasons given across the West Midlands as a whole were waiting for an appointment to see their hospital specialist for the first time (26%), the length of time between the GP referring them and contact from the hospital (19%) and the wait for an operation (15%).

Patient choice at time of referral Although more patients across the West Midlands did not talk with their GP or doctor about their choice of hospital for treatment than did talk about their choice, only between three per cent and 10% in each PCT said they did not talk about their choice and would have liked to have been more involved. Across the West Midlands, around half of patients werenâ&#x20AC;&#x2122;t offered a choice, but didnâ&#x20AC;&#x2122;t mind (49%). For those who did talk about their choice of hospital, the location of the hospital was the main reason underlying their choice (66%). The vast majority of patients were able to go to their first choice of hospital.

18 Week Patient Experience Survey NHS West Midlands

Making hospital appointments Few patients found it difficult to arrange their first hospital appointment, although it was more difficult for those in Coventry and Wolverhampton PCTs, for younger patients and for ethnic minority patients. The vast majority of patients across PCTs felt they were not offered a choice of dates and times of day for their appointments. Having said this, the dates and times offered were convenient for most. For those who found the dates offered inconvenient, this was generally because they were not soon enough or patients were not given enough choice. For those who found times inconvenient, the main reasons given were them being too early in the day, not being outside working hours, or being too late in the day. Across the West Midlands as a whole, 16% of patients had their appointment cancelled or rearranged by the hospital or call centre and 10% cancelled or rearranged their appointment themselves. When actually at the hospital, however, patients were sometimes having to wait a while after their appointment time before they are seen – 23% across the West Midlands waited for 30 minutes or longer after their given appointment time.

Aspects of care Corroborating patients’ overall satisfaction with the care they received, they were also generally positive about all aspects of their care. A majority thought the hospital was clean and were satisfied with the general condition of hospital buildings. Very few said the specialist didn’t explain what would happen next in their treatment clearly, or that they were not as involved in decisions about their care as they would have liked. Virtually all patients say they were treated with respect and dignity. Younger patients and ethnic minority patients were consistently less satisfied with these various aspects of care.

Aftercare Not all patients discussed aftercare or recommendations on exercise, lifestyle or diet with a healthcare professional, or were given written information following their treatment – across the SHA, two in five said they discussed aftercare fully (42%) and half were given written information (50%). Levels of aftercare tended to be higher for those admitted to a hospital bed for treatment.

18 Week Patient Experience Survey NHS West Midlands

Recommendations This section of the summary aims to identify some areas that may fit into PCTs’ improvement plans. Of course, priorities for each PCT are likely to differ, depending on how well they perform relative to other PCTs on each individual measure. We would recommend that a PCT not performing so well on a given measure looks at the actions that PCTs who are performing well are taking. It is important to remember that the survey reflects patients’ perceptions of the 18 weeks pathway. Hence, it may be that differences between PCTs are a result of differing perceptions or expectations rather than actual differences. Where this seems to be the case, information provision may serve to improve perceptions, while further qualitative work can explore in more depth why perceptions and expectations differ, and what expectations the local population has. This may apply to younger patients, ethnic minority patients and patients with a long-term illness or disability, who are consistently less satisfied throughout the 18 week pathway. We often find in other research that these groups are less satisfied, which suggests it is because perceptions and expectations differ rather than because of any “real” difference. It may also be a case of needing different methods of communication if language barriers are part of the problem. It is worth noting that there is some overlap between groups – ethnic minority patients tend to be younger. In addition, one in five ethnic minority patients across the West Midlands are from Heart of Birmingham PCT, raising the question of whether this sample reflects the views of ethnic minority patients in Heart of Birmingham PCT rather than ethnic minority patients more generally. Qualitative research with these three groups of patients would help to delve into these questions. Other specific areas of the pathway that may need improvement include: lengths of waits when actually in the hospital – 23% across the West Midlands waited for 30 minutes or longer after their given appointment time. This can create difficulties for patients, for example, with car parking, taking time off work and arranging childcare; improving perceptions of waiting times – PCTs may decide it is more important to improve the service patients receive rather than their perceptions of waiting times. However, there may be relatively simple “wins” here – with GPs reassuring patients at the time of referral, for example;

18 Week Patient Experience Survey NHS West Midlands

the appointment system â&#x20AC;&#x201C; it may be possible to make the appointment system more efficient to avoid the hospital needing to cancel or rearrange 16% of appointments and 10% of patients themselves cancelling or rearranging appointments. Perhaps the system could be made more flexible and tailored to the needs of individual patients through offering greater choice of days and times. For example, those of working age may prefer their appointments at the beginning or end of the day, while older patients may find it easier to attend hospital in the middle of the day; aftercare â&#x20AC;&#x201C; patients may benefit from greater explanation of what to expect following their treatment and any actions they need to take. The results indicate that this might not be happening for all patients at present. Along with these areas for improvement, it is important to remember that patients tended to be very satisfied with the care they received, and communication of this to staff and patients alike may improve perceptions.

18 Week Patient Experience Survey NHS West Midlands

This report presents the findings of a research study conducted by Ipsos MORI on behalf of the 17 PCTs within NHS West Midlands, in response to a specification from the Department of Health.

Background The NHS wants to ensure that waiting time from referral to treatment does not exceed a maximum of 18 weeks. Within that time, all patients for whom it is clinically appropriate and who choose to do so should have started receiving their treatment, or a decision should be made that no treatment is required. From the start of 2009 virtually all patients can expect to be seen, diagnosed and start treatment within 18 weeks of their referral. In order to guarantee this, the NHS needs to understand the overall experience that patients have of elective care waits and act on the results to drive improvement. The Department of Health has asked Primary Care Trusts (PCTs) to capture patients’ experiences of waiting times to help drive this improvement. The 18 Week Patient Experience Survey has therefore been designed by Ipsos MORI, on behalf of local PCTs, with the aim of establishing patients’ experiences of their care from referral to treatment and to assess whether patients are satisfied with the length of time they waited for treatment. The survey also aims to highlight local causes of patients’ dissatisfaction with access and what action can be taken to improve the service experience for patients, in line with the competencies outlined in the World Class Commissioning assurance framework.

Objectives Ultimately, the 18 Week Patient Experience Survey seeks to establish patient experiences of waiting times and assess whether patients perceive that they have received care when they need it. One of the main objectives of this research was to provide PCTs with the data necessary for their improvement plans. In order to achieve this aim, the research objectives were to examine: patients’ perceptions of waiting times from the date of their referral to the time at which they began treatment, or were told that no treatment was available/necessary;

18 Week Patient Experience Survey NHS West Midlands

patientsâ&#x20AC;&#x2122; assessment of their wider patient experience (including satisfaction with aspects of their care, patient choice and the manner in which they were treated by NHS staff); and coverage of patient experiences from a range of stages along the 18 week pathway â&#x20AC;&#x201C; please see methodology for further details.

Methodology The research uses a self-completion postal methodology to collect the opinions of patients who have been referred by their GP or another healthcare professional to an NHS healthcare provider within the last 20 weeks for treatment or further assessment. This methodology was adapted from the National Patient Choice Survey (NPCS) in which NHS Trusts mail out a bimonthly self-completion questionnaire. Questionnaire design The 18 Week Patient Experience Survey was designed by Ipsos MORI in collaboration with each SHA. Ipsos MORI designed a core set of questions for the survey, along with some optional questions that the SHA could choose to include if they wished. The design of the core questionnaire has been heavily influenced by the 18 Week Pilot Survey which Ipsos MORI conducted on behalf of the Department of Health between June 2007 and March 2008. This Pilot phase provided tried-and-tested questions which successfully measure patient satisfaction with their wait for treatment as well as the wider patient experience. For instance questions around aspects of care such as hospital cleanliness, the manner in which they were treated and patient choice were designed to be consistent with the Healthcare Commission Inpatient Survey and The National Patient Choice Survey. These questions were once again thoroughly reviewed by a panel of experts in questionnaire design at Ipsos MORI before inclusion in the questionnaire for this full phase of the 18 Week Patient Experience Survey.

18 Week Patient Experience Survey NHS West Midlands

Sampling and mailout Due to restrictions around external access to patient records and patient confidentiality, the PCTs themselves were responsible for overseeing the sampling of patients and the administration of the survey mailout to this sample. Each PCT in the West Midlands paired up with one or two of its main healthcare providers in order to sample patients for the survey. Providers were selected by PCTs due to the high proportion of patient referrals dealt with through these hospitals. Following the identification of a suitable provider(s), a sample of patients was drawn from the Patient Administration System using ‘clock start’ information. In order to allow comparisons across the region, for all PCTs, patients were selected if they had a ‘clock start’ around 20 weeks prior to the mailout date at the end of November (w/c 30 June and w/c 7 July). This time lapse since the initial referral was advised to be optimal by Ipsos MORI as the majority of these patients should have at least been able to book their appointment, and preferably attended their first appointment. Sampling patients from a time period earlier than 20 weeks introduces problems of recall for patients when they come to complete the questionnaire as was found during the Pilot phase. It was also anticipated that patients approached after approximately 20 weeks would naturally be at different points in the pathway – many would have started treatment, while others would have had their appointments and been discharged, and others would still be awaiting treatment. The length of the sampling period was dependent on the desired sample size and the average number of referrals in a given week for any given PCT or provider. Most PCTs in the West Midlands used a sample of 1,500 patients – based on a rough estimate of a 33% response rate, this would result in the return of 500 questionnaires per PCT, to allow analysis of different patient groups. All patients were eligible for the survey excluding: deceased patients; children under the age of 16; those who require a termination of pregnancy, those referred to maternity; mental health and psychiatric patients; patients who have no UK address;

18 Week Patient Experience Survey NHS West Midlands

non-NHS patients; and those who have been â&#x20AC;&#x2DC;stop notedâ&#x20AC;&#x2122;. Fieldwork Cognitive testing of the questionnaire took place between 27 and 29 August 2008. The main fieldwork period took place between the 24th November 2008 and 2nd January 2009 (i.e. this was the designated period between the mailout of the questionnaires by Trusts and the cutoff date for the completed questionnaires to be returned). Exact mailout figures and response rates for NHS West Midlands are included in the technical note in the appendices of this report. The appendices also show which trust(s) each PCT paired up with.

Presentation and interpretation of the data It should be remembered that a sample, not the entire population of the area, has been interviewed. In consequence, all results are subject to sampling tolerances, which means that not all differences are statistically significant. A guide to statistical reliability is appended. Each chart in the report marks the PCTs that are performing significantly higher and lower than the West Midlands average. For example, in the chart overleaf, PCTs are ranked by % excellent. Although shown as a league table, results for the Heart of Birmingham and Birmingham East and North PCTs for this question are not statistically significant. The shaded area for Worcestershire, Shropshire and South Birmingham PCTs denotes that % excellent for these three PCTs is significantly higher than the West Midlands average. The shaded area for Wolverhampton PCT, Walsall PCT and Solihull Care Trust denotes that % excellent for these three PCTs is significantly lower than the West Midlands average. The PCTs in the unshaded area in the middle of the chart are in line with the West Midlands average.

18 Week Patient Experience Survey NHS West Midlands

# Q

Overall, how would you rate the care you received since you were told you needed treatment? % Poor or terrible

% Fairly good

% Very good

% Excellent

% excellent / Base good

(6,783)

(413)

210

(523)

Worcestershire

6 10

(461)

Warwickshire

3 12

(494)

Telford & Wrekin

310

(451)

Herefordshire

3 12

(535)

South Staffordshire

3 12

(436)

North Staffordshire

4 11

(373)

Heart of Birmingham

(172)

Dudley

4 15

(468)

Coventry

5 14

(401)

Sandwell

2 17

(339)

Birmingham East and North

3 15

(315)

Stoke on Trent

7 13

(295)

Wolverhampton City

5 11

(328)

Walsall Teaching

6 16

(417)

Solihull Care Trust

5 17

(344)

West Midlands PCT average

4 13

South Birmingham

311

Shropshire County

39 38

Base: All, fieldwork 24 November 2008 – 2 January 2009

Please note that a West Midlands PCT average is presented throughout the report. This figure is the average across the SHA’s 17 PCTs. It cannot be said to be a figure for the West Midlands as a whole because a census was not carried out – only certain providers were involved in the survey. However, it is useful to serve as a benchmark for PCTs to measure themselves against.

