A survey on NHS patients' experiences of coronary heart disease suggests that even 'green light' hospitals have no justification for complacency, says John Appleby

Everyone would recognise that gathering - and acting on - information about patients' experience of NHS care is vital in improving quality and satisfaction. The New NHS: modern, dependable white paper recognised this and instituted a series of large-scale surveys of patients' experiences of the NHS.

The first survey was carried out in 1998 and looked at GP services and was conducted under the auspices of a consortium led by the National Centre for Social Research in collaboration with the Picker Institute Europe and Imperial College. The results were revealing. However, the sample size of 65,000 meant that results could not be meaningfully broken down to individual primary care groups.

The second and most recent survey - on coronary heart disease - has had a long and problematic gestation. The sample - 84,000 - was designed to be large enough to produce statistically useful results for all but the very smallest of the 194 participating trusts.

Although the survey was carried out between May and October 1999, with preliminary tabulations available in February 2000, highly aggregated results were only available from the Department of Health in mid-April last year.

The detailed results by trust were posted on the DoH's website last December (www. doh. gov. uk/nhspatients/) although downloading the PDF reports takes a very long time.

It is only now that trusts will shortly be receiving personal printed reports showing their position relative to other trusts on each survey question.

These delays are somewhat puzzling, although the results may suggest part of the reason.

The findings of the survey reveal distressingly wide variations in patients' experience across trusts. It seems hard to comprehend that in some hospitals over 60 per cent of patients with coronary heart disease had no self-administered pain relief. Or that in the worst, at 20 per cent of hospitals between a fifth and one-third of patients felt that staff did not always help with pain.

Even in the top 20 per cent of best-performing hospitals some findings from the survey are hardly encouraging. For example, between 15 per cent and 25 per cent of patients stated that toilets were not very clean, around 30 per cent felt there were not enough nurses on duty, and a quarter to over half were in pain while on the waiting list.

A key message from this survey for all trusts is that they should not sit back just because they have a 'green' traffic light. And if they are in the red, then action is absolutely required. To the extent that patients' experience of hospital care defines the often elusive notion of quality, then patient surveys provide essential information to pinpoint quality failures in the NHS. But information from the surveys needs to be published much more quickly, and the entire dataset made available.

This would help answer questions such as, do those hospitals which do poorly on one aspect of patient experience tend also to do badly on others? Would concentrating efforts on pain relief have a positive knock-on effect on patients' experiences of, for example, their perception of the helpfulness of doctors and nurses?