COVID-19 Insight 5: The experiences of hospital inpatients during the early stage of the pandemic

COVID-19 has hugely impacted on the delivery of hospital care: providers and staff have had to adapt services at speed and under huge pressure, while ensuring hospitals remain a safe environment for patients and staff.

To understand how people in hospital were affected, we commissioned a survey of inpatients who were discharged from hospital from April to May 2020, when the first wave of the pandemic was at its height.

More than 10,000 people across the country told us about the care they had received, whether they were diagnosed with COVID-19 or admitted for other reasons.

Generally, people’s experiences remained positive, in line with previous inpatient surveys. Most patients overall (83%) said they felt safe from the risk of catching COVID-19 in hospital, though those who were diagnosed while in hospital were the group who felt least safe (68%), when compared with those who did not receive a COVID diagnosis (84%). People in hospital with COVID-19 reported consistently poorer experiences than those who did not have COVID.

The majority of patients said they were involved ‘a great deal’ or ‘a fair amount’ in decisions made about their care and treatment, as well as in decisions made about their discharge (77% and 73% respectively). They were similarly positive about the emotional support that they received from staff during their stay (70% said they ‘always’ had enough). Most said they ‘always’ had confidence and trust in the staff treating them (83%).

Overall, patients said they had good communication with staff during their stay – for example, 77% said they were ‘always’ able to get attention from staff when needed. But almost a quarter of patients said they were only ‘sometimes’ able to understand the information that staff gave them in response to their questions, or that they could ‘never’ understand the answers. Just over a quarter said that the information they were given was ‘sometimes’ or ‘always’ contradictory.

While most patients were able to keep in touch with their family and friends during the pandemic (75% said they were ‘often’ able to do this), 13% said they did not receive the help they needed to do so.

Patients who were in hospital during the pandemic reported high levels of cleanliness; 80% said that their room or ward was ‘very clean’. Most also recalled seeing a range of infection control measures, including staff wearing PPE, handwashing, provision of waste bins, and cleaning of surfaces. However, over a third of patients did not remember seeing social distancing measures, such as markers on the floor or signage at the entrance (this was slightly worse for those with a COVID-19 diagnosis).

Discharge and care after leaving hospital were the most problematic aspects of care. Results for people with COVID-19 were even worse. When leaving hospital, 32% of people with COVID-19 did not know what would happen next with their care, compared with 18% for people without COVID. One in three people diagnosed with COVID-19 felt help from health and social care services would have been ‘useful’ after leaving hospital, but did not receive this. People discharged to a care home were also less positive about the information they received prior to leaving and about their involvement in discharge arrangements.

Looking across all results from the survey, we found worrying indications that some groups of people found their hospital stays more difficult than others.

Generally, people with dementia or Alzheimer’s disease, those with a mental health condition, and patients with a neurological condition reported poorer experiences of most aspects of inpatient care.

People with dementia or Alzheimer’s disease:

• were least likely to say they were involved in decisions about their care or received answers to questions that they could ‘always’ understand
• were least likely to ‘always’ understand staff who were wearing PPE
• had (among groups with long-term health conditions) by far the lowest rate of feeling able to keep in touch with their families during their stay (23% said they ‘never’ spoke with friends or family while in hospital).

Older patients (those aged 75 and over) were also more likely to say they were unable to keep in touch with family and friends during their stay.

Deaf people, those with a learning disability, dementia or Alzheimer’s, people aged over 85 and autistic people also found it particularly difficult to understand staff when they were wearing PPE.