18 Week Patient Experience Survey NHS West Midlands

It is also important to note that not all patients sent the survey responded to it – response rates vary between 11% in Heart of Birmingham PCT to 36% in Herefordshire PCT. It is therefore worth bearing in mind that some groups of patients may not be included in the results for each PCT. Younger people and men are less likely to respond to postal surveys. Those with more time – such as the retired – are more likely to respond to surveys, as are those who have a particularly strong opinion. For Heart of Birmingham PCT in particular, where the response rate was very low (probably a result of the population profile of this PCT), results should be treated with some caution and would benefit from further exploration. Please refer to the appendices for an outline of the sample profiles and respondent profiles. In the graphs and tables, the figures quoted are percentages. The size of the sample base from which the percentage is derived is indicated. Note that the base may vary – the percentage is not always based on the total sample. Caution is needed when comparing responses between small sample sizes (fewer than 100 respondents). Where an asterisk (*) appears it indicates a percentage of less than half of one per cent, but greater than zero. Where percentages do not add up to 100% this can be due to a variety of factors – such as the exclusion of ‘Don’t know’ or ‘Other’ responses, multiple responses or computer rounding. Please note the results presented in the tables and topline, and throughout this report, are based on unweighted data. This is due to the lack of respondent profile information across every PCT. Data tables are also available for each PCT. Please refer to the appendices of this report for a guide to using computer tables.

Measuring perceptions It is also worth pointing out that this survey deals with patients’ perceptions at the time the survey was conducted rather than facts. Patients’ perceptions, therefore, may not accurately represent the level and quality of services that are currently provided by the NHS. Indeed, one of the challenges will be to link these perceptions with other data that is available, for example performance indicators or other measurements of service quality. Further investigation on many of these points will be needed to explore whether differences in the results relate to differences in actual service provision, or to differences in perceptions and expectations.

18 Week Patient Experience Survey NHS West Midlands

Publication of data Our standard Terms and Conditions apply to this, as to all studies we carry out. Compliance with the MRS Code of Conduct and our clearing is necessary of any copy or data for publication, web-siting or press releases which contain any data derived from Ipsos MORI research. This is to protect your reputation and integrity as much as our own. We recognise that it is in no-one’s best interests to have findings published which could be misinterpreted, or could appear to be inaccurately, or misleadingly, presented.

Report layout Immediately preceding this introduction is an executive summary, which summarises the key findings and implications of the report. The main body of the report is divided into six different sections: 1. Overall satisfaction with care: looks at how patients rate their overall care. 2. Waits for treatment: explores how long patients thought they would have to wait, along with their views of how long they actually had to wait and reasons for any delays in treatment. 3. Patient choice at time of referral: looks at whether or not patients discussed their choice of hospital at the time of referral, along with reasons underlying their choice for those who made one, and whether or not they were able to go to their first choice of hospital. 4. Making hospital appointments: looks at how patients booked their first hospital appointment and how easy they found it, along with whether or not they were offered a choice of dates and times for the appointment and whether the dates and times they were offered were convenient. It also explores whether patients’ appointments were cancelled or rearranged by the hospital or call centre, whether they cancelled or rearranged their own appointments and if they did, how easy it was. Finally, it looks at experiences of waiting times when actually at the hospital. 5. Aspects of care: looks at patients’ satisfaction with various aspects of their care, focusing on cleanliness and the general condition of the hospital, explanations of treatment and whether they feel they were involved in decisions, and whether they were treated with dignity and respect.

18 Week Patient Experience Survey NHS West Midlands

6. Aftercare: explores the information patients were given following their treatment â&#x20AC;&#x201C; both discussions with healthcare professionals and written information.

Acknowledgements Ipsos MORI would like to thank Louise Jackson and Jan Yeates for their help and assistance in the development of the project. In addition, we would like to thank all the staff at the PCTs and hospital trusts who drew the samples and administered the mailouts. Special thanks also go to the patients who took the time to take part in this survey.

ÂŠIpsos MORI/J34480 Checked & Approved:

Anna Carluccio (Research Director) Anna Quigley (Associate Director) Kate Duxbury (Research Manager)

18 Week Patient Experience Survey NHS West Midlands

( )

18 Week Patient Experience Survey NHS West Midlands

( )

This section looks at patients’ overall perceptions of their care and how good or poor it was. Summary Overall, patients across the West Midlands tended to be very satisfied with the care they had received since they were told they needed treatment – approaching two in five said their care was excellent (37%). Only between two per cent and seven per cent in each PCT said the care they received was poor or terrible.

However, this did vary widely across PCTs –

patients in South Birmingham PCT were most positive about their care, while those in Stokeon-Trent and Walsall PCTs were most negative. There was also variation among other groups in the population, with younger patients, women, ethnic minority patients and those with a long-standing illness all less satisfied with the care they received. Overall, patients tended to be very satisfied with the care they had received since they were told they needed treatment. Across the West Midlands as a whole, approaching nine in ten said their care was excellent or good (88%), while fewer than one in twenty said their care was poor or terrible (four per cent). The level of care was rated particularly highly in South Birmingham PCT, where more than two in five said their care was excellent (44%) and nine in ten said it was excellent or good (91%). In contrast, patients receiving care in Stoke-on-Trent PCT and Walsall Teaching PCT were more likely than elsewhere to rate their care as poor or terrible (seven per cent and six per cent respectively, compared with four per cent overall).

18 Week Patient Experience Survey NHS West Midlands

# Q

Overall, how would you rate the care you received since you were told you needed treatment? % Poor or terrible

% Fairly good

% Very good

% Excellent

% excellent / Base good

(6,783)

(413)

210

(523)

Worcestershire

6 10

(461)

Warwickshire

3 12

(494)

Telford & Wrekin

310

(451)

Herefordshire

3 12

(535)

South Staffordshire

3 12

(436)

North Staffordshire

4 11

(373)

Heart of Birmingham

(172)

Dudley

4 15

(468)

Coventry

5 14

(401)

Sandwell

2 17

(339)

Birmingham East and North

3 15

(315)

Stoke on Trent

7 13

(295)

Wolverhampton City

5 11

(328)

Walsall Teaching

6 16

(417)

Solihull Care Trust

5 17

(344)

West Midlands PCT average

4 13

South Birmingham

311

Shropshire County

38 27

Base: All, fieldwork 24 November 2008 â&#x20AC;&#x201C; 2 January 2009

18 Week Patient Experience Survey NHS West Midlands

There were some differences within PCTs: for those referred to Sandwell and West Birmingham Hospitals NHS Trust, patients in Sandwell PCT were more likely to say their care was very good than patients in Heart of Birmingham PCT (37% compared with 27%) â&#x20AC;&#x201C; this may benefit from further investigation to look at possible differences in the delivery of care; for South Staffordshire PCT, patients using Burton Hospitals NHS Trust were more likely to rate their care as excellent than those using Mid Staffordshire General Hospitals NHS Trust (46% compared with 31%); for Warwickshire PCT, patients using South Warwickshire General Hospitals NHS Trust were more likely to rate their care as excellent than those using the George Eliot Hospital NHS Trust (46% compared with 32%); Looking across the West Midlands as a whole, the following groups tended to be least satisfied with the care they received: those aged between 16 and 34 (10% said the care they received was fairly poor, very poor or terrible) and between 35 and 54 (six per cent said it was poor or terrible); around one in three women rated the care they received as excellent, compared with two in five men (36%, compared with 41%); only one in four ethnic minority patients rated their care as excellent (25%), compared with two in five white patients (39%); and patients who have a long-standing illness or disability were more likely than those who do not to say the care they received was poor or terrible (five per cent compared with three per cent), with those whose condition affects their day-to-day activities a great deal or a fair amount more negative than those who arenâ&#x20AC;&#x2122;t affected very much or at all (six per cent, compared with three per cent).

18 Week Patient Experience Survey NHS West Midlands

This section looks at patientsâ&#x20AC;&#x2122; expectations of how long they thought they would have to wait to receive treatment when they were first referred, along with their satisfaction with how long they actually had to wait. It also explores the causes for delays in treatment among patients. Summary A majority of patients in each PCT were concerned about how long they would have to wait to receive treatment when they were first told they needed to see a specialist (54% across the region as a whole). Having said this, a sizeable minority across the region as a whole were not at all concerned (40%). In addition, many patients were happy with the length of time they actually waited for treatment (77% in the West Midlands for those answering who had started treatment). Among those who said they experienced some kind of delay in receiving treatment, the most common reasons given across the West Midlands as a whole were waiting for an appointment to see their hospital specialist for the first time (26%), the length of time between the GP referring them and contact from the hospital (19%) and the wait for an operation (15%).

Expectations of wait for treatment Patientsâ&#x20AC;&#x2122; concerns about how long they would have to wait to receive treatment when they were first told they needed to see a specialist do not necessarily reflect the progress made in reducing waits in recent years. A majority in each PCT were at least a little concerned (54% across the West Midlands as a whole). Having said this, across the region as a whole, two in five were not at all concerned (40%). Levels of concern did not vary greatly across PCT, although patients in the Heart of Birmingham and North Staffordshire PCTs were more concerned, while patients in South Birmingham PCT were less so.

18 Week Patient Experience Survey NHS West Midlands

&( Q

When you were first told you needed to see a specialist, how concerned, if at all, were you with how long you would have to wait to receive treatment? % Very concerned

% A little concerned

% Fairly concerned

% Not at all concerned

% at least a little concerned Base West Midlands PCT average

12 12

South Birmingham

11 11

South Staffordshire

8 11

Warwickshire

(6,783)

(413)

(436)

9 14

(494)

Shropshire County

13 11

(523)

Dudley

10 13

(468)

11 10

(315)

Coventry Teaching

13 13

(401)

Walsall Teaching

12 12

(417)

Worcestershire

11 12

(461)

Sandwell

11 10

(339)

Wolverhampton City

12 13

(328)

Herefordshire

11 13

(535)

Telford & Wrekin

14 10

(451)

(344)

(295)

Birmingham East and North

Solihull Care Trust

13 14

Stoke on Trent Teaching

14 15

North Staffordshire

15 13

(373)

Heart of Birmingham Teaching

19 10

(172)

Base: All, fieldwork 24 November 2008 â&#x20AC;&#x201C; 2 January 2009

The following groups were more concerned than others about how long they thought they would have to wait receive treatment: women were more concerned than men (39% of women say they were not at all concerned, compared with 42% of men);

18 Week Patient Experience Survey NHS West Midlands

younger patients were more concerned than older patients (35% of those aged 16 to 54 were not at all concerned, compared with 44% of those aged 65 and over); and ethnic minority patients were more concerned than white patients (30% of ethnic minority patients were not at all concerned, compared with 41% of white patients).

Satisfaction with wait for treatment Despite these levels of concern about what they thought waiting times would be like, patients were satisfied with how long they actually waited between referral by their healthcare professional and the time when they started receiving treatment. More than three in four of those across the region who answered the question and who had started treatment were happy with the length of time they had to wait for treatment (77%), while one in five thought they should have been treated a bit sooner or a lot sooner (20%). Patients in South Birmingham PCT, as well as being less concerned in advance about their wait, were also happiest with the length of time they had to wait. In contrast, patients in Solihull Care Trust and Walsall Teaching PCT were most likely to say they should have been treated at least a bit sooner.

