Unplanned Care Report Draft v5

Calderdale and Huddersfield
Health and Social Care

Strategic Review
Summary of findings from the engagement process -
Public, Patients and Carers
UNPLANNED CARE
November 2012 January 2013
Report prepared by:
Calderdale, Kirklees and Wakefield Communications and
Engagement Team
Document control:
Authors: D!a Farmer/Nick Ward
Date: 1 February 2013
Version: 5
Status: Draft
Circulation:
A partnership programme led by Calderdale Clinical Commissioning Group, Calderdale Council, Calderdale &
Huddersfield NHS Foundation Trust, Greater Huddersfield Clinical Commissioning Group, Kirklees Council,
Locala Community Partnerships and South West Yorkshire Partnership Foundation Trust.
Contents
1. Purpose of the report Page 4
2. Background Page 4
3. Our responsibilities; including legal requirements Page 5
4. Engagement process and use of existing data Page 6
5. Findings from the engagement process Page 7
5.1 Main themes Page 8
5.2 Unplanned care survey Page 9
5.2.1 General survey results Page 10
5.2.2 Location survey results Page 20
5.3 Patient feedback/enquiries Page 24
5.3.1 PALS and Complaints information NHS Kirklees Page 24
5.3.2 Complaints information Locala Page 26
5.3.3 PALS and Complaints information CHFT Page 27
5.3.4 Patient Opinion website Page 29
5.4 Other engagement evidence from Intelligence Library Page 33
5.4.1 Accident and Emergency services Page 34
5.4.2 West Yorkshire Urgent Care service Page 38
5.4.3 Trauma services Page 40
5.4.4 Paediatric Emergency services Page 41
5.4.5 GP practices Page 43
5.4.6 Inpatients (including hospital readmissions) Page 44
6. Equality data Page 47
7. Conclusion Page 50
8. Recommendations Page 51
9. Next Steps Page 51
10. References Page 51
Appendices
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Appendix 1 Engagement action plan
Appendix 2 Schedule for engagement activity
Appendix 3 Engagement survey and equality data monitoring form
Appendix 4 Engagement survey children and young people
Appendix 5 Unplanned Care survey additional analysis
Appendix 6 Glossary
Appendix 7 National A&E Survey 2012 Results
Appendix 8 National A&E Survey 2012 Patient Comments
Appendix 9 National A&E Survey 2012 Long Term Conditions analysis
Appendix 10 Local A&E Discharge survey results 2012
Appendix 11 Patient comments by category A&E Discharge Survey 2012
Appendix 12 GP Survey results for Calderdale and Greater Huddersfield
Appendix 13 National Inpatient Survey scores/ratings for CHFT 2006-2011
Appendix 14 National Inpatient Survey 2011 Local peer group scores by section
Appendix 15 Patient comment analysis National Inpatient Survey 2011
Appendix 16 National Inpatient Surveys 2010-12 emergency vs planned
admissions
Appendix 17 Readmissions Survey results 2012
Appendix 18: National A&E Survey 2012 Long Term Conditions analysis
1. Purpose of the report
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The purpose of this report is to present the findings from the engagement stage of the
Calderdale and Huddersfield Health and Social Care Strategic Review. The report captures
intelligence collected from all previous engagement and consultation activities and reports
on recent feedback from public, patients and carers. The engagement findings will enable
the care stream to:
! Consider the views of patients as part of the strategic review; and
! Ensure that public, patient and voluntary community sector feedback is considered in the
development of any future options to change the way a current service is provided or
delivered.
! Highlight patient and public priorities and ensure these priorities are in line with current
thinking.
2. Background
The health and social care economy in Calderdale and Huddersfield has embarked on a
major programme of transformation. Local commissioners and providers of these services
are working together to address the significant challenges facing the sectors and ensure that
people continue to receive high quality services, now and in the future.
Over recent years, the local health and care system has seen many changes. There have
been huge advances in care and treatments, and a shift to providing services as close to
peoples homes as possible. There have also been changes in the needs of the local
populations and the emergence of some significant challenges, not least the impact of the
current economic climate. The Strategic Review aims to address these issues and transform
services to ensure that patients can continue to receive the highest quality care possible in
the most appropriate setting, within the resources available.
The programmes vision is: We want to make sure you get the best possible care to keep
you healthy, safe and well. To do this, services need to change the way they provide health
and social care services to ensure the public;
Get the best possible results from the care they receive
Have services that meet their needs, personal and easy to access
Receive high quality, safe, specialist services available when they are needed
Are looked after in the local community wherever possible
And receive the right information, guidance and support when it is needed
Work with us to make the best use of the resources we have, including public money.
Four key areas (care streams) have been identified as focal points for the programme and
each will be used to develop new models of care. These are:
! Planned care
! Unplanned care
! Childrens care
! Long-term care
3. Our responsibilities
Engaging people is not just about fulfilling a statutory duty or ticking boxes; it is about
understanding and valuing the benefits of listening to patients and the public in the
commissioning process.
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Patient and public engagement can be defined as the active participation of patients,
including children, service users, carers, community representatives and the wider public in
the development of health services and as partners in their own health care. Involving
people gives local people a say in how services are planned, commissioned, delivered and
reviewed. It is important to recognise who to involve through engagement activity. Individuals
and groups play different roles and there needs to be engagement opportunities for both.
A Communications, Engagement and Consultation Strategy underpins the principles by
which the engagement and consultation operate and highlights the commitment to good
practice in delivery. Engaging people who use health and social care services, and other
stakeholders in planning services is vital to ensure services meet the needs of local
communities. It is also a legal requirement that patients and the public are not only consulted
about any proposed changes to services, but have been actively involved in developing the
proposals.
3.1 Legal requirements
There are a number of statutory requirements relating to engagement that must be taken
into account.
Health and Social Care Act 2012
The Health and Social Care Act 2012 sets out responsibilities for NHS commissioners. This
includes the statutory requirement for CCGs to involve and consult patients and the public,
replacing Section 242 of the NHS Act 2006.

Specifically, CCGs must involve and consult patients and the public in:
! their planning of commissioning arrangements
! the development and consideration of proposals for changes in the commissioning
arrangements where the implementation of the proposals would have an impact on the
manner in which the services are delivered to the individuals or the range of health
services available to them, and
! decisions affecting the operation of the commissioning arrangements
The Act also updates Section 244 of the NHS Act 2006 which requires NHS organisations to
consult relevant Overview and Scrutiny Committees on any proposals for a substantial
development of the health service in the area of the local authority, or a substantial variation
in the provision of services.
The Equality Act 2010
Section 149 of the Equality Act 2010 states that a public authority must have due regard to
the need to a) eliminate discrimination, harassment and victimisation, b) advance Equality of
Opportunity, and c) foster good relations. It unifies and extends previous disparate equality
legislation. Nine characteristics are protected by the Act: age; disability; gender re-
assignment; marriage and civil partnership; Pregnancy and maternity; race; religion or belief;
sex; and sexual orientation.
An Equality Impact Assessment (EQIA) will need to be undertaken on any proposals for
changes to services that are developed through the programme, in order to understand any
impact on the protected groups and ensure equality of opportunity. Engagement must span
all protected groups and other disadvantaged groups and care should be taken to ensure
that seldom-heard interests are as engaged as much as others and supported to participate.
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The NHS Constitution
The NHS Constitution came into force in January 2010, setting out a number of rights for
patients which are protected by law. This includes the following right at Section 2a: You
have the right to be involved, directly or through representatives, in the planning of
healthcare services, the development and consideration of proposals for changes in the way
those services are provided, and in decisions to be made affecting the operation of those
services.
Secretary of States key tests
Any plans for reconfiguring health services also need to comply with the four tests set down
by the Secretary of State, the second of which relates specifically to engagement. These will
be assessed through the Strategic Health Authoritys Service Change Assurance Process
(SCAP) to assure there is sufficient evidence to progress to consultation if required. The four
tests are:
1) Support from GP commissioners
2) Strong engagement, including local authorities, public and patients
3) A clear clinical evidence base underpinning proposals
4) The need to develop and support patient choice.
3.2 Other considerations
There is another major transformation taking place in the adjoining Mid Yorkshire health and
social care economy, which will have direct implications for the work taking place in
Calderdale and Huddersfield. There is considerable commonality in the drivers for change
and issues being addressed so it is important that messages around these are consistent
across the region.
4. Engagement process and use of existing data
An action plan for the engagement process was drafted and agreed by the Unplanned Care,
Care Stream (Appendix 1). The action plan identified three stages for the engagement
process, the three stages are:
! Stage 1: To source existing intelligence which can be used to evidence patient, carer
and public views.
! Stage 2: To further engage with patients, public and carers; and
! Stage 3: To conclude the engagement process by providing a report of findings.
Stage 1
The engagement team searched local and national files for any existing feedback from
public, patients and carers on the theme of Unplanned Care. It was agreed that a search
would go back as far as three years for most intelligence with an exception for relevant
information. All the documentation collected was placed in a library folder on the
SharePoint site for all care stream members to access and consider. Intelligence from the
Health Informatics Service, Patient Advise and Liaison Service (PALS), complaints, Patient
Opinion and partner organisations was also included.
A key messages report was written to ensure that the care stream had an overview of the
key issues, concerns and priorities for patients. In addition the key messages report
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highlighted what we had already been told. This information was used to identify the areas
of focus for the care stream as part of Stage 2.
Stage 2
The method of involvement to engage further with public, patients and carers was to deliver
a questionnaire (Appendix 3). The survey aimed to gather the views of the general public in
respect of the services they had used the last time they had an unexpected health problem.
This work looked at capturing experiences that had occurred in the last 12 months from the
date of the engagement activity.
Two surveys were produced; firstly, a general survey was developed to be used both in
hard copies and on line. Secondly, a location survey was developed, which was used by
the engagement team to capture the views of people in locations across Calderdale and
Huddersfield, including GP practices and Accident and Emergency departments.
Furthermore, an additional version of the general survey was produced specifically for
children and young people and this work conducted by an external organisation. The results
of this survey can be found in the report entitled Childrens Care produced for the purposes
of that care stream. Copy of the survey developed for this engagement initiative can be
found in Appendix 4.
Stage 3
The findings from the library of intelligence and the engagement process in stage 2 are
captured in the next section of the report.
5. Findings from the engagement process
Engagement evidence was gathered from three main sources:
! Unplanned Care survey conducted over the period November 2012 to January 2013
[see Section 5.2 for detailed findings].
! Patient feedback and enquiries over the last three years, gathered from Complaints
and Patient and Advice Liaison Service information, together with a review of local
patients posts on the Patient Opinion website [details in Section 5.3].
! Evidence from other engagement activities undertaken in the last three years
[Section 5.4 provides individual summaries of the key findings from each of these].
This broad, inclusive approach was designed to maximise the use of all feedback and views
provided by public, patients, carers and local voluntary and community groups, and ensure
good representation from all sections of the community, including a wide range of minority
groups.
5.1 Main themes
There are a number underpinning themes which were evident across the whole range of
engagement evidence gathered. These are described below, and are evidenced in detail in
the sub-sections of the report, as appropriate:
! Patients did not always feel that they knew where best to go to access the care they
needed.
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! GPs and community-based health care elements were often closed when the patients
needed to access them, forcing them to go elsewhere, despite their preferences to
use these services. Other access issues, most commonly related to availability/choice
of appointments, were also commonly raised by patients.
! Patients found the system fragmented with poor continuity of care passed round
from pillar to post, sometimes returning to A&E and other services on multiple
occasions**. There was a need identified to build a more patient-centred approach
and particularly to improve discharge and hand-on processes.
! Delayed diagnosis and/or mis-diagnosis.
! Some concerns that staff not sufficiently caring and did not take patients concerns
about their health seriously enough, or consider their individual circumstances and
needs.
! Inconsistencies in standards/quality of care received - patients consistently cited high
standard/quality of care as important, but quite often report big inconsistencies in
services or along different stages of their pathway.
! A number of examples of poor communication/ information provided to patient on their
condition and subsequent management, and sometimes between different areas
within the wider healthcare system at various stages of the patient pathway.
! Several cases where patients felt they were inappropriately discharged from A&E and
were subsequently readmitted to hospital shortly afterwards.
! Patients placed high value on rehabilitation services/ being supported to self-manage/
manage their condition at home.
! Several groups of patients, most notably those with long term conditions, regularly
used and reported poor experiences of a number of aspects of emergency and urgent
care services. This further highlighted the importance of effective management of
long-term conditions within the urgent care and wider local healthcare system. This
review also highlighted the need to put in place better plans to cater for
disadvantaged groups such as elderly people and/or those with cognitive impairment,
and families with young children, who all featured heavily as users of urgent care
systems, across the evidence base.
! Issues were raised about making better use of supporting technology, for instance
telecare facilities and problems related to health professionals having limited (and
variable) access to patient information available at point of contact.
! Other problems, mentioned predominantly in relation to A&E attendance, were
patients concerns about long waits and not being told how long they would have to
wait/ reasons why, and some patients were concerned that they received no, or
inadequate pain relief.
** Note that this theme was also highlighted in the Planned Care engagement event, which
is described in detail in the Planned Care Engagement Summary Report.
5.2 Unplanned care survey
The survey was conducted over a two month period from mid-November 2012, with the final
surveys completed on 16 January 2013.
The general survey was distributed in paper form to individuals via a wide range of
participating organisation across Calderdale and Greater Huddersfield. These included local
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community groups, organisations and their distribution networks, local venues (e.g. a
primary school, toddler group, womens activity centre).
In addition, the survey was also made available to the public in web form, accessible through
the external websites of the partnership programme organisations. 93 forms were returned
via this channel. In total, 1,339 general surveys were gained during the engagement
process.
The location survey (an assisted survey) was used as an assisted survey in settings across
Calderdale and Huddersfield, reaching a geographical spread of the venues and consisting
of GP practices in Skelmanthorpe, Fartown, Slaithwaite, Hebden Bridge, Rastrick,
Boothtown, Southowram and Todmorden. In addition, the two A&E departments were also
used as locations and these particular surveys were conducted from mid December 2012 to
mid January 2013.It should be noted that the general survey was used in addition to the
location survey at various venues across the area.
In terms of the conduct of the assisted surveys, these were carried out following a formal
approval from each venue to access their premises. Participants were made aware of the
purpose of the survey and the option to freely decide on participation or otherwise. The
independence of the work to the services within the setting was noted to ensure that relevant
patient experience data were captured.
Completed surveys were submitted for analysis to The Health Informatics Service. Surveys
were scanned, and a rigorous data management process applied. Surveys were only
considered fit for analysis where question 1a had a valid answer (i.e. one tick only) and a
minimum of one other survey question was answered. 63 returned surveys were excluded
from analysis as a result of this process (further details are provided in Appendix 4).
Returned Excluded Usable
General Paper 1313 71 1242
Web 97 0 97 1339**
Location Paper 247 1 246 246
** 1,339 responses in final analysis (8 additional surveys were excluded in error during the analysis).
In total, 1,339 general survey and 246 location survey responses were included in the final
analysis.
Results tables and cross-tabulations for the general survey are presented in Section 5.2.1,
whilst the main summary tables for the location survey are shown in Section 5.2.2.
Note that, as the numbers of respondents are much smaller for the location survey caution
needs to be taken when comparing sub-groups. The main top-level findings of the survey,
based primarily on the results from the much larger general survey, are summarised below:
55% of patients went to a GP, 17% went to A&E, with the remainder attending a mix of
community based services (e.g. pharmacy, walk-in centre, dentist), took care of
themselves, or contacted a telephone-based service.
Although acute problems were most commonly given for reason of attendance (One
off symptom 32%, sudden illness 15%, accident or injury 8%), it was also relatively
common for patients to attend for problems related to chronic conditions (an ongoing
problem 29%, long term condition 12%).
A wide mix of reasons for choosing a particular service were given [Question 3], with
the most popular being location (24%) and I have been here before (17%).
