CQC inpatients’ survey

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You’ve probably seen or heard about the findings of the Care Quality Commission’s
Mental health acute inpatient service users survey 2009, released to an indifferent public last week. There wasn’t much media coverage, just an article in the Guardian:
CQC describe the survey as follows:
The survey of acute adult inpatient mental health services involved 64 NHS trusts providing mental health inpatient services (including combined mental health and social care trusts and primary care trusts). We received responses from more than 7,500 people who used services, a response rate of 28%. People were eligible for the survey if they were aged 16-64, had stayed on an acute ward or a psychiatric intensive care unit (PICU) for at least 48 hours between 1 July 2008 and 31 December 2008 and were not current inpatients at the time of the survey. Fieldwork for the survey took place between April and June 2009.

The first thing that strikes me is the response rate. 28% is impressively high, but it begs the question of how representative the respondents were. It’s far from inconceivable that patients which had poorer experiences would be more likely to complete the survey.

I’ve also got views on many of the findings!

Q6. During your most recent stay did you feel safe?

Yes, always 45%
Yes, sometimes 39%
No 16%
Number of respondents 7414
Answered by all

Do patients, staff, relatives, managers, politicians, campaigners have realistic expectations about feelings of safety? Firstly, do we distinguish between being safe and feeling safe, and the different personal and organisational issues that these prompt? Secondly, it’s impossible (without harsh chemical and physical interventions) to have wards where the most distressed, disturbed and often the most damaged of us are locked up together. Many of us are in hospital because we are so unsafe from ourselves.

And is 45% of patients feeling safe all the time a ‘bad result’? I think it’s pretty impressive that given the circumstances, so many inpatients always feel safe.

Q10. In your opinion, how clean was the hospital room or ward that you were in?

Very clean 53%
Fairly clean 39%
Not very clean 7%
Not at all clean 2%
Number of respondents 7385
Answered by all

My visitors when I was in hospital were suitably impressed with the ward cleanliness and many of them remarked on how this contrasted with what they or family/friends have experienced in general hospitals.

Q13. During your most recent stay, did you need any help from hospital staff with organising your home situation (e.g. payment of bills, looking after pets, taking care of relatives, keeping in touch with work)?

Yes 22%
No 78%
Number of respondents 7303
Answered by all

I’m astonished that 78% of respondents didn’t want help with domestic stuff and wonder whether this is partly because of the nature of the 28% who did the survey?

Q15. Did the psychiatrist(s) listen carefully to you?

Yes, always 57%
Yes, sometimes 30%
No 13%
Number of respondents 7073
Answered by all

Q16. Were you given enough time to discuss your condition and treatment with the psychiatrist(s)?

Yes, always 50%
Yes, sometimes 30%
No 19%
Number of respondents 7096
Answered by respondents that saw a psychiatrist

These are much more positive results than anecdotal evidence usually suggests, as were those for the other 2 questions about psychiatrists:
Q17. Did you have confidence and trust in the psychiatrist?
Q18. Did the psychiatrist(s) treat you with respect and dignity?

Q19. Did the nurses listen carefully to you?

Yes, always 48%
Yes, sometimes 40%
No 12%
Number of respondents 7417
Answered by all

This is my cue to give another plug for TalkWell, the training resource on conversations between HCAs, others and patients.

Q24. Did the hospital staff explain the purpose of this medication in a way you could understand?

Yes, completely 40%
Yes, to some extent 36%
No 24%
Number of respondents 6407
Answered by respondents that were given medication as part of their treatment

Q25. Did the hospital staff explain the possible side effects of this medication in a way you could understand?

Yes, completely 26%
Yes, to some extent 26%
No 48%
Number of respondents 6362
Answered by respondents that were given medication as part of their treatment

These are very worrying findings.

Q27. Were you involved as much as you wanted to be in decisions about your care and treatment?

Yes, definitely 34%
Yes, to some extent 40%
No 27%
Number of respondents 7356
Answered by all

Some way to go here as well.

Q28. During your stay in hospital, did you ever want talking therapy?

Yes 52%
No 48%
Number of respondents 7229
Answered by all

Interesting that only half of patients wanted talking therapy and given what a scarce resource this still is, it’s possible that this wasn’t exactly a bigged up option.

Q30. If you had talking therapy during your stay in hospital, did you find it helpful?

Yes, definitely 50%
Yes, to some extent 42%
No 8%
Number of respondents 2092
Answered by respondents that had talking therapy

Again raises the issues of information and expectations.

Q31. During your most recent stay, were there enough activities available for you to do during the day on weekdays (Monday to Friday)?

Yes, all of the time 24%
Yes, some of the time 41%
No 35%
Number of respondents 7291
Answered by all

Q32. During your most recent stay, were there enough activities available for you to do during evenings and/or weekends?

Yes, all of the time 14%
Yes, some of the time 32%
No 54%
Number of respondents 7302
Answered by all

In terms of service improvements, this looks like a huge advance. When I was in The Priory a few years ago (in the days when they hadn’t banned me) there was a full programme of activities during the day but almost nothing in the evenings or weekends. And that was felt to be reasonable.