18 Week Patient Experience Survey NHS West Midlands

& Q

( )(

Thinking about the time between your referral to a specialist by your GP/assessment centre doctor and the time when you started receiving treatment. Which of the following apply to you? % I was happy with the length of time I had to wait for treatment % I should have been treated a bit sooner or a lot sooner

West Midlands PCT average

Base (4,650)

South Birmingham

(303)

South Staffordshire

(314)

Warwickshire

(361)

Telford & Wrekin

(289)

Worcestershire

(304)

Birmingham East and North

(226)

Coventry Teaching

(281)

North Staffordshire

(266)

Herefordshire

(366)

Sandwell

(238)

Wolverhampton City

(208)

Stoke on Trent Teaching

(185)

Dudley

(313)

Shropshire County

(329)

Walsall Teaching

(293)

Solihull Care Trust

(225)

Heart of Birmingham Teaching

(136)

Base: All answering who have started treatment

Looking across the West Midlands as a whole, the following groups were more likely to think they should have been treated a bit sooner or a lot sooner: younger patients (22% of those aged between 16 and 54 thought they should have been treated at least a bit sooner, compared with 19% of those aged 55 and over);

18 Week Patient Experience Survey NHS West Midlands

ethnic minority patients, particularly Asian or Asian British patients (30% of ethnic minority patients thought they should have been treated at least a bit sooner, rising to 39% among Asian or Asian British patients); and those who have a long-standing illness or disability (23% thought they should have been treated at least a bit sooner, compared with 17% of those who do not have a long-standing illness or disability). These groups are unlikely to have experienced longer waits than West Midlands residents more generally, suggesting that differences are likely to be a result of varying expectations about what is an acceptable wait.

Causes of delay in receiving treatment Of those who experienced some kind of delay in receiving treatment, the most common reason given across the West Midlands as a whole was waiting for an appointment to see their hospital specialist for the first time (26%). Other reasons commonly mentioned were the length of time between the GP referring them and contact from the hospital (19%) and the wait for an operation (15%). The following table outlines the top three reasons given in each PCT. PCT

Base: all answering who experienced a delay in their treatment (numbers given in brackets after each PCT name)

Birmingham East & North1 (87)

Wait for appointment with hospital specialist (30%)

Wait for operation (20%)

Time between GP referral and contact from hospital (17%)

Coventry

Wait for appointment with hospital specialist (23%)

Time between GP referral and contact from hospital (18%)

Wait for operation (17%)

Wait for appointment with hospital specialist (31%)

Time between GP referral and contact from hospital (20%)

Wait for results of diagnostic test (15%)

Wait for appointment with hospital specialist (27%)

Time between GP referral and contact from hospital (18%)

My appointment was cancelled (13%)

(105)

Dudley (118)

Hereford (149)

Results should be treated with caution, as they are based on a small number of people (87)

18 Week Patient Experience Survey NHS West Midlands

PCT Heart of Birmingham2 (68)

North Staffordshire (103)

Sandwell (120)

Shropshire (149)

Solihull (103)

South Birmingham (110)

South Staffordshire (105)

Stoke-on-Trent3 (84)

Telford & Wrekin (110)

2 3

Time between GP referral and contact from hospital (34%)

Wait for appointment with hospital specialist (29%)

Wait for operation / wait for results of diagnostic test (both 10%)

Wait for appointment with hospital specialist (27%)

Wait for results of diagnostic test (18%)

Time between GP referral and contact from hospital / wait to take diagnostic test (both 15%)

Wait for appointment with hospital specialist (24%)

Time between GP referral and contact from hospital (19%)

Wait for operation / wait for results of diagnostic test / my appointment was cancelled (all 13%)

Wait for appointment with hospital specialist (31%)

Time between GP referral and contact from hospital (15%)

Wait for operation (13%)

Wait for appointment with hospital specialist (32%)

Wait for results of diagnostic test (15%)

Wait for operation / wait to take diagnostic test (both 14%)

Time between GP referral and contact from hospital (32%)

Wait for appointment with hospital specialist (23%)

Wait for operation (15%)

Wait for appointment with hospital specialist (22%)

Time between GP referral and contact from hospital (18%)

Wait for operation / wait for initial assessment (CAS) / my appointment was cancelled (all 10%)

Wait for appointment with hospital specialist (23%)

Time between GP referral and contact from hospital (19%)

Wait for operation (18%)

Wait for appointment with hospital specialist (23%)

Time between GP referral and contact from hospital (18%)

Wait for operation (17%)

Results should be treated with caution, as they are based on a small number of people (68) Results should be treated with caution, as they are based on a small number of people (84)

18 Week Patient Experience Survey NHS West Midlands

PCT Walsall (140)

Warwickshire (114)

Wolverhampton4 (95)

Worcestershire (110)

Time between GP referral and contact from hospital (24%)

Wait for appointment with hospital specialist (21%)

Wait for results of diagnostic test (12%)

Wait for appointment with hospital specialist (24%)

Wait for operation (22%)

Time between GP referral and contact from hospital (16%)

Wait for appointment with hospital specialist (25%)

Time between GP referral and contact from hospital (19%)

Wait for operation (14%)

Wait for appointment with hospital specialist (30%)

Time between GP referral and contact from hospital / wait for operation (both 18%)

Wait for results of diagnostic test (10%)

Patients in Heart of Birmingham PCT and South Birmingham PCT were more likely than others to point to the length of time between their GP referring them and contact from the hospital as the cause of the delay in receiving treatment. Patients in Warwickshire, meanwhile, were more likely than patients in other PCTs to attribute the delay to waits for an operation. North Staffordshire patients were more likely than those in other PCTs to mention diagnostic tests â&#x20AC;&#x201C; both waiting for the results and waiting to take the test. There were more mentions of waiting times for an appointment with a different specialist among patients in Coventry PCT than elsewhere, while those in Herefordshire were more likely to talk about appointments being cancelled than other patients. As we might expect, patients who were admitted as part of their treatment (and were therefore more likely to be having some kind of operation) were more likely to attribute delays in their treatment to waits for an operation (27%, compared with five per cent among those who were not admitted) â&#x20AC;&#x201C; correspondingly those not admitted pointed more to waits for the first appointment with the hospital specialist (30%, compared with 22% among those admitted) and the length of time between the GP referral and contact from the hospital (21% compared with 17%).

Results should be treated with caution, as they are based on a small number of people (95)

18 Week Patient Experience Survey NHS West Midlands

Linking with the higher proportion of patients in Heart of Birmingham PCT who identified the length of time between the GP referral and contact from the hospital as the reason for a delay in treatment, two in five Asian or Asian British patients identified this cause (39%, compared with 19% overall). Further investigation would be needed to explore whether this group of patients are receiving a different service from GPs (perhaps linked to the area being under-doctored), or if they simply have different perceptions â&#x20AC;&#x201C; and what these have been driven by.

18 Week Patient Experience Survey NHS West Midlands

) &

& $

18 Week Patient Experience Survey NHS West Midlands

)

This section explores whether or not patients talked with their GP or doctor about their choice of hospital for treatment, along with the reasons underlying the choice of those who did talk about it with their GP. It also looks at whether those who made a choice were able to go to their first choice of hospital. Summary Although more patients across the West Midlands did not talk with their GP or doctor about their choice of hospital for treatment than did talk about their choice, only between three per cent and 10% in each PCT say they did not talk about their choice and would have liked to have been more involved. For those who did talk about their choice, the location of the hospital, or the fact that it is the local hospital, was the main reason underlying their choice of hospital. The vast majority of patients were able to go to their first choice of hospital.

Discussion of patient choice The extent to which the GP or other healthcare professional discussed the patientâ&#x20AC;&#x2122;s choice of hospital with them varies greatly from PCT to PCT. Across the West Midlands as a whole, more than two in five did discuss their choice (43%). While over half did not discuss their choice of hospital (55%), only six per cent would have liked to have been more involved in the decision. Hence, it is worth bearing in mind that although 68% of Herefordshire patients said they didnâ&#x20AC;&#x2122;t discuss their choice of hospital, 62% did not mind this.

18 Week Patient Experience Survey NHS West Midlands

) Q

At the time of your referral, did you talk about your choice of hospital for treatment with your GP (or another doctor assessing you)? % No, and I would have liked to have been more involved in the decision

% Yes, but I wanted the GP to decide for me

% No, but I didn’t mind

% Yes

Base

West Midlands PCT average

49 7

Solihull Care Trust

Birmingham East and North

Shropshire County

44 10

Heart of Birmingham Teaching

(5,778)

(311)

(265)

(438)

(138)

Warwickshire

(425)

Sandwell

(264)

South Staffordshire

(364)

Coventry Teaching

(363)

Walsall Teaching

(381)

Worcestershire

(389)

Telford & Wrekin

(373)

(280)

Wolverhampton City North Staffordshire

(314)

South Birmingham

(363)

Stoke on Trent Teaching

(246)

Herefordshire

(434)

Dudley

(416)

Base: All answering who were not referred to hospital from an A&E Department

Older patients aged 75 and over were particularly likely to say that they did not discuss their choice of hospital but didn’t mind (54%, compared with 49% overall). Those aged 35 to 54, meanwhile, were more likely to say they had discussed their choice (47%, compared with 43% overall) – although the same proportion as overall said they had discussed their choice but wanted their GP to decide for them (both four per cent).

18 Week Patient Experience Survey NHS West Midlands

Similarly, white patients in particular didnâ&#x20AC;&#x2122;t mind that they didnâ&#x20AC;&#x2122;t discuss their choice of hospital (50%), while ethnic minority patients were less likely to have discussed their choice, but would have liked to have been more involved (10%, compared with six per cent overall). Patients with a long-standing illness or disability were more likely to feel they didnâ&#x20AC;&#x2122;t discuss their choice of hospital and would have liked to be more involved (eight per cent, compared with five per cent of those who do not have a long-standing illness or disability). Those admitted to hospital were marginally more likely than those not admitted to say they talked about their choice with their GP or other doctor (and had wanted to), suggesting that perhaps healthcare professionals talk about choice more for more major referrals (41% compared with 38%).

Reasons for hospital choice Across every PCT in the West Midlands, those patients who talked with their GP about their choice of hospital chose it because of its location (66% overall). The only exception was in Shropshire, whose patients thought the reputation of the hospital (45%) was as important as its location (43%). The following chart outlines the main reasons patients gave for their first choice of hospital across the West Midlands as a whole (all reasons over 10%).

)

Q. What were your main reasons for your first choice of hospital (even if you were not able to go there)? %

Location / local hospital Good previous experience Transport / easy to get to Quality of care Friendliness of staff Reputation of hospital Reputation of consultant Cleanliness / low infection Length of wait for appt Car parking availability Convenience of appt time GP / doc recommend

66 31 27 25 24 21 19 18 16 13 13 13

Base: All answering who were not referred to hospital from an A&E Department and talked with their about their choice of hospital

18 Week Patient Experience Survey NHS West Midlands

These were the main reasons underlying patientsâ&#x20AC;&#x2122; choice of hospital for all PCTs. However, there were some variations in the reasons given, notably5: the reputation of the hospital (45%) and consultant (27%), along with the quality of care (36%) were more frequently cited in Shropshire PCT than in other PCTs â&#x20AC;&#x201C; while location was less important than elsewhere (43%); Solihull Care Trust patients were particularly likely to mention the location of the hospital (74%) or that it is easy to get to (39%), along with the reputation of the hospital (30%); South Birmingham PCT patients put more emphasis than others on the friendliness of staff and reputation of the hospital (both 34%), cleanliness (30%) and the convenience of the appointment time (20%); patients in Walsall PCT were particularly likely to consider the location of the hospital in making their choice (75%), but less likely to consider the quality of care (17%), friendliness of staff (17%), reputation of the hospital (nine per cent) or cleanliness (nine per cent); Telford and Wrekin PCT patients were more likely than others to mention the reputation of the consultant (28%); transport or being easy to get to was a reason for more patients in Heart of Birmingham PCT (42%)6; patients in Dudley PCT were less likely than others to point to a good previous experience (19%), the reputation of the hospital (eight per cent), the reputation of the consultant (11%) or cleanliness (11%) as reasons for their choice; patients in Birmingham East and North were more likely than others to talk about a good previous experience (40%) or convenient appointment time (18%); South Staffordshire PCT patients were more likely to choose their hospital because of a good previous experience (38%) or the availability of car parking (19%); and patients in Warwickshire PCT were more likely than others to base their choice on the location of the hospital (74%). 5 6

Where a PCT is not mentioned, its results are broadly in line with the average across the region Results should be treated with caution, as they are based on a small number of people (64)

18 Week Patient Experience Survey NHS West Midlands

Able to attend first choice hospital? The vast majority of patients who talked with their healthcare professional about their choice of hospital (who answered the question) were able to go to their first choice of hospital. However, fewer were able to go to their first choices in Coventry, Solihull and Heart of Birmingham.

