Call for standards after publication of hospital assessments

Results of first Patient-Led Assessements of the Care Environment (PLACE) reveal opportunities for improvement

The Government has published the results of the first ever Patient-Led Assessments of the Care Environment (PLACE)

A number of hospitals, hospices and health centres across England are falling well below the national average in key areas such as cleanliness, privacy and dignity and food and nutrition, according to the first results of the new patient-led assessments.

The Health and Social Care Information Centre has recently published the first figures for the annual Patient-Led Assessements of the Care Environment (PLACE), which replaced the former Patient Environment Action Team (PEAT) assessment from April this year.

Under the initiative, self assessments are undertaken by teams of NHS and private/independent healthcare providers. For the first time, these teams include at least 50% members of the public, known as patient assessors. They focus on the environment in which care is provided.

Local people leading these inspections ensure independent, fresh pairs of eyes checking out our hospital wards, really making clear to senior managers how their patients feel when receiving care

But the results show that while there are pockets of good practice, some providers are falling well below standard.

For cleanliness the national average score was 96%, with 90% of sites scoring more than 80% and 144 facilities getting 100%. For the condition, appearance and maintenance of sites, including decoration, signage, linen and carpark access, the national average was 89%, with 68% scoring more than 80% and just two sites getting a perfect score.

In terms of privacy and dignity, including the provision of changing facilities, separation of the sexes, telephone access and the availability of appropriate clothing, the national average was 89%, with 65% scoring more than 80% and 18 recording 100%.

The last area, covering food and hydration, saw a national average score of 85%, with 70% scoring more than 80% and four getting 100% pass rates.

Just three facilities managed to score the highest mark in more than one area - The Mild May Mission Hospital in London got 100% for both food and nutrition and cleanliness; while Derbyshire Royal Infirmary Resource Centre received top scores for cleanliness and facilities. Finchley Memorial Hospital recorded 100% for both cleanliness and privacy and dignity.

Commenting on the figures, Neil Churchill, director for patient experience at NHS England, said: “NHS England is determined to place patients at the heart of everything the NHS does, and PLACE is a further shift towards patient power.

"The condition and cleanliness of wards has a huge effect on how comfortable, relaxed and confident patients feel, which in turn affects how quickly they recover.

“Local people leading these inspections ensure independent, fresh pairs of eyes checking out our hospital wards, really making clear to senior managers how their patients feel when receiving care. Patients were keen to get involved, and more than a quarter of hospitals had more volunteers than they needed.

“National publication of the results is also another step forward in our mission to be completely transparent about everything the NHS does, and I would urge everyone to take a look at the assessments, alongside the increasing volume of other information we are publishing about hospitals’ safety and quality. We want hospitals to study and act on the data, and patients to look at the information when making choices about their care.”

PLACE scores should not be used as yet another stick, but the carrot to catalyse continuous, quality improvements

The new approach has been widely welcomed. Andy Jones, chairman of the Hospital Caterers Association (HCA), told BBH : "The HCA warmly welcomes the new PLACE inspection system which fully integrates, for the first time, patients in the assessment process. Although the inaugural results have been termed ‘experimental statistics’ by the Department of Health, with the possibility of refinements being made to the process in its second year, the new system already appears to be providing a much more comprehensive insight into the patient’s view of key services. In terms of patient food and drink services, these first overall results are encouraging with high levels of patient satisfaction with hospital food across NHS trusts and other health care centres in England."

But he warned against the PLACE assessments being seen as league tables and used as a stick with which to beat trusts, adding: “While I believe that patient involvement is essential to providing a more accurate perspective of views on food, drink and general catering services and to identifying where improvements should be made, we must not allow ourselves to become distracted by overly focusing on scoring and league tables.

"It is key that our menus and beverage choice meet and are suitable for the patient groups we serve as well as being flexible in both their offering and adaptability. The advantage of the PLACE data is that it enables us to take a step back and explore in depth, patient feedback on specific aspects of the service and to work with the patients on those individual areas that have been identified as weaker.

"PLACE scores should not be used as yet another stick, but the carrot to catalyse continuous, quality improvements. In order to achieve that across the board, a view needs to be taken about how some of the catering service is managed in future, such as night time ward snacks and drinks, as these fall under ward budgets and are outside of the caterer’s area of responsibility. In order to improve the quality of all aspects of patient food and drink provision, the caterer should be allowed to take responsibility for the whole of the ward service."

With this in mind, the HCA has pledged its support for the Campaign for Better Hospital Food, which is calling for the introduction of mandatory standards for all patient meals in England, based on those outlined in the British Dietetic Association’s Digest .

Jones said: "In order for all hospitals across the country to achieve a national standard, it will also be essential for a mandatory minimum expenditure on all patient meals to also be introduced. In addition, the HCA is calling for Protected Meal Times to be made mandatory by the Government in all hospitals and for more help to be provided for patients who need assistance to eat."

Cleaning in healthcare is a complex, specialist operation and a professional qualification would go a long way towards raising cleanliness standards and ultimately reducing the risk of infection outbreaks in hospitals

Similar standards are being sought by the Association of Healthcare Cleaning Professionals (AHCP). Its outgoing chairman, Denise Foster, said cleaners in the NHS should have professional qualifications if cleanliness standards are to be raised. This view was supported by 79% of cleaning professionals who responded to a survey by Jigsaw Cleaning. Its managing director, James Blackhurst, said: "The question of whether cleaning professionals should hold a relevant qualification is widely debated in the healthcare industry and, as we predicted, the vast majority of respondents called for cleaners to be qualified.

“Cleaning in healthcare is a complex, specialist operation and a professional qualification would go a long way towards raising cleanliness standards and ultimately reducing the risk of infection outbreaks in hospitals.

“Now we must look at how we can move forward and work with healthcare providers to push for the national certification of cleaners in the industry.”

To see the scores in full, click here.

The Hospital Caterers Association is calling for national standards to help drive up the quality of food

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