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The most common expected outcomes of the visit were diagnosis (29%), treatment
(21%), and medication/prescription (15%).
Satisfaction rates, measured in several ways [see Questions 4b, 5, 6], were similar for
GP, A&E and community based services, with an overall average of just under 90% of
patients would recommend the service to family or friends.
More detailed comparisons of how the three main types of service (A&E, GP, Community-
based services) are accessed and used, together with differences in behaviour of
demographic sub-groups, is provided in Section 5.2.
5.2.1 General survey results
Summary results
Note: totals for individual questions may differ as respondents left some questions blank.
I am completing this survey...
Number Percentage
About me 969 74.1%
As a carer 83 6.3%
As a parent 154 11.8%
On behalf of someone else 102 7.8%
Total 1308
Q1a. What did you FIRST DO the last time you had an unexpected health problem (tick ONE
choice only)
Number Percentage
Went to A&E 226 16.9%
Went to GP 729 54.6%
Went to Pharmacy 59 4.4%
Went to Walk-in Centre 38 2.8%
Went to Optician 32 2.4%
Went to Dentist 50 3.7%
Contacted Crisis Intervention Centre 3 0.2%
Called NHS Direct 68 5.1%
Visited the NHS Direct Website 10 0.7%
Called West Yorkshire Urgent Care Service 9 0.7%
I took care of myself/ patient 60 4.5%
Other - (please state) 52 3.9%
Total 1336
A full list of the Other category breakdown is provided in Appendix 5.
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Q1b. At the time, would you describe your health problem as....? (Tick ONE choice only)
Number Percentage
An ongoing problem 376 28.9%
A one off symptom 410 31.5%
A long term condition 162 12.5%
A sudden illness 190 14.6%
An accident or injury 98 7.5%
Prefer not to say 24 1.8%
Total 1300
Q1c. Which of the following did your health problem relate to? (Tick ONE choice only)
Number Percentage
Physical symptom 869 68.2%
Your eyes 91 7.1%
Dental health 63 4.9%
Mental health problem 61 4.8%
Substance misuse 29 2.3%
Total 1275
Q2. Why did you choose to use that service? (tick ALL that apply)
Number Percentage
It was my decision 834 53.8%
Family/friend suggested I go there 203 13.1%
A health professional referred me 70 4.5%
Poster/leaflet 28 1.8%
NHS Direct sent me there 39 2.5%
Advice from NHS Direct website 17 1.1%
Advice from another website 9 0.6%
I did not know where else I could go 83 5.4%
I have used the service before 216 13.9%
Total 1551
Note: Includes multiple answers from some respondents. A full list of the Other category
breakdown is provided in Appendix 5.
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Q3. Were there any other reasons why you chose that service? (tick ALL that apply)
Number Percentage
Location 567 24.2%
Parking 184 7.8%
Public transport 55 2.3%
More culturally sensitive 32 1.4%
Confidence in the staff 247 10.5%
Environment 81 3.5%
Opening times 239 10.2%
I have been here before 394 16.8%
I have a good experience/outcome before 178 7.6%
I could fit it in with my daily routine 162 6.9%
No 85 3.6%
Total 2347
Q4a. What did you expect would be the outcome of using that service? (Tick ALL that apply)
Number Percentage
The diagnosis of a problem/illness/symptom 615 28.9%
The opportunity to speak to a health care professional 282 13.3%
A second opinion 93 4.4%
A referral for further consultation/treatment 191 9.0%
Medication/prescription 328 15.4%
Diagnostics such as X rays and blood tests 115 5.4%
Treatment 455 21.4%
Total 2128
Q4b. Were your expected outcomes of that service met?
Number Percentage
Yes, all expectations were met 865 68.2%
Some expectations were met 269 21.2%
No 90 7.1%
Don't know 45 3.5%
Total 1269
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Q5a. How confident were you that the service you used was right for your health problem?
Score
Number Percentage
1 17 1.4%
2 18 1.5%
3 25 2.0%
4 41 3.3%
5 66 5.4%
6 89 7.2%
7 140 11.4%
8 212 17.2%
9 195 15.8%
10 430 34.9%
Total 1233
Average Score 8.0
Q6. Would you recommend this service to a family member or friend as a high-quality place
to receive treatment and care?
Number Percentage
Yes 1077 89.6%
No 125 10.4%
Total 1202
Q8a. How long did it take you to travel to this service?
Number Percentage
Under 15 minutes 279 22.8%
15-30 minutes 542 44.3%
30-60 minutes 289 23.6%
1-2 hours 113 9.2%
Total 1223
Q8b. What would be the maximum amount of time you would be prepared to travel for a high
quality healthcare service?
Number Percentage
15-30 minutes 320 26.2%
30-60 minutes 78 6.4%
1-2 hours 12 1.0%
Not applicable - travelled by Ambulance 41 3.4%
Total 1220
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It is interesting to note, when combining the information provided by individual responders
for questions 8a and 8b, that:
! 54.6% of respondents would be prepared to travel further (for a high quality
healthcare service) than the journey they actually made
! 41.6% of respondents would be prepared to travel the same distance
! 3.8% of respondents would only be prepared to travel a shorter distance
The majority of respondents travelled Under 15 minutes for the surveyed service visit, but
would generally be prepared to travel 30-60 minutes.
Detailed Results By Service
Detailed cross-tabulated results, splitting out findings by the type of service respondents
accessed, are shown below. Note that for this analysis Community covers all response
categories from question 1a other than Went to A&E or Went to GP.
A&E GP Community
An ongoing problem 9% 75% 16%
A one off symptom 13% 50% 37%
A long term condition 10% 65% 25%
A sudden illness 20% 45% 35%
An accident or injury 65% 15% 19%
Other - (please state) 10% 30% 60%
Prefer not to say 25% 29% 46%
Total 17% 55% 29%
A&E GP Community
Physical symptom 17% 61% 22%
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Your eyes 14% 34% 52%
Dental health 3% 17% 79%
Mental health problem 10% 52% 38%
Substance misuse 34% 28% 38%
Prefer not to say 30% 50% 20%
Total 17% 54% 29%
A&E GP Community
It was my decision 15% 62% 23%
Family/friend suggested I go there 21% 47% 32%
A health professional referred me 17% 52% 30%
Poster/leaflet 7% 18% 75%
NHS Direct sent me there 23% 46% 31%
Advice from NHS Direct website 6% 47% 47%
Advice from another website 0% 22% 78%
I did not know where else I could go 30% 49% 20%
I have used the service before 10% 53% 36%
Total 17% 55% 28%
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A&E GP Community
Location 17% 66% 17%
Parking 13% 67% 20%
Public Transport 9% 55% 36%
More culturally sensitive 19% 52% 29%
Confidence in the staff 7% 68% 24%
Environment 11% 69% 20%
Opening times 17% 50% 32%
I have been here before 12% 60% 28%
I have a good experience/outcome before 6% 59% 35%
I could fit it in with my daily routine 10% 51% 40%
No 26% 42% 32%
Total 13% 56% 30%
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A&E GP Community
The diagnosis of a problem/illness/symptom 19% 63% 18%
The opportunity to speak to a health care professional 15% 56% 29%
A second opinion 17% 45% 38%
A referral for further consultation/treatment 14% 66% 20%
Medication/prescription 8% 69% 22%
Diagnostics such as X rays and blood tests 40% 48% 12%
Treatment 25% 51% 24%
Total 18% 58% 23%
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A&E GP Community
Yes, all expectations were met 146 474 243
Some expectations were met 49 155 65
No 16 46 28
Don't know 9 25 11
Total 220 700 347
Average Score ** 80.8 81.7 82.0
** Note: Score calculated as 100 for Yes, all expectations were met, 50 for Some
expectations were met, 0 for No. Dont know responses are excluded from the
calculation.
Score
A&E GP Community
1 2 5 10
2 2 11 5
3 8 10 7
4 7 21 13
5 15 39 12
6 14 46 29
7 22 81 37
8 31 132 48
9 32 111 51
10 80 225 125
Total 213 681 337
Average Score
8.0 8.1 7.9
A&E GP Community
Yes 188 614 273
No 20 64 41
Total 208 678 314
Would Recommend 90.4% 90.6% 86.9%
No significant differences between the three groups, although slightly lower percentage
would recommend for those who attended Community-based services.
A&E GP Community
Under 15 minutes 115 (53%) 500 (72%) 153 (49%)
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15-30 minutes 71 (33%) 154 (22%) 94 (30%)
30-60 minutes 14 (7%) 28 (4%) 36 (12%)
1-2 hours 2 (1%) 6 (1%) 4 (1%)
Not applicable - travelled by Ambulance 13 (6%) 2 (0%) 26 (8%)
Total 215 690 313
A larger proportion of those attending GP Practices (72%) travelled for less than 15 minutes,
than those attending A&E (53%) or a variety of Community-based services (49%).
A&E GP Community
Under 15 minutes 57 (27%) 161 (24%) 60 (18%)
15-30 minutes 89 (42%) 285 (42%) 168 (51%)
30-60 minutes 49 (23%) 174 (25%) 66 (20%)
1-2 hours 16 (8%) 64 (9%) 33 (10%)
Total 211 684 327
No significant differences between the three groups.
Detailed results by patient characteristics
Detailed cross-tabulated results, splitting out findings by patient characteristics, are shown
below. Note that results are only displayed for those areas where clear differences exist
between patient groups. Full results are available on the analysis files held in the project
SharePoint area.
The most striking differences were seen with respect to age groups; in particular, the
behaviour of the younger age groups (0-16, 16-25) is noticeably different to others. The main
differences were:
Larger proportion of 0-25 group go to A&E (25% vs 12-14% for other age groups).
0-25 group scored lower for Were your expected outcomes of that service met and
Would you recommend this service to a family member or friend.
Although the profiles of actual distance travelled were similar for all age groups, there
was a marked difference in the distance respondents were willing to travel with 76%
of 0-25 age group (and/or their parents) only willing to travel 0-15 minutes.
Smaller differences could also be seen for some other patient groups:
A higher proportion of females tended to go to A&E (21%) than males (14%).
Females also chose location as a reason for choice of service (28% vs 22%) and
were generally prepared to travel less far for healthcare services than males (for
example 25% of females indicated maximum travel time of Under 15 minutes vs
18% males).
Unsurprisingly, a much larger proportion of respondents who indicated they had a
disability, indicated that their reason for attendance was because of an ongoing
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problem (44% vs 25% others) or a long term condition (23% vs 10%), and this was
more likely to be related to a mental health problem (9% vs 4%).
choice only)
Age 0-25
26-55 56-75 76+
Went to A&E 25% 14% 12% 13%
Went to GP 45% 55% 69% 60%
Community - other 30% 31% 19% 27%
0-25
26-55 56-75 76+
An ongoing problem 23% 27% 39% 42%
A one off symptom 32% 35% 28% 23%
A long term condition 8% 12% 16% 18%
A sudden illness 18% 16% 10% 8%
An accident or injury 12% 7% 5% 6%
Other - (please state) 4% 3% 1% 3%
Prefer not to say 3% 0% 0% 0%
0-25
26-55 56-75 76+
Yes, all expectations were met 59% 71% 71% 74%
Some expectations were met 22% 21% 22% 15%
No 13% 5% 6% 7%
Don't know 6% 2% 1% 4%
Average Score ** 74.2 82.0 82.9 84.8
calculation
0-25
26-55 56-75 76+
Yes 82% 92% 92% 94%
No 18% 8% 8% 6%
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0-25
26-55 56-75 76+
Under 15 minutes 76% 28% 19% 16%
15-30 minutes 8% 47% 46% 44%
30-60 minutes 10% 19% 26% 27%
1-2 hours 6% 7% 8% 14%
Although the profiles of actual distance travelled (Q8a not shown) were similar for all age
groups, there was a marked difference in the distance respondents were willing to travel with
76% of 0-25 age group (and/or their parents only willing to travel 0-15 minutes.
5.2.2 Location survey results
Top level summary results are provided in the section below. Detailed cross-tabulated
results, mirroring those from the general survey shown in Section 5.1, are provided in
Appendix 5. Note that as survey numbers are relatively small, caution needs to be taken in
interpreting these results. Patterns broadly mirror those seen for the general survey results.
Summary Results
I am completing this survey...
Number Percentage
About me 169 71.9%
As a carer 10 4.3%
As a parent 33 14.0%
On behalf of someone else 23 9.8%
Total 235
choice only)
Number Percentage
Went to A&E 136 57.6%
Went to GP 99 41.9%
Went to Walk-in Centre 1 0.4%
Total 236
Number Percentage
An ongoing problem 51 22.0%
21
A one off symptom 50 21.6%
A long term condition 10 4.3%
A sudden illness 25 10.8%
An accident 61 26.3%
For results 3 1.3%
Because I don't know what's wrong 19 8.2%
Total 232
Note: This question has a slightly different response structure to the equivalent question in
the General Survey. A full list of the Other category breakdown is provided in Appendix 5.
Number Percentage
Physical symptom 190 82.3%
Your eyes 7 3.0%
Dental health 2 0.9%
Mental health problem 7 3.0%
Substance misuse 2 0.9%
Total 231
Number Percentage
It was my decision 130 42.5%
Family/friend suggested I come here 27 8.8%
A health professional referred me 29 9.5%
Poster/leaflet 0 0.0%
NHS Direct sent me here 12 3.9%
Advice from NHS Direct website 5 1.6%
Advice from another website 0 0.0%
I did not know where else I could go 14 4.6%
I have used the service before 60 19.6%
Total 306
22
Number Percentage
Location 117 20.2%
Parking 24 4.2%
Public transport 6 1.0%
More culturally sensitive 2 0.3%
Confidence in the staff 62 10.7%
Environment 33 5.7%
Opening times 49 8.5%
I have been here before 124 21.5%
I have a good experience/outcome before 65 11.2%
I could fit it in with my daily routine 34 5.9%
No 41 7.1%
Total 578
Number Percentage
The diagnosis of a problem/illness/symptom 135 34.4%
The opportunity to speak to a health care professional 37 9.4%
A second opinion 10 2.5%
A referral for further consultation/treatment 21 5.3%
Medication/prescription 47 12.0%
Diagnostics such as X rays and blood tests 52 13.2%
Treatment 86 21.9%
Total 393
Number Percentage
Yes, all expectations were met 119 64.0%
Some expectations were met 21 11.3%
No 2 1.1%
Don't know 44 23.7%
Total 186
23
Note: Patients were asked to complete the survey whilst still on-site so not all had completed
their episode of care at that point. As a result of this, there were a relatively high number of
non-responders or people who answered Dont know for this question.
Score
Number Percentage
1 1 0.4%
2 2 0.9%
3 0 0%
4 0 0%
5 11 4.8%
6 8 3.5%
7 19 8.4%
8 40 17.6%
9 41 18.1%
10 105 46.3%
Total 227
Average Score 8.7
Note: The Average Score (8.7) is higher than in the General Survey (8.0), but the two scores
may not be directly comparable. A number of studies have shown that patients typically mark
higher scores at point of care (as in this Location-based survey) compared to completing
surveys retrospectively (as was the case for the General Survey).
Number Percentage
Yes 197 94.7%
No 11 5.3%
Total 208
Note: The percentage of responders who answered Yes for this question (94.7%) is higher
than in the General Survey (89.6%), but the two scores may not be directly comparable. A
number of studies have shown that patients typically mark higher scores at point of
care (as in this Location-based survey) compared to completing surveys retrospectively (as
was the case for the General Survey).
Number Percentage
15-30 minutes 61 26.8%
30-60 minutes 9 3.9%
1-2 hours 4 1.8%
24
Total 228
Number Percentage
15-30 minutes 127 58.0%
30-60 minutes 46 21.0%
1-2 hours 21 9.6%
Total 127
It is interesting to note, when combining the information provided by individual responders
for questions 8a and 8b, that:
! 70.0% of respondents would be prepared to travel further (for a high quality
healthcare service) than the journey they actually made.