+ Q

)

Were you able to go to your first choice of hospital?

% No

% Yes Base

West Midlands PCT average

(2,337)

Wolverhampton City

(103)

North Staffordshire

(103)

Shropshire County

(212)

Warwickshire

(202)

Walsall Teaching

(161)

South Birmingham

(120)

Dudley

(112)

South Staffordshire

(166)

Telford & Wrekin

(142)

Stoke on Trent Teaching

(75)*

Herefordshire

(121)

Sandwell

(123)

Birmingham East and North

(142)

Worcestershire

(141)

Solihull Care Trust Heart of Birmingham Teaching Coventry Teaching

(179)

(66)*

(163)

* Please treat results with caution, as they are based on a small number of people Base: All answering who were not referred to hospital from an A&E Department and who talked with their GP about their choice of hospital

18 Week Patient Experience Survey NHS West Midlands

This section looks at how patients booked their first hospital appointment and how easy they found it, along with whether or not they were offered a choice of dates and times for the appointment and whether the dates and times they were offered were convenient. It also explores whether patients’ appointments were cancelled or rearranged by the hospital or call centre, whether they cancelled or rearranged their own appointments and if they did, how easy it was. Finally, it looks at experiences of waiting times when actually at the hospital. Summary Few patients found it difficult to arrange their first hospital appointment, although it was more difficult for those in Coventry and Wolverhampton PCTs, for younger patients and for ethnic minority patients. The vast majority of patients across PCTs were not offered a choice of dates and times of day for their appointments. Having said this, the dates and times offered were convenient for most – with patients in Sandwell PCT and Heart of Birmingham PCT finding their dates and times less convenient than others.

For those who found dates

inconvenient, this was generally because they were not soon enough or patients were not given enough choice. For those who found times inconvenient, the main reasons given were them being too early in the day, not being outside working hours, or being too late in the day. Across the West Midlands as a whole, 16% of patients had their appointment cancelled or rearranged by the hospital or call centre and 10% cancelled or rearranged their appointment themselves. When actually at the hospital, however, patients were sometimes having to wait a while after their appointment time before they were seen – 23% across the West Midlands waited for 30 minutes or longer after their given appointment time.

Booking hospital appointments Patients were asked how they booked their first hospital appointment and amalgamating the methods that suggest a booking via Choose and Book (via the appointments line, on-screen, or by internet), around two in five booked their appointment through the system (44%). Choose and Book seems more highly used in the following PCTs: Solihull Care Trust (51%); Coventry PCT (52%); Birmingham East and North PCT (54%);

18 Week Patient Experience Survey NHS West Midlands

Stoke-on-Trent PCT (51%); and Warwickshire PCT (51%). Most patients found it easy to arrange their first hospital appointment, with only one in twenty on average across the region saying it was difficult (five per cent). Patients in South Birmingham PCT found it particularly easy (85%), while those in Coventry and Wolverhampton PCTs found it particularly difficult (both nine per cent).

18 Week Patient Experience Survey NHS West Midlands

& Q

Was it easy or difficult to arrange your first hospital appointment? % Difficult

% Easy Base

West Midlands PCT average

South Birmingham

(413)

Birmingham East and North

(315)

Solihull Care Trust

(344)

Dudley

(468)

Coventry Teaching

(401)

Warwickshire

(494)

Walsall Teaching

(417)

South Staffordshire

(436)

Telford & Wrekin

(451)

Herefordshire

(535)

Shropshire County

(523)

North Staffordshire

(373)

Stoke on Trent Teaching

(295)

Sandwell

(339)

Worcestershire

(461)

Wolverhampton City

(328)

Heart of Birmingham Teaching

(172)

(6,783)

Base: All, fieldwork 24 November 2008 â&#x20AC;&#x201C; 2 January 2009

Other groups who found it more difficult to book their appointments include: younger patients (10% of 16 to 34 year olds found it difficult, compared with five per cent overall); and ethnic minority patients (11% found it difficult).

18 Week Patient Experience Survey NHS West Midlands

When presented with a number of possibilities that may have happened when trying to book an appointment, the most commonly experienced problems were waiting longer than five minutes to speak to someone (six per cent) and not being given clear information about who to contact if they wanted to discuss or rearrange their appointment (four per cent). Patients in the Heart of Birmingham and Sandwell PCTs were particularly likely to say they had to wait more than five minutes to speak to someone (14% and 12% respectively), while those in Heart of Birmingham PCT were also more likely to say they were not given clear information about who to contact if they wanted to discuss or rearrange their appointment (six per cent). Patients in Solihull Care Trust and Warwickshire PCT were more likely than others to point to difficulties getting through to both the local call centre (both five per cent) and the national appointments line (four per cent and three per cent respectively). The following groups were more likely to say they did not have any of these difficulties: those who do not have a long-standing illness or disability (60%, compared with 53% among those who do have a long-standing illness or disability; men (58% had none of these difficulties, compared with 55% of women); older people aged 75 and over (51%, compared with 54% overall); and white patients (58% had none of these difficulties, compared with 40% of ethnic minority patients).

Convenience of appointment dates and times Patients were generally not offered a choice of different dates or times when their first hospital appointment was made. Across the region, one in four were offered a choice of dates (24%) and one in five were offered a choice of times of day (19%). Patients in Dudley and Worcestershire PCTs were least likely to have been offered a choice of days or times, while patients in Telford and Wrekin PCT and Shropshire PCT were more likely to have been offered choices. Younger patients and ethnic minority patients were also more likely to have been offered a choice of dates and times.

18 Week Patient Experience Survey NHS West Midlands

) Q

When your first appointment was made, were you offered a choice of different dates? % Yes

% No

Base West Midlands PCT average

(6,783)

Telford & Wrekin

(451)

Shropshire County

(523)

(413)

South Birmingham Heart of Birmingham Teaching

(172)

South Staffordshire

(436)

Stoke on Trent Teaching

(295)

Warwickshire

(494)

Birmingham East and North

(315)

Walsall Teaching

(417)

Coventry Teaching

(401)

North Staffordshire

(373)

(339)

Sandwell Solihull Care Trust

(344)

Herefordshire

(535)

Wolverhampton City

(328)

Worcestershire

(461)

Dudley

(468)

Base: All, fieldwork 24 November 2008 â&#x20AC;&#x201C; 2 January 2009

18 Week Patient Experience Survey NHS West Midlands

Across the West Midlands, one in five patients were offered a choice of times of day (19%).

) Q

When your first hospital appointment was made, were you offered a choice of times of day? % No

% Yes Base

West Midlands PCT average

(6,783)

Heart of Birmingham Teaching

(172)

South Staffordshire

(436)

Telford & Wrekin

(451)

Shropshire County

(523)

(413)

South Birmingham

Stoke on Trent Teaching

(295)

Warwickshire

(494)

Wolverhampton City

(328)

North Staffordshire

(373)

Sandwell

(339)

Walsall Teaching

(417)

Coventry Teaching

(401)

Herefordshire

(535)

Birmingham East and North

(315)

(344)

Solihull Care Trust

Dudley

(468)

Worcestershire

(461)

Base: All, fieldwork 24 November 2008 â&#x20AC;&#x201C; 2 January 2009

However, despite largely not having been offered a choice of dates or times, most found the dates and times that were offered convenient (82% and 80% respectively found them convenient across the West Midlands as a whole). Patients in Warwickshire were particularly likely to say the dates and times they were offered were convenient, while those

18 Week Patient Experience Survey NHS West Midlands

in Sandwell PCT and Heart of Birmingham PCT were particularly unlikely to say they were convenient (and times were less convenient in Walsall PCT). Again, further exploration is needed into why dates and times are perceived to be more convenient in some PCTs than in others.

& Q

Were the date(s) offered convenient? (sufficient to allow you to make childcare or work arrangements, for example) % Yes

% No

Base West Midlands PCT average

Warwickshire

(494)

South Birmingham

(413)

Shropshire County

(523)

Coventry Teaching

(401)

Worcestershire

(461)

South Staffordshire

(436)

North Staffordshire

(373)

Solihull Care Trust

(344)

Birmingham East and North

(315)

(468)

Herefordshire

(535)

Wolverhampton City

(328)

Walsall Teaching

(417)

Stoke on Trent Teaching

(295)

Telford & Wrekin

(451)

Sandwell

(339)

Dudley

Heart of Birmingham Teaching 13

Base: All, fieldwork 24 November 2008 â&#x20AC;&#x201C; 2 January 2009

(6,783)

(172)

18 Week Patient Experience Survey NHS West Midlands

A similar proportion found the times of day offered convenient (80%).

& Q

Were the time(s) of day offered convenient?

% Yes

% No

Base SHA average

(6,783)

Worcestershire

(461)

Warwickshire

(494)

South Birmingham

(413)

Coventry Teaching

(401)

Shropshire County

(523)

South Staffordshire

(436)

Herefordshire

(535)

Wolverhampton City

(328)

North Staffordshire

(373)

Stoke on Trent Teaching

(295)

Solihull Care Trust

(344)

Dudley

(468)

Birmingham East and North

(315)

Telford & Wrekin

(451)

Sandwell

(339)

(417)

Heart of Birmingham Teaching 13

(172)

Walsall Teaching

Base: All, fieldwork 24 November 2008 â&#x20AC;&#x201C; 2 January 2009

18 Week Patient Experience Survey NHS West Midlands

The following groups were less likely to say they were offered convenient dates and times: younger patients â&#x20AC;&#x201C; 14% of those aged 16 to 34 and 10% of those aged 35 to 54 said the dates offered were not convenient (seven per cent overall), and 15% of 16-34 year olds and 10% of 35 to 54 year olds said the times offered were not convenient (seven per cent overall); and ethnic minority patients â&#x20AC;&#x201C; 14% of ethnic minority patients said the dates were not convenient and 17% said the times were not convenient, compared with seven per cent of white patients for both. Those who have a long-standing illness or disability were equally as likely as those who do not to say the day offered was convenient (seven per cent of each say it was not), but found the times of day offered marginally less convenient (eight per cent of those with a disability say it was not convenient, compared with six per cent of those who do not). For those whose appointment date was not convenient, the main reasons given were that it was not soon enough (23%), they werenâ&#x20AC;&#x2122;t given enough choice (23%), it was too soon (nine per cent), that they were going on holiday (nine per cent), or had other engagements (five per cent) or work commitments (five per cent). For those whose appointment time was not convenient, the main reasons given were that it was too early in the day (30%), not outside working hours (29%), too late in the day (21%), or that they did not have transport (three per cent). Older patients were particularly likely to point to appointments being too early in the day (58% among those aged 75 and over7) or not having transport (11%), those aged between 65 and 748 were more likely to mention times being too late in the day (39%), and those aged between 35 and 64 were more likely to say times were not convenient because they were not outside working hours (42%). Similarly, patients with a long-standing illness or disability were more likely to say the times offered were not convenient because they were too early (40%) or too late (25%) in the day, while those without a disability were more likely to say they were not outside working hours (47%).

