DHSC has identified 6 important areas for development:

• data
• awareness and understanding
• decision making processes
• communication of restrictions by providers
• distinction between ‘visitor’ and ‘care supporter’
• monitoring and enforcement.

The outcome report sets out the findings of the review and the work DHSC will take forward to address these gaps. This work aims to ensure Regulation 9A is more effective and support a change in culture and practice to embed Regulation 9A in health and care settings. This is vital to ensuring that the rights of people in health and care settings to see their loved ones are upheld consistently and transparently, supporting person-centred care and meaningful connections.

• Demand for services is growing. People cannot always access the care and treatment they need when they need it, and the system often fails to deliver effective, joined-up care, resulting in long waits and unmet needs.
• Over 700,000 more patients were registered with a GP on average in 2024/25 compared with 2023/24, and the number of appointments has risen by nearly 10% over the last 2 years.
• In adult social care, the demand for support funded by a local authority continued to rise – new requests for care were 4% higher in 2023/24 than in the previous year, and 8% higher than in 2019/20. 
• In 2024/25, people were still waiting too long for mental health care and were unable to access the care they need when they needed it. During the year, there was an average of 453,930 new referrals to secondary mental health services every month – an increase of 15% from 2022/23. 

Workforce and capacity

• Issues with recruitment, retention and understaffing in some areas are affecting people’s care.
• Despite an 11% growth in the sector during the last year, the CQC have expressed concern that some homecare providers have said they are handing back local authority contracts due to rising costs.
• The CQC also note concern about the burden on unpaid carers.
• District nursing services are an important part of shifting care from hospital settings into the community, but the number of qualified district nurses per 10,000 people aged 65 and over has dropped by 50% in the last 14 years. 

People’s experiences

• The health and care system remains fragmented and pressure in the system has an impact on people’s experiences of care.
• There are significant challenges around funding and system working, as poor communication and collaboration between services, and problems with shared care protocols can have a negative impact on people’s experience of care, the co-ordination of their care and transitions between care pathways.
• Navigating the care system remains challenging, especially for people with needs that are more complex to meet or who have limited advocacy – this includes people living with dementia, autistic people and people with a learning disability and people living in more deprived areas.

Inequalities and concerns for specific groups of people

• The CQC have stated that they continue to see significant unwarranted variation and inequalities in care. This persists in how people access and experience care, and their outcomes from it.
• Variation at both a regional and ICS level is leading to inconsistent quality across the country.

Signs of improvement and innovation

• Although the system is under serious pressure, we have seen evidence of innovation and improvement making a difference for people. In CQC assessments, they state that they continue to see how good leadership can promote a culture of openness and learning.

Deprivation of Liberty Safeguards

• The number of applications to authorise the deprivation of a person’s liberty have continued to increase significantly over the last decade – far beyond the levels expected when the safeguards were designed, which often results in lengthy delays.
• Issues with the Deprivation of Liberty Safeguards (DoLS) system continue to disproportionately affect certain groups of people. Our survey of Mental Capacity Act leads in hospitals highlighted particular concerns around older people, including those with dementia.

• how CQC are proposing to develop their frameworks and guidance for assessing providers
• how CQC propose to change their methods for inspecting, assessing and awarding ratings to health and care services.

It is focusing on four areas that CQC have identified as causing the most issues:

1. Making sure they can publish reports of assessments that they have completed, which providers have been waiting too long for.
2. Increasing the number of assessments completed each month, so they can provide up-to-date ratings and ensure people understand the quality of care in services in their area.
3. Clearing their registration backlog to enable new services to start delivering care and increasing capacity in the system.
4. Making sure they’ve acted promptly on information of concern and statutory notifications that providers tell us about.