! 27.2% of respondents would be prepared to travel the same distance.
! 2.8% of respondents would only be prepared to travel a shorter distance.
The majority of respondents travelled Under 15 minutes for the surveyed service visit, but
would generally be prepared 30-60 minutes.
25
5.3 Patient feedback/enquiries
5.3.1 PALS and Complaints information NHS Kirklees
Note that this information covers the Kirklees population as a whole. We are unable to split
out the data to focus purely on our main area of interest for this report, Greater Huddersfield,
but would expect key messages to be valid across each component area.
PALS and complaints information most relevant to Unplanned Care was accessed by
focusing on information held in the Datix system which related to either A&E or Community
Urgent Care. In addition, information on other, mostly condition-related complaints such as
stroke and cancer, was also reviewed for any elements which helped inform our
understanding of the patients experience of urgent/unplanned care.
There were a total of 19 complaints (5 A&E/14 Community Urgent Care) and 44 PALS
contacts (12/32), made over the period from 1 September 2009 to 31 August 2012. These,
together with relevant condition-related complaints were primarily related to the following
themes:
needed.
needed to access them, forcing them to go elsewhere.
from pillar to post.
needs.
! Inconsistencies in standard/quality of care received.
Illustrative extracts from the Datix system are shown below:
Presented himself to his GP on a number of occasions and also visited A&E at HRI
complaining of abdominal pain and constipation . On attending the GP a further time and
seeing the locum an urgent ultrasound scan was arranged which confirmed the complainant
had advanced pancreatic cancer He feels the diagnosis could have been made sooner.
Although he attended A&E on a number of occasions he was diagnosed with 'whip-lash' and
given an exercise sheet and some painkillers. He eventually presented to his GP who
immediately rang HRI to book an urgent CT scan which resulted in the complainant being
immediately transferred to LGI where he was diagnosed with a broken neck.
The patient felt that the A&E dept did not explain what was wrong with him and sent him
away still in pain returned to the A&E dept on three further occasions but was not given
any further information .. (later) After undergoing emergency surgery caller was told that he
had septic arthritis in his hip bone.
She doesn't know why this dentist didn't admit her to A and E due to her worsened
condition. She is also complaining predominantly about A&E at HRI due to not treating her at
all.
26
This is the second occasion that Ive been unable to access a doctor and spoken too by the
receptionist in a degrading way offering no help at all except go to A&E.
She is angry that she was left for 2 days in severe pain and felt that the Doctor didn't care.
After undergoing emergency surgery caller was told that he had septic arthritis in his hip
bone The patients complaint is that the correct investigations were not conducted by the
A&E dept at HRI.
She was then told to either see her Doctor or to come back to the hospital two days later for
her son's hand to be checked. Her Doctors does not redress burns so they directed her to
the district nurse. She tried to get through to the district nurse but after a while gave up and
contacted A and E. She spoke to the charge nurse told her to visit the walk in centre at
Dewsbury Hospital on Mon to again check it.
Her daughter was also admitted with vomiting blood and pain. She felt unreassuringly by
the staff and felt they didn't do anything for her.
Caller had taken her son to A and E with a swollen hand, they sent him away with just
bruised muscles. However she just had a letter yesterday from the consultant that he wants
to review the x rays. It turns out he has 2 fractures in his hand.
Complainant attended Laura Mitchell Health Centre Out of Hours dental service requiring
urgent dental treatment and feels as though has been passed from pillar to post and treated
shabbily.
Diagnosed with bowel cancer last week she became less mobile and in a lot of pain. The Dr
visited but did not examine her and told her to contact the Macmillan Nurses for pain relief.
The patient had to ring Macmillan then the District Nurses and the GP and ended up asking
the GP for a home visit. She had to explain that she could not get out of bed. The same Dr
visited and said that she needed to go urgently to hospital and that he would send an
ambulance.
The patient woke up with a severely swollen neck and face. When she went to the Walk-In
centre to see a Dr the receptionist refused her an appointment as it is dental and the Dr's
won't see her. The complainant then had to attend A and E where she was given antibiotics
and then further sent to Pinderfields for IV antibiotics and 3 operations.
The complainant has been treated at Calderdale Royal Hospital and has felt that she did not
receive the correct diagnosis about her mental health. She also felt that people were
conspiring against her.
She mentioned that she was in a lot of pain and so needs to be seen quickly. She was told
that due to a new directive the GP can't refer directly from a GP and instead have to go
through a physiotherapist.
However, he did not allow the complainant to hold his wife's hand and made him hold the
nurses. This made him feel very uncomfortable. The complainant feels that as another
Muslim he should have known that this is not allowed.
at logger heads with the new dentist. She has rung the emergency dentist but they say
her mouth is not swollen enough to see her. She has also been to A and E as she is in so
much pain but they can't deal with dental problems.
Caller rang explaining that he had rung up NHS Direct and told to go to A and E they would
only give him ibuprofen. He rang NHS Direct up again and they said that A and E should
have treated you.
The caller had rung the out of hours service at about 6.30 in the morning on Tues
(21.06.11), she was told that as she was not next of kin to the grandson (25 years old) the
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mother will need to ring. The mother rang and was told that there were no Dr's available to
visit as they were all busy.
They had to wait 12 hours before they could get an appointment, which took place at 8:15
that evening, at a time when he is normally fast asleep in bed . Caller went to the
pharmacy recommended by the dentist as open at Greenhead Road, it was closed. They
then went to Boots on Leeds Rd, closed. Caller rang Pendoc to see if there was anywhere
else they could go, the answer was no. very disappointed with both services, why did my
grandson have to wait 12 hours for an appointment, particularly when it meant that we could
not then find a pharmacist open to have the prescription filled?
In the end we had to trail over to HRI as his own practice emergency contact numbers were
ringing out without answer and the practice, which says is open on Saturday morning, was
not open.
She has been offered the next available appointment of next Tues. She then tried NHS
Direct and were told that they can't help as her GP is open. She could ring this evening after
6pm and get an emergency appointment with a doctor. She then tried the pharmacy and
was told that she needs to see a doctor.
As a parent if she is unable to get in contact with her child's doctors because they are
closed on a particular afternoon or if they are unable to get her a suitable appointment to see
him caller feels that she should expect to be able to find an NHS walk-in centre to take him
to.
Enquirer from WYUCS wanted to make the PCT aware that they were receiving a lot of calls
from Practice's patients as their phones are being diverted directly through to WYUCS.
Enquirer stated that WYUCS were not aware that the Practice would be closed and needing
to use WYUCS.
5.3.2 Complaints information Locala
Information below has been summarised from the Locala Community Partnerships Quality
Account 2011-12 [Reference 3] and a graphical presentation of the complaints data covering
the period 1 April 2011 to 30 June 2012 [4].
Note that this information covers the Kirklees population as a whole. We are unable to split
out the data to focus purely on our main area of interest for this report, Greater Huddersfield,
but would expect key messages to be valid across each component area.
Of a total of 45 complaints received by Locala over the year 2011-12, the largest numbers
were seen for the following services:
! District Nursing primarily staff attitude (12)
! Podiatry primarily quality of service (10)
! Dental services primarily waiting times (5)
Overall, the most common reasons for the complaints (DH categories used) related to:
! Aspects of clinical treatment (17)
! Attitude of staff (13)
! Delay/cancellation of appointments (8).
The Quality Account highlighted, in particular, the need to learn from complaints around staff
attitude as a priority and described how learning from complaints now formed an integral part
of recently implemented Service reviews throughout Locala.
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5.3.3 Complaints information Calderdale and Huddersfield Foundation Trust (CHFT)
Complaints information most relevant to Unplanned Care was accessed by focusing on
information held in the Datix system which related to A&E, using a combination of search
criteria based on the Specialty field and a series of keyword/phrase searches.
The searches identified a total of 279 complaints made over the period from 1 September
2009 to 31 August 2012. These were primarily related to the following themes:
from pillar to post, sometimes returning to A&E on multiple occasions.
! A number of patients complained about long waits and were often not told how long
they would have to wait, or reasons why.
needs.
! Several cases where patients were concerned that they received no, or inadequate
pain relief.
! Poor communication/ information provided to patient on their condition and
subsequent management, and sometimes between different areas within the hospital
system.
! A few cases highlighting poor hand hygiene, or problems of cleanliness of treatment
rooms and surrounding areas.
! Inconsistencies in standard/quality of care received.
It is also interesting to note, from the narratives, the mix of patient characteristics for the
reviewed cases; a sizeable proportion appear to relate to children, elderly patients requiring
support from family, physically disabled patients, and several patients with some form of
cognitive impairment.
Illustrative extracts from the Datix system are shown below:
Complainant's daughter who has learning difficulties, cerebral palsy and is a quadriplegic
and is wheelchair bound, pulled out her feeding tube and needed to go to A & E. They were
booked in at 2.55 pm and was still there at 11.35, still in her wheelchair, which is not meant
to sit in for more than 4 hours and the staff knew this, there was no bed available to change
her pad or make her more comfortable.
Concerns re care and treatment following biopsy, unable to contact ward for advise had to
come to A&E for post op bleeding and high temperature; doctor in A&E confused re
procedure undertaken diagnosed infection and patient admitted; following short stay
discharged; confusion re which type of antibiotics and diagnosis; GP had to chase results;
patient worsened and developed urine retention; GP arranged admission and conflicting
information and lack of pain relief; poor communication.
Concerns re lack of care and treatment of son's knee and discharged with no advice.
29
Daughter concerned re standard of care offered to wheelchair bound elderly father; issues
re doctor's handling of hygiene, despite wearing gloves large of amount of blood transferred
to stainless steel trolley and whilst with bloodied gloves doctor rummaged through trolley
taking out and putting back bandages not to be used. Doctor did not wash her hands; only
hand wound looked at daughter had to ask re head wound. Poor communications skills and
difficult to understand what was being said, especially when chewing on sweet.
Concerns regarding her mother's stay on MAU. The attitude of one of the doctors. The
miscommunication regarding her mother's possible discharge and the possible increase in
her medication, when A&E had thought this needed to be decreased.
Daughters of elderly patient not happy she was kept 7 hours in A&E before being admitted
and moved to MAU just after midnight. Raised this with a matron in A&E but have not heard
anything further. Also concerns around the communication with the ward regarding
discharge.
Concerns that elderly patient attended A&E and was discharged the same day despite an x-
ray showing lungs to be congested. Patient was admitted a few days later and is quite
poorly with pneumonia, heart failure and renal failure. Daughter feels no consideration of
her mother's age and condition were thought out before her discharge from A&E.
Patient attended A&E department twice after injury to her wrist. Patient received X-ray and
advised muscle injury/sprain. Patient has returned to GP who confirmed patient had
dislocated her wrist and referred back for orthopaedic OPD.
Unclear, confusing and misleading information from nurses, consultant and social workers.
No contact was made with family regarding potential homelessness.
Patient explained he presented in A&E at approx 2pm with chest pains and was advised
that he was to be admitted. Patient advised he was then left by himself on the ward in A&E
until 12.20am when he was then discharged home in a taxi as there were no beds has
now contacted his GP and is awaiting a call back.
Call from mum who wished to make a complaint regarding the way both herself and her 2
year old daughter were communicated with in A&E following an injury to her eye. Mum was
unhappy that her daughter was called Alfie (a boy's name) as staff could not pronounce her
daughter's name (Aofie). Mum was also unhappy about the fact that they were left waiting
and were not informed how long they would be waiting or what they were waiting for. When
a doctor eventually came to see them he/she did not introduce themselves and as they had
been waiting so long it was too late to glue her daughter's injury.
5.3.4 Patient Opinion website
The Patient Opinion website offers patients a chance to submit and search information on
their healthcare experiences of NHS services across England and Wales. It describes itself
as An independent site about your experiences of UK health services, good or bad. We
pass your stories to the right people to make a difference. This media also links with
information held on NHS Choices.
Information on patient stories related to local services was downloaded and analysed to help
us better understand patients views and experiences. The website search facility was used
to pick out posts related to any of the following:
! Calderdale and Huddersfield Foundation Trust
! NHS Calderdale
30
! NHS Kirklees
! Locala
! Calderdale Royal Hospital
! Huddersfield Royal Infirmary
! and a number of other related searches on smaller individual community-based
services (e.g. Moorfield Primary Care Centre, Holme Valley Hospital)
After reviewing information to remove duplicates and out of area cases, the dataset
consisted of 256 individual patient posts.
A cautionary note should be applied to interpretation and extrapolation of the findings below.
As an external site, we do not have the ability to audit or verify the authenticity of the posts,
and it should also be borne in mind that this forum is likely to only attract a certain subset of
the service user and wider population. It is also noticeable that certain clusters of similar
posts occur from time to time, suggesting these may have been prompted by an element of
marketing and/or referral to the site.
Common themes prevalent in the patient feedback information, included:
Patients sometimes found the system fragmented with poor continuity of care/
discharge passed round from pillar to post (several positive comments re.
Importance of effective triage)
When she returned home from the hospital she was in so much pain we had to call an
ambulance. The ambulance arrived after 20 minutes and in my opinion then wasted
approximately 45 more minutes in deciding whether or not she needed to be taken into
hospital, even though she was clearly in a lot of pain. When we arrived at the hospital I
found the staff I saw inconsiderate My mother was then seen to by a junior surgeon who
did not seem to take into account my mothers previous surgery After a 3 hour wait the staff
came to an assumption that my mother needed constipation tablets and could return home
On our arrival at home my mother was violently vomiting and was still in a lot of pain. We
managed to ease the pain till the morning. We then had to call the hospital regarding the
cannula in my mothers arm. They sent a district nurse out to remove it who told us she was
baffled at why my mother had been sent home in such a state as she also suffers from low
blood pressure.
The doctor saw her on a Friday morning and said she could go home but the nurse pointed
out that there were some blood test results that were still awaited The nurse then told me
it was too late to book ambulance transport to let mum come home with proper planning
she could probably have been discharged on the Friday and as a result she was in hospital
for 3/4 days longer than I felt was necessary.
She prescribed for me something I had already tried, I went back the next day to pick up
my prescription and the day staff had no idea what I was talking about because the night
staff kept no record.
Having been passed from pillar to post, the guys at the diabetic podiatry unit and Dewsbury
Hospital have taken responsibility for my care and are doing a great job.
On Sunday we sent for an ambulance for my wife and she was taken to Calderdale Royal.
The ambulance staff, A&E, the nurses and the doctors were excellent (but) when the first
set of paramedics arrived my wife was in too much pain to move. However, neither of them
were allowed to administer entonox had to wait an hour for another paramedic to come.
The doctor wanted a slab plaster putting on my left shoulder for overnight stability but there
was no person in A & E that had the capability to fit this plaster.
31
I trotted off to A and E as it was a deep cut and prepared myself for a long wait. What a
pleasant surprise I had instead. I had to wait around 20 mins for triage but as soon as I got in
there the male nurse assessed the damage ... I was patched up in two minutes - tetanus
background checked and on my way. It was a very pleasant surprise and something I hope
happens more and more in triage with minor injuries.
GPs and community-based health care elements were often closed when the patients
needed to access them, forcing them to go elsewhere.
After having rung NHS direct for advice about my 7 month old granddaughter, I was told to
take her to the drop in centre at 1.30pm Sunday. All signs on the door said the centre was
closed, but I gave the buzzer a press anyway but did not get any response, so took the baby
to A&E to ask where we should take her.
This was my first experience of using 'out of hours' services, and I am left feeling a bit
alarmed by the lack of professional care available during times deemed inconvenient to GP
and dental practices (totalling more than half the year, if you include nights, weekends and
holidays).
A number of other different issues with access to services/healthcare facilities
I called the surgery today for an appointment with the nurse. I was told that they only now
have one nurse and that she would be going on holiday and I would therefore have to wait
until the end of September for an appointment.
The appointment system is a farce. The GP told me to call or go online for a choice of
hospital and appointment times. The reality was that there was no appointments available.