7 8

Results should be treated with caution, as they are based on a small number of people (81) Results should be treated with caution, as they are based on a small number of people (56)

18 Week Patient Experience Survey NHS West Midlands

Rearranging hospital appointments Around one in six patients say they had their initial hospital appointment cancelled or rearranged by the hospital or call centre (16%). Patients in Heart of Birmingham PCT and Sandwell PCT were particularly likely to say their appointment was cancelled or rearranged, while this was perceived as less of a problem in Worcestershire.

Again, it would be

interesting to explore whether there are actual differences in the proportion of appointments cancelled or rearranged, or if patients perceptions differ for some reason.

$$ %

% %

Did the hospital or call centre cancel or rearrange your initial hospital appointment? % Yes

% No

Base West Midlands PCT average

(6,783)

Heart of Birmingham Teaching

(172)

Sandwell

(339)

(401)

(295)

Coventry Teaching Stoke on Trent Teaching

73 69

Walsall Teaching

(417)

North Staffordshire

(373)

Solihull Care Trust

(344)

Warwickshire

(494)

Shropshire County

(523)

Telford & Wrekin

(451)

South Birmingham

(413)

South Staffordshire

(436)

Herefordshire

(535)

Dudley

(468)

Wolverhampton City

(328)

Birmingham East and North

(315)

(461)

Worcestershire

Base: All, fieldwork 24 November 2008 â&#x20AC;&#x201C; 2 January 2009

18 Week Patient Experience Survey NHS West Midlands

Groups of patients who seemed to have more appointments cancelled or rearranged include: ethnic minority patients (22%); those with a long-standing illness or disabiltiy (19%); and those who were admitted to hospital (19%). In addition, one in ten patients across the West Midlands cancelled or rearranged their hospital appointment themselves (10%). This was particularly prevalent in Heart of Birmingham PCT, South Birmingham PCT and Dudley PCT, but less so in Telford and Wrekin PCT and Warwickshire PCT. Again, this needs further analysis â&#x20AC;&#x201C; although Heart of Birmingham PCT patients were more likely to say the dates and times were not convenient, patients in the other PCTs were no more likely than average to say so â&#x20AC;&#x201C; which raises the question of why they needed to cancel or rearrange.

18 Week Patient Experience Survey NHS West Midlands

$$ % Q

% %

Did you cancel or rearrange your initial hospital appointment?

% Yes

% No

Base West Midlands PCT average

Heart of Birmingham Teaching

80 70

(6,783)

(172)

South Birmingham

(413)

Dudley

(468)

Solihull Care Trust

(344)

Walsall Teaching

(417)

Stoke on Trent Teaching

(295)

Coventry Teaching

(401)

North Staffordshire

(373)

Herefordshire

(535)

Sandwell

(339)

Worcestershire

(461)

Wolverhampton City

(328)

South Staffordshire

(436)

Birmingham East and North

(315)

Shropshire County

(523)

Telford & Wrekin

(451)

Warwickshire

(494)

Base: All, fieldwork 24 November 2008 â&#x20AC;&#x201C; 2 January 2009

18 Week Patient Experience Survey NHS West Midlands

The following groups were particularly likely to cancel or rearrange their own appointments: women (11%); younger patients (16% of those aged 16 to 34 and 13% of those aged 35 to 54); ethnic minority patients (16%); those who do not have a long-standing illness or disability (11%); and those admitted to hospital (11%). Of those who did cancel or rearrange their appointment, around one in ten found it difficult to do so (12%), while most found it easy (85%).

Wait at time of appointment When attending the hospital for their appointment, around one in three patients across the West Midlands were seen on time, or early (32%). However, approaching one in four were seen over 30 minutes after their appointment time (23%). Patients in South Birmingham PCT tend to be seen more promptly, while those in North Staffordshire and Dudley PCTs tend to have to wait longer. Men (36%), older patients (35% of those aged 65 and over), white patients (33%) and those without a disability (34%) were also more likely to say they were seen on time, or early. This suggests that waiting times within the system need to be looked at, along with perceptions of overall waiting. Again, more in-depth research is needed to explore what drives these perceptions of shorter waits among these groups.

18 Week Patient Experience Survey NHS West Midlands

) ) Q

How long after your appointment time were you seen? % On time, early, or up to 30 minutes later

% Over 30 minutes later

Base West Midlands PCT average

(6,783)

Herefordshire

(535)

South Staffordshire

(436)

Warwickshire

(494)

Heart of Birmingham Teaching

(172)

Coventry Teaching

(401)

South Birmingham

(413)

Birmingham East and North

(315)

Worcestershire

(461)

Solihull Care Trust

(344)

Telford & Wrekin

(451)

Walsall Teaching

(417)

Shropshire County

(523)

Wolverhampton City

(328)

Sandwell

(339)

Stoke on Trent Teaching

(295)

Dudley

(468)

North Staffordshire

Base: All, fieldwork 24 November 2008 â&#x20AC;&#x201C; 2 January 2009

(373)

18 Week Patient Experience Survey NHS West Midlands

This section looks at patientsâ&#x20AC;&#x2122; satisfaction with various aspects of their care, focusing on cleanliness and the general condition of the hospital, explanations of treatment and whether they feel they were involved in decisions, and whether they were treated with dignity and respect. Summary Patients were generally positive about all aspects of their care.

A majority thought the

hospital was clean and were satisfied with the general condition of hospital buildings. Very few said the specialist didnâ&#x20AC;&#x2122;t explain what would happen next in their treatment clearly, or that they were not as involved in decisions about their care as they would have liked. Virtually all patients said they were treated with respect and dignity. Younger patients and ethnic minority patients were consistently less satisfied with these various aspects of care.

Hospital cleanliness and general condition On the whole, patients were very satisfied with the cleanliness of their hospital or clinic, with more than half saying it was very clean (56%) and a further two in five saying it was fairly clean (37%). Only two per cent said it was not very clean or not at all clean. However, views vary hugely from PCT to PCT, as shown in the chart below.

18 Week Patient Experience Survey NHS West Midlands

$ $

How clean was the hospital or clinic? % Very clean

% Fairly clean

Base West Midlands PCT average

Shropshire County

(6,783) (523)

Coventry Teaching

(401)

Worcestershire

(461)

South Birmingham

(413)

Dudley

(468)

Telford & Wrekin

(451)

Sandwell

(339)

Wolverhampton City

(328)

Herefordshire

(535)

Birmingham East and North

(315)

Solihull Care Trust

(344)

Warwickshire

(494)

South Staffordshire

(436)

North Staffordshire

(373)

Stoke on Trent Teaching

(295)

Heart of Birmingham Teaching

(172)

Walsall Teaching

(417)

Base: All, fieldwork 24 November 2008 â&#x20AC;&#x201C; 2 January 2009

There are some differences within PCTs for those using more than one provider: for Warwickshire PCT, more said the hospital was very clean for those referred to South Warwickshire General Hospitals NHS Trust than for those referred to the George Eliot Hospital NHS Trust (61% compared with 45%);

18 Week Patient Experience Survey NHS West Midlands

for South Staffordshire PCT, patients using Burton Hospitals NHS Trust were more likely to say the hospital was very clean than those using Mid Staffordshire General Hospitals NHS Trust was (58% compared with 47%); and for Shropshire PCT, patients using the Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust were particularly satisfied with cleanliness (78% said it was very clean), with those using Shrewsbury and Telford Hospitals NHS Trust less positive (53%). Perceptions of cleanliness tended to be more negative among: women, in comparison with men (55% say the hospital was very clean, compared with 59% of men); younger patients (50% of patients aged 16 to 64 say it was very clean, compared with 64% of those aged 65 and over); ethnic minority patients (41% say it was very clean, compared with 58% of white patients); those who have a long-standing illness or disability (55% say it was very clean, compared with 58% of those who do not have one); and those who visited hospital but were not admitted to a bed at all (57% say it was very clean, compared with 61% of those not admitted). Patients also tended to be satisfied with the general condition of the hospital buildings where they were seen or treated â&#x20AC;&#x201C; over half were very satisfied and only two per cent were very or fairly dissatisfied. Again, opinions varied largely by PCT.

18 Week Patient Experience Survey NHS West Midlands

/ Q

$0 $

How satisfied or dissatisfied were you with the general condition of the hospital building(s) where you were seen or treated? % Fairly satisfied

% Very satisfied Base

West Midlands PCT average

(6,783)

Dudley

(468)

Shropshire County

(523)

Coventry Teaching

(401)

Worcestershire

(461)

Birmingham East and North

(315)

Telford & Wrekin

(451)

Herefordshire

(535)

Solihull Care Trust

(344)

(328)

Wolverhampton City

South Staffordshire

(436)

South Birmingham

(413)

Sandwell

(339)

Warwickshire

(494)

Heart of Birmingham Teaching

(172)

North Staffordshire

(373)

Stoke on Trent Teaching

(295)

Walsall Teaching

(417)

Base: All, fieldwork 24 November 2008 â&#x20AC;&#x201C; 2 January 2009

PCTs highly thought of for cleanliness also performed well on the general condition of hospital buildings. However, there were fewer differences within PCTs for those using more than one provider. The exception was for Shropshire PCT, where 68% were very satisfied with buildings in the Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, but less satisfied for Shrewsbury and Telford Hospitals NHS Trust (51%).

18 Week Patient Experience Survey NHS West Midlands

Similar patterns among demographic groups hold as for cleanliness with regard to the general condition of hospital buildings.

Discussions with a specialist Most patients felt that their specialist explained clearly what would happen next in their treatment (86%) and only seven per cent said they didnâ&#x20AC;&#x2122;t explain it clearly.

18 Week Patient Experience Survey NHS West Midlands

$ Q

After you saw the specialist, did they explain clearly what would happen next in your treatment? % Yes

% No

Base West Midlands PCT average

(6,783)

Warwickshire

(494)

South Birmingham

(413)

Shropshire County

(523)

Dudley

(468)

Sandwell

(339)

Worcestershire

(461)

Coventry Teaching

(401)

South Staffordshire

(436)

North Staffordshire

(373)

Telford & Wrekin

(451)

Herefordshire

(535)

Birmingham East and North

(315)

Wolverhampton City

(328)

(417)

Heart of Birmingham Teaching

(172)

Stoke on Trent Teaching

(295)

(344)

Walsall Teaching

Solihull Care Trust

Base: All, fieldwork 24 November 2008 â&#x20AC;&#x201C; 2 January 2009

Patients aged 16 to 34 were more likely to think their treatment was not clearly explained (18%), as were ethnic minority patients (12%). As well as feeling like their treatment was explained, nine in ten were involved as much as they wanted to be in decisions about their care and treatment (89%) â&#x20AC;&#x201C; of these, three in five said they were definitely involved as much as they wanted to be (61%).

18 Week Patient Experience Survey NHS West Midlands

$ Q

Were you involved as much as you wanted to be in decisions about your care and treatment?

% No

% Yes, to some extent

% Yes, definitely

Base West Midlands PCT average

(4,916)

South Staffordshire

(320)

Telford & Wrekin

6 22

South Birmingham

(316)

Warwickshire

(385)

Shropshire County

(347)

Dudley

(329)

Solihull Care Trust

Worcestershire

(326)

Birmingham East and North

(239)

Coventry Teaching

(293)

Sandwell

Herefordshire

(394)

North Staffordshire

(270)

Wolverhampton City

(229)

Walsall Teaching

Stoke on Trent Teaching

Heart of Birmingham Teaching

36 30

(314)

(237)

(255)

(311) (197) (139)

Base: All answering, fieldwork 24 November 2008 â&#x20AC;&#x201C; 2 January 2009

Those in South Staffordshire PCT were more likely to say they were definitely involved in decisions when they were referred to Burton Hospitals NHS Trust than for Mid Staffordshire General Hospitals NHS Trust (71% compared with 59%). Similarly, Warwickshire PCT patients were more positive about South Warwickshire General Hospitals NHS Trust than George Eliot Hospital NHS Trust (70% compared with 57%).