Interactions with hospital staff

• 82.2% of respondents felt they were ‘always’ treated with respect and dignity while in hospital and 79.9% of respondents felt they were 'always' treated with kindness and compassion.
• Most respondents felt they were able to talk to hospital staff about their worries and fears to some extent (60.4% ‘always’ and 30% ‘sometimes’).
• 76.2% of respondents ‘always’ felt included in conversations about their care by both doctors, while 76.8% ‘always’ felt included by nurses.
• A majority of respondents felt staff involved them in decisions about their care and treatment to some extent (43.8% were involved ‘a fair amount, 36.8% ‘a great deal’).
• Confidence and trust in hospital staff remains high, with 80.1% and 78.3% saying they ‘always’ had confidence and trust in doctors and nurses respectively (compared to 80.2% and 77.8% in 2022, respectively).

Staff availability

• 57.9% felt there were ‘always’ enough nurses on duty to care for them, compared to 55.7% in 2023 and having previously fallen to 51.6% in 2022.
• Most respondents felt they were able to get a member of staff to help them when they needed attention to some extent (64.5% ‘always’ and 33.1% ‘sometimes’).

Overall experience

• 52.1% of respondents rated their overall experience of inpatient care as a 9 or 10 (where 10 is a very good experience) compared with 50.8% in 2023. Those who gave scores of 0 or 1, indicating they had a very poor experience, remains low at 3.4%.

Key areas for improvement

Waiting times

• 22.2% of elective patients said they would like to have been admitted ‘a bit sooner’, while 19.9% said ‘a lot sooner’.
• 25.2% of elective patients said their health got ‘a bit worse’ while waiting to be admitted to hospital, while a further 17.7% said it got ‘much worse’.
• 17.8% of respondents felt they waited ‘far too long’ to get a bed after arriving at hospital, unchanged compared to 2023 (17.8%).
• 25.5% of patients who had to wait to be admitted onto a ward did so from between 6 to 12 hours, with a further 17.5% waiting from 12 to 24 hours, and 9.8% waiting more than 24 hours.

Care after leaving hospital

• 19.9% of respondents said that hospital staff did not discuss whether they would need any additional equipment or changes to their home after leaving the hospital but would have liked them to. Analysis also indicates a downward trend in most positive response option for this question since 2020.
• Less than a half (47.5%) of respondents felt they ‘definitely’ got enough support from health or social care services to help them manage their condition after leaving hospital, and 23.1% said they did not receive enough support.

Positive results

Antenatal care

• More women were asked about their mental health during antenatal check-ups (76% said they were ‘definitely’ asked compared with 75% in 2023). There has been steady improvement seen in this question area over the past five years.
• Eighty-nine per cent of people surveyed said they received mental health support as part of their antenatal care compared with 88% in 2023, and 85% in 2022.
• Most of those surveyed (83%) also said that their midwives ‘always’ listened to them, that they were ‘always’ spoken to in a way they could understand (88%), and they were ‘always’ involved in decisions about their antenatal care (80%).

Labour and birth

• More people surveyed felt they were given appropriate information on the risks associated with an induced labour prior to being induced (74% in 2024 compared with 69% in 2023).

Postnatal care

• Respondents reporting that their partner or someone else close to them was able to stay as much as they wanted in hospital after the birth increased from 56% in 2023 to 63% in 2024.

Key areas for improvement

Confidence and trust

• Fewer people said they ‘definitely’ had confidence and trust in the staff providing their antenatal care (70% in 2024 compared with 71% in 2023), during labour and birth (77% in 2024 compared with 78% in 2023) and postnatally (69% in 2024 compared with 72% in 2023).

Communications and interactions with staff

• A quarter (25%) of respondents felt they did not have the opportunity to ask questions after their baby was born.
• Only 58% of people surveyed said they were ‘always’ given the information and explanations needed in hospital after birth (compared to 60% in 2023).
• Fewer people reported ‘always’ feeling listened to by staff providing postnatal care after leaving hospital (75% in 2024 compared with 77% in 2023).

