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National children's hospital survey finds most children have good experiences of care – but highlights inequalities for those with specific needs
The experiences of almost 19,000 children and young people who stayed in hospital overnight or were seen as a day patient reveal that the majority of children and young people said they were happy with the care received, thought staff did everything possible to control their pain and they understood the information given to them by staff.
However, children with physical or learning disabilities, or mental health needs reported poorer experiences of care than those without.
The results of Care Quality Commission’s (CQC) first survey in England to get views of children and teenagers about their hospital care have been published today (1 July 2015). They show that 87% of children and young people and 88% of parents or carers rated their overall experience as seven or above out of ten – the highest scores that are available.
Nationally, the results from the 137 acute NHS trusts which took part in the survey shows:
- Almost nine out of ten of all eight to fifteen year olds (89%) said that they felt safe on the ward at all times
- 91% of parents or carers said they felt that their child was always safe
- 80% of all eight to fifteen year olds told us that staff did everything they could to help control their pain
- Almost three quarters (73%) of children and young people who have had surgery or a procedure received explanations about what had happened in a way that was easy for them to understand
- Most 8-15 year olds told us staff always listened to them (78%), staff talked to them when they had worries (75%) and that staff spoke to them in a way they could understand (82%).
Some of the findings that indicated relatively poorer quality of care include:
- 41% of parents and carers felt staff were not always aware of their child’s medical history before treating them
- 43% of 12 to 15 year olds told us that they were not fully involved in decisions about their care
- Over one third (35%) of parents and carers said that they were not definitely encouraged to be involved in decisions about their child’s care and treatment
- Less than half the children between 8-15 (45%) liked the food on offer
- Almost one in three (32%) parents or carers said that staff were not always available when their child needed attention
- Over four in ten children aged 8-11 (42%) said staff did not play or do any activities with them while in hospital
When it came to the arrangements for leaving hospital:
- One in every eight children were not told who to talk to or what to do if they were worried about anything when they got home.
- One in five parents or carers were not given any written information about their child’s condition or treatment to take home, but would have liked some.
Commenting on the findings, Professor Edward Baker, CQC’s Deputy Chief Inspector of Hospitals, said:
“There is much to celebrate in our first survey to ask children and young people about their care.
“Nationally, most young people and children said they were happy with their care, are able to understand the information given by staff following an operation or procedure, and that they have confidence staff are doing everything they can to manage their pain.
“However, there is marked variation between the results from individual hospitals. We have now inspected the majority of children’s hospital services in England, and those inspections have also shown marked variation in the quality of care provided.
“Hospitals should examine the results of this survey, together with our inspection reports and take steps to improve their care where necessary. Children should not have different standards of care depending on which hospital they go to.
“We’re encouraging more children and young people to share their experiences of care with us, and along with our inspections, these are crucial to help drive improvements in the quality of children’s services.”
Responses were less positive across all areas that involved children with mental health conditions, learning or physical disabilities, compared to the children and parents or carers of children without these conditions.
The results show:
- 45% of parents and carers of children with physical disabilities and 49% of parents and carers of children with mental health conditions or learning disabilities thought staff were aware of their child’s medical history before caring for them or treating them, compared with 59% for parents or carers of children without these conditions
- Less than half (49% of parents and carers of children with a physical disability, and 48% of those with children with mental health needs or a learning disability) felt that staff definitely knew how to care for their child’s individual needs. This compares to 72% of parents and carers of children without these conditions.
- Almost two thirds (64% per cent) of parents and carers of children with a physical disability, and 68% of those with children with mental health needs or a learning disability, said the ward had appropriate equipment or adaptations suitable for their child, compared with 81% of parents and carers whose children did not have these needs.
- Five per cent of children with these long term conditions awarded overall experience scores of between 0 and 2 (with ten being the highest score possible). In comparison, children without these conditions did not give such low scores.
Professor Baker added: “What is particularly worrying is that children with physical, learning or mental health needs are telling us they have poorer experiences. This needs to be addressed straight away so that services meet the needs of all children, irrespective of any disability or specific need.”
