Poor hospital discharge affecting patients’ satisfaction with care, survey finds

Poorly co-ordinated discharge from hospital is having an effect on patients’ satisfaction with NHS care, a survey has found, with some saying they do not feel involved in decisions and are not being given enough notice.

More than one in four people also think their health deteriorated while waiting to be admitted to hospital.

The Care Quality Commission (CQC) said an “imbalance” between demand and treatment capacity “is putting people at risk”.

Overall satisfaction rates with NHS care remain “far lower” than pre-pandemic, according to the hospital regulator.

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Its adult inpatient survey for 2023 captures the views of more than 63,500 people over the age of 16 who were in the care of one of 131 NHS trusts in England for at least one night during November last year.

Patient satisfaction levels are largely unchanged from 2022, the CQC said, but remain “significantly worse” than the levels seen before the Covid-19 pandemic.

When asked about being discharged from hospital, 29% of patients said they had little or no involvement in decisions, up from 25% in the previous year.

A third said they were involved “a great deal” in the process, a drop of 4%.

Almost half (48%) said they were given enough notice about when they would leave hospital, consistent with 2022 levels, while 46% said they received enough support from health and social care services after being discharged, which is unchanged since 2021 but 5% lower than 2020.

Louise Ansari, chief executive at Healthwatch England, said: “These findings reflect what people have told us about their experience of hospital discharge, with a lack of communication from services making them feel forgotten and confused about the next steps.

“Poor hospital discharge processes can leave people unable to get home or get the appropriate help once at home. It also leaves people at risk of returning to their GP, hospital or social care teams soon after discharge. And uncertainty about next steps can increase the pressure on unpaid carers who are left without support to help the person they care for.”

Some 23% of patients waiting for elective treatment told the CQC survey they would have liked to have been seen “a bit sooner”, compared with 22% in 2022.

Some 19% said they would have liked to have been admitted “a lot sooner”, up from 17% in the previous year.

More than four in 10 patients (43%) told the survey they felt as if their health had deteriorated while waiting to be admitted to hospital, although 49% said their health remained the same.

Earlier this month, it emerged that NHS waiting lists had risen for the third month in a row.

An estimated 7.62 million treatments were waiting to be carried out at the end of June in England, relating to 6.39 million patients – up slightly from 7.60 million treatments and 6.37 million patients at the end of May.

Tim Mitchell, president of the Royal College of Surgeons of England, said: “We can’t get away from the fact that the NHS is in dire need of capital investment to fix crumbling estates and increase surgical capacity – this includes establishing more surgical hubs.

“We also need more surgeons, theatre nurses and anaesthetists. If we don’t see this investment, hundreds of thousands of patients will continue to live in pain on waiting lists.”

Sir Julian Hartley, chief executive of NHS Providers, said: “NHS trust leaders and their teams are working flat-out to ensure people get the care they need as quickly as possible.

“But, as these latest figures from CQC show, they still have a long way to go to restore patient satisfaction with their care while in hospital to pre-pandemic levels.

“Far too many people face long delays for care and treatment – often at the expense of their health and wellbeing. These frustrations are being compounded at the end of their care when patients are ready to leave hospital too.”

Nicola Wise, director of secondary specialist healthcare at the CQC, said: “It’s disappointing that we haven’t seen more improvement in patient experience since the last time the survey was carried out.

“Overall, satisfaction rates remain far lower than they were pre-Covid, with delays in accessing care and poorly co-ordinated discharge from hospital both clear factors impacting on the quality of people’s hospital stay.

“It’s also concerning that we’ve seen an increase in the number of people who feel their health deteriorated while they waited for elective care – further evidence that the current imbalance between patient demand and treatment capacity is putting people at risk.”

The majority of patients shared positive experiences about their interactions with NHS staff as part of the CQC survey.

Three-quarters said they “always” felt included by doctors in conversations about their care, while 82% felt they were treated with dignity by NHS staff.

Ms Wise said this is “encouraging”, adding: “We know that staff and leaders are doing all they can to minimise delays, manage the flow of patients from admission through to discharge, and provide compassionate person-centred care.

“But, as pressures persist, ensuring the best possible experience throughout the entirety of the patient journey is a task that needs input from all parts of the health and care system.

“It also needs to be supported by continued efforts to address staff shortages, improve retention of our highly-skilled workforce and ensure recognition of the commitment and dedication from frontline staff.”

An NHS spokesperson said: “While most patients who responded to this survey reported a positive overall experience and high level of trust in doctors and nurses, these results clearly demonstrate there is much more to do to ensure waiting times, care in hospital, and the discharge process reach the standards patients should expect – given that at the time of this survey more than 12,500 beds each day were occupied by patients who no longer required hospital treatment and could be better cared for elsewhere.”