Availability of staff

• There has been a five-year downward trend in the number of people reporting that they were ‘always’ able to get help from staff during labour and birth (64% in 2024 and 72% in 2019) and in those who said they were ‘always’ spoken to by staff in a way they could understand (85% in 2024 and 90% in 2019).
• Just over half (60%) of people surveyed said they saw or spoke to a midwife as much as they wanted after the birth (down from 63% in 2023).

The 2023/24 report highlights some areas of specific concern. The concerns involve issues around safety, quality, workforce, and inequalities, including:

• Too many women are still not receiving the high-quality maternity care they deserve. Of the 131 locations we inspected in our national maternity inspection programme, almost half were rated as either requires improvement (36%) or inadequate (12%).
• We have concerns that children and young people are not always able to access services in a timely way – both planned and in an emergency. Anecdotal evidence suggests that parents and carers are well placed to recognise when their child is very unwell, but many feel they are not being listened to.
• The number of health visitors, who give individual support for young children and their parents, has declined by 45% over the last 9 years.
• Only around a quarter of people with a learning disability were recorded on the learning disability register, which means that many people are missing out on the proactive care and treatment they are entitled to.
• Despite fewer new referrals for autism diagnoses over 2023/24, the average waiting time to start an assessment reached a peak of nearly a year (328 days) in April 2024, rather than the recommended 3 months.
• People in Black or Black British ethnic groups are over 3 and a half times more likely to be detained under the Mental Health Act than people in white ethnic groups.
• Work on our cross-sector dementia strategy is highlighting the compassionate care and initiatives that are improving people’s lives, but staff do not always understand the specific needs of people with dementia.

Conclusion 1: poor operational performance 

There has been a stark reduction in activity with just 6,700 inspections and assessments carried out in 2023, compared with almost 15,800 in 2019. This has resulted in:

• a backlog in new registrations of health and care providers
• delays in re-inspecting after a ‘requires improvement’ or ‘inadequate’ rating
• increasing age of ratings

The review has concluded that poor operational performance is impacting CQC’s ability to ensure that health and social care services provide people with safe, effective and compassionate care, negatively impacting the opportunity to improve health and social care services, and, in some cases, for providers to deliver services at all. 

Conclusion 2: significant challenges with the provider portal and regulatory platform

New IT systems were introduced at CQC from 2021 onwards. However, the deployment of new systems resulted in significant problems for users and staff.

The review has concluded that poorly performing IT systems are hampering CQC’s ability to roll out the SAF, and cause considerable frustration and time loss for providers and CQC staff.

Conclusion 3: delays in producing reports and poor-quality reports

All sectors told the review that they can wait for several months to receive reports and ratings following assessments. The review has heard multiple comments about poor-quality reports - these have come from providers and from members of the public. 

Poor-quality and delayed reports hamper users’ ability to access information, and limit the credibility and impact of assessments for providers.

Conclusion 4: loss of credibility within the health and care sectors due to the loss of sector expertise and wider restructuring, resulting in lost opportunities for improvement

CQC underwent an internal restructuring in 2023, alongside the introduction of the SAF and new IT systems. The restructuring moved operational staff from 3 directorates with a focus on specific sectors into integrated teams operating at a local level, resulting in a loss of expertise.

The review has found that the current model of generalist inspectors and a lack of expertise at senior levels of CQC, combined with a loss of relationships across CQC and providers, is impacting the credibility of CQC, resulting in a lost opportunity to improve health and social care services.

Conclusion 5: concerns around the single assessment framework (SAF) and its application

The SAF has set out 34 areas of care quality (called ‘quality statements’) that could be applied to any provider of health or social care with a subset applied to assessments of integrated care systems (ICSs) and local authorities. These align to the 5 domains of quality used for many years and referred to as ‘key questions’ within the SAF. For each of the 34 quality statements, there are 6 ‘evidence categories’. These are: people experience, staff experience, partner experience, observations, processes and outcomes.