18 Week Patient Experience Survey NHS West Midlands

Again, younger patients and ethnic minority patients were more likely to say they were not involved as much as they wanted to be (both 13%, compared with eight per cent overall). Patients with a disability also felt less involved than those without (10% compared with six per cent).

Respect and dignity Across the West Midlands, patients were generally very positive about whether they were treated with dignity and respect. Almost all said they were (97%), and 86% of these said they always were.

18 Week Patient Experience Survey NHS West Midlands

* Q

% Overall, do you feel you have been treated with respect and dignity since you were told you needed treatment?

% No

% Yes, sometimes

% Yes, always

Base West Midlands PCT average

311

(6,448)

Worcestershire

(438)

Heart of Birmingham Teaching

1 19

South Birmingham

2 13

(400)

Warwickshire

211

(473)

Shropshire County

(492)

Stoke on Trent Teaching

311

(279)

South Staffordshire

410

(417)

Telford & Wrekin

310

(429)

Dudley

311

(446)

Solihull Care Trust

3 12

(325)

Birmingham East and North

2 12

(298)

Coventry Teaching

311

(385)

Sandwell

2 15

(323)

Herefordshire

311

(508)

North Staffordshire

2 12

(347)

Wolverhampton City

311

(300)

Walsall Teaching

4 13

(403)

(167)

Base: All answering, fieldwork 24 November 2008 â&#x20AC;&#x201C; 2 January 2009

South Staffordshire PCT patients using Burton Hospitals NHS Trust were more likely to say they were always treated with respect and dignity than those using Mid Staffordshire General Hospitals NHS Trust (90% compared with 83%). Again, younger patients aged 16 to 34 seemed less satisfied, with seven in ten saying they were always treated with respect and dignity (71%, compared with 86% overall), as were

18 Week Patient Experience Survey NHS West Midlands

ethnic minority patients (79%) and those with a disability (83%). Again, this relates to perceptions of respect and dignity, so more exploration is needed on what these groups expect and how that might differ to other groups. Other research conducted with patients for the NHS by Ipsos MORI, as well as by the Healthcare Commission, shows a strong relationship between levels of overall satisfaction with care and agreement that patients have been treated with dignity and respect. Indeed, across the West Midlands the vast majority of patients also believe they were treated with dignity and respect at all times during their referral-to-treatment pathways. The graph below, taken from our Frontiers analysis using Healthcare Commission data9, illustrates the strength of this relationship across a range of PCTs around the country.

Treated with dignity and respect and ratings of overall inpatient care Newcastle

0.85

= 0.877

upon Tyne

South Manchester

0.80 Norfolk & Norwich

Ratings of overall care

UCLH

0.75

Peterborough & Stamford

Newham

0.70

Barnet & Chase Farm

0.65 N. Middlesex

Mayday

0.60 0.75 Source: NHS inpatient survey 2006

0.80

0.85

0.90

0.95

Treated with dignity and respect

* National Survey of Adult Inpatients 2006, Healthcare Commission

This graph is taken from Frontiers of Performance in the NHS II, Ipsos MORI, 2008

18 Week Patient Experience Survey NHS West Midlands

'.&

18 Week Patient Experience Survey NHS West Midlands

'.& This section explores the information patients were given following their treatment â&#x20AC;&#x201C; both discussions with healthcare professionals and written information. Summary Not all patients discussed aftercare or recommendations on exercise, lifestyle or diet with a healthcare professional, or were given written information following their treatment. Levels of aftercare tended to be higher for those admitted to a hospital bed for treatment. Across the West Midlands, two in five said they fully discussed any aftercare or recommendations on exercise, lifestyle or diet with a healthcare professional (42%), and a further one in four said they did so briefly (25%). However, three in ten said they did not have these discussions at all (30%).

18 Week Patient Experience Survey NHS West Midlands

1 Q

& $$ (

Following your treatment (or being told you did not need treatment) did you discuss any aftercare or recommendations on exercise, lifestyle or diet with the healthcare professional that would help you to recover and improve your health? % Yes, briefly

% No, not at all

% Yes, fully

Base West Midlands PCT average

Warwickshire

Shropshire County

(345)

South Staffordshire

(306)

South Birmingham

(304)

Herefordshire

(375)

Birmingham East and North

(230)

Worcestershire

(317)

Telford & Wrekin

North Staffordshire

Heart of Birmingham Teaching

19 24

42 44

48 43

(4,757) (366)

(301) (266)

(134)

Dudley

(321)

Solihull Care Trust

(235)

Sandwell

Walsall Teaching

(305)

Stoke on Trent Teaching

(191)

Coventry Teaching

(284)

Wolverhampton City

(248)

(216)

Base: All answering, fieldwork 24 November 2008 â&#x20AC;&#x201C; 2 January 2009

Half were given written information (50%), while one in five (20%) said they were not given any written information at all (i.e. they did need it and were not told where to find it).

18 Week Patient Experience Survey NHS West Midlands

& Q

Were you given any written information?

% No, not at all

% No, but I was told where to find it

% No, but I didn’t need it

% Yes

Base West Midlands PCT average

South Birmingham

22 5

(4,934)

16 5

(312)

21 4

(322)

(139)

South Staffordshire

Heart of Birmingham Teaching

17 14 9

Warwickshire

21 5

(376)

Telford & Wrekin

22 3

(311)

(388)

Herefordshire

Sandwell

18 7

(257)

Birmingham East and North

23 4

(237)

Solihull Care Trust

20 4

(244)

Worcestershire

24 3

(323)

Walsall Teaching

18 6

(316)

Stoke on Trent Teaching

20 7

(207)

North Staffordshire

(273)

Shropshire County

(354)

Dudley

(336)

Wolverhampton City

(231)

Coventry Teaching

(293)

Base: All answering, fieldwork 24 November 2008 – 2 January 2009

For both discussions and written information, Coventry and Wolverhampton PCTs may need to improve the provision of information following treatment – alternatively, it may be that patients in these areas require different kinds of information, or have different expectations about what they want to receive. Further work is needed to probe this. Other groups for whom discussions and information about aftercare seem less complete were:

18 Week Patient Experience Survey NHS West Midlands

women; younger patients; ethnic minority patients for discussions with healthcare professionals; and written information for those with a disability. Patients admitted to a hospital bed for treatment were more likely than those not admitted to have had full discussions with a healthcare professional about aftercare and recommendations (51% compared with 36%) and to have received written information (67% compared with 39%). This suggests that interaction with healthcare professionals may be enough for patients to feel they have received aftercare, or that it is more routinely given for more major treatment.

18 Week Patient Experience Survey NHS West Midlands

& &

)

18 Week Patient Experience Survey NHS West Midlands

)

This section gives some recommendations for further research – areas that may benefit from more exploration in qualitative research. The 18 Week Patient Experience Survey is a quantitative survey focusing on specific aspects of the 18 week pathway, and understanding patients’ perceptions of that pathway. There are three broad options for further research and analysis to explore the pathway in more detail: 1. Research in particular PCTs where patients appear more or less satisfied than others. 2. Research among particular groups who seem more or less satisfied than others. 3. Research on particular aspects of the pathway that may need improvement. This research should seek to understand whether actual differences in patient experience exist, or whether differences are a result of varying expectations and perceptions. Where perceptions differ, it would be interesting to explore where they differ, why they may differ, and what could be done to improve perceptions.

Research in particular PCTs PCTs that may benefit from further research include: Heart of Birmingham PCT – patients were often less satisfied with the patient pathway which, coupled with the very low response rate in this area, suggest further research is needed; and South Birmingham PCT – patients often tended to be more satisfied with various aspects of their care.

Research among particular groups of patients The following groups of patients often appeared less satisfied with the pathway, and so warrant further research – particularly research that is able to compare them to the more satisfied groups: ethnic minority patients; younger patients; and

18 Week Patient Experience Survey NHS West Midlands

patients with a long-term illness or disability.

Aspects of the pathway Aspects of the pathway that perhaps were not as highly thought of, and so could benefit from further research, include: perceptions of how long patients thought they would have to wait when first told they would need treatment; waiting times when actually at the hospital; the reasons patients seemed not to be concerned about their GP talking with them about their choice of hospital; patientsâ&#x20AC;&#x2122; needs when making appointments and how to make the system more flexible; and aftercare requirements.

18 Week Patient Experience Survey NHS West Midlands

. These appendices are intended to provide the information and details required to read and understand the data generated by the 18 Week Patient Experience Survey. The following sections are included: mailout and response rate figures; sample profile; guide to statistical reliability; reading computer tabulations; and questionnaire

18 Week Patient Experience Survey NHS West Midlands

A. Mailout and response rate figures The survey was conducted among 25,321 patients in the West Midlands through a selfcompletion questionnaire between 24th November 2008 and 2nd January 2009. Selfcompletion questionnaires were sent by participating healthcare providers to a sample of their patients who had a â&#x20AC;&#x2DC;clock startâ&#x20AC;&#x2122; up to 20 weeks prior to fieldwork. The mailout figures and returns are presented in table below along with the response rate achieved. PCT

Provider

Mailout

Returns

Response rate (%)

Birmingham East and North

Heart of England NHS Foundation Trust

1,321

315

Coventry

University Hospitals Coventry & Warwickshire

1,500

401

Dudley

Dudley Group of Hospitals NHS Trust

1,500

468

Heart of Birmingham

Sandwell & West Birmingham Hospitals NHS Trust

1,500

172

Herefordshire

Hereford Hospitals NHS Trust

1,500

535

North Staffordshire

University Hospital of North Staffordshire

1,500

373

Sandwell

Sandwell & West Birmingham Hospitals NHS Trust

1,500

339

Shropshire

Shrewsbury & Telford Hospitals NHS Trust

1,500

523

Robert Jones & Agnes Hunt NHS Trust Solihull

Heart of England NHS Foundation Trust

1,500

344

South Birmingham

University Hospital Birmingham NHS Trust

1,500

413

1,500

436

Royal Orthopaedic Hospital NHS Trust South Staffordshire

Mid Staffordshire General Hospitals NHS Trust Burton Hospitals NHS Trust

18 Week Patient Experience Survey NHS West Midlands

PCT

Provider

Mailout

Returns

Response rate (%)

Stoke-on-Trent

University Hospital of North Staffordshire

1,500

295

Telford and Wrekin

Shrewsbury & Telford Hospitals NHS Trust

1,500

451

Walsall

Walsall Hospitals NHS Trust

1,500

417

Warwickshire

George Eliot Hospitals NHS Trust

1,500

494

South Warwickshire General Hospitals NHS Trust Wolverhampton

Royal Wolverhampton Hospitals NHS Trust

1,500

328

Worcestershire

Worcestershire Acute Hospitals NHS Trust

1,500

461

18 Week Patient Experience Survey NHS West Midlands

B. Respondent profile The tables below and overleaf outline the profile of the patients who responded in each PCT. BEN Total Gender Male Female Age 16-34 35-54 55-64 65-74 75+ Ethnicity White BME Mixed Asian/Asian British Black/Black British Chinese or other ethnic group Disability Yes No Admitted Yes No