Q40. Once you were due to leave hospital, was your discharge delayed for any reason?

Yes 22%
No 78%
Number of respondents 7289
Answered by all

This is roughly the extent I assumed, but it is something that none of us should be complacent about. (Er, sorry, you probably aren’t complacent about it – and nor am I any longer.) Almost a quarter of patients’ stays unnecessarily extended.

Q41. What was the MAIN reason for the delay?

I had to wait to see a doctor or nurse in change of the ward 34%
I had to wait for suitable accommodation 9%
I had to wait for financial help 1%
I had to wait for community services to become available 7%
Something else 49%
Number of respondents 1551
Answered by respondents that had their discharge delayed

I was very surprised by these findings. The 49% ‘something else’ figure is intriguing and the 9% housing-related delay is astonishingly low.

Q43. Do you have the number of someone from your local NHS Mental Health Service that you can phone out of office hours?

Yes 69%
No 31%
Number of respondents 6942
Answered by all

Q44. Before you left hospital, were you given information about how to get help in a crisis, or when urgent help is needed?

Yes 71%
No 29%
Number of respondents 6718
Answered by all

Not good, but don’t get me started on the topic of crisis teams.

Q47. Overall, how would you rate the care you received during your recent stay in hospital?

Excellent 21%
Very good 28%
Good 24%
Fair 16%
Poor 12%
Number of respondents 7283
Answered by all

As the care minister, Phil Hope, said:
‘It’s good news that 73% of people described their care overall as good, very good or excellent. It’s also important to remember that nearly half of the people who responded to this survey had been detained under the mental health act and had severe mental health problems, which may have affected how safe they felt. It is vital they get the care, support and treatment they need.”

Q50. In general, how is your mental health right now?

Excellent 12%
Very good 17%
Good 22%
Fair 30%
Poor 15%
Very poor 5%
Number of respondents 7216
Answered by all

This was relatively soon after the 7,000 people had been inpatients, and only 5% experiencing ‘very poor’ mental health is very heartening and a credit to hospital and community services.

Q52. Does your physical or mental health cause you difficulty with any of the following?:

This condition causes me difficulty with everyday activities that people of my age can usually do 49%
This condition causes me difficulty at work, in education, or training 39%
This condition causes me difficulty with access to buildings, streets, or transport vehicles 14%
This condition causes me difficulty with reading or writing 17%
This condition causes me difficulty with people’s attitudes to me because of my condition 40%
This condition causes me difficulty with communicating, mixing with others, or socialising 53%
This condition causes me difficulty with other activities 14%
This condition does not cause me difficulty with any of these 24%
Total specific responses 7096
Answered by those with a long-standing condition
Multiple response question

For me, this is the most depressing of all the answers. I’d like to offer myself to join the 49% of ex-inpatients struggling with everyday activities, perhaps nudging us to a round half? Although my BPD produces colourful episodes, it’s my inability to get downstairs for a glass of water or to clean the fish tank for weeks that I find particularly upsetting. And although my friends, family and I manage to see lots of each other, I’ve become almost phobic about the phone. These were very astute questions for the CQC to include and the results reinforce the need for staff and patients to focus on these issues. What do you think about a version of TalkWell to support patients with our communication skills, especially those connected with the impact of our illness?

Q53. Are you currently in paid work?

Yes 15%
Yes, but I am currently on sick-leave 5%
No 67%
No, I am retired 6%
No, but I work on a casual or voluntary basis 7%
No, but I am a full-time student 1%
Total specific responses 7128
Answered by all

15% currently in work. Oy vey.

The 2009 survey of mental health acute inpatient services results, questionnaire and scoring can be found at:

and to recap on the Guardian article:

The following feels ego-maniacal, even in a blog, but, a-hem, here’s a letter I wrote in response

Society section 24th Sep 2009

Most mental health patients do not feel safe, survey reveals

Dear Letters Editor

The findings of the Care Quality Commission’s survey of mental health acute inpatient services make gloomy reading. Partly because the limp state of some wards reflects the woeful poverty of funding of and political commitment to inpatient care. And partly because of what wasn’t said. Most of the mental health wards in the country are now taking part in Star Wards – over 550, from acute admission to Broadmoor. I set up the project to support mental health wards, following my astonishingly healing stint ‘detained’ (but without her majesty deriving any pleasure from this) at my local hospital.

Our recent survey of ward staff showed that taking part in Star Wards has resulted in increased: activities (88% of wards), patient satisfaction (83%), staff patient contact (82%) and safety (63%). Last Friday I visited Bowman low secure ward in Bodmin. The quality, professionalism, humanity, imagination and energy of the staff were awe-inspiring. I’ve been fortunate to visit many other superb NHS wards across the UK, and to be cared for with expertise and tenacity (and, yes, care) in my local, lively, Tottenham hospital.

That’s the other side of the story.

Best wishes

marion janner

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