There are approx 10,000 patients at the practice at Ravensthorpe health Centre Dewsbury
and only 2, yes 2, disabled parking bays. How ridiculous is this? Oh Yes there's lovely green
grass going to waste and needs maintaining but how on earth are disabled patients
expected to attend the surgery when they cannot park?
I only waited around 3 weeks before i received a letter to ask me to ring to make an
appointment. The lady on the phone was very helpful, offering various dates for me to attend
that fitted around my work schedule (unlike the main hospital where a date is sent out
through the post, which is usually not convenient and trying to change it is made to feel like a
chore).
I've had one appointment cancelled without anyone telling me, another appointment where I
turned up and there wasn't even a clinic, and one appointment that over-ran by 1.5 hrs with
no apology or reason given.
I just rang up to make an appointment with the bookings secretary and she says I cant
have an appointment for 26 weeks! Its outrageous. I wanted to complain to NHS Kirklees
about this, but when I call their PALS line, no one answers.
Patients did not always feel that they had been provided with sufficient information to
know where best to go to access the care they needed.
From my experience, people in their late 70s sometimes do not get enough information
about services and help available for dementia patients.
Delayed diagnosis and/or mis-diagnosis.
I considered then and still consider now that the explanations provided by this doctor should
in reality have been provided by A & E when I first went to A&E or by Orthopaedics the
following morning.
I saw all 3 GP's at the Marsden surgery who prescribed anti-depressants When I
suggested to the GP's that maybe I had Chronic Fatigue Syndrome (CFS) I met a very
32
negative response which bordered on hostile from one GP. It was made very clear that I
didn't know what I was talking about and that I just had to be patient and take higher doses
of anti-depressants. In August I saw an independent consultant who immediately diagnosed
me as having CFS and has since put me on several treatments which are slowly making me
better.
Patients consistently cite high standard/quality of care as important, but quite often
report big inconsistencies in services or along different stages of their pathway
From the minute I walked onto Ward 4C to the minute I left I was treated with care,
compassion, respect and professionalism.
Staff attitude/Care/ Some concerns that staff not sufficiently caring and did not take
patients concerns about their health seriously enough, or consider their individual
circumstances and needs.
Locala member of staff at the reception desk was abrupt, unhelpful and a little rude in
directing me to the correct location for my appointment. The phlebotomist from Calderdale
and Huddersfield Trust was very efficient and had a warm, approachable manner, I
particularly noticed how gentle and reassuring she was towards the older people who were
waiting.
The paramedics, the A & E team, medical assessment staff and especially the staff on ward
6D were efficient, concerned, and caring not only towards my mother but also to myself at a
very difficult time. The consultant was sensitive to the need of the family to be kept informed
and aware of the options open to us as to her continuing care.
I was telling my doctor about this problem I have had since I got back from my travels and
was showing him the palm of my hand and my foot. He was on his computer, he glanced
over and said he couldn't see anything and continued typing. I said the spots are tiny and
they are under my skin and if he could actually take a closer look. He got irritated and said
there was nothing there and continued typing.
I went to the Huddersfield Royal Infirmary last week for a blood test. They asked me to roll
up the sleeve of my right arm so I explained that I have Parkinson's and that my right arm
shakes especially when extended. "That's all right love, it doesn't matter we can still get it"
they said to me. Even though I was thinking that wasn't what I meant I think some medical
personnel ought to listen more to a patient's concerns rather than making some people like
me feel patronised.
Patients put high value on rehabilitation services/ being supported to self-manage/
First I attended joint therapy class where everything was explained, went home happier. I
came home on 5th day and on the 6th day met my home therapist, who put me through my
exercises.
Being introduced to the staff at Eddercliffe Physiotherapy Centre, first "at Home" and the
centre itself was the best thing that has happened to me since leaving hospital. Having
fractured my spine and broken a shoulder my balance was completely lost and confidence at
rock bottom worked with me at home, having assessed me, they showed me exercises to
do. were both very understanding and I developed an empathy with both. They
encouraged me to try hard to do the exercises daily. Later at the centre I met the physio in
charge who explained the structure of the session and introduced me to the other people in
the group very professional and encourages everyone making them feel valued and
respected.
33
I have now been having the District Nurses from Cleckheaton Health centre visit me at
home for 8 weeks almost every day. They are such a fantastic team of community
nurses ....all so friendly ...patient ...empathetic ...sensitive and so many more things.
I have received so much support from every nurse that has visited. They really do see the
person and not just the "condition /illness /disability " which makes such a difference. They
are so incredibly busy and have so much pressure with so many patients to see....but I can
honestly say that they never let that affect the care. They will give that time to just sit and
listen when you just need that little bit more.
Once I had recovered sufficiently to return home I was booked in for regular home visits
Initially he came every 14 days but I have now recovered sufficiently for the visits to cease
and I now simply have to call if I feel I need assistance. I would like to say how absolutely
wonderful these have been.
My introduction to your physio and reduced mobility has been excellent for me. Lovely
friendly staff, very helpful, as I have struggled for a while to keep myself mobile when I
should have asked for help.
After visiting the Podiatrist I was very pleased at the care, treatment and advice that was
given. was a little embarrassed regarding the condition of my feet and the past operations
that had left slight deformities. I was soon put at my ease and a problem that I had been
experiencing and unable to correct was soon diagnosed and treated they have kept me
out of hospital and sorted out my regular medication.
Patients generally provide very positive feedback about a number of local community-
based services in the area, particularly Moorfield Primary Care Centre (primarily for
Dermatology service) and Locala services for Continence, Contraception and Sexual Health,
and Podiatry **. Patients rate the ease of location, ease of access, and standards of care
and communication provided by staff, highly.
[** Note: this conflicts somewhat with Locala complaints information provided in Section 5.3]
I only required three appointments with the Continence Advisor but found the service
provided very impressive and would happily recommend it to anyone in the same situation
The advisor who I was seen by was very friendly and approachable which made it easy to
talk about problems despite their intimate nature.
I contracted chlamydia the other week and rang up my local chlasp clinic to see if I could
get an appointment. There and then I told my story of what happened and we arranged to
meet that same day. This was all done within an hour and a half at the longest.
Great service right on your doorstep. Lots of interesting leaflets.
They felt that everything was kept confidential and that the staff went out of their way to
accommodate their needs, such as re-arranging appointments and offering extra support.
I recently visited the clinic with a skin complaint and would like to say what a fantastic place
this is.
I have nothing but praise for the treatment I receive at Moorfield Primary Care Centre which
I regularly go to on a 3-monthly basis for skin cancer. I have been seen by one of two
doctors. I am always seen on time or before on the treatment given has been excellent.
5.4 Other engagement evidence from Intelligence Library
A significant amount of local engagement work has been undertaken in the last three to four
years to:
34
! gather insight into peoples experiences of using urgent and unplanned care services,
! better understand their views on existing service provision,
and to use this information to
! drive improvements in existing services, and
! redesign and reconfigure services, where required.
Full reports and supporting analyses for all these elements are stored on the Project
SharePoint Intelligence Library for reference and audit as required, and a full list of
references is provided in Section 10 of this report.
Summaries of each engagement area are provided in this section to help draw out key
recurring themes and further evidence these with specific data and patient quotes.
Key messages are drawn from reviews of the following services:
! Accident and Emergency Services
! West Yorkshire Urgent Care Service
! Trauma Services
! Paediatric Emergency Services
! GP Practices
! Inpatients
35
5.4.1 Accident and Emergency services
Source(s) National A&E Survey 2012
Local A&E Discharge Survey 2012
Local A&E Real Time Monitoring Results 2010-12
Audit of A&E/Minor Injuries Unit 2011
Data collection period March 2012 (National Survey)
November 2011 January 2012 (Discharge Survey)
February 2011 (Minor Injuries Unit audit)
Engagement population Patients attending A&E Departments at HRI/CRH
Local GP Practice patients (Minor Injuries Unit audit)
No. of respondents/
participants
338 patients (National Survey)
218 patients (Discharge Survey)
50 patients (Minor Injuries Unit audit)
References (5), (6), (7), (8)
National A&E Survey 2012
338 patients who had visited the A&E Department at either Huddersfield Royal Infirmary or
Calderdale Royal Hospital during March 2012, returned the form, a local response rate of
40%, slightly above that achieved nationally (38%).
National results highlighted mixed patient experience:
Respondents reported longer waiting times than in previous A&E surveys (2004/08).
Confidence and trust in the doctors and nurses working in A&E Departments
continues to be high.
17% of patients thought staff did not do everything they could to help control their
pain, an increase from previous surveys.
Although many respondents felt their interactions with doctors and nurses in A&E had
been positive a substantial proportion reported communications that were
unsatisfactory in some areas.
Feedback on other aspects of communication was mixed: although most people
felt they were definitely listened to by doctors and nurses (75%), there has been a
slight increase in those who did not feel listened to.
59% of respondents were not told how long they would wait for their examination.
Just under a fifth of respondents felt their fears about their condition or treatment
were not talked about at all (an increase since 2004 and 2008).
Substantially more people felt they were given enough privacy when talking with a
receptionist than in 2008, although percentage still remains low (48%).
Perceptions of cleanliness have substantially improved from previous surveys.
Transitions between services is a key area where improvement is required:
Almost a quarter of respondents said they waited more than 15 minutes for their care
to be transferred from ambulance to A&E staff.
36
Almost half of respondents who were discharged from A&E did not feel their home or
family situations were considered prior to them leaving hospital.
Overall, the 2012 local results showed only marginal improvement to those achieved in
2008, although there was an increase in the number of green-rated questions (top 20% of
Trusts nationally) from two in the 2008 survey to seven in 2012. A full table of results for
survey questions is provided in Appendix 7, whilst a themed summary of patient comments
is shown in Appendix 8.
Positive areas for the Trust included
! Ambulance service and A&E staff working together and short waiting time for
handover
! Short wait time before speaking to a nurse or doctor
! Caring staff especially nurses
! Information given whilst in A&E
whilst key areas requiring improvement include:
! Communication - a number of negative patient comments and low scores for
questions on explanation of results/ explanation about the purpose and side effects of
medication
! Waiting time and organisation mixed results, with most patient comments relating to
not being told how long/why they had to wait
! Privacy and dignity
I would say the treatment I received both with the doctors and nurses was very good
indeed. The nurses in particular were very caring
All grades of staff were polite, respectful and attentive, especially the male triage nurse who
gave me immediate pain relief and was very thorough and professional
Waiting time and lack of information around this has been a consistent problem
The triage nurse was very good and informed me of the possible wait time. She also said
she'd speak to a doctor as to whether I'd need an x-ray. If I did she'd arrange for me to be
done prior to me seeing the doctor to cut down on my waiting time
I have to wait for long time while I was in severe pain
It was early in the morning so very quiet and efficient. The receptionist and nurse were very
efficient.
Issues with giving personal information at reception. People can sometimes overhear what
you give out (Dob or Address)
The porter took me from my cubicle to x-ray and from x-ray to the ward and did not say a
word to me the whole time
Further local analysis of the survey has recently been performed to better understand how
the specific subgroup of patients with long term conditions viewed their experience of
visiting A&E. Patients were asked to indicate whether they had any of the following (multiple
boxes could be ticked):
! deafness or severe hearing impairment
! blindness or partially sighted
! a long-standing physical condition
37
! a learning disability
! a mental health condition
! a long-standing illness
46% of patients indicated that they had one or more of these long term conditions.
This work provided strong evidence that this group rate several aspects of their patient
experience significantly lower than those without long term conditions, particularly with
respect to:
! patient care, and emotional and practical well-being
! communication
! provision of information around medications and managing day-to-day activities
Detailed results of survey questions responses and an analysis of patient comments is
shown in Appendix 18. The survey questions with the biggest differences between the two
groups of patients were:
While you were in the A&E Department, did a doctor or nurse explain your condition
and treatment in a way you could understand?
If you had any anxieties or fears about your condition or treatment, did a doctor or
nurse discuss them with you?
Were you involved as much as you wanted to be in decisions about your care and
treatment?
Did a member of staff explain why you needed these test(s) in a way you could
understand?
Did a member of staff explain the results of the tests in a way you could understand?
Were you able to get suitable food or drinks when you were in the A&E Department?
Did a member of staff explain the purpose of the medications you were to take at
home in a way you could understand?
Did a member of staff tell you about medication side effects to watch for?
Did a member of staff tell you when you could resume your usual activities, such as
when to go back to work or drive a car?
Whilst the proportion of positive comments received was markedly lower for the group who
considered themselves to have one or more long term condition (51% vs 62% positive), with
more negative comments particularly on privacy and dignity issues, care and doctors
communication. Comments on poor aspects of patient experience included:
Nurses attitudes toward people with mental health problems.
Staff and doctors could have had patience and time due to my severe hearing loss.
Being spoken to so you understand medical jargon instead of being spoken down to.
Having staff talk about patients, (including self) and after making jokes/ disparaging
remarks.
Attitude of the doctor due to the nature of my visit. He could have been more understanding
and less judgemental.
When we arrived in A&E I collapsed on the floor and it took my husband some time to find a
member of staff. Then he had to lift me up and take me to a cubicle unaided.
38
Local A&E Discharge Survey 2012
The local A&E Discharge Patient Experience survey received responses and comments from
218 patients (22% response rate) over the period November 2011 to January 2012.
Responses were compared to those achieved by the Trust in previous National A&E Survey
in 2008.
The main themes largely matched those seen in the later national survey observed may be
summarised as follows:
Patients generally commented positively about their experience of nursing care, but
gave mixed feedback on that provided by doctors.
The biggest improvement since 2008 was related to providing information about who
to contact if worried about condition/treatment after leaving the A&E Department.
Explanations on medications were generally poor reflected in both question
responses and negative patient comments.
Mixed results were seen for waiting times, with a number of patients reporting there
were not told why they had to wait. The waiting areas themselves were also criticised.
Results for the two hospital sites, HRI and CRH, were broadly similar.
I found the A&E department extremely cold and draughty - especially as I went into shock -
but my family were in total agreement that it was a very dismal area to sit in
I was fortunate that I had to visit A&E at a quiet time and I was only in for 30 minutes before
being discharged, the overall service was excellent Very good and expedient
I know there are accidents & emergencies coming into the hospital all the time in
ambulances but I was left for nearly 3 hours with no information and when you are urinating
blood and in shock and panic thats not very good
The triage system worked well as there was a possibility that I had stomach bleeding I was
seen very quickly. My visit to A&E was a wholly positive experience
Triage nurse was very empathetic and spoke in terms I could understand
Doctors are too proud and have no sensitivity to what the patient is experiencing. There
should be recognition between genuine illnesses and instances where patients have minor
ailments
The nurse was excellent, very pleasant and knew just what she was talking about. Doctors
also very helpful
The staff nurse who attended my injury could have explained more about my injury &
medication and how to take it and be a little more patient friendly
I felt the doctors were too busy to see me, one doctor kept saying he would be back with
some tablets and after ages came back having forgot them
Broadly similar results have also been seen in the Trusts ongoing real time monitoring
programme, which gathers regular feedback from patients whilst they are in the clinic. An
ongoing improvement programme is being undertaken to address problems highlighted with:
! General lack of awareness of Patient Experience agenda
! Communication at reception
39
! Information about waiting times
! Pain management
! Information on discharge regarding medications and condition
[Action plan taken from Patient Experience in A&E The Story So Far]
Audit of A&E/ Minor Injuries Unit local GP practice
A local GP Practice (University based) undertook engagement with patients in February
2011, to establish whether behaviour had changed following the introduction of a local Minor
Injuries service in the Autumn of 2009.
Responses to a questionnaire were gathered from 50 respondents (41 students, 8 non-
students, 1 not declared). The predominant age group was 18-25 years (74%) and non-
British students made up a sizeable minority of the sample (24%), representative of the
Practice population as a whole (2,598 out of total of 9,756 were immigrants to the UK).
