The NPSP is comprised of five self-completion surveys, which following initial pilots are all now using a mixed-mode methodology. For each survey, NHS trusts collate a sample of patients who are eligible to take part in the survey based on the following criteria:
- Adult Inpatient Survey – Patients are selected if they spent at least one night in hospital (and were not admitted to maternity or psychiatric units), are aged 16 years or over and were discharged during the sampling month(s).
- Maternity Survey – Individuals are selected if they are aged 16 years or over at the time of delivery and gave birth under the care of an NHS trust during the sampling month(s).
- Children and Young People’s Patient Experience Survey – Patients are included if they are between the ages of 15 days to15 years at discharge and were discharged during the sampling month(s) (including planned/unplanned (emergency) admissions, day/overnight patients).
- Urgent and Emergency Care Survey – Individuals are selected if they are aged 16 years or over at attendance, and if they attended urgent or emergency care services within the sampling month(s).
- Community Mental Health Survey – Service users are included if they are aged 18 years or over and were seen by someone at their trust within the sampling month(s).
To give a sense of the rich and varied data the NPSP captures, some recent findings are highlighted below:
The Adult Inpatient Survey measures patients’ experience of their hospital journey from admission to discharge, and support received after leaving hospital. Results from the latest 2021 survey show that:
Over half of patients rated their overall experience as nine out of ten or above (52%), with 82% saying they felt they were always treated with respect and dignity while in the hospital. - Older patients, those who had an elective (planned) stay, and those who stayed for one night reported more positive experiences.
The Maternity Survey looks at the experiences of women and other pregnant people across the maternity pathway. Results from the latest 2022 survey show that:
- Most women and other pregnant people were asked about their mental health during antenatal (93%) and postnatal (96%) check ups . Over four fifths (85%) said they were given enough support for their mental health during pregnancy.
- Recovery efforts from the Covid-19 pandemic continue to have a big impact, with 41% saying that their partners were able to stay with them as much as they wanted during their stay in hospital (compared to 74% in 2019).
The Children and Young People's Patient Experience Survey looks at the experiences of children and young people admitted to hospital as an inpatient or day case; the Urgent and Emergency Care Survey measures experiences of adults who received care from an emergency department or an Urgent Treatment Centre, and the Community Mental Health Survey assesses the experiences of people who received care in the community for a mental health condition.
The value of the data
Results are published at national, NHS trust and site-level, which provides a snapshot of patient experience across England – data from previous years is archived and made available for access on the NPSP website. The results are used by CQC for regulatory activities such as registration, monitoring ongoing compliance and reviews; and by NHS England and the Department of Health and Social Care to support their work.
Each NHS trust gets an individual report of results, to help identify areas where they are doing well and areas for improvement. These reports were redeveloped for the 2020 Adult Inpatient Survey through engagement with trusts and stakeholders to make sure they are impactful. Trusts also receive results from the open-ended questions which provide valuable, granular feedback from patients.
Transitioning to mixed mode
While NPSP surveys have traditionally been paper-based, the CQC identified the need to introduce an online methodology, given the challenge of declining response rates (see chart below) and increasing postage costs. A consultation was undertaken between September 2019 and February 2020 to determine the views of stakeholders on transitioning surveys to an ‘online first’ method. The public, colleagues working within NHS Trusts and data users were consulted through various engagement activities, and results found that the majority supported the proposed move to a digital-first approach.
Between 2019 and 2022, pilots were then run by Ipsos to assess the feasibility of a mixed-mode approach (where patients can take part online or on paper) for each survey in the NPSP.
All the pilots demonstrated the feasibility of moving to a mixed-mode methodology. The results raised considerations around the response rate, the proportion taking part online, demographic profile of participants, and the subsequent breaking of trend data. Following these pilots, all NPSP surveys have successfully transitioned to a mixed-mode approach, with participants receiving a letter (and SMS reminder) inviting them to complete the survey online. If participants choose not to take part online, they are sent a paper questionnaire in the final mailing.
The full results of pilots for the Adult Inpatient, Children and Young People, Maternity, Community and Mental Health, and Urgent and Emergency Care surveys can be found on the NHS Surveys website.
The Maternity Survey and Adult Inpatient Survey mainstages have since been delivered using a mixed-mode approach. For the Maternity Survey, the transition to mixed-mode led to an impressive increase in response rate: in 2019 the response rate for the paper-based postal survey was 36%, in 2021 this increased to 52% using the mixed-mode methodology. Online responses comprised 89% of total answers – this stayed similar in the 2022 Maternity Survey (88%). Whilst in 2022, there was a drop in the overall response rate (46.5%), this was still significantly higher than when previously run as a paper-based postal survey.
The move to mixed-mode was also successful for the 2020 Adult Inpatient Survey, which had an overall response rate of 46% (compared with 45% in 2019), and 64% of online responses – though there was a drop in overall response rate in 2021 (39%). It is important to note that fieldwork for the Adult Inpatient Survey for 2020 was taking place during the height of the pandemic, when significant health and social curbs were in place, plus there is growing evidence emerging to indicate a ‘gratitude bias’ had developed amongst patients towards the NHS given the pressure they were under . By the time the Adult Inpatient Survey for 2021 was in field, both the ‘gratitude bias’, plus the health social curbs had eased, which may in part explain the drop in response rate between the two years.
Chart: NPSP response rates (2002-2022)
Developing inclusive sex and gender questions
The transition to mixed-mode methodology, and the resulting break in trends, provided the opportunity to review questions, which included those related to sex and gender.
To develop inclusive sex and gender questions for the NPSP, cognitive testing was conducted with cisgender and non-cisgender individuals to explore options for the sex and gender questions. These interviews aimed to assess the clarity and interpretation of each question and to ensure the redeveloped gender question was suitable for participants who don’t identify as cisgender.
The final chosen questions are shown below. In sum, these two questions provide information on the protected characteristics of sex and transgender identity, while allowing participants to provide more information on gender if they wish to.
Image: Screenshot of redeveloped sex and gender questions
The future of the NPSP
The CQC is committed to continue increasing the value, efficiency and accessibility of the survey programme, working alongside the Coordination Centre commissioned to run the survey to ensure it is as inclusive as possible.
If you would like to get in touch you can contact us at [email protected]
Table: Overview of NPSP surveys
Where to find survey materials and reports: https://nhssurveys.org/surveys/
Access to datasets (with links): https://nhssurveys.org/data-library/
AUTHOR BIOS
Ben is a Senior Research Executive at Ipsos and was part of the team that delivered the 2021 Adult Inpatient Survey. He also works on a range of qualitative, quantitative, and evaluative studies with a particular focus on health.
Laura has over 20 years of experience of designing, directing and delivering research projects for a range of government clients but particularly specialising in health. She jointly leads on patient experience and directs the CQC NHS Patient Survey Programme in Ipsos’ role as the Coordination Centre.
Tamatha Webster is Principal Researcher at the Care and Quality Commission, leading a team focusing on use of people’s experiences of care to support regulation and service improvement.