The review has identified 7 concerns with the SAF as follows:

• the way in which the SAF is described is poorly laid out on the CQC website, not well communicated internally or externally, and uses vague language
• there is limited information available for providers and users or patients as to what care looks like under each of the ratings categories, resulting in a lack of consistency in how care is assessed and a lost opportunity for improvement
• there are questions about how data on user and patient experience is collected and used
• more could be done to support and encourage innovation in care delivery
• there is insufficient attention paid to the effectiveness of care and a lack of focus on outcomes (including inequalities in outcomes)
• there is no reference to use of resources or the efficient and economic delivery of care, which is a significant gap
• there is little reference to, or acknowledgement of, the challenges in balancing risk and ensuring high-quality care across an organisation or wider health and care system

Conclusion 6: lack of clarity regarding how ratings are calculated and concerning use of the outcome of previous inspections (that often took place several years ago) to calculate a current rating

The review has learnt that overall ratings for a provider may be calculated by aggregating the outcomes from inspections over several years. This cannot be credible or right. Furthermore, providers do not understand how ratings are calculated and, as a result, believe it is a complicated algorithm, or a “magic box”.

Ratings matter - they are used by users and their friends and family, they are used by commissioning bodies (the NHS, private health insurers and local authorities), and they drive effective use of capacity in the sector. They are a significant factor in staff recruitment and retention.

Conclusion 7: there are opportunities to improve CQC’s assessment of local authority Care Act duties

The Health and Care Act 2022 gave powers to CQC to assess local authorities’ delivery of their adult social care duties after several reports and publications identified a gap in accountability and oversight of adult social care. The review found broad support for the overall assessment framework but also heard feedback that the assessment process and reporting could be improved. 

Conclusion 8: ICS assessments are in early stages of development with a number of concerns shared

The Health and Care Act 2022 introduced a new duty for CQC  to review and assess ICSs. Statute sets out 3 priority areas for CQC to look at: leadership, integration and quality of care; and the Secretary of State can set priorities on other themes. CQC developed a methodology for these assessments, which was tested in pilots in Dorset and Birmingham and Solihull, but wider rollout has been paused as a result of a number of concerns shared with the review.

Conclusion 9: CQC could do more to support improvements in quality across the health and care sector

The review heard a consistent comment that CQC should not be an improvement body per se, but, at the same time, could do more to support the health and care sectors to improve. It could do this, for example, through the description of best practice and greater sharing of new models of care delivery, leading international examples of high-quality care and more innovative approaches - particularly the use of technology. 

Governance structures within organisations are crucial to improvement. A greater focus on how organisations are approaching and delivering improvement, rather than looking at input metrics, could enable more significant improvements in quality of care.

Conclusion 10: there are opportunities to improve the sponsorship relationship between CQC and the Department of Health and Social Care (DHSC)

DHSC’s sponsorship of CQC should promote and maintain an effective working relationship between the department and CQC, which should, in turn, facilitate high-quality, accountable, efficient and effective services to the public.

The review has found that DHSC could do more to ensure that CQC is sponsored effectively, in line with the government’s Arm’s length body sponsorship code of good practice.

The review’s recommendations

The health and care sector is one of the most significant drivers of health, public satisfaction and economic growth. It needs - and deserves - a high-performing regulator.

In order to restore confidence and credibility and support improvements in health and social care, there is a need to:

• rapidly improve operational performance, fix the provider portal and regulatory platform, and improve the quality of reports
• rebuild expertise and relationships with providers
• review the SAF to make it fit for purpose with clear descriptors and a far greater focus on effectiveness, outcomes and use of resources
• clarify how ratings are calculated and make the results more transparent
• continue to evolve and improve local authority assessments
• formally pause ICS assessments
• strengthen sponsorship arrangements.

