Scottish Health and Care Experience Survey 2013/14 - Technical Report

1 Introduction and background

Introduction

1.1 The Health and Care Experience Survey is a postal survey which was sent to a random sample of patients who were registered with a GP in Scotland in October 2013. The survey is the successor to the 2011/12 Patient Experience Survey of GP and Local NHS Services.

1.2 Like its predecessor, the survey asked patients about their experience of accessing their GP practice, making an appointment, visiting reception, seeing either a doctor and/or nurse at the surgery, receiving medication, the overall care provided by the practice, out of hours care and outcomes from NHS treatment. New questions were added this year to find out about patients' experiences of tests organised by their GP practice and addressing mistakes made in their care.

1.3 In addition a series of questions were added to capture respondents' experience of social care services and the experience of carers to reflect the principles underpinning the integration of health and care in Scotland proposed under The Public Bodies (Joint Working) (Scotland) Bill 2014^[1].

1.4 The focus of this report is on the survey development, design and analysis. The national report provides the national results and is available at:

1.5 http://www.gov.scot/Topics/Statistics/Browse/Health/GPPatientExperienceSurvey/Survey1314

1.6 Individual reports for each GP practice, Community Health Partnership (CHP) /Local Authority and NHS Board are available at:

http://www.healthcareexperienceresults.org/

Scottish Care Experience Survey Programme

1.1 The Health and Care Experience survey is one of four national surveys which are part of the Scottish Care Experience Survey Programme. The surveys aim to provide local and national information on the quality of health and care services from the perspective of those using them. They allow local health and care providers to compare with other areas of Scotland and to track progress in improving the experiences of people.

1.2 The other national care experience surveys are:

Patient Experience Inpatient Survey
Maternity Patient Experience Survey
Radiotherapy Survey

1.3 The survey programme supports the three quality ambitions of the Healthcare Quality Strategy for $1cotland (or Quality Strategy)- Safe, Effective, Person-centred by providing a basis for the measurement of quality as experienced by service users across Scotland. In particular the surveys support the person-centred quality ambition which is focused on putting people at the centre of care, ensuring that care that is responsive to individual personal preferences, needs and values, and assuring that individual values guide all care decisions.

Aims of the survey

1.4 The survey's specific objectives were to:

For local improvement

• provide GP practices with structured feedback on their patients' experience of their service, relative to other practices in Scotland and to previous results;
• provide NHS Boards and CHPs / Local Authorities with information about people's experiences in their respective areas and on variation within and between local areas;

National results

• provide national results for the survey, identifying variation within and between local areas on if and how the level of positive and negative experiences have changed over time;
• highlight areas of best practice and areas for improvement;
• monitor the $1cotland HEAT standards on accessing GP services;
• assess the types of outcomes patients had from any NHS treatment to inform the quality outcome indicator on patient reported outcomes;
• contribute to the patient experience quality outcome indicator;
• contribute to the draft health and wellbeing outcomes indicators proposed under the Public Bodies (Joint Working) (Scotland) Bill 2014.

Survey design

1.5 The survey was redeveloped during summer 2013 with an aim of widening it beyond primary care to cover local care and support services as well as the experience of unpaid carers. Improvements were also made to a number of existing primary care questions and a number of new questions were introduced around medical tests and errors.

1.6 Consultation workshops were held with members of the public to test out any potential changes and find out what was important to them. The survey was then cognitively tested with members of the public to ensure that the new questions worked well in terms of understanding the purpose of the questions and the response scales.

Survey fieldwork and response

1.7 The sample was designed to provide results for individual GP practices as well as providing information for use by NHSScotland, NHS Boards and CHPs/ Local Authorities.

1.8 People who were sent the survey were randomly sampled from the lists of patients registered with each GP practice in Scotland. This was done confidentially by the Information Services Division (ISD) of the NHS National Services Scotland^[2]. The survey was administered by Picker Europe^[3] a charity which provides support for patient experience surveys, with assistance from ISD and Scottish Government Health Analytical Services. Fieldwork for the survey began on 25 November 2013 and ended on 17 February 2014.

1.9 A total of 584,070 questionnaires were sent out and 112,970 were returned giving a response rate of 19.3%. This response may appear low compared to that achieved for the first survey in 2009/10 (38 per cent). This is because the first survey sent two reminders, but since then we have designed the sample to achieve the required number of responses for each practice without reminders to all non- respondents.

1.10 It proved to be cost effective to send more surveys initially than to send fewer surveys and reminders. During the fieldwork period a small number of reminders were issued to non-respondents from 29 GP practices where the number of responses were felt to be low.

1.11 The response rates have been analysed by ISD and are discussed in Chapter 8 of this report.

1.12 More information on the survey design, response rates and methodology can be found in Chapters 4, 8 and 9 of this report.

Survey fieldwork and response

1.13 The survey data collected and coded by Picker Institute Europe were securely transferred to ISD. The main analysis contained in the national report was carried out by ISD. In addition, ISD prepared the supplementary tables showing analysis of results for NHS Boards and CHPs / local authorities in conjunction with Scottish Government.

1.14 The national report was released on 27 May 2014. It presents national results for each survey question and compares the results with those from the 2011/12 survey. It is available at:

1.15 http://www.gov.scot/Topics/Statistics/Browse/Health/GPPatientExperienceSurvey/Survey1314

1.16 Throughout the national report, weighted average percentages have been presented. This accounts for the different sizes of GP practices. Weighting the results in this way provides results that are more representative of the population at Scotland, NHS Board and CHP / Local Authority level.

1.17 Changes from the 2011/12 national results that are discussed in the national report are statistically significant at the 5% level, unless otherwise indicated. Due to the large sample size, even small changes of one per cent in the national results are statistically significant. For tables showing changes in results for NHS Boards, statistically significant differences are highlighted in bold within the national report.

1.18 The national report also explores the variation in results between GP practices, NHS Boards, CHPs/ Local Authorities.