The Practice reported disappointing results, with the majority of patients (62%) unaware of
the local Minor Injuries service, and only very limited actual usage (4%), with most regarding
using A&E as the default option.
In particular, there had been a clear increase in the number of patients who would consider
attending A&E for minor conditions, compared to a previous survey carried out in 2009
(e.g. glass wound up from 26% to 48%, sprains from 22% to 38% and flu like illness 7% up
to 14%).
The Practice highlighted the following planned actions in response to these results:
! Further promote educational programme for the coming months and particularly over
the Fresher period in the Autumn of 2011.
! Notice boards will be utilised to communicate this message
! A message will be placed on the back of prescriptions
! The practice will utilise its website to inform patients of when it is appropriate to utilise
A&E and what alternative services they may consider, i.e. ringing the surgery,
contacting NHS direct, using a local pharmacy.
5.4.2 West Yorkshire Urgent Care Service
Source(s) West Yorkshire Urgent Care Services Engagement 2012
Data collection period January - March 2011
Engagement population Calderdale, Kirklees and Wakefield District Cluster
residents
No. of respondents/
participants
320 (185 in Calderdale and Kirklees)
References (9)
As part of a wider review of West Yorkshire Urgent Care Services, NHS Calderdale, Kirklees
and Wakefield District Cluster undertook an engagement exercise to better understand local
peoples awareness and usage of the service.
40
An engagement document provided background information on existing services and the
new telephone-based NHS 111 service. Feedback was obtained using a form made
available in both paper and online form - which included questions on what was important to
patients and the public within the service.
A total of 320 responses were received, including 85 from Calderdale and 100 from Kirklees.
These 185 responses have been combined in the analysis summary below:
! The bulk of respondents were either members of the public (71%) or voluntary or
community organisation members (18%).
! 55% were aware of West Yorkshire Urgent Care Services.
! 42% had previously used West Yorkshire Urgent Care Services; 60 of the 185 people
had accessed the Out of Hours service offered, with a further 19 using the
unscheduled Dental service (only one patient used the GP surgery-based Minor
Injuries unit).
! Those who had used the services reported mixed experiences of access - only 55%
said it was easy or very easy to contact West Yorkshire Urgent Care Services.
The main themes highlighted in the engagement were:
! The West Yorkshire Urgent Care Service is seen as a valued and essential service to
those who have used it.
! There is currently a lack of public awareness about West Yorkshire Urgent Care
Service with many people calling for more effective awareness-raising of the service.
! There appears to be some confusion between different urgent and emergency care
services such as NHS Direct and A&E.
! The majority of people engaged with had a good experience of the service, receiving
quick, effective treatment and good advice and information from helpful staff.
! A small number of issues were raised about slow or no call backs.
! A small number of people stated that there had been reluctance to undertake home
visits from the service on occasions.
! People were keen to ensure that this service was local and accessible to those who
did not have, or were unable to use, their own transport.
5.4.3 Trauma Services
Source(s) Regional Trauma Networks Stakeholders Views 2011
Data collection period April - May 2010
Engagement population National stakeholders, including patients
No. of respondents/
participants
Not stated
References (10)
41
A multi-strand engagement approach was used to gather views of a number of stakeholders
who were keen to improve the delivery of major trauma services. The approach adopted a
mix of telephone and face-to-face interviews, focus groups, online feedback and social
media to achieve the following:
! To engage with the full range of stakeholder groups who had direct and recent
experience of major trauma, including hard to reach groups.
! To generate a detailed understanding of the current trauma pathway and perceived
strengths and weaknesses of the current service, highlighting key areas requiring
change.
! To gain a wide perspective of responses on proposed recommendations put forward
by the Clinical Advisory Group.
The key themes from the engagement may be summarised as follows:
Respecting the patient journey should be at the heart of a new major trauma care. i.e. we
must build the system around the patients and their needs. This should consider the
complexity of patients needs and plan for rehabilitating the whole person, paying particular
attention to psycho-social needs at earlier stages of the pathway.
Standards of care are not universally high. Patients reported lack of consistency along
the trauma care pathway both in terms of variable quality along different stages of the
pathway, and regional/ local differences. Standards of initial assessment and care also vary
depending on the time of day when the major trauma occurs.
The system continues to be fragmented and uncoordinated, with hospitals not
adequately networked together to provide a package of care along the pathway. A key area
of focus will be to achieve greater organisational cooperation in the future, and improve a
number of aspects of the pathway, including initial handover to acute services, and better
pre-hospital assessment to ensure people are transferred to a hospital best equipped to treat
their injuries.
Both paramedics and A&E staff need more specialist training and greater exposure to
major trauma to increase their experience and skills.
Ongoing management of major trauma in the acute setting can be truncated because
of limited bed capacity, staffing shortages and pressures to reduce length of hospital stay.
Acute rehabilitation and community or general rehabilitation facilities were viewed as
inadequate and significantly underfunded by many patients. There is currently a lack of
coordination and support once people are discharged from acute hospital care. Patients and
carers commented frequently about the need to provide non-medical support and
psychological support, again taking a holistic approach to trauma care. Currently, they felt,
this type of care is generally not seen as being part of the whole, integrated care pathway,
and several comments were received about how difficult it is to access dedicated specialist
services and wider support groups.
At the moment rehabilitation is an afterthought rather than being planned the moment first
contact begins with trauma team.
The psychological effects of trauma may not be given sufficient priority throughout
the trauma pathway, and it is perhaps not sufficiently recognised that non psychologist health
professionals can play a role in the assessment and support of peoples psychological
needs.
42
Patients expressed their desire to be able to plan for their futures, and they were especially
concerned about their lack of choices, uncoordinated care and ineffective communication
about their care plans.
A team approach to rehabilitation care, with a lead professional, was seen as desirable.
Some professionals noted the lack of connection between rehabilitation and primary and
community-based services, which often resulted in poor care following discharge and in
some cases readmission.
What I needed was someone to make that cross over a named district nurse who could
be a lead or a team who could support me.
Patients experience of multi-agency working and the quality of social care was also poor.
especially where there were ongoing care needs.
Need to make better use of technology, for example timely and accurate assessment can
be aided by sending data and pictures to a central hub from the moment a paramedic arrives
on the scene.
Commissioners need to consider realignment of incentives to better match the whole
system needs and provide sufficient resource where it is most needed.
5.4.4 Paediatric Emergency Services
Source(s) Choose Well For Your Child Campaign Report, 2012
Listening to Childrens Views on Heath Provision, 2012
Data collection period April 2012
Engagement population Greater Huddersfield public
No. of respondents/
participants
Wide-ranging marketing and engagement campaign,
including direct mail to approximately 10,000 parents/
guardians
References (11), (12)
Choose Well For Your Child Campaign Report, (2012)
Background information:
Hospital attendance figures in Greater Huddersfield show that children under five
years of age account for nearly 10% of all A&E visits.
Those with children in the household are the most likely to have had contact with
West Yorkshire Urgent Care: a 24/7 service that directs callers to the appropriate
service (mainly called in relation to sick children.
For Greater Huddersfield A&E attendances are highest from patients attending GP
practices in HD1 (Huddersfield town centre) and HD2 (outskirts of Huddersfield town
centre) postcodes. Presumably these are closest to the facility, although also some
profiling around low income families, vulnerable young parents, and South Asian
communities.
43
Confusion between different urgent and emergency services/ lack of awareness
about West Yorkshire Urgent Care Services (Choose well for your child campaign
report).
The Choose Well for your Child Campaign was conducted in Huddersfield during April 2012,
on behalf of Greater Huddersfield Clinical Commissioning Group (CCG), in order to educate
parents and carers of children aged 0-4 within the area about which health services to use
when their child is ill or injured.
Focus groups were conducted at childrens centres in order to gain an understanding of the
target audience; their views were used to help tailor design of communications and
marketing methods and materials. Methods included press releases and a social media
campaign, a large direct mailing(10,000 parents/guardians), an advertising campaign on 30
local buses, distribution of leaflets and posters to local venues such as childrens centres,
libraries and GP Practices.
Pre and post campaign evaluations were undertaken to assess the effectiveness of the
campaign, with the following results:
! The campaign recall proved to be very strong: pre-campaign feedback demonstrated
that none of the respondents questioned could identify the Choose Well name when
shown the logo. Post-campaign, this percentage increased to 40%.
! 63% of those questioned recalled seeing the Choose Well for your Child campaign.
! 55% of people questioned said that they recognised the campaign from receiving
the promotional materials through the post.
! 65% of people thought that the information contained on the promotional materials
about where to go or who to call if their child is ill or injured was very good. The
remaining 35% thought that it was good.
Listening to childrens views on health provision (2012)
Key Messages:
! Working groups should be set up that allow primary care practitioners and
emergency department clinical staff to develop services together to meet the
requirements of commissioners. (Evidence that absence of dialogue between
commissioners and both groups of clinicians appears to be a barrier to improving
care).
! The objective should be to break down the barriers between primary care and
emergency care clinicians, between the different organisations that employ the
staff, and that promotes good joint"working. However, this must be based on absolute
clarity over the strengths that each group has, how they are best deployed in or
alongside the emergency department and what each group is expected to do. Only
with this clarity will it be obvious to the clinician involved in a consultation when the
expertise of another group needs to be drawn on to meet the needs of that patient.
! Enablers include improving and linking IT systems, and align funding into more
collaborative approach.
! commissioners must see any initiative of this kind within the broader context of the
full urgent and emergency care pathway.
44

5.4.5 GP Practices
Source(s) Patient Participation Direct Enhanced Service, 2011-12
MORI National GP Surveys, 2009-10 and 2010-11
Data collection period April 2011- March 2012 (DES)
April 2009 - March 2011 (Surveys)
Engagement population Calderdale and Kirklees GP patients
No. of respondents/
participants
21 Practices (78%) in Calderdale and 43 Practices (60% in
Kirklees participated. 264 Calderdale and 881 Kirklees
patients are involved in Patient Reference Groups (DES)
References (13), (14)
Patient Participation DES
The results from the surveys showed the following to be of particular concern to patients:
Patients want a telephone system in place that enables them to get through, first time,
to the practice to make an appointment
Patients want flexibility in being able to make appointments sometimes with their
preferred GP within 24 hours and, at other times, booking several weeks in advance.
Patients want opening hours to be increased.
Patients want their waiting rooms to be pleasant environments that provide them with
up to date information on services available at the practice.
Patients expressed concerns with regards to the lack of privacy and confidentiality
when talking to the receptionist.
Patients want to be able to have their blood tests at the practice.
Patients were concerned about the number of Did Not Attends (DNAs).
The surveys also highlighted a lack of awareness of the different ways of making an
appointment, services provided by practices and the opening hours of practices, in particular
extended opening hours, and some concerns with the attitude of reception staff and lack of
parking.
National GP Survey
National Survey results for Calderdale and Greater Huddersfield GPs are displayed in
Appendix 12. Whilst overall results broadly match the national average, two particular
observations stand out:
Scores for the section on getting through on the telephone (ease of getting through/
speaking to a doctor/ speaking to a nurse/ getting test results on the phone) are
noticeably lower both nationally and locally than other aspects of patient
experience.
Patients experience varies considerably between Practices, with some Practices
scoring markedly lower than others, and rated red (bottom 20% nationally) for all, or
virtually all, questions across the survey.
45
5.4.6 Inpatients
Source(s) National Inpatient Survey 2011
Readmissions Survey 2012
Data collection period June 2011
January March 2012
Engagement population Patients treated as inpatients at CHFT
No. of respondents/
participants
475 (Inpatients)
300 (Readmissions)
References (15)
National Inpatient Survey 2011
!
The National Inpatient Survey 2011 was sent to a sample of 850 patients who were
discharged from either Huddersfield Royal Infirmary or Calderdale Royal Hospital in June
2011. Four hundred and seventy five patients responded to the survey, representing a
response rate of 56%, the highest seen locally in the last five years.
!
The individual Trust reports were published by the CQC on 24th April 2012, these were a
new style of report, with the main differences being:
"
Data presented as a score out of 10 (previously out of 100).
"
Data categorised differently using a statistical technique called the 'expected range',
rather the previous style of top and bottom 20% of trust scores.
Using this approach the Trust scored 'About the same' when compared to other trusts for
all but one of the questions and 'Better' for the question 'Did you see any posters or
leaflets on the ward asking patients and visitors to wash their hands or to use hand-wash
gels?', with a score of 9.8 out of a possible 10.
!
In order for the Trust to continue with ongoing improvement and performance monitoring,
and benchmarking with other Trusts, additional local analysis was performed, accessing a
full data set for all questions and for all Trusts, and analysed the data using the previous
approach of top 20% (green), middle 60% (amber) and bottom 20% (red).
!
The 2011 results were the best results the Trust has achieved in 5 years and have moved
it from an estimated position of 53rd to an actual ranked position of 37
th
out of 100.
!
Detailed results for inpatient survey performance over the last six years 2006-11 are
provided in Appendix 13, whilst Appendix 14 shows a comparison with local peers for the
2011 survey. A diagram displaying the key themes related to patient comments is
displayed in Appendix 15.
Positive areas for the Trust included:
"
Cleanliness and hand hygiene (6 questions - mostly rated green)
"
Nurses (increase in scores for all five questions)
"
Leaving hospital (increase in score for 8 of the 13 questions, 3 remaining the same,
2 reduced by 0.1). Represented main area of improvement work for Trust in previous
year, although some problems remain (highlighted in example patient comments
below)
Huddersfield hospital is always clean & tidy going in to coming out. Doctors, nurses,
cleaners are all polite and helpful.
46
Ward cleanliness is excellent.
I found all nurses extremely friendly and caring. All made a real effort to make me feel
comfortable.
The nurses were very good, kind and caring.
I would like to say a big thank you to all staff on the wards, if it wasnt for the doctors and
nurses exceptional care I believe I wouldnt be here today, they were all fantastic and nothing
was too much trouble for them.
On discharge the nurse was really good at explaining to me about my condition and meds
put my mind at rest.
Areas requiring further improvement work:
" Doctors communication - Q31 has remained red for 3 years (do you get answers
you can understand from doctors?)
" Explanation re operations / procedures (Q52 57, two red out of six questions)
" Information provided in A&E red-rated question
" Issues to watch out for following discharge (questions on medication side effects,
danger signals to watch out for), both of these are amber, however they are 2 of the
lowest scoring questions across the survey. Delayed discharge see example patient
comments below
" Food a relatively large number of negative patient comments
The communication and consulting skills of the clinicians need attention, their approach is
not patient centred.
Very difficult to speak to the specialist/consultant who did the operation, didnt like the fact
some other doctor coming to explain what was done in op.
More information to explain results of tests and what to do following discharge (from a
doctor or nurse).
More efficient & speedy discharge needed. Doctor wrote prescription out wrong for my
support stocking, my poorly husband and daughter had to wheel me around to find the right
dept.
Moving from ward to ward due to closure of a ward caused stress and confusion. Problems
with discharge drugs from hospital pharmacy (existing drugs not new).
Discharge badly managed, had to ask about medication.
Discharge was a shambles. No referral for Physiotherapy or Occupational Therapy or to a
general specialist.
Length of wait on discharge waiting for prescriptions.
I was discharged on xxx. On that day I had a blood test, waited for the result and then had
to wait for the doctor to come to discharge me. I waited from breakfast time until 7 o'clock at
night - I know they are very busy but I feel that it didn't warrant that length of delay.
A lot of the food is so lacking in nutrients, it cant be helping patients recover.
The food could have been a lot warmer.
I am a retired cook and have been in business over the years. I understand the difficulties of
catering - but do feel better results would be achieved by using fresh ingredients, I would sit
on a committee to advise on food.
47
More choice with food, especially halal food. There was an alleged choice on the menu but I
was not given what I had chosen.