1. A fundamental reset of the organisation is needed. This needs to be akin to the reset in 2012/13, following the problems related to the regulator that were revealed by the report of the public inquiry into Mid Staffordshire NHS Foundation Trust (the Robert Francis inquiry) and the BBC investigation of Winterbourne View.
2. The previous organisational structure should be re-instated as soon as reasonably possible. Chief inspectors should lead sector-based inspection teams at all levels. These teams can be brought together to assess integration of care across a local area, while retaining focus on their own specialism.
3. The current Operations directorate should be disbanded and reformed into sector-based inspection directorates. Many of the staff currently working in the regulatory leadership directorate should be re-assigned to the relevant inspection directorate.
4. At least three permanent Chief Inspectors should be appointed as soon as reasonably possible to lead the sector-based inspection directorates. Serious consideration should be given to the appointment of a fourth Chief Inspector to lead regulation of mental health services and to oversee inspections under the Mental health Act.
5. Ongoing relationships between inspection staff with relevant skills and experience and providers should be re-instated as soon as possible. Regular dialogue coupled with appropriate levels of support and challenge in respect of required improvements has been sorely missed both by CQC staff and by health and social care providers.
6. Aspects of the single assessment framework could be retained – with some modifications. Other aspects should be suspended and almost certainly scrapped, including the evidence categories and scoring system. More work needs to be done to define what good looks like in different services.
7. Decisions on the future of the regulatory platform are outside the scope of this review. However, it is possible that simplifying the assessment framework (e.g. by scrapping evidence categories and scoring) may make it easier to resolve the problems with the IT system, but expert advice will be needed on this.
8. The use of data to inform judgements should be given much higher priority than at present. Existing datasets already collected by NHS England and associated bodies should be incorporated into assessments of hospitals and primary care services as soon as possible. New data sharing agreements between national bodies should be instituted as soon as possible. Uniform availability of high-quality data/intelligence would reduce the burden on both CQC staff and providers.
9. Staffing levels and pay scales within the inspection directorates should be reviewed as a matter of urgency. There are currently too few staff working in the hospital and primary care inspection programmes to undertake the duties of the regulator within reasonable timescales. The gap between NHS and CQC pay scales has almost certainly contributed to the loss of inspection staff.
10. Priorities for inspection within the healthcare sectors need to be reviewed, given current staffing levels. Possible approaches to prioritisation are discussed in greater detail in later sections of this report.
11. CQC should work closely in partnership with leaders of health care and adult social care to design improved approaches to assessment and inspection. This would be welcomed by those being regulated. They would also welcome a return to a larger element of peer review in the process.
12. Further work to determine how the current backlogs in registration can be reduced or eliminated is urgently required.
13. During the course of this review, the issue of “one-word ratings” was raised on numerous occasions by providers. Further consideration should therefore be given to this issue. In particular, the level at which ratings makes sense to people using services should be considered.

The Penny Dash review found significant failings in the internal workings of CQC which have led to a substantial loss of credibility within the health and social care sectors, a deterioration in the ability of CQC to identify poor performance and support a drive to improved quality—and a direct impact on the capacity and capability of both the social care and the healthcare sectors to deliver much needed improvements in care.

The findings are summarised around five topics:

1. Poor operational performance.
2. Significant challenges with the provider portal and regulatory platform.
3. Considerable loss of credibility within the health and care sectors due to the loss of sector expertise and wider restructuring, resulting in lost opportunities for improvement.
4. Concerns around the Single Assessment Framework (SAF).
5. Lack of clarity regarding how ratings are calculated and concerning use of the outcome of previous inspections (often several years ago) to calculate a current rating.

Recommendations

The interim report makes five recommendations:

1. Rapidly improve operational performance.
2. Fix the provider portal and regulatory platform.
3. Rebuild expertise within the organisation and relationships with providers in order to resurrect credibility.
4. Review the SAF to make it fit for purpose.
5. Clarify how ratings are calculated and make the results more transparent particularly where multi-year inspections and ratings have been used.

• people staying in a care home, hospital or hospice can receive visits from people they want to see
• people living in a care home are not discouraged from taking visits outside the home
• people attending appointments in a hospital or hospice, that do not require an overnight stay, can be accompanied by a family member, friend or advocate if they want someone with them.
• The regulation explains what providers must do to make sure they respect the right of each person to receive visits and to be accompanied, following an assessment of their needs and preferences.