N 315

% 100

Coventry % N 100 401

Dudley

HoB

N 468

% 100

N 172

% 100

Herefordshire N % 100 535

117 155

37 49

149 213

37 53

164 251

35 54

65 79

38 46

200 264

37 49

31 64 54 69 52

10 20 17 22 17

33 91 89 64 90

8 23 22 16 22

28 97 98 95 108

6 21 21 20 23

12 42 31 32 25

7 24 18 19 15

27 82 91 126 142

5 15 17 24 27

246 36 8 14

78 11 3 4

353 20 1 12

88 5 * 3

420 16 1 8

90 3 * 2

64 82 8 46

37 48 5 27

477 8 0 2

89 1 0 *

124 149

39 47

156 206

39 51

200 225

43 48

83 58

48 34

222 243

41 45

87 145

37 61

102 188

35 65

110 215

33 65

58 72

41 51

158 241

39 60

18 Week Patient Experience Survey NHS West Midlands

Total Gender Male Female Age 16-34 35-54 55-64 65-74 75+ Ethnicity White BME Mixed Asian/Asian British Black/Black British Chinese or other ethnic group Disability Yes No Admitted Yes No

North Staffs % N 100 373

Sandwell % N 100 339

Shropshire N % 100 523

Solihull N % 100 344

S. Birming N % 100 413

171 163

46 44

124 170

37 50

185 278

35 53

128 173

37 50

174 201

42 49

20 74 94 76 80

5 20 25 20 21

12 58 67 72 86

4 17 20 21 25

26 98 114 131 96

5 19 22 25 18

16 63 70 65 95

5 18 20 19 28

22 89 96 90 82

5 22 23 22 20

347 1 0 0

93 * 0 0

285 21 2 9

84 6 1 3

468 8 3 1

89 2 1 *

302 12 0 6

88 3 0 2

351 35 3 10

85 8 1 2

177 160

47 43

169 122

50 36

195 264

37 50

114 190

33 55

168 213

41 52

115 155

42 57

136 116

52 45

161 189

45 53

93 147

38 61

156 157

49 50

18 Week Patient Experience Survey NHS West Midlands

Total Gender Male Female Age 16-34 35-54 55-64 65-74 75+ Ethnicity White BME Mixed Asian/Asian British Black/Black British Chinese or other ethnic group Disability Yes No Admitted Yes No

South Staffs % N 100 436

Stoke

T&W

Walsall

N 295

% 100

N 451

% 100

N 417

% 100

Warwickshire % N 100 494

157 227

36 52

121 143

41 48

168 224

37 50

159 210

38 50

175 257

35 52

33 107 78 86 86

8 25 18 20 20

26 59 55 65 61

9 20 19 22 21

22 83 101 94 96

5 18 22 21 21

32 111 89 91 51

8 27 21 22 12

35 101 112 113 82

7 20 23 23 17

391 5 0 1

90 1 0 *

254 17 2 8

86 6 1 3

397 9 1 3

88 2 * 1

347 38 2 28

83 9 * 7

430 17 2 10

87 3 * 2

164 225

38 52

157 111

53 38

190 201

42 45

183 187

44 45

175 262

35 53

120 201

37 62

83 114

41 56

166 152

51 47

124 188

39 58

142 232

38 62

18 Week Patient Experience Survey NHS West Midlands

Total Gender Male Female Age 16-34 35-54 55-64 65-74 75+ Ethnicity White BME Mixed Asian/Asian British Black/Black British Chinese or other ethnic group Disability Yes No Admitted Yes No

Wolverhamp % N 100 328

Worcs N 461

% 100

119 164

36 50

174 245

38 53

26 66 68 80 48

8 20 21 24 15

21 96 110 108 92

5 21 24 23 20

248 41 5 27

76 13 2 8

428 8 2 2

93 2 * *

140 142

43 43

185 234

40 51

102 127

44 55

141 186

43 57

18 Week Patient Experience Survey NHS West Midlands

The table below outlines the age and gender of patients who responded, in comparison with who the surveys were actually sent to. Data is only given for organisations we have the sample profile for. Please note that the percentages of respondents do not add up to 100% as a result of some respondents not stating their age or gender. Gender Male Female % % BEN Sample Respondents Coventry Sample Respondents Dudley Sample Respondents HOB Sample Respondents Herefordshire Sample Respondents North Staffs Sample Respondents Sandwell Sample Respondents South Staffs Sample Respondents Stoke Sample Respondents T&W Sample Respondents Walsall Sample Respondents Wolverhamp Sample Respondents Worcs Sample Respondents

16-34 %

35-54 %

Age 55-64 %

65-74 %

75+ %

37 37

63 49

27 10

29 20

13 17

16 22

15 17

n/a 37

n/a 53

19 8

31 23

19 22

13 16

18 22

n/a 35

n/a 54

n/a 6

n/a 21

17 20

20 23

42 38

58 46

22 7

31 24

16 18

17 19

15 15

48 37

52 49

12 5

26 15

19 17

20 24

23 27

44 46

56 44

17 5

28 20

19 25

17 20

20 21

39 37

61 50

10 4

26 17

18 20

21 21

25 25

41 36

59 52

17 8

31 25

17 18

16 20

19 20

44 41

56 48

20 9

29 20

15 19

16 22

19 21

42 37

58 50

15 5

29 18

18 22

19 21

18 21

43 38

57 50

17 8

34 27

19 21

15 22

15 12

39 36

61 50

21 8

32 20

15 21

17 24

15 15

41 38

59 53

17 5

31 21

18 24

17 23

17 20

18 Week Patient Experience Survey NHS West Midlands

C. Guide to statistical reliability Because a sample, rather than the entire population, was interviewed the percentage results are subject to sampling tolerances – which vary with the size of the sample and the percentage figure concerned. For example, for a question where 50% of the people in a sample of 400 respond with a particular answer, the chances are 95 in 100 that this result would not vary by more than 5 percentage points, plus or minus, from the result that would have been obtained from a census of the entire population (using the same procedures). The tolerances that may apply in this report are given in the table below.

Approximate sampling tolerances applicable to percentages at or near these levels (at the 95% confidence level) Unweighted base

10% or 90% ±+

30% or 70% ±+

50% +± ±

6,783 (All patients from NHS West Midlands)

0.7

1.1

1.2

400 (Average number of results per PCT)

2.9

4.5

4.9

Size of sample on which survey result is based

Source: Ipsos MORI

Strictly speaking the tolerances shown here apply only to random samples; actual levels for a postal survey will differ, but we can use these as a guide. Tolerances are also involved in the comparison of results between different elements of the sample. A difference must be of at least a certain size to be statistically significant. The following table is a guide to the sampling tolerances applicable to comparisons between subgroups.

Differences required for significance at the 95% confidence level at or near these percentages Unweighted base

10% or 90% ±+

30% or 70% ±+

50% +± ±

6,783 (NHS West Midlands) vs 400 (a PCT)

3.0

4.6

5.0

400 (average PCT) vs 400 (average PCT)

4.2

6.4

6.9

Size of sub-groups involved in this survey

Source: Ipsos MORI

18 Week Patient Experience Survey NHS West Midlands

D. Guide to Using Computer Tabulations The ‘toplines’ (marked up questionnaire in Excel) and more detailed tables, provide the findings from the study. They present the number of patients, expressed as percentages or numbers, who gave a response to each question and are analysed against a breakdown of other key questions to show which types of patients have given a particular response. Each table contains: the wording of the question and the question number; headings for the downbreak categories (see below); headings for the crossbreak categories (see below); a description of who answered each question; the number of respondents in each crossbreak that answered the question (the base); and total figures. The downbreaks The downbreaks are listed down the left-hand side of each table and include the range of all possible responses to a particular question. They include all the pre-coded responses that were available to the respondent. When interpreting the findings, it is important to remember that the results are based on a sample of patients and not the entire population of NHS patients. Consequently, results are subject to sampling tolerances, and not all differences between sub-groups will be statistically significant. In the computer tables the crossbreaks have been tested as to whether they contain statistically significant differences. These tests are shown by letters following a percentage. Each column in the tables is assigned a letter – if the overall percentage in the column of the left has the letter of a column next to it, it means the result in this column is significantly different to the overall result. If a percentage has, for example, z and d next to it, this means it is significantly different to the results in columns z (the overall column) and d. Where percentages do not sum to 100%, this may be due to computer rounding, the exclusion of ‘don’t know’ categories or multiple responses. An asterisk (*) denotes a value of less than 0.5% that is higher than zero.

18 Week Patient Experience Survey NHS West Midlands

The tables also include “combination” scores. These are combined responses to two or more response categories on the same side of a scale, for example, “very/fairly satisfied” and “very/fairly dissatisfied”. The crossbreaks The crossbreaks are found across the top of the table as column headings. The crossbreaks include gender, age and whether the patient knew about choice. Viewing the results in this way can highlight any notable differences in the responses of these different groups of patients. The tables also include additional subgroups based on other relevant categories. Bases The ‘base’ is the number of respondents who have answered a given question – it is given both overall, and for each crossbreak. Ideally, every subgroup base will be at least 100 to allow apparent differences between subgroups to be taken as real. Normally where the base number is very low (<50) it is not advisable to make any inferences about that sub-group. Interpreting the Data Develop a method which works for you. A sensible approach is to start with the overall picture and then look at specific details. Look first at the total column, absorb it, decide whether there appears to be anything particularly interesting and look to see whether anything is different to what you had expected. Then look at the rest of the table. Are there any major differences between sub-groups? Are things similar where you expected to find differences? Why do I have more than one set of tables? Where a PCT has used only one provider, there is one set of tables for that PCT. Where a PCT has used more than one provider, there will be three sets of tables: one set for the PCT as a whole, combining the two providers – these have crossbreaks to show differences between the two providers; and one set for each provider so differences between groups can be seen within each provider;

18 Week Patient Experience Survey NHS West Midlands

In addition, if a provider has mailed out surveys for two PCTs, there will be a set of tables for that provider, with crossbreaks to compare their two PCTs.

18 Week Patient Experience Survey NHS West Midlands

E. Questionnaire

NHS_WestMidlands-core_PatientSurvey_7_printReady.qxp

28/10/2008

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PATIENT EXPERIENCE QUESTIONNAIRE Your answers to this survey about your recent NHS experiences will help to improve local services. What is the survey about? The survey asks about your experience as a patient and the care you have received since you were first told that you were being referred for further assessment or treatment. This care may have been provided in an NHS or private hospital, a treatment centre, a clinic, an assessment centre or another kind of health care centre. This survey calls all these places “hospitals”. Please answer all the questions only in relation to your referral on the date shown in the covering letter. By “referral” we mean when the GP or doctor assessing you first told you that you needed to see a specialist. By “treatment”, we mean anything which helps to improve your health problem. Your doctor may treat you using medicines or you may have an operation, receive some other therapy such as physiotherapy or be discharged as no treatment is needed. Who should complete the questionnaire? The questions should be answered by the person named in the covering letter. If that person needs assistance the answers should be given from his/her point of view, not the person assisting. Completing the questionnaire For each question please place a tick ✓ clearly inside one box using a blue or black pen. Don’t worry if you make a mistake; simply cross out the mistake and put a tick in the correct box. Please do not write your name or address anywhere on this questionnaire unless you are happy to be re-contacted for further research. If you are happy to be re-contacted, please provide your details on the back page. Questions or help The cover letter includes some general information about the questionnaire. If you have any queries about the questionnaire, or need a LARGE PRINT VERSION please call the FREEPHONE helpline number on 0800 975 3022. Details about how to get the questionnaire in other languages are on the covering letter. Taking part in this survey is voluntary and will in no way affect the treatment you receive. Your answers will be treated in confidence. Please post this questionnaire back in the FREEPOST envelope provided by Friday 19th December 2008 – THANK YOU. FOR PCT/TRUST USE ONLY

100 101 110 120 130 140 150 160 170 300 301 320 330 340 361 400 410 430 501 502 X01

Hospital Reference:

PCT Reference:

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Were you able to go to your first choice of hospital? PLEASE TICK ONE BOX.

YOUR REFERRAL TO HOSPITAL

F Yes F No F Don’t know/can’t remember

If you were referred to hospital from an Accident and Emergency Department, please move on to question 5. Otherwise, please answer question 1. Q1

At the time of your referral, did you talk about your choice of hospital for treatment with your GP (or another doctor assessing you)?