Further local analysis of the survey has recently been performed to better understand how
the specific subgroup of patients who were admitted to hospital as an emergency or
unplanned case viewed their experience of the hospital care. This work provided strong
evidence that this group rate several aspects of their patient experience significantly
lower than those who were admitted from the waiting list or planned in advance,
particularly with respect to:
! Long time to get a bed
! Doctors communication
! Involvement in decisions about care
! Provision of information about condition and treatment
! Information of explanation on a number of aspects of discharge process (medications,
what you should or should not do after leaving hospital, and who to contact if worried
about condition or treatment after discharge)
Detailed results of survey questions responses are provided in Appendix 16.
Readmissions Survey 2012
The Readmissions Patient Experience survey was conducted at HRI and CRH over a
three month period starting in January 2012, gathering responses and comments from
300 patients using hand held PDA devices. Each site was sent a daily list each morning with
the information of all the patients (over 16 years old) who had been re-admitted on the
previous day (within 30 days of previous discharge). The study gathered feedback from
patients on 12 main questions, primarily related to previous discharge.
A summary of results is provided in Appendix 17. Comparison with related National Inpatient
survey data indicated that those being readmitted generally had a poorer patient experience
associated with their initial Inpatient stay, particularly with respect to being provided
information and advice on:
What to watch out for regarding your condition getting worse. (danger signals)
Who to contact if your condition got worse.
Provision of written information/understanding of information about what you should
or should not do after leaving hospital.
Explanation from staff on which medication to take when you left and which ones to
discontinue, and purpose of any newly prescribed medications.
Patients were also given the opportunity to make additional comments on the survey form.
Feedback included:
When I came in I brought in my own medication, the Dr on A&E lost them so I had a full day
without my medication, which is not right, my husband complained because he gave them to
the ambulance man who in turn said the last he saw of them a young lady doctor had them.
Not being moved from room to room at 2:00 in the morning. My bed has been moved 4
times in the night and I cant get back to sleep Pharmacy always takes too long to get meds
48
for discharge. If the ward knows I am going home in the next day or two, why cant it be done
sooner?
The nursing staff are very attentive, I cant really fault them at all, although very occasionally
there is one or two who are crabby. On one occasion I was on the floor and couldnt get up,
the nurse just shouted at me to get up and I couldnt. 90% of the time they are very good.
I was on 2A recently, nursing staff never stopped working, would never pass by without a
smile and a word, If ever I have to come into hospital again I hope it will be on this ward,
they are so caring in everything they did for me, I wont forget them.
Patient was sent home from A&E without transport in the early hours of the morning, in
below freezing temperatures in just her nightgown with no blankets. She had to find her own
way home, said staff nurse in A&E was rude and was re-admitted to a ward just hours later,
considerably unwell and stayed for several days as an inpatient.
I think my dad was sent home too soon first time, he was in two days, came home poorly,
back in seven days with pneumonia.
The hospitals are currently undertaking an assessment of a virtual ward process to better
manage discharge, and subsequent home re-ablement and hand-on to appropriate
Intermediate Care/Primary care services.
6. Equality data
Equality data has been combined for respondents to the General (1,339) and Location-
based (246) parts of the Unplanned Care Survey, giving a total of 1,585 respondents.
The information gathered is summarised in the tables below:
Home Postcode Number Percentage
Halifax postcode area 958 69.6%
Huddersfield postcode area 313 22.7%
Oldham postcode area 62 4.5%
Bradford postcode area 12 0.9%
Wakefield postcode area 10 0.7%
Leeds postcode area 6 0.4%
Other 16 1.2%
Total 1377
A full list of respondent postcodes is provided in Appendix 5.
Gender
Number Percentage
Female 541 36.9%
Male 880 59.9%
Total 1468
49
Transgender
Number Percentage
Yes 41 3.1%
No 1228 93.8%
Total 1309
Age
Number Percentage
Under 16
75 5.1%
16-25
242 16.4%
26-35
270 18.3%
36-45
245 16.6%
46-55
196 13.3%
56-65
172 11.7%
66-75
154 10.4%
76-85
76 5.1%
86+
11 0.7%
Prefer not to say
35 2.4%
Total 1476
Sexual Orientation
Number Percentage
Bisexual 33 2.3%
Gay man 15 1.0%
Heterosexual 1226 84.8%
Lesbian 17 1.2%
Other 21 1.5%
Total 1445
Ethnicity
Number Percentage
Bangladeshi 12 0.8%
Chinese 4 0.3%
Indian 23 1.5%
Kashmiri 20 1.3%
Pakistani 284 19.1%
African 13 0.9%
Caribbean 6 0.4%
Asian & White 18 1.2%
Black African & White 5 0.3%
50
Black Caribbean & White 6 0.4%
British 949 63.9%
European 22 1.5%
Gypsy/ Traveller 3 0.2%
Irish 48 3.2%
Other 14 0.9%
Prefer not to stay 57 3.8%
Total 1484
Religion
Number Percentage
Buddhism 11 0.8%
Christianity 571 39.7%
Hinduism 6 0.4%
Islam 329 22.8%
Judaism 5 0.3%
Sikhism 11 0.8%
Other 59 4.1%
No religion 336 23.3%
Total 1440
Disability
Number Percentage
Yes 299 20.2%
No 1091 73.7%
Total 1480
Type of Disability
Number Percentage
Learning disability/ difficulty 16 4.1%
Long standing illness or health condition 84 21.5%
Mental health condition 51 13.0%
Physical or mobility 84 21.5%
Hearing 22 5.6%
Visual 23 5.9%
Other 21 5.4%
Total 391
51
Note. Some respondents ticked multiple items.
Carer
Number Percentage
Yes 286 19.7%
No 1103 76.0%
Total 1451
Details of equality information for other engagement activities, covered in Section 5.4 of the
report, are available in the original full reports held on the Project SharePoint facility.

7. Conclusion
There are a number of key themes which were evident across the whole range of
engagement evidence gathered. These need to be carefully considered and prioritised in any
redesign of existing services and development of future local healthcare systems:
needed.
needed to access them, forcing them to go elsewhere, despite their preferences to
use these services. Other access issues, most commonly related to availability/choice
of appointments, were also commonly raised by patients.
from pillar to post, sometimes returning to A&E and other services on multiple
occasions. There was a need identified to build a more patient-centred approach and
particularly to improve discharge and hand-on processes.
needs.
! Inconsistencies in standards/quality of care received - patients consistently cited high
standard/quality of care as important, but quite often report big inconsistencies in
services or along different stages of their pathway.
! A number of examples of poor communication/ information provided to patient on their
condition and subsequent management, and sometimes between different areas
within the wider healthcare system at various stages of the patient pathway.
! Patients placed high value on rehabilitation services/ being supported to self-manage/
52
! Several groups of patients, most notably those with long term conditions, regularly
used and reported poor experiences of a number of aspects of emergency and urgent
care services.
! Issues were raised about making better use of supporting technology, for instance
telecare facilities and problems related to health professionals having limited (and
variable) access to patient information available at point of contact.

8. Recommendations
PMO/Care Stream/Engagement
9. Next steps
Any additional engagement activities required as part of EDS or otherwise (PMO/ Care
stream/Engagement to add)
10.References
The following are available on the Project SharePoint area in full:
(1) PALS and complaints data, NHS Kirklees (2009-12)
(2) PALS and complaints data, CHFT (2009-12)
(3) Locala Community Partnerships Quality Account 2011-12
(4) Locala Complaints 1 April 2011 to 30 June 2012
(5) National A&E Survey 2012 Local and National reports (2012)
(6) Patient Experience in A&E The Story So Far (local summary) (2011)
(7) A&E Discharge Patient Experience Local Survey (2012)
(8) A&E/Minor Injuries Audit report (2011)
(9) West Yorkshire Urgent Care Service Engagement Report (2012)
(10) Regional Trauma Networks Executive Summary of Stakeholders Views (2010)
(11) Choose Well For Your Child Campaign Report (2012)
(12) Listening to Childrens Views on Heath Provision (NCB, 2012)
(13) Patient Participation DES Report Year 1 (2012)
(14) National GP Surveys (MORI, 2009/10, 2010/11)
(15) National Inpatients Surveys 2010, 2011, 2012 Local Reports and Analysis (2010-12)
(16) Readmissions Survey (2012)
53
Appendix 1: Engagement Action Plan
Unplanned Care - Engagement Action Plan
KEY: DP (Dawn Pearson), DF (Dasa Farmer), MH (Mohammed Hanif), RK (Richard
Kennedy), HIS (Health Informatics Service), PPE (Patient and Public Engagement),
WF Leads (work stream members/Leads), (TM) Tabitha Makin
Objective: Source existing intelligence which can be used to evidence patient/ public
views. (Sept)
views. (Sept)
views. (Sept)
views. (Sept)
Activity (what) Action to be taken (how) Lead
(who)
Timescales
(by when)
Gather Existing
intelligence, including
Pals and complaints
on the work stream
area. Areas defined
as:
!
Trauma
!
Orthopaedics
!
Surgical
Assessment
!
A&E
!
Medical
Assessment
!
Paediatric
Assessment
!
Stroke
!
Contact internal PALS and complaints
teams to search for public comments.
!
Pull off any existing national surveys
completed on the work stream area.
!
Identify any findings from Local surveys.
!
Gather any information provided at any
focus groups, public events or meetings
on the work stream area.
DP
supporte
d by HIS
MH/DF
DF to
contact
WF
leads.
DF to
contact
WF
leads.
Mid Sept 2012
Analyse the
intelligence
!
Combine the information received and
identify key messages.
!
Identify any gaps in client group or
questions.
!
Ensure the key messages are fed into the
process.
MH End Sept 2012
Objective: Engage with Patients, public and Carers. (Oct-Dec) Objective: Engage with Patients, public and Carers. (Oct-Dec) Objective: Engage with Patients, public and Carers. (Oct-Dec) Objective: Engage with Patients, public and Carers. (Oct-Dec)
Activity (what) Action to be taken (how) Lead
(who)
Timescales
(by when)
Identify the target
audience.
!
Create a list of key partners.
!
Identify or create a diversity forum.
!
Identify patients and carers.
MH/DF
TM
MH/DF
Mid Oct 2012
Mid Oct 2012
Mid Oct 2012
Identify the resources
required.
!
Identify a readers panel.
!
Decide on the mechanisms for
engagement.
!
Develop the materials for engagement.
!
Identify a budget.
!
Test out the materials with the readers
panel.
!
Book meeting venues, catering,
facilitators as required.
!
Develop an evaluation form.
TM
MH/DF
MH/DF
DP
TM
MH/DF
MH/DF
Beginning Oct
2012
Mid Oct 2012
End Oct 2012
End Oct 2012
End Oct 2012
End Oct 2012
End Oct 2012
54
Deliver the
engagement activity.
Activity still to be agreed by each work
stream; ideas so far
!
Possible Trauma discussion
Forum range of health
conditions and pathways.
!
Current service views/suggested
improvements (ward
questionnaires)
!
Think tank on A and
E (confidential forum to look at
current A and E views (survey)
and testing out concepts for
changing the service.
Work
stream
with PPE
team as
facilitator
s /
enablers.
Nov Mid Dec
2012
Objective: Conclude the engagement process, provide feedback and ensure the
findings are used as evidence to support future activity.




Report the findings of
the engagement
activity.
!
Collate the evaluation forms from
each activity
!
Collate the Diversity Monitoring
Forms
!
Collate the findings from the
engagement activity
!
Develop a report template
!
Develop a report of findings which
includes the existing intelligence as
appendices.
DP
DP
DP
DP
DF
Nov-Mid
December 2012
Nov-Mid
December 2012
Mid December
2012
Mid December
2012
Ensure the report
forms part of the
evidence for options.
!
Engagement report findings to be
u s e d t o s u p p o r t f u t u r e
recommendations as part of the audit
trail.
DP January 2012 ?
Provide Feedback
!
Develop a summary document on the
engagement activity.
!
Check the summary document with
the readers panel.
!
Circulate the document to key
partners, diversity forum, patients,
public and carers engaged in the
process.
!
Upload the findings to the website for
public information.
PPE
team
PPE
team
PPE
team
Comms
Team.
January 2013
January 2013
January 2013
January 2013
55
Appendix 2: Schedule for engagement activity
Overview
Engaging patients, the public and other stakeholders in planning services is vital to ensure
services meet the needs of local communities. It is also a legal requirement that patients and
the public are not only consulted about any proposed changes to services, but have been
actively involved in developing the proposals.
Successful engagement cannot be carried out as a stand-alone activity; it needs to be an
integral part of the programme. It is vital that senior clinicians and managers invest time in
working directly with all stakeholders so that meaningful discussions can take place and to
ensure stakeholder views really do drive the planning and delivery of services.
Key Drivers and Considerations
There are a number of statutory requirements relating to engagement that must be taken
into account.
Health and Social Care Act 2012
The Health and Social Care Act 2012 sets out responsibilities for NHS commissioners. This
includes the statutory requirement for CCGs to involve and consult patients and the public,
replacing Section 242 of the NHS Act 2006, which currently applies to PCTs.
Specifically, CCGs must involve and consult patients and the public in:
! their planning of commissioning arrangements
! the development and consideration of proposals for changes in the commissioning
arrangements where the implementation of the proposals would have an impact on the
manner in which the services are delivered to the individuals or the range of health
services available to them, and
! decisions affecting the operation of the commissioning arrangements
The Act also updates Section 244 of the NHS Act 2006 which requires NHS organisations to
consult relevant Overview and Scrutiny Committees on any proposals for a substantial
development of the health service in the area of the local authority, or a substantial variation
in the provision of services.
The Equality Act 2010
Section 149 of the Equality Act 2010 states that a public authority must have due regard to
the need to a) eliminate discrimination, harassment and victimisation, b) advance Equality of
Opportunity, and c) foster good relations. It unifies and extends previous disparate equality
legislation. Nine characteristics are protected by the Act: age; disability; gender re-
assignment; marriage and civil partnership; Pregnancy and maternity; race; religion or belief;
sex; and sexual orientation.
An Equality Impact Assessment (EQIA) will need to be undertaken on any proposals for
changes to services that are developed through the strategy, in order to understand any
impact on the protected groups and ensure equality of opportunity. Engagement must span
all protected groups and other disadvantaged groups and care should be taken to ensure
that seldom-heard interests are as engaged as much as others and supported to participate.
The NHS Constitution
56
SECTION 1: CONTEXT
The NHS Constitution came into force in January 2010, setting out a number of rights for
patients which are protected by law. This includes the following right at Section 2a: You
have the right to be involved, directly or through representatives, in the planning of
healthcare services, the development and consideration of proposals for changes in the way
those services are provided, and in decisions to be made affecting the operation of those
services. Commitment to upholding the NHS Constitution has been made within the CCG
own Constitutions.
Secretary of States key tests
Any plans for reconfiguring health services also need to comply with the four tests set down
by the Secretary of State, the second of which relates specifically to engagement. These will
be assessed through the Strategic Health Authoritys Service Change Assurance Process
(SCAP) to assure there is sufficient evidence to progress to consultation if required. The four
tests are:
5) Support from GP commissioners;
6) Strong engagement, including local authorities, public and patients;
7) A clear clinical evidence base underpinning proposals;
8) The need to develop and support patient choice.
2.1 Public survey
Aim of the survey
To support the work of the Maximising Unplanned care in Primary Care and Community
Services care stream, it is proposed to develop and carry out a survey with the public in the
Calderdale and Huddersfield areas. The proposed areas of feedback to be sought are:
! The drivers / reasons for people accessing A&E services.
! The perceived gaps within the community setting which the public would find
beneficial.
Other benefits would include:
! Identify gaps and improvements in current services and behavioural drivers.
! Begin to engage service users and generate ideas on the support that the public
needs in the community setting.
Outcomes
! Survey co-produced with THIS. This would be a large scale survey distributed via the
following channels:
o
Direct mailout using the Engagement Teams networks and direct engagement
work with client groups/geographical areas where need for the services is
highest, e.g. the homeless
o
Online survey linked to all partners websites
o
Community settings, such as Childrens Centres
o
Service settings, such as A&E and Pharmacies
57
SECTION 2: ENGAGEMENT PLAN
! The analysis of feedback would be carried out by THIS and a report produced by the
Engagement Shared Service. Data on the demographics of participants would be
sought to further identify any potential trends.