• Assessing quality and performance
• Key questions and quality statements
• People's experience of health and care
• How we will roll out our new assessments
• Evidence categories
• I statements.

• Outcomes for people were better where there was good partnership working, including with voluntary and community partners as well as health partners.
• Integrated working around discharging people from hospital was working and had improved the flow out of hospitals.
• Staff tended to stay with a local authority when they felt valued, had learning and development opportunities, and where there was a positive culture.
• There were different practices across the 5 local authorities in how they worked with young people who are transitioning from children’s services to adult services, so young people’s experiences were varied.

Read the reports via the link below.

Getting access to services remains a fundamental problem, particularly for people with protected equality characteristics. Along the health and care journey, people are struggling to get the care they need when they need it.

Record numbers of people are waiting for planned care and treatment, with over 7 million people on elective care waiting lists in June 2023. But the true number of people could be much higher, as some people who need treatment are struggling to get a referral from their GP.

In the community, people are facing ongoing struggles with getting GP and dental appointments. As a result, some people are using urgent and emergency care services as the first point of contact, or not seeking help until their condition has worsened.

Once at hospital, people are facing longer delays in getting the care they need. In 2022, over half (51%) of respondents to our urgent and emergency care survey said they waited more than an hour before being examined by a nurse or doctor, up from 28% in 2020.

Insufficient capacity in adult social care is continuing to contribute to delays in discharging people from hospital. Ongoing staffing and financial pressures in residential and community services are having an impact on the quality of people’s care, with some at greater risk of not receiving the care they need.

Quality of care

Increasing demand and pressures on staff are taking a toll on their mental health and wellbeing. Staff have said, without the appropriate support, this is affecting the quality of care they deliver.

Many people are still not receiving the safe, good quality maternity care that they deserve, with issues around leadership, staffing and communication. Ingrained inequality and the impact on people from ethnic minority groups remains a key concern.

The quality of mental health services is an ongoing area of concern, with recruitment and retention of staff still one of the biggest challenges for this sector.

Innovation and improvement varies, but the use of artificial intelligence (AI) in health care has the potential to bring huge improvements for people. Given the speed of growth of AI, it is important to ensure that new innovations do not entrench existing inequalities.

Inequalities

Midwives from ethnic minority groups say that care for people using maternity services is affected by racial stereotypes and a lack of cultural awareness among staff. They described a ‘normalised’ culture where staff tolerate discrimination from colleagues, and say they are less likely to be represented in leadership and managerial roles.

People from ethnic minority groups who have a long-term condition felt they were talked down to about their treatment and were not treated as individuals. They also said a lack of cultural competency was a barrier to receiving good quality care.

These people were also more than 2.5 times more likely to say that staff in the emergency department talked as if they were not there, compared with people in White ethnic groups who did not have a long-term condition.

Failures in the system and a lack of funding can mean that budgets are prioritised above truly person-centred approaches to support in supported living services.

The health and care workforce

Staff regularly fed back that they are overworked, exhausted and stressed – sometimes to the point of becoming ill, injured or leaving their job altogether. They say this can affect their ability to provide safe and effective care to people.

Just over a quarter (26%) of NHS staff were satisfied with their level of pay. This is 12 percentage points lower than before the pandemic. Dissatisfaction with pay is linked to industrial action by healthcare staff during 2023.

In adult social care, some providers are struggling to pay their staff a wage in line with inflation.

Over half of the respondents of adult social care providers in England said they were having challenges recruiting new staff, and 31% said they were having challenges in retaining them.

Despite this, there has been a steady decrease in staff vacancy rates for care homes, from 11% in January to March 2022 to 7% in April to June 2023.

In 2022/23, approximately 70,000 people arriving to work in the UK from overseas started direct care roles in the independent adult social care sector, compared with around 20,000 in 2021/22. Providers of adult social care services have told us that recruiting staff from overseas has enhanced the diversity and skills of their team and helped resolve staffing issues.