MAKING YOUR APPOINTMENT Now thinking about when the hospital appointment was made…

PLEASE TICK ONE BOX.

Yes Yes, but I wanted the GP to decide for me No, but I didn’t mind....................GO TO Q4 No, and I would have liked to have been more involved in the decision ......GO TO Q4 F Don’t know/can’t remember .......GO TO Q4

F F F F

PLEASE TICK ONE BOX.

F By telephone via the appointments line F F

If you did talk with your GP about your choice of hospital, please answer questions 2 and 3. Otherwise, please move on to question 4. Q2

F F F

What were your main reasons for your first choice of hospital (even if you were not able to go there)?

F F

PLEASE THINK ABOUT THE MOST IMPORTANT REASONS AND TICK ALL THAT APPLY.

F F F F F F F F F F F F F F F

Availability of car parking Lower cost of car parking Location/Local hospital Transport/Easy to get to Cleanliness/low levels of infection Friendliness of staff Quality of care Recommendation of family or friend GP/assessment centre doctor recommendation Reputation of hospital Reputation of consultant Good previous experience Convenience of appointment time Length of wait for appointment Other (If you ticked other, please write your reason in the box below)

How did you book your first hospital appointment?

0845 608 8888 On screen (done by GP/assessment centre doctor) On screen (done by GP practice staff/ assessment centre staff) On the internet via my Healthspace On the internet via NHS Choices The GP/assessment centre doctor wrote to the hospital asking them to contact me Via a local call centre Other (If you ticked other, please write in the box below)

F Don’t know/can’t remember Everyone should answer from question 5 onwards. Q5

When your first hospital appointment was made, were you offered a choice of different dates? PLEASE TICK ONE BOX.

F Yes F No F Don’t know/can’t remember Q6

Were the date(s) offered convenient? (sufficient to allow you to make childcare or work arrangements, for example) PLEASE TICK ONE BOX.

F Don’t know/can’t remember Page No.

F Yes F No F Don’t know/can’t remember

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Why did you think the appointment date(s) you were offered were not convenient?

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F Easy F Difficult F Don’t know/can’t remember

Too soon (in the next two weeks, for example) Not soon enough Not enough choice Does not apply, dates were convenient Other (If you ticked other, please write in the box below)

Was it easy or difficult to arrange your first hospital appointment? PLEASE TICK ONE BOX.

PLEASE TICK ALL THAT APPLY.

F F F F F

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Q12

Did any of the following apply to you while you were arranging your first hospital appointment? PLEASE TICK ALL THAT APPLY.

F I could not get through to the local call centre

F I could not get through to the national Choose and Book appointments line 0845 608 8888

F Don’t know/can’t remember Q8

F I was not given clear information about

When your first hospital appointment was made, were you offered a choice of times of day?

who to contact if I wanted to discuss or rearrange my appointment

F I had to wait longer than 5 minutes to

PLEASE TICK ONE BOX.

speak to someone

F Yes F No F Don’t know/can’t remember

F I was given incorrect appointment information

F I did not receive a confirmation letter or e-mail

Were the time(s) of day offered convenient? Q9

F There was no translation service available F No arrangements were made to

PLEASE TICK ONE BOX.

F Yes F No F Don’t know/can’t remember Q10

accommodate my disability

F Other (If you ticked other, please write in the box below)

Why did you think the appointment time(s) you were offered were not convenient? PLEASE TICK ALL THAT APPLY.

F F F F F

F Don’t know/can’t remember F No, none of these

They were too early in the day They were too late in the day They were not outside working hours Does not apply, times of day were convenient

Q13

PLEASE TICK ONE BOX.

Other (If you ticked other, please write in the box below)

F Don’t know/can’t remember

Did the hospital or call centre cancel or rearrange your initial hospital appointment? F Yes F No F Don’t know/can’t remember

Q14

Did you cancel or rearrange your initial hospital appointment? PLEASE TICK ONE BOX.

F Yes F No F Don’t know/can’t remember Page No.

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Did you find it easy or difficult to cancel or rearrange your appointment?

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PLEASE TICK ONE BOX.

F F F F Q16

Easy

F F F F F F

Don’t know/can’t remember Does not apply, did not cancel appointment

When you were first told you needed to see a specialist, how concerned, if at all, were you with how long you would have to wait to receive treatment? F I was not at all concerned about how long I would have to wait

Q20

F I was a little concerned about how long I would have to wait

F I was very concerned about how long I F Don’t know

AT YOUR LAST HOSPITAL APPOINTMENT Now thinking about your last hospital appointment.

How long after your appointment time were you seen? PLEASE TICK ONE BOX.

Q18

Fairly satisfied Neither satisfied nor dissatisfied Fairly dissatisfied Very dissatisfied Don’t know

After you saw the specialist, did they explain clearly what would happen next in your treatment? F Yes F No F Don’t know/can’t remember

F I was fairly concerned about how long I would have to wait

Very satisfied

PLEASE TICK ONE BOX.

would have to wait

F F F F F F F

How satisfied or dissatisfied were you with the general condition of the hospital building(s) where you were seen or treated? PLEASE TICK ONE BOX.

Difficult

PLEASE TICK ONE BOX.

Q17

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If you have completed your treatment for your condition, or if you have been discharged, please answer questions 21 to 26. IF YOU HAVE NOT RECEIVED ANY TREATMENT, PLEASE GO TO Q27. Q21

Thinking about the time between your referral to a specialist by your GP/assessment centre doctor and the time when you started receiving treatment. Which of the following apply to you?

I was seen on time, or early

PLEASE TICK ONE BOX.

Up to 15 minutes later

F I was happy with the length of time I had

Over 15 up to 30 minutes later Over 30 up to 60 minutes later Over 60 minutes up to 2 hours later More than 2 hours later I had to leave because the appointment started too late

to wait for treatment

F I should have been treated a bit sooner F I should have been treated a lot sooner F I thought I received my treatment too quickly

F Don’t know/can’t remember

F I am still waiting for my treatment to start F I have been advised to make some lifestyle

How clean was the hospital or clinic?

F Don’t know

changes before my treatment can start

PLEASE TICK ONE BOX.

F F F F F

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Very clean Fairly clean Not very clean Not at all clean Don’t know

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If there was a delay in you receiving treatment, what was the cause?

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AFTER YOUR TREATMENT

PLEASE TICK ALL THAT APPLY.

F Length of time between my GP referring F F F F F F F F F

me and contact from the hospital Waiting for an initial assessment before seeing a specialist (Clinical Assessment Service) Waiting for an appointment to see your hospital specialist for the first time My appointment was cancelled Waiting time for an appointment with a different specialist Waiting to take a diagnostic test Waiting for the results of a diagnostic test Waiting for therapy Waiting for an operation Other (If you ticked other, please write in the box below)

F Don’t know/can’t remember F None of these, there was no delay

Q25

F F F F Q26

Yes, briefly No, not at all Don’t know

PLEASE TICK ONE BOX.

F F F F F

Yes No, but I was told where to find it No, not at all No, but I didn’t need it Don’t know/can’t remember

Everyone should answer from question 27.

Overall, do you feel you have been treated with respect and dignity since you were told you needed treatment? PLEASE TICK ONE BOX.

F F F F

Thinking now about the care you received…

Q24

Yes, fully

Were you given any written information?

YOUR CARE AND TREATMENT

Have you stayed in a hospital bed as part of your treatment, or have you been told that you will need to stay in a hospital bed as part of your treatment? This could mean a stay overnight or occupying a bed during the day.

Following your treatment (or being told you did not need treatment) did you discuss any aftercare or recommendations on exercise, lifestyle or diet with a healthcare professional that would help you to recover and improve your health? PLEASE TICK ONE BOX.

Q27

Q23

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Q28

Yes, always Yes, sometimes No Don't know

Overall, how would you rate the care you received since you were told you needed treatment?

PLEASE TICK ONE BOX.

F Yes F No F Don’t know/can’t remember

F F F F F F F

Were you involved as much as you wanted to be in decisions about your care and treatment? PLEASE TICK ONE BOX.

F F F F Page No.

Excellent Very good Fairly good Fairly poor Very poor Terrible No opinion

Yes, definitely Yes, to some extent No Don’t know

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OTHER COMMENTS

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ABOUT YOU

Please write any other comments you may have in the box below. We are interested in hearing about any good or bad things you have to say about your experiences.

The following questions will help us to see how experiences vary between different groups of the population. Your responses will be used for analysis purposes only and will be treated in confidence. Q1

Please indicate which of the following applies to you. PLEASE TICK ONE BOX ONLY

F I am the patient named in the letter F I am a carer who is not a family member or friend filling in the questionnaire on behalf of the patient

F I am a family member or friend filling in the questionnaire on behalf of the patient

If you are filling in this questionnaire on behalf of someone else, please ensure the patient’s details are entered here, not those of the person filling in the form. Please remember that throughout the following questions “you” refers to the patient.

Are you (the patient) male or female? Q2

PLEASE TICK ONE BOX ONLY.

F Male F Female How old are you (the patient)? Q3

(PLEASE WRITE IN E.G.

0 )

F I am over 100 Q4

Do you (the patient) have any long standing illness, disability or infirmity? PLEASE TICK ONE BOX ONLY.

F Yes F No

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IF YOU HAVE A LONG-STANDING ILLNESS, DISABILITY OR INFIRMITY, PLEASE ANSWER QUESTIONS 5 AND 6. OTHERWISE, PLEASE MOVE ON TO QUESTION 7.

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Everyone should answer from question 7 onwards. Q7

To which of these ethnic groups would you say you belong? PLEASE TICK ONE BOX ONLY.

What is the nature of your condition?

White

PLEASE TICK ALL THAT APPLY.

F Physical impairment (such as using a

F British F Irish F Any other White background

F Sensory impairment (such as being

(PLEASE WRITE IN THE BOX IF YOU TICKED “ANY OTHER”)

wheelchair to get around and/or difficulty using your arms or walking) blind/having a serious visual impairment or being deaf/having a serious hearing impairment)

F Mental health condition (such as

depression, schizophrenia or severe anxiety)

F Learning disability, (such as Down’s

syndrome or dyslexia) or cognitive impairment (such as autism or head injury)

F Longstanding illness or health condition (such as cancer, HIV, diabetes, chronic heart disease, or epilepsy)

Mixed

F F F F

White and Black Caribbean White and Black African White and Asian Any other Mixed background

(PLEASE WRITE IN THE BOX IF YOU TICKED “ANY OTHER”)

F Other F Don’t know Q6

How much of an effect does this condition/do these conditions have on your ability to carry out day-to-day activities? PLEASE TICK ONE BOX ONLY.

F F F F F

A great deal A fair amount

Asian or Asian British

F F F F

Indian Pakistani Bangladeshi Any other Asian background

(PLEASE WRITE IN THE BOX IF YOU TICKED “ANY OTHER”)

Not very much None at all Don’t know

Black or Black British

F Caribbean F African F Any other Black background (PLEASE WRITE IN THE BOX IF YOU TICKED “ANY OTHER”)

Chinese or other ethnic group

F Chinese F Any other ethnic group (PLEASE WRITE IN THE BOX IF YOU TICKED “ANY OTHER”)

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In the next six months, Ipsos MORI may want to re-contact some people to talk about your experiences in more detail. PLEASE PROVIDE YOUR NAME, ADDRESS AND TELEPHONE NUMBER IF YOU WOULD BE HAPPY FOR US TO CONTACT YOU.

Your contact details would be used to invite you to take part in any further research related to this survey. They would stay confidential to the research team at Ipsos MORI and will be separated from your responses to this survey. PLEASE USE BLOCK CAPITALS.

Name

Signature

Address

Post code

Daytime telephone number:

Thank you for completing this questionnaire.

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West Midlands â&#x20AC;&#x201C; Patient Experience questionnaire