! Report of findings produced and presented to the Task and Finish Group/unplanned
care stream.
! To identify the requirements for any future engagement activity to test out ideas.
.2 Current patient experience data
The Health Informatics Service has been asked to provide any relevant data on patient
experience. Additional work has also been collated and analysed to inform a composite
report of key messages arising from the data held by partner organisations.
.3 Resources
The cost of delivering this work will be as follows:
Activity Resource Cost
Administration Printing surveys, posting surveys,
general distribution to healthcare
settings (4 days over a month = 24
hours)
PPE team no cost
Ward interviews
Community setting
interviews
PPE staff time 10 scheduled interview
dates in various settings
(10 x 7 hours staff time = 70 hours)
PPE team- no cost
Media Utilise existing websites of all partners. No Cost
THIS contract Design, development, collection and
collation of data and final report of
findings
tbc
58
Appendix 3: Engagement Questionnaire and Equality Data Monitoring Form - General
59
60
61
62
Engagement Questionnaire and Equality Data Monitoring Form - location-based
63
64
65
66
Appendix 4: Childrens survey to be inserted
67
68
69
70
Appendix 5: Unplanned Care survey additional analysis
General survey
choice only)
A full list of the Other category responses is provided below:
999 Paramedics 1
Basement Recovery Project 1
CALLED 999 1
Called wheelchair services 1
71
CAMHS 1
Conacted consultant 1
contacted depression support group 1
Contacted Nutritionist for repeat bio-acidophilus capsules to reestablish
better balance of gut flora 1
dialled 999 for ambulance 1
Didn't Care 1
District Nurse 1
Dropped off a labelled urine sample at surgery 1
Emergency Services - Ambulance 1
EPAU 1
GP Home visit 1
GP visit 1
GP visited home 1
GP visited patient 1
Haematology 1
Healthy Minds 1
Issue with daughter's hearing picked up by school 1
lynfield mount H+Catal 1
Medical Centre on Queen Victoria 1
N/A 1
No health problems 1
No medical problem - just routine check up 1
Out patients 1
Patient breast cancer found - contacted private medical insurer/
hospital. 1
Phoned 999 1
Practice Nurse 1
Prefer not to say 3
Psychiatrist 1
Rang bringhouse clinic 1
Rang for ambulance 1
Rang my daughter - A nurse 1
Range Eye clinic 1
Seen prison doctor 1
Self Medicated 1
spoke to my health visitor 1
This depends - severe pain being sick - self care 1
Took Drugs 1
Tried to see GP went to walk in centre 1
used carephone 1
Visited basement Project 1
went to hospital 1
Went to my cpn nurses building 1
72
Check up 1
pregnancy 1
Blank 7
Eye test appointment 1
They could not find the cause 1
High blood pressure 1
Exma 1
Check-up 2
Addiction 1
Fell off the toilet 1
Bleeding while pregnant 1
Over dose 1
started suddenly and after several weeks still had a
cough 1
Severe disability complex needs from birth 1
Eye infection 1
N/A 1
Start of dementia 1
Went for check up 1
don't have one 1
New problem from old op 1
Prescription 1
Enquiry about breast feeding and after care 1
Fine 1
None 1
Insection 1
Health Check 1
Cosmetic 1
Eye test 2
Broken hearing aid snapped 1
Worsened mental health 1
Depression 1
dental 1
Blood Pressure 1
Ears 1
pregnancy 5
Moving house too much work 1
Thyroid 2
Vitemin B12 injections 1
chronic neurological disorder 1
Asthma 3
MSK 1
73
Heart problem 1
Constant cough and chest
pain 1
Diabetic 1
Exma on my hands 1
Diabetes 1
Blood test 1
2 wt 1
Bone injury 1
Spine operation 1
Diabetis 1
C.O.F.D. 1
lupus sle 1
Temple Artheritus 1
Stress @ work 1
Back Problems 1
Broken Leg 1
My back 1
N/A 1
Skin problem 1
Gender disfore 1
Hernia 1
Diabetes Hypofit 1
Pain in chest 1
Diabities 1
Bowel condition 1
Seisure 1
Bronical Asthma 1
Took tablets 1
Cancer 2
Flu symptoms 1
Bladder 1
Stomache 1
Flu 1
Tonsilitis/virus 1
Tonsilitis 1
Sickness 1
finger 1
Chest pains 1
kidney 1
Epilepsy and stroke 1
Frozen Shoulder 1
None 1
Asmath 1
Epilepsy 1
Broken Ankle 1
Cosmetic 1
2nd left hand finger 1
Skin rash 1
74
HCAD 1
Ribs and back 1
Headpain - Temple artheritis 1
Viral 1
Pains 1
Throat-chest 1
Breathing 1
Blood presure 1
Hand/Back/Side/Other 1
Blood pressure pulse 1
Facial 1
Car acident 1
head injury 1
Asthma/chest infection 1
previously broken hip 1
Combination of issues 1
Ear infection 1
FALL IN A FIELD 1
gynea 1
Emergency 3
Carred for's descision 1
Obvious place to go 1
Couldn't get appointment with my doctor too late in the day 1
Contact Lense broke in my eye-it was an emergency on a sunday
morning 1
No Choice 1
District Nurse 1
Taken by Ambulance 1
Self Managed 1
Never use any 1
Unconsious 1
Door ways 1
Breakfast and advice 1
Doctor 1
Went with partner 1
didn't know there was any other service 1
It was the most appropriate in emergency 1
Was advice from GP 1
The GP/Doctors surgery was closed for 4 days over Easter 1
I asked to be refered 1
N/A 1
Needed expert help 1
Check-up 1
75
My own dentist couldn't fit me in 1
Been Before 1
Only service available 1
Prefer not to say 1
Doctor wanted to see me 1
Ambulance took me 1
Teenage son was taken to A&E by ambulance from the cinema 1
Physiotherapist 1
Work at hospital 1
I am a pharmacist 1
Didn't need to go 1
Because doctor's surgery always too busy and no appointment
available 1
Because of medication I have to ask Dr before taking anything 1
As a parent I was concerned 1
Cheapest eye test 1
No where was open 1
Did not have to wait for appointment 1
My Local GP 1
Emergency - Ambulance 1
No option at Sea 1
Emergency Need 1
unable to get through to nhs direct 1
Closer to where I work 1
Emergency 6
Local GP 5
My GP 4
Only practice in Tod 3
Convenience 2
Only A&E in the area 2
my own doctor 2
Ambulance took me 2
Intense pain very worried 1
Nearest Practice 1
A&E 1
Because of the pain I experienced 1
Didn't need to go out 1
It was the appropriate service for the condition 1
Thought that was what I had to do 1
For speed. I knew I would see a Dr same day. 1
refered by specialist 1
Registered GP 1
My Local GP 1
76
It is the appropriate service for my condition 1
It was an emergency 1
My Doctor's surgery 1
she wanted urgent advice 1
Severe pain 1
Needed Immediate Action 1
I was very ill. Seriously ill 1
Registered here 1
GP's Sugestion 1
Only GP in Tod 1
Only appropriate place 1
not my decision - staff at cinema took decision to call
ambulance 1
Self Managed 1
My Doctors 1
I needed help 1
It was the obvious one 1
Was an emergency 1
Middle of night could not breath 1
My Local G.P. 1
Recommended 1
Emergency Referal 1
Knowledge of eye condition 1
medication 1
Speed and Confidence 1
No other choice 1
knew I had flu and no pint bothering any professionals 1
Was part of care package 1
Surgery was closed 1
It was a medical problem so GP seemed obvious choice 1
Only GP in town 1
Necescary 1
Always come here 1
staff at surgery advision 1
For good advice 1
Immediate information 1
Local Practice 1
N/A 1
Speed of service 1
Only A&E 1
late at night - phone easily accessable 1
Panicking 1
It is my GP 1
Extreamly polite professional 1
No where else would x-ray my leg 1
Local (my) GP. 1
Taken by an ambulance 1
It's the doctors - where else would I go? 1
My Dentist 1
77
My Daughter Rang 1
No other option avaliable 1
Because he's my doctor 1
Cost 1
It's my doctor 1
My Local Hospital 1
thought I was having a heart attack 1
Because of senows condition 1
Its my Doctors 1
Felt right thing to do. 1
Unable to visit GP 1
My CPN Nurse is based here 1
No choice # lousr 1
Necessary to go to A&E 1
Ongoing health problem 1
MOst appropriate service to access 1
My Surgery I use 1
emergency! 1
Because its my surgery which I use 1
It was the appropriate service 1
GP knows my medical history 1
I knew I had a time-limited problem 1
Urgency 1
only option available 1
No appointments available at Quln Drs 1
to chase up hospital app 1
Advice, what to do next 1
Near Home 1
Recovery 1
To get out of depression - talk to people 1
Birth of child 1
Advice 2
Reassurance 1
A thourough check up of my eyes explaining their health 1
Self Managed 1
To get well 1
Sobriety 1
Check up 1
NA 1
Feel better in time 1
N/A 1
She advised me to see G.P. 1
it didn't explain anything 1
78
Glass in my eye 1
Prefer not to say 1
Care and safe environment 1
sick note for work 1
Medical chick and told to get to hospital 1
it would have beenfine if I needed it 1
Get well after a good rest 1
Expected to get paramedic dispatch 1
eye test new glasses 1
A new mould for hearing aid 1
New Glasses 1
If my G.P. Couldn't help then he could arrange x-ray and
blood tests 1
Check for any serious injury 1
support 2
OTC medicine to alleviate symptoms 1
ambulance 1
help in alleviating pain 1
eventually get better 1
My wife and I suspected a broken ankle 1
Put my mind at rest as this was making me extremely
anxious. 1
Location survey
Check up 1
Complications post op 1
Flujab 1
NHS Direct Referal 1
Pregnancy 3
Refered from optician 1
Several issues with 18 month
old 1
Test 3
Contraception 1
Faulty blood test
result 1
79
Flu jab 1
Pregnancy 2
Smeer test 1
Test 3
Ambulance 3
appointment available 1
Care home advice 1
Doctors were full and wouldn't see
me 1
First time at practice 1
Football injury 1
It was nearest 1
Live Locally 1
Meant to be quicker than Dewsbury 1
My GP 4
Nearest A&E 3
Out of Doctor's hours 1
Police Advice 1
Regular check up 1
School 4
A&E 1
Ambulance 2
Asked by hospital staff 1
Been advised 1
Best option 1
Closer than halifax 1
Dr sent me 1
due to serevity 1
Huddersfield are very busy 1
I work here 1
Local 1
NHS Direct 1
No appointments at Hebden 2
Registered 1
Registered practice 1
Weekend 2
My GP 2
80
Blood test 1
Check out 1
Given flu jab 1
rehydration admission 1
Detailed results by service (location survey)
Detailed cross-tabulated results, splitting out findings by the type of service respondents
accessed, are shown below. Note that this mirrors the detailed analysis presented for the
general survey in Section 5.1 of the report.
A&E GP
An ongoing problem 24% 76%
A one off symptom 49% 51%
A long term condition 30% 70%
A sudden illness 57% 43%
An accident 98% 2%
For results 0% 100%
I don't know what's wrong 67% 33%
Other - (please state) 54% 46%
Total 57% 43%
A&E GP
Physical symptom 61% 39%
Your eyes 57% 43%
Dental health 100% 0%
Mental health problem 33% 67%
Substance misuse 100% 0%
Prefer not to say 56% 44%
Total 58% 42%
81
A&E GP
It was my decision 45% 55%
Family/friend suggested I go there 83% 17%
A health professional referred me 86% 14%
Poster/leaflet - -
NHS Direct sent me there 92% 8%
Advice from NHS Direct website 50% 50%
Advice from another website - -
I did not know where else I could go 64% 36%
I have used the service before 29% 71%
Total 53% 47%
A&E GP
Location 49% 51%
Parking 30% 70%
Public Transport 17% 83%
More culturally sensitive 50% 50%
Confidence in the staff 45% 55%
Environment 48% 52%
Opening times 45% 55%
I have been here before 48% 52%
I have a good experience/outcome before 45% 55%
I could fit it in with my daily routine 29% 71%
No 85% 15%
Total 49% 51%
A&E GP
The diagnosis of a problem/illness/symptom 55% 45%
The opportunity to speak to a health care professional 36% 64%
A second opinion 80% 20%
A referral for further consultation/treatment 67% 33%
Medication/prescription 24% 76%
Diagnostics such as X rays and blood tests 83% 17%
Treatment 82% 18%
Total 60% 40%
82
A&E GP
Yes, all expectations were met 61 53
Some expectations were met 9 12
No 1
Don't know 31 10
Total 102 75
Average Score ** 92.3 90.8
calculation
Score
A&E GP
1 1
2 2
3
4
5 6 4
6 5 3
7 11 6
8 23 14
9 22 17
10 54 50
Total 124 94
Average Score
8.6 9.0
A&E GP
Yes 103 85
No 7 3
Total 110 88
Would Recommend 93.6% 96.6%
A&E GP
Under 15 minutes 39% 61%
15-30 minutes 91% 9%
83
30-60 minutes 86% 14%
1-2 hours 100% 0%
Not applicable - travelled by Ambulance 100% 0%
Total 56% 44%
A&E GP
Under 15 minutes 48% 52%
15-30 minutes 54% 46%
30-60 minutes 64% 36%
1-2 hours 68% 32%
Total 57% 43%
Equality data
Home postcode
A full list of respondent postcodes is provided below:
Postcode Frequency
HD06 1
HD1 43
HD13 1
HD14 1
HD2 35
HD3 18
HD4 28
HD46 1
HD47 1
HD5 15
HD6 71
HD61 1
HD63 3
HD7 31
HD8 45
HD88 2
HD9 15
HDG 1
HX 2 1
HX 6 1
HX0 1
HX1 330
HX11 1
HX13 6
84
HX14 4
HX15 1
HX2 243
HX26 2
HX27 3
HX28 1
HX29 1
HX3 127
HX31 1
HX35 1
HX39 1
HX4 20
HX43 1
HX48 1
HX5 52
HX50 1
HX51 1
HX53 3
HX54 2
HX55 1
HX56 1
HX57 1
HX59 2
HX6 83
HX61 1
HX64 1
HX7 57
HX76 3
HX8 1
HX9 1
BD 1
BD10 1
BD12 2
BD13 6
BD6 2
LS13 1
ls14 1
LS15 1
LS20 1
LS27 1
LS28 1
OL14 60
0L14 2
WF 1
WF12 2
WF13 2
wf14 3
WF4 2
AD6 1
85
BO13 1
BP13 1
H02 1
H05 1
H3 1
H59 1
HK7 1
HL8 1
HV6 1
RD7 1
S36 2
S75 1
UX2 1
UX3 1
Grand Total 1377**
** Note: not all respondents completed this question. Some typographical errors existed
within the above list of returned responses.
Sexual orientation
Female 5
Illegiable 1
I'm normal 1
Noemal 1
None 1
Normal 2
Straight 3
Strat 1
Unknown yet, only a
baby 1
Why?? 1
Ethnicity
Arabic 2
Asian - English 1
Asian - Philippines 1
English 2
Filipino 1
Iranian 1
Srilankan 2
Syria 1
White-English 1
One response written in error as went to hospital a few days later
86
Religion
Agnostic 1
Anglican 1
Athiest 1
Believe in Jesus 1
Catholic 10
Church of England 6
GB 1
Heretic 1
Jedi 1
Jehovahs Witness 1
Methodist 1
N/A 2
No 1
Non 1
Non m8 1
None 5
Pagan 2
R.C. 2
RC 1
Roman Catholic 2
Roman Catholics 1
Wicca 1
87
Appendix 6: Glossary
A&E Accident and Emergency
AQP Any Qualified Provider
CHFT Calderdale & Huddersfield Foundation Trust
COPD Chronic Obstructive Pulmonary Disease
CRH Calderdale Royal Hospital
DES Direct Enhanced Service
DH - Department of Health
ENT Ear, Nose and Throat
EPP Expert Patient Programme
HRI Huddersfield Royal Infirmary
JSNA Joint Strategic Needs Assessment
ME - Myalgic Encephalomyelitis
MSK Musculo-skeletal
PALS - Patient and Advice Liaison Service
TCS - Transforming Community Services
88
Appendix 7: National A&E Survey 2012 results
Appendix 8: National A&E Survey 2012 Patient Comments
89
90
Appendix 9: National A&E Survey 2012 Long Term Conditions analysis
Note: Groups 0 = No Long Term Conditions (LTC), 1+ = One or more LTC, RAG rating relates to bottom 20%/
middle 60%/ top 20% of Trusts nationally.