But there is a growing trend of unethical international recruitment practices. In 2022/23, we made 37 referrals for concerns regarding modern slavery, labour exploitation and international visas – more than 4 times the number made in 2021/22.

Deprivation of Liberty Safeguards

There are ongoing problems with the current Deprivation of Liberty Safeguards (DoLS) system that have left many people who are in vulnerable circumstances without legal protection for extended periods.

Systems

The way health and social care works in England has changed significantly over the past year, with new integrated care systems now formalised.

Local systems should now implement plans to address unwarranted variations in population health and disparities in people’s access, outcomes, and experience of health and social care.

Local authorities are tackling workforce problems in adult social care and trying to address gaps in care as they plan for the future. But they will need to demonstrate an understanding and preparedness for the changing and complex needs of local populations.

Assessing carers’ needs is vital. Carers, including many unpaid carers, are a critical part of all local care systems and they are not always getting the support they need – there is variation across the country and many carers are facing financial problems.

Interactions with staff

• Most people (72% for doctors and 73% for nurses) said they ‘always’ got answers to their questions they could understand, although this has decreased for both doctors (73% in 2021) and nurses (74% in 2021).
• 81% and 79% of respondents said they ‘always’ had confidence and trust in doctors and nurses respectively, remaining unchanged from 2021.
• 2% of respondents felt they were treated with dignity and respect; consistent compared with 2021.

Meeting individual needs

• 70% of respondents reported ‘always’ getting help to wash or keep themselves clean.
• 75% of respondents said they were ‘always’ offered food that met any dietary needs or requirements they had, which is a small but significant increase from 74% in 2021.
• 91% said they got enough to drink during their time in hospital, which is consistent with 2021.

Involvement in care

• When asked about being included in conversations, 74% said doctors ‘always’ included them and 75% said this for nurses, compared with 73% and 75% respectively in 2021.

Key areas for improvement

Waiting times and staffing levels

• 22% of elective patients said they would like to have been admitted ‘a bit sooner’ and 17% ‘a lot sooner’ (compared with 20% and 16% respectively in 2021), while 61% said they ‘did not mind waiting as long as they did’, compared with 65% in 2021.
• 41% of elective patients said their health deteriorated while waiting to be admitted to hospital, though 51% said their health remained the same.
• 18% of respondents felt they had to wait ‘far too long’ to get to a bed on a ward after admission, which has increased significantly compared to 2021 (15%) and 2020 (8%), representing a 10-percentage point increase over 2 years.
• 52% of respondents thought there were ‘always’ enough nurses on duty to care for them in hospital, compared to 55% in 2021 and 62% in 2020.

Patient discharge from hospital

• 38% of respondents said they were involved ‘a great deal’ in decisions about their discharge (unchanged from 2021), while 25% said they had little to no involvement (17% said they were ‘not very much’ involved and 8% said they were ‘not at all’ involved).
• 48% of respondents said they were given enough notice about when they were going to leave hospital, compared to 50% in 2021.
• 45% of respondents ‘definitely’ knew what would happen next with their care after leaving hospital, remaining consistent with 2021.

Overall experience

• 50% of respondents rated their overall experience of inpatient care as a 9 or 10 (where 10 is a very good experience) compared with 52% in 2021. 4% of respondents reported a very poor experience overall with scores of 0 or 1, which remains unchanged since 2021.

How experience varies for different groups of people

• People admitted for emergency care and those who were considered frail reported poorer than average experiences for all the questions we explored in the survey.
• People aged 16 to 50, those who stayed in hospital for two nights or more, and those who reported having Dementia or Alzheimer’s consistently reported poorer experiences of inpatient care.
• Respondents with a neurological condition reported poorer experiences for more than half of the questions.
• In contrast, older people, people who were in hospital for an elective admission, those who stayed in hospital for only one night, and those considered less frail generally reported better experiences.