Professor Neena Modi, President of the Royal College of Paediatrics and Child Health, said:
“Today’s report shines a spotlight on the care experienced by children and young people in hospital. Encouragingly the majority of children and their families have good experiences of the care they received; they feel safe, are listened to and are spoken to in a way that they can understand.
“What is concerning is that 41% of parents and carers felt staff were not always aware of their child’s medical history; this extended to 51% of those with mental health issues or learning disabilities and 55% when a child had a physical disability.
“The importance of clinicians, patients and their families communicating effectively with each other cannot be underestimated, particularly when a child has a number of complex needs. This must start with taking a detailed history and ensuring every health professional involved in the child’s care is familiar with this. It also means nurses, doctors and parents being present on ward rounds together and providing frequent opportunity for patients and their parents to discuss plans and progress with medical staff.
“Now we have this report, it is vital that we share its findings so we can target action to improve the care delivered to our patients, their experiences in hospital, and their health outcomes.”
Kath Evans, Head of Patient Experience – Children and Young People at NHS England, said:
“This survey shows that most children have good experiences of care, but providers will want to act on less good experiences highlighted by those with complex and mental health needs. All patients including children and young people deserve the very best health care experiences.”
Sarah Brennan, Chief Executive of Young Minds, said:
“For both children and their parents a stay in hospital can be a traumatic experience it is therefore very disturbing to see the lack of confidence that parents have in staff to provide the appropriate care for their child. We know from our work bringing parents and clinicians that often small steps like improving communications with parents can greatly help increase this confidence
“The Care Quality Commission’s first ever survey of children and young people’s experience of hospital stays sheds an important light on the massive gulf that we see between physical health and mental health service provision. Clearly there is a long way to go for us to achieve the Government’s stated aim of ‘parity of esteem’ between physical and mental health services.
“The results of this survey must be used to give further support to all those who are striving to improve children and young people’s mental health impatient services. We have to see change happen for those desperately struggling children, young people and their families.”
While some trusts performed ‘better than expected’ across many of the questions in the survey, some were consistently ‘worse than expected’. Queen Victoria Hospital NHS Foundation Trust in East Grinstead performed ‘better than expected’ in 21 out of the 24 questions it participated in. This was followed by Moorfields Eye Hospital (13), Northern Devon Healthcare NHS Trust (11) East Lancashire Hospitals NHS Trust and Salisbury NHS Foundation Trust (9).
North Middlesex University Hospital NHS Trust and Bradford Teaching Hospital both had 11 questions where the performance was ‘worse than expected’.
As part of the survey, we asked children and young people to draw pictures of their care. These are available on our Pinterest site
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- Last updated:
- 29 May 2017
Notes to editors
This is the first national children’s survey conducted by CQC. It represents the experiences of nearly 19,000 children and young people who received inpatient or day case care in one of the 137 acute NHS trusts which took part in the survey.
This survey was completed by children, young people and families who used general paediatric wards not by children on mental health wards or using adolescent mental health services
CQC has published an infographic to accompany the national report, which highlights some of the key national findings
Individual trust reports are available on our website
We asked children and young people who were discharged from hospital during July, August, and/or September 2014 to tell us about their experiences of care.
Children between the ages of eight to 11 and 12 to 15 who were either seen as a day-case or who stayed for one night or more were sent a questionnaire which asked a range of questions about their stay in hospital to see if the care was safe, caring, effective and responsive to their needs. These included: did you feel safe, how clean was your ward, did staff control your pain, did you like the food, were you able to understand what staff told you and were staff available when you needed them?
Each questionnaire contained a section asking for children’s views, with a supplementary section for parents and carers to complete. Where a child was under eight years old, a questionnaire was sent to their parent or carer only.
The ‘better’, ‘about the same’, and ‘worse’ categories are based on the expected range that is calculated for each question for each trust. This is the range within which we would expect a particular trust to score if it performed about the same as most other trusts in the survey. The range takes into account the number of respondents from each trust as well as the scores for all other trusts, and allows us to identify which scores we can confidently say are better or worse than the majority of other trusts.
We’re encouraging more children and young people to share their experiences of care, and to know about the standards they have a right to expect from health and care services.