91
92
93
Appendix 10: Local A&E Discharge Survey Results 2012
94
Appendix 11: Patient comments by category A&E Discharge Survey 2012
95
Appendix 12: GP Survey Results for Calderdale and Greater Huddersfield
96
Red/Amber/Green Rating - scores for applicable questions have been separated into those in the top 20%,
middle 60%, and bottom 20% of all the practices which took part in the Mori National Survey in either 2009/10
and 2011/12
97
98
Appendix 13: National Inpatient Survey Scores/Ratings for CHFT
2006-2011
National Inpatient Survey Year National Inpatient Survey Year National Inpatient Survey Year National Inpatient Survey Year National Inpatient Survey Year National Inpatient Survey Year
2006 2007 2008 2009 2010 2011
The
A&E
Depar
tment
Q3. While you were at the A&E Department, how much
information about your condition or treatment was given to you?
7.9 7.9 5.7 8.2 8.3 7.8
The
A&E
Depar
tment
Q4 Were you given enough privacy when being examined or
treated in the A&E Department?
8.9 9.0 8.7 8.8 8.7 8.8
The
A&E
Depar
tment
Q5 Following arrival at the hospital, how long did you wait before
being admitted to a bed on a ward?
6.6 6.2 5.8 6.3 6.1 6.3
Waitin
g List
or
Plann
ed
Admi
ssion
/ Wait
for
Bed
Q8 Overall, from the time you first talked to this health
professional about being referred to hospital, how long did you
wait to be admitted to hospital?
6.9 5.0 6.1 6.2 6.1 5.6
Waitin
g List
or
Plann
ed
Admi
ssion
/ Wait
for
Bed
Q9 How do you feel about the length of time you were on the
waiting list before your admission to hospital?
8.5 8.1 8.2 8.5 8.0 8.0
Waitin
g List
or
Plann
ed
Admi
ssion
/ Wait
for
Bed
Q10 Were you given a choice of admission dates? 2.9 3.3 2.9 3.0 3.4 2.8
Waitin
g List
or
Plann
ed
Admi
ssion
/ Wait
for
Bed
Q11 Was your admission date changed by the hospital? 9.1 9.4 9.6 9.3 9.3 9.3
Waitin
g List
or
Plann
ed
Admi
ssion
/ Wait
for
Bed
Waitin
g List
or
Plann
ed
Admi
ssion
/ Wait
for
Bed
Q12 From the time you arrived at the hospital, did you feel that
you had to wait a long time to get to a bed on a ward?
8.4 7.7 7.0 7.9 7.4 7.9
The
Hospi
tal
And
Ward
Q14&Q17 Did you ever share a sleeping area, for example a
room or bay, with patients of the opposite sex?
8.0 7.5 7.3 8.5 7.9 8.9
The
Hospi
tal
And
Ward
Q19 While staying in hospital, did you ever use the same
bathroom or shower area as patients of the opposite sex?
7.0 6.6 7.1 8.3 8.0 8.5
The
Hospi
tal
And
Ward
Q20 Were you ever bothered by noise at night from other
patients?
6.6 6.1 6.1 6.2 6.5 6.5
The
Hospi
tal
And
Ward
Q21 Were you ever bothered by noise at night from hospital
staff?
8.7 8.9 7.8 8.2 7.6 8.1
The
Hospi
tal
And
Ward
Q22 In your opinion, how clean was the hospital room or ward
that you were in?
8.4 8.2 8.3 8.7 8.9 9.0
The
Hospi
tal
And
Ward
Q23 How clean were the toilets and bathrooms that you used in
hospital?
8.1 7.8 8.0 8.4 8.6 8.8
The
Hospi
tal
And
Ward
Q24 Did you feel threatened during your stay in hospital by other
patients or visitors?
N/a 9.7 9.7 9.5 9.7 9.8
The
Hospi
tal
And
Ward
Q25 Did you have somewhere to keep your personal belongings
whilst on the ward?
N/a 6.0 6.2 6.2 6.4 6.3
The
Hospi
tal
And
Ward
Q26 Did you see any posters or leaflets on the ward asking
patients and visitors to wash their hands or to use hand-wash
gels?
N/a N/a N/a 9.8 9.6 9.8
The
Hospi
tal
And
Ward
Q27 Were hand-wash gels available for patients and visitors to
use?
N/a N/a N/a 9.9 9.7 9.8
The
Hospi
tal
And
Ward
Q28 How would you rate the hospital food? 5.1 5.0 4.8 5.4 4.8 5.1
The
Hospi
tal
And
Ward
Q29 Were you offered a choice of food? 8.6 8.6 8.4 8.5 8.3 8.6
The
Hospi
tal
And
Ward
Q30 Did you get enough help from staff to eat your meals? 6.8 7.5 7.4 7.5 7.3 7.1
Docto
rs
Q31 When you had important questions to ask a doctor, did you
get answers that you could understand?
8.0 7.9 7.9 7.6 7.8 7.7
Docto
rs
Q32 Did you have confidence and trust in the doctors treating
you?
9.0 8.9 9.0 8.9 8.8 8.7
Docto
rs
Q33 Did doctors talk in front of you as if you werent there? 8.4 8.2 8.4 8.4 8.2 8.4
Docto
rs
Q34 As far as you know, did doctors wash or clean their hands
between touching patients?
7.9 7.5 8.4 8.7 8.3 8.5
99
Nurse
s
Q35 When you had important questions to ask a nurse, did you
get answers that you could understand?
8.5 8.2 8.1 8.2 8.0 8.3
Nurse
s
Q36 Did you have confidence and trust in the nurses treating
you?
8.9 8.8 8.6 8.8 8.5 8.7
Nurse
s
Q37 Did nurses talk in front of you as if you werent there? 9.0 8.9 8.7 8.7 8.8 9.1
Nurse
s
Q38 In your opinion, were there enough nurses on duty to care
for you in hospital?
7.4 6.9 7.1 7.5 7.3 7.4
Nurse
s
Q39 As far as you know, did nurses wash or clean their hands
between touching patients?
8.4 8.0 8.6 8.9 8.8 9.2
Your
Care
and
Treat
ment
Q40 Sometimes in a hospital, a member of staff will say one
thing and another will say something quite different. Did this
happen to you?
8.2 7.9 7.8 8.1 8.0 8.2
Your
Care
and
Treat
ment
Q41 Were you involved as much as you wanted to be in
decisions about your care and treatment?
7.3 6.9 7.2 6.9 7.0 7.0
Your
Care
and
Treat
ment
Q42 How much information about your condition or treatment
was given to you?
7.9 7.9 7.6 7.9 7.9 7.7
Your
Care
and
Treat
ment
Q43 If your family or someone else close to you wanted to talk to
a doctor, did they have enough opportunity to do so?
6.4 6.3 6.1 6.1 6.3 6.3
Your
Care
and
Treat
ment
Q44 Did you find someone on the hospital staff to talk to about
your worries and fears?
6.3 6.2 5.8 5.8 5.7 5.9
Your
Care
and
Treat
ment
Q45 Do you feel you got enough emotional support from hospital
staff during your stay?
N/a N/a N/a N/a N/a 7.2
Your
Care
and
Treat
ment
Q46 Were you given enough privacy when discussing your
condition or treatment?
8.3 8.0 7.8 8.2 8.1 8.0
Your
Care
and
Treat
ment
Q47 Were you given enough privacy when being examined or
treated?
9.5 9.3 9.2 9.3 9.4 9.3
Your
Care
and
Treat
ment
Q49 Do you think the hospital staff did everything they could to
help control your pain?
8.5 8.6 8.3 8.3 8.4 8.4
Your
Care
and
Treat
ment
Q50 How many minutes after you used the call button did it
usually take before you got the help you needed?
7.2 6.9 6.5 6.7 6.9 6.6
Opera
tions
&
proce
dures
Q52 Beforehand, did a member of staff explain the risks and
benefits of the operation or procedure in a way you could
understand?
8.9 8.7 8.9 8.8 9.1 8.9
Opera
tions
&
proce
dures
Q53 Beforehand, did a member of staff explain what would be
done during the operation or procedure?
8.4 8.2 8.4 8.2 8.5 8.4
Opera
tions
&
proce
dures
Q54 Beforehand, did a member of staff answer your questions
about the operation or procedure in a way you could
understand?
8.5 8.6 8.7 8.6 8.6 8.4
Opera
tions
&
proce
dures
Q55 Beforehand, were you told how you could expect to feel
after you had the operation or procedure?
6.8 6.9 6.9 7.0 6.9 7.0
Opera
tions
&
proce
dures
Q56 Before the operation or procedure, did the anaesthetist or
another member of staff explain how he or she would put you to
sleep or control your pain in a way you could understand?
8.7 8.9 8.9 8.9 9.3 8.9
Opera
tions
&
proce
dures
Q57 After the operation or procedure, did a member of staff
explain how the operation or procedure had gone in a way you
could understand?
7.3 7.4 7.5 7.4 7.7 7.7
Leavi
ng
Hospi
Q58 Did you feel you were involved in decisions about your
discharge from hospital?
N/a 6.9 6.9 7.2 6.8 6.9
Leavi
ng
Hospi
Q59 On the day you left hospital, was your discharge delayed for
any reason?
N/a N/a N/a N/a N/a N/a
Leavi
ng
Hospi
Q60 What was the MAIN reason for the delay? 7.1 7.3 6.6 6.9 6.7 6.8
Leavi
ng
Hospi
Q61 How long was the delay? 8.4 8.4 7.9 8.2 8.1 8.1
Leavi
ng
Hospi
Q62 Before you left hospital, were you given any written or
printed information about what you should or should not do after
leaving hospital?
N/a 6.2 6.3 6.4 6.5 7.2
Leavi
ng
Hospi
Q63 Did a member of staff explain the purpose of the medicines
you were to take at home in a way you could understand?
8.6 8.3 8.3 8.4 8.1 8.3
100
Leavi
ng
Hospi
tal
Q64 Did a member of staff tell you about medication side effects
to watch for when you went home?
4.5 4.5 4.7 4.7 4.6 4.6
Leavi
ng
Hospi
tal
Q65 Were you told how to take your medication in a way you
could understand?
N/a 8.1 8.4 8.1 8.2 8.2
Leavi
ng
Hospi
tal
Q66 Were you given clear written or printed information about
your medicines?
7.7 7.4 7.1 7.2 7.5 7.4
Leavi
ng
Hospi
tal
Q67 Did a member of staff tell you about any danger signals you
should watch for after you went home?
4.7 4.8 4.7 5.0 5.3 5.2
Leavi
ng
Hospi
tal
Q68 Did the doctors or nurses give your family or someone
close to you all the information they needed to help care for you?
5.2 5.2 5.2 5.3 5.5 5.7
Leavi
ng
Hospi
tal
Q69 Did hospital staff tell you who to contact if you were worried
about your condition or treatment after you left hospital?
7.7 7.4 7.5 7.4 7.5 7.9
Leavi
ng
Hospi
tal
Q70 Did you receive copies of letters sent between hospital
doctors and your family doctor (GP)?
4.8 4.3 3.4 4.0 4.6 6.9
Leavi
ng
Hospi
tal
Q71 Were the letters written in a way that you could
understand?
N/a N/a N/a 7.8 8.2 8.8
Overa
ll
Q72 Overall, did you feel you were treated with respect and
dignity while you were in the hospital?
8.9 8.7 8.6 8.9 8.7 9.0
Overa
ll
Q73 How would you rate how well the doctors and nurses
worked together?
7.8 7.6 7.6 7.7 7.5 7.7
Overa
ll
Q74 Overall, how would you rate the care you received? 7.9 7.8 7.6 7.9 7.7 7.8
Overa
ll
Q75 During your hospital stay, were you ever asked to give your
views on the quality of your care?
0.5 0.6 0.6 0.9 0.8 1.0
Overa
ll
Q76 While in hospital, did you ever see any posters or leaflets
explaining how to complain about the care you received?
1.5 3.3 3.0 3.5 3.6 4.7
Overa
ll
Q77 Did you want to complain about the care you received in
hospital?
N/a N/a 8.8 9.1 9.4 N/a
CHFT
Extra
Optio
nal
Quest
ions
Are you confident that the hospital is keeping your personal
information / health records secure and confidential?
N/a N/a N/a N/a 9.3 9.4
CHFT
Extra
Optio
nal
Quest
ions
Would you recommend this hospital to your family and friends? N/a N/a N/a N/a 7.8 7.8
CHFT Mean Total All Questions 7.4 7.3 7.2 7.5 7.5 7.6
101
Appendix 14: National Inpatient Survey 2011 Local Peer Group Scores by Section
Mean Section Scores
CHFT East Lanc Aire-dale Brad-ford Harro-gate LTH Mid Yorks Shef-field York
PEER
Avg.
The A&E Department 7.6 7.8 8.0 7.4 8.2 7.3 7.6 8.0 8.0 7.8
Waiting Lists/Planned Admission 6.4 6.9 6.7 6.6 6.7 6.6 6.2 6.6 6.9 6.6
Waiting to get a bed on a Ward 7.9 7.8 8.6 7.1 8.6 7.8 7.0 8.4 8.1 7.9
The Hospital and Ward 8.2 8.3 8.4 8.0 8.4 8.1 8.3 8.1 8.2 8.2
Doctors 8.3 8.6 8.5 8.4 8.7 8.5 8.6 8.7 8.8 8.6
Nurses 8.5 8.6 8.6 8.2 8.7 8.2 8.3 8.6 8.5 8.4
Your Care and Treatment 7.5 7.7 7.5 7.3 7.8 7.4 7.5 7.8 7.6 7.5
Operations and Procedures 8.2 8.4 8.2 8.3 8.6 8.3 8.3 8.5 8.5 8.4
Leaving Hospital 7.1 6.9 6.7 6.6 7.1 6.3 6.5 7.0 7.0 6.8
Overall 6.0 6.2 6.1 5.9 6.1 5.9 5.6 6.1 5.9 5.9
TOTAL 7.6 7.7 7.6 7.4 7.8 7.4 7.4 7.7 7.7 7.6
National Ranking Percentile
(Percentile out of 161 Trusts)
37
th
21
st
33
rd
68
th
12
th
73
rd
57
th
20
th
22
nd

National Inpatient Survey 2011- Quadrant Chart

102
Appendix 15: Patient Comment Analysis National Inpatient Survey 2011
Note: Patient comments were analysed (above) to further enhance our understanding of the
issues raised by patients, with 254 positive comments being received and a similar number of
negative comments 249. There were significantly more positive comments made regarding
care than there were negative. Some of the areas where we received a high proportion of
negative comments related to food, communication and the discharge process
103
Appendix 16: National Inpatient Surveys 2010-12 Emergency vs Planned
Admissions Emerg Plan
104
Appendix 17: Readmissions Survey Results
105
Appendix 18: National A&E Survey 2012 Long Term Conditions Analysis
Note: Groups 0 = No Long Term Conditions (LTC), 1+ = One or more LTC, RAG rating relates to bottom 20%/
middle 60%/ top 20% of Trusts nationally.
106

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