Association for Public Policy Analysis & Management

The paper uses the Adult Inpatient Survey 2012 to build up an in-depth quantitative evidence base on experiences of quality of care during hospital stays in England. The Adult Inpatient Survey is a major feedback survey commissioned by healthcare regulators. It covers adults aged 16 or above who stay in hospital for at least one night. In 2012, the survey had 64,505 respondents from 156 NHS acute hospital trusts.

The paper focusses on inpatient experiences of dignity and nutrition which, following the Independent and Public Inquiries into Mid-Staffordshire NHS Foundation Trust, are increasingly regarded as key markers of the quality of care. It extends and deepens our previous study (Vizard and Burchardt 2015) which provided a new, robust quantitative evidence base on the extent to which age, gender, disability, length of stay, number or wards, the quality and quantity of nursing staff, and hospital trust impact on experiences of the quality of care in English hospitals.

Whereas our previous study did notassess the importance of socio-economic inequality as a driver of patient experience, the current paper examines the relationship between patient experiences of hospital care (the outcome variable with which we are concerned) and inequality along the spectrum of socio-economic advantage and disadvantage (as an explanatory variable). Our operational measure of socio-economic inequality is derived from patient level data on the index of multiple deprivation at the postcode level.

The paper provides new descriptive breakdowns of patient experiences of care by socio-economic deprivation. It also examines how our previous multilevel logistic regression analysis findings are modified by the inclusion of socio-economic inequality as an independent variable.

The findings suggest that there is a strong (though nonlinear) descriptive relationship between inpatient care and socio-economic inequality, with individuals admitted into hospitals with the highest proportion of inpatients from a more disadvantaged background more likely to report poor standards of care than their counterparts in hospitals with the lowest proportion of individuals from disadvantaged backgrounds.

Once socio-economic inequality is controlled for, multilevel logistic regression analysis suggests that the risk of poor care is significantly higher for women than for men; for people who experience a disability (experiencing a long-standing condition which causes difficulties, compared to not experiencing such a condition); and for those who report the quantity or quality of nursing staff to be lower. Age is also found to have a statistically significant effect.

The effect of socioeconomic inequality is notobserved to have an independent effect once all other factors (including age, gender, disability, quantity and quality of nursing staff etc.) are controlled for. However, a strong relationship between socio-economic inequality and the quantity and nursing staff is observed, with individuals from a more deprived background more likely to report poor standards of care than those from a less deprived background. The paper examines these inter-relationships and comments on their importance in explaining variations in inpatient experiences in the English context.

The project is funded by a grant from the LSE International